Binder 1

OET SAMPLE TEST
ROLEPLAYER CARD NO. 1 MEDICINE
Local Medical Clinic
PATIENT You are 45 years old and recovering from a mild heart attack which you had two
weeks ago. You were discharged from hospital four days ago. You are seeing the
doctor because you are unsure how much physical activity is appropriate; you’re
concerned it might bring on another heart attack.
• When asked, say you’ve felt much weaker and very tired since the heart attack;
you’re worried that any physical activity, such as walking, gardening or
swimming, might bring on another heart attack.
• Say you’d like to know how much physical activity is advisable.
• When asked, say you’re an office worker. You sit at a desk all day; you don’t get
much exercise at work.
• When asked, say you’re worried about having another heart attack so you’d like
to know what you can do to reduce the risk of further attacks.
• Say that information has been very helpful. You’ll try to gradually do more
exercise and you’ll look into the rehabilitation programme.
© Cambridge Boxhill Language Assessment SAMPLE TEST
OET SAMPLE TEST

CANDIDATE CARD NO. 1 MEDICINE
DOCTOR You see a 45-year-old patient who suffered a mild anterior acute myocardial
infarction two weeks ago. Recovery was uncomplicated and the patient was
discharged from hospital four days ago. He/she is now concerned about how
much physical activity is appropriate during recovery.
• Find out reason for visit.

• Reassure patient about fatigue (e.g., expected: 4–6 weeks for return of full energy
levels, etc.). Remind patient about heart attack recovery (e.g., gradual, lifestyle
changes and medication to help, etc.). Emphasise importance of exercise
(e.g., heart health: strengthening heart; overall health: lowering cholesterol; etc.).
• Give recommendations for exercise (moderate physical activity: patient’s recovery
uncomplicated, already two weeks since hospital admission, etc.). Advise
importance of joining cardiac rehabilitation programme (e.g., increasing exercise
tolerance under supervision, etc.). Explore patient’s job (type of work, etc.).
• Give timescale for return to work (e.g., 4–6 weeks for desk job, etc.). Explain
need to be physically and emotionally ready (e.g., not rushing back, planning
return to work: assistance/support from employer, etc.). Explore any concerns.
• Provide recommendations for prevention of future attacks (diet: vegetables,
whole grains; lifestyle: physically active; etc.). Reassure patient about his/her
concerns (e.g., normal, appropriate, etc.).
OET SAMPLE TEST
Local Clinic
PARENT You are the parent of a five-year-old boy. Your son was diagnosed with asthma a
couple of days ago, after attending the Emergency Department with a severe bout
of coughing, breathing difficulty and wheezing. You are attending a follow-up
appointment with your son’s doctor. Your son has gone to the bathroom with your
spouse and is not present for the discussion.
• When asked, say your son’s asthma hasn’t been too bad. He’s had one attack
since he was diagnosed at the Emergency Department. He used the inhaler and
the spacer that were given to him at the hospital and it seemed to help his
symptoms.
• When asked, say no one in your family has asthma or eczema, but you usually
get mild hay fever in the summer. When asked, say no one in your house
smokes, and you usually keep it really clean. You think he has attacks after he
has been running about outside.
• When asked, say you found the diagnosis really overwhelming and you’re not
sure how you’re going to be able to help him manage his asthma.
• Say you feel a bit more reassured about managing your son’s asthma now.
• Say you’ll just go and get your son so that he can be examined.
OET SAMPLE TEST

Local Clinic
DOCTOR You see the parent of a five-year-old boy who was diagnosed with asthma a
couple of days ago, after attending the Emergency Department with a severe bout
of coughing, breathing difficulty and wheezing. This is a follow-up appointment. The
child is not present for the discussion.
• Confirm reason for appointment (follow-up following asthma diagnosis). Find out
how child has been since hospital visit (severity of asthma, frequency of attacks,
effect of treatment, etc.).
• Find out further relevant details (any family history of: asthma, eczema, hay fever,
etc.). Explore possible triggers of child’s asthma attacks (exposure to: cigarette
smoke, dust mites, pollen; exercise; cold air; etc.).
• Give information about childhood asthma (chronic lung condition: tightening or
narrowing of muscles in airways, swelling/inflammation, production of extra
mucus; risk factors: family history of hay fever; etc.). Find out any concerns.
• Reassure parent about child’s asthma (e.g., manageable, regular monitoring,
support available, etc.). Describe asthma management (e.g., identifying and
controlling triggers, assessing severity of symptoms, knowing how to respond in
urgent situation, informing child’s school, etc.).
• Outline next steps (e.g., examination of child, creation of asthma action plan,
discussion of treatment, organising: support, follow-up appointments, etc.).
Establish parent’s willingness to bring child into room for examination.
OET SAMPLE TEST
PATIENT You are a 45-year-old office worker, and have been feeling tired and unwell. You
think you are a bit overweight and are concerned you may have diabetes. Recent
publicity about diabetes (on TV, in the newspaper) has made you decide to get a
check-up.
• When asked, say lately you’ve been feeling tired and unwell. Sometimes you feel
dizzy, thirsty, and breathless; you also have itchy skin.
• Say you have a busy and stressful office job, and three teenage children, which
leaves you no time for exercise. Ask if the symptoms might mean you have
diabetes.
• Say if it is diabetes, you’d like to know how it would be treated.
• Say that information is helpful but you’re not sure what to do next.
• Say you’ll do a blood test and make an appointment to discuss the results.
OET SAMPLE TEST

DOCTOR Your patient is a 45-year-old office worker who is complaining of fatigue and feeling
unwell. The patient appears to be overweight and thinks he/she may have
diabetes. Recent publicity about diabetes (on TV, in the newspaper) has made
him/her decide to get a check-up.
• Find out how patient is feeling (any symptoms, concerns, etc.).

• Explore patient’s lifestyle (exercise, work/life balance, etc.).
• Discuss possible significance of symptoms (e.g., possible underlying condition
such as diabetes, etc.). Reassure patient about his/her symptoms (e.g., different
possible causes, diabetes: only one possibility, can be managed, etc.).
• Briefly explain diabetes (e.g., type 1: insulin not produced; type 2: insulin not
sufficient/effective, etc.). Outline management of diabetes (e.g., medication, diet,
exercise, monitoring of blood glucose, etc.).
• Outline next steps (diagnostic blood test, return visit for results, consequent
assessment of patient’s health and lifestyle, etc.).

OET SAMPLE TEST
Emergency Department
PARENT You are the parent of a four-year-old boy who came to the Emergency Department
two hours ago, after 36 hours of recurrent vomiting and stomach pain. The doctor
told you that your son had viral gastroenteritis. He was kept in for two hours on oral
re-hydration fluids. Your son is not present for your discussion with the doctor.
• When asked, say you still don’t really understand what viral gastroenteritis is.
• Say you don’t know how your son got viral gastroenteritis.
• Say your son looks very weak; you really think he needs to be kept in hospital.
• When asked, say you’re concerned about taking your son home; you just don’t
know what to do if he starts to feel worse at home.
• Say you feel better about taking your son home now that you know what to look
for and when to come back to the Emergency Department.
OET SAMPLE TEST

Emergency Department
DOCTOR The parent presented two hours ago at the Emergency Department with his/her
four-year-old son. The child had a 36-hour history of recurrent vomiting and
stomach pain which was diagnosed as viral gastroenteritis. He was given oral
re-hydration fluids and observed for two hours. He is now ready to be discharged.
The child is not present for your discussion with the parent.
• Confirm child is ready to be discharged. Find out about parent’s concerns.

• Explain viral gastroenteritis (e.g., irritation of stomach or intestines due to viral
infection, etc.).
• Give information about how gastroenteritis is spread (e.g., contact with
vomit/faeces of infected person: shaking hands, contaminated foods/objects,
etc.).
• Resist request to keep child in hospital (e.g., oral re-hydration therapy usually
effective, etc.). Advise on hydration and appropriate clear fluids (e.g., watered
down unsweetened fruit juice, electrolyte drinks, etc.). Find out any other
concerns.
• Advise when to seek medical advice (e.g., signs of severe dehydration: extreme
thirst, lethargy, irritability, pale/sunken eyes, etc.).
OET SAMPLE TEST
Medical Clinic
PATIENT You are 86 years old and attend regular chair exercise classes as you have
difficulty walking and use a walking frame. You are concerned about your lower
back, as you felt some discomfort when you woke up this morning.
• When asked, say when you got out of bed this morning, you noticed some slight
discomfort in your back; you’re concerned you might have damaged it.
• When asked, say the problem is in your lower back. You aren’t really in any pain;
it’s more discomfort. When asked, say you haven’t had any injuries. You went to
your regular chair exercise class yesterday, but nothing happened during the
class. You only noticed it when you got out of bed this morning.
• Say you’re not in any real pain so you don’t think it’s necessary to miss a week of
classes.
• Say now you’re wondering if exercise classes are right for you; perhaps you
should just give them up.
• Say you’ll follow that advice; you’re okay to start the examination.
OET SAMPLE TEST

Medical Clinic
DOCTOR You see an 86-year-old patient who has limited mobility. He/she uses a walking
frame, and attends regular chair exercise classes. He/she has come to see you
about discomfort in his/her lower back. You suspect mild back strain.
• Find out reason for patient’s visit.

• Find out more details about problem (exact location, any pain, etc.). Explore any
possible causes (injury, exercise, etc.).
• Give possible diagnosis of mild back strain (over-stretching of muscles/ligaments:
not cause for concern, etc.). Advise on next steps (e.g., physical examination to
confirm diagnosis, etc.). Recommend one week off exercise classes (e.g., not
exercising when in pain, not ignoring pain, etc.).
• Stress importance of rest from exercise (e.g., prevention of further injury/strain,
time to recover, etc.). Make further recommendations (e.g., heat pack,
paracetamol/acetaminophen, etc.).
• Emphasise benefits of exercise classes (e.g., improved posture, maintaining
muscle strength, boosting energy/mood, social interaction, etc.). Advise against
overdoing exercise (e.g., awareness of own limits, etc.). Establish patient’s
consent for physical examination.
Darren Walker
Today's Date - 15.08.12
Patient History
• Darren Walker
• DOB - 05.07.72
• Regular patient in your General Practice
09.07.12
Subjective
• Regular checkup, Family man, wife, two sons aged 5 and 3
• Parents alive - father age 71 diagnosed with prostate cancer 2002.
• Mother age 68 hypertension diagnosed 2002.

• Smokes 20 cigarettes per day - trying to give up
• Works long hours - no regular exercise
• Light drinker 2-3 beers a week
Objective
• BP - 165/90 , P - 80, regular
• Cardiovascular and respiratory examination - normal
• Height - 173 cm , Weight - 85 kg

• Urinalysis normal
Plan
• Advise re weight loss, smoking cessation

• Review BP in 1 month
• Request PSA test before next visit
14.08.12
Subjective
• Reduced smoking to 10 per day
• Attends gym twice a week,

• Weight - 77 kg
• complains of discomfort urinating
Objective
• BP - 145/80 , P - 76
• DRE - hardening and enlargement of prostate

• PSA reading 10
Plan
• Review BP, smoking reduction in 2 months

• Refer to urologist - possible biopsy prostate
Writing Task
Write a referral letter addressed to Dr. David Booker (Urologist), 259 Wickham Tce, Brisbane
4001 Ask to be informed of the outcome.

Arthur Benson
Today's Date - 12/09/17
Patient History
• Arthur Benson
• DOB: 15/04/92
• Computer Programmer
• Regularly works 55 - 60 hr a week
• Married with twin boys aged 6 months
• Non-smoker and social drinker

• Father died at 69 due to stroke
• Mother is a diabetic on metformin
P.M.H
• Asthma since childhood - on steroid inhaler
• Allergic to penicillin
25/08/17
Subjective
• c/o headache (2/12), mild sensation of pins and needles, no nausea or vomiting
• Had a car accident 3 months ago. Hospitalised and discharged after 24 hrs with no
complications.
• CT scan normal
Objective
• O/E - overweight , BMI - 32
• Gait - normal, has lumbar lordosis
• Mild weakness in L hand

• Vision - good
Plan
• Review - 2/52
• Panadol 2 tab 4/24 and rest 2/52
• Advise to reduce weight and increase exercise
06/09/17
Subjective
• Feeling better, no new complaints, no worsening of pins and needles sensation
• Has been walking 30 minutes 3 times a week

• Advised to start work and come back if any concern
Objective
• Weight loss 3kg
12/09/17
Subjective
• c/o worsening headaches for 3 days, dizziness, nausea, blurred vision
• Pain not responded to Panadol but noticed mild response to Panadeine Forte
Objective
• No weight change
• Gait - normal
• Could not read 2 lines of eye chart

• Oedematous optic disk on fundi examination
• BP - 160/70 , PR - 98 bpm
• Mild weakness and loss of sensation in medial aspects of L hand
• Reflexes: Elbow-normal, Wrist- no reflexes
Diagnosis: Subdural haematoma
Writing Task
You are a General Practitioner at a suburban clinic. Arthur Benson and his family are regular
patients. Using the information in the case notes, write a letter of referral to a neurosurgeon
for MRI scan. Address the letter: Dr J Howe, Neurosurgeon, Spirit Hospital, Woolloongabba.
Mrs. Daniela Starkovic
45 years old, married 2 children
Past history - Migraines
Medications - nil
20/01/07
Subjective
• presents with abdominal pain

• doesn't like fatty foods
• otherwise well
10 days ago
• epigastric pain radiating to R side 1 hour after dinner
• associated nausea, no vomiting / regurgitation
• pain constant for 1 hour

• no medications
• no change bowel habits, no fever, no dysuria
Last night
• recurrence similar pain, worse
• duration 2 hours
• vomited x 1, no haematemesis
• pain constant, colicky features

• aspirin x 2 taken, no relief
Objective
• Overweight
• T - 37° , P - 80 reg, BP 130/70
• mild tenderness R upper quadrant abdomen
• no masses, no guarding, no rebound, bowel sounds normal

• Murphy's sign - neg
• Urine - trace bilirubin
Assessment:
• ?? biliary colic
• ?? peptic ulcer
Plan
• Liver function Tests (LFTS)

• Biliary ultrasound (US)
• R/V - 3/7
23/01/07
Subjective
• No further episodes
• patient anxious re possibility cancer
Objective
• LFTs - bilirubin 12 (normal range 6-30)

• Alkaline phosphatase (ALP) 120 (normal < 115)
• Aspartate transaminase (AST) 20 (normal 12-35)
Assessment
• ? mild obstruction
• US - small contracted gallbladder, multiple gallstones
• Common bile duct diameter - normal
• Normal liver parenchyma
Assessment: cholelithiasis
Plan
• Reassurance re cancer
• Referral Dr. Andrew McDonald (general surgeon) assessment, further management,
possible cholecystectomy
Writing Task
Using the information in the case notes, write a letter of referral to Dr Andrew McDonald a
general surgeon at North Melbourne Private Hospital 86 Elm Road North Melbourne 3051.
Peter Ludovic
Peter Ludovic, 8 years old
22/12/06
• complains of sore throat.
• Mother reports fever, irritable.
• Voice hoarse
O/E:
• Enlarged tonsils, exudate
• Tender, large cervical nodes

• T - 39.5°
Assessment: Tonsillitis
Plan: Penicillin V 250 mg qid 7 days
15/01/07
• Mrs. Ludovic reported son's urine brown 4 days previously
• says Peter is lethargic,

• no report of frequency, trauma or dysuria.
O/E:
• tonsillar hypertrophy
• BP - 90 / 60
• Urinalysis - macroscopic haematuria
Assessment:
• ? post streptococcal nephritis
• ? urinary tract infection
Plan:
• R/V - 2 days , Fluids, rest

Tests:
• Full Blood Examination (FBE), urea and creatinine (U&E), electrolytes,

• mid stream urine (MSU), micro/culture/sensitivity (M/C/S),
• Antistreptolysin-O Titre (ASOT) and cell morphology
18/01/07
• Peter - asymptomatic
O/E:
• BP - 110/90
• macroscopic haematuria
Test results:
• FBE - normal
• U&E
• ASOT +++
• MSU - 4 x 10 RBC (red blood cells) of renal origin
Assessment: post streptococcal nephritis with early renal failure
Plan: Refer to paediatrician
WRITING TASK
Using the information in the case notes, write a letter of referral to Dr Xavier Flannery, a
paediatrician at 567 Church St Springvale 3171.

Dave Cochrane
Today's Date - 30/09/17
Patient History
• Mr. Dave Cochrane
• D.O.B - 20/11/64
• Smoker: 20 cig/day
• Drinks 12-14 u alcohol per week
• No reg exercise
• Retired at 50
• lives with wife

• 3 children all married
12/08/17
Subjective
• Shortness of breath
• tightness in chest
• coughing especially at night

• Shortness of breath worse when lying down and feels better when head is raised at
end of bed
Objective
• Dyspnoeic
• B/L ankle oedema

• High jugular venous pressure
• Apex beat lateral to mid-clavicular line and in the 6th ICS

• Cardiovascular normal , Abdomen normal
• Crepitations in lung base
• ECG shows cardiomegaly
• C x-ray - features of infection

Plan
• Diagnosed as left ventricular failure

• Broad spectrum antibiotic for 7 days
• Frusemide 40 mg/day
• Digoxin 0.25 mg/day
• Advise to stop smoking and drinking

• Review 14 days later
• Mild tenderness in lower abdo, no guarding and rebound
25/08/17
Subjective
• Feels better
• Reduced cig to 10/day and alcohol to 10 u / week
Objective
• Mild B/L ankle oedema
• Few crepitations in lung bases
Plan
• Continue Furosemide and Digoxin
• Rest for one week
30/09/17
Subjective
• Presented with severe shortness of breath, chest pain, sweating for 2 hours
• Anxious
Objective
• Dyspnoeic, B/L ankle oedema
• Jugular venous pressure high
• No murmurs
• Apex beat is 6th ICS
• Lateral mid-clavicular line

• BP: 120/60 • PR: 66 BPM
• B/L crepitations in both lung bases
Plan
• Needs admission to Cardiology Unit for stabilisation
Writing Task
Using the information in the case notes, write a letter of referral to Emergency Department
QE11 Hospital, 240 Wickham Tce, Brisbane, A001 explaining the patient's current condition.
Mrs Sally Fletcher
You are a first-year resident in a surgical ward. Sally Fletcher is a 25-year-old woman who
has recently undergone surgery. You are now discharging her from hospital.
Hospital - Fairbanks Hospital, 1001 Noble St, Fairbanks, AK 99701
Mrs Sally Fletcher
Date of Birth: 3/10/1993
Marital status: Married, 5 years
Appointment date: 25/03/2018
Diagnosis: Endometriosis
Past medical history
• Painful periods - 3 years
• Wants children, trying - 1 year ++
Social background
• Accountant, regular western diet.
• Exercises 3 x week, local gym
Medical background
• Frequent acute menstrual pain localised to the lower left quadrant.
• Pain persists despite taking OTC naproxen

• Shy discussing sexual history
• Occasional constipation, associated with pain in lower left quadrant.
• Trans-vaginal ultrasound showing 6cm cyst, likely of endometrial origin.
• Patient recovering post op from laparoscopic surgery

• (25/03/2018) – no complications
Post op care
• Keep incisions clean and dry.

• Showering is permitted 26/03/2018
Mobility post op
• Patient can ambulate if confident.
• Driving is prohibited when on analgesics.
• Driving can be resumed 24-48 hrs after final dose analgesics.

• Sexual activity can be resumed 2 weeks post op.
Nursing management
• Encourage oral fluids.
• Patient may return to regular diet.
• Ambulation encouraged as per patient tolerance.
Medical progress
• Afebrile
• Hct, Hgb, Plts, WBC, BUN, Cr, Na, K, Cl, HCO3, Glu all within normal limits.
• Patient sitting comfortably, alert, oriented × 4 (person, place, time, situation).
Assessment
• Good progress overall.
Discharge plan
• Patient to be discharged when can eat, ambulate, urinate independently.
• Patient must be discharged to someone who can drive them home.
Writing Task
Using the information given to you in the case notes, write a letter of discharge to the
patient’s GP, Dr Stevens, Mill Street Surgery, Farnham, GU10 1HA.

Julian McDonald
Admissions Officer
Cabrini Hopetoun Rehabilitation
2-6 Hopetoun Street
Elsternwick, Vic 3185
24/7/2018
Dear Doctor,
Re: Julian McDonald,
DOB: 12/01/1950
Thank you for accepting this 68-year-old man, who has recently undergone left total knee joint
replacement, for rehabilitation and assessment for suitability to return to his home.
His background medical issues include obesity, hypertension, hypercholesterolemia, gout, cigarette
smoking and excess alcohol intake. Please note that he is allergic to penicillin.
Mr McDonald underwent the replacement operation with Dr. B Mossley on 20/7/18. Postoperatively,
he experienced significant analgesic issues, and a possible catheter-related UTI which has been
treated accordingly. In addition, we noted signs consistent with sleep apnoea. His discharge
medications are Zyloric, Karvina, Lipitor, paracetamol, ibuprofen, a Nicabate patch, Targin, and
oxycodone. Please see the attached list of dosages.
Please provide Mr McDonald with rehabilitation including physiotherapy, as well as preparation for
his return to living at home in a caravan. We anticipate his rehabilitation may be slow given the pain
issues, and his isolated home situation will be problematic. Occupational therapy home visits and
some social work input will be needed; moreover, drug and alcohol counselling and further sleep
studies for possible obstructive sleep apnoea may be beneficial to him.
Please note, Mr McDonald’s sutures need removal on 30/7/18 and an appointment with Dr. Mossley
has been made 6 weeks postoperatively on 7/9/18.
Please contact us with any queries.
Yours faithfully,
Doctor Words Count: 210

OCCUPATIONAL ENGLISH TEST
WRITING SUB-TEST: MEDICINE
TIME ALLOWED:
READING TIME: 5 MINUTES WRITING TIME: 40 MINUTES
Read the case notes below and complete the writing task which follows.
Notes:
Mrs May Hong is a 43-year-old patient in your general practice.
07/02/2014
Subjective:
• Noted a productive cough over last 3/7
• No dyspnoea or pain
• Feverish
• Continues to smoke 10 cigarettes/day
History:
• Rheumatic carditis in childhood, resulting in mitral regurgitation & atrial fibrillation

(AF)
Objective:
• Looks tired
• T: 380 C
• P: 80, AF
• BP: 140/80
• Ear, nose, throat (ENT) - NAD
• Moist cough
• Scattered rhonchi through chest, otherwise OK

• Apical pansystolic murmur
Assessment: Acute bronchitis; cigarettes , condition severity ++

Plan:
• Advised - cease smoking

• Amoxycillin 500mg; orally t.d.s.
• Other medications unchanged (digoxin 0.125mg mane, warfarin 4mg nocte)
• No known allergies (NKA)
• Review 2/7
• Check prothrombin ratio next visit
09/02/2014
Subjective:
• Cough , thick yellow phlegm
• Feels quite run-down

• Not dyspnoeic
• Taking all medications
• No cigarettes for last 2 days
Objective:
• Looks worn-out
• T: 38.50 C
• P: 92, AF
• BP: 120/80
• Mild crackles noted at R lung base posteriorly

• Occasional scattered crackles. Otherwise unchanged
Assessment: Bronchitis ; early R basal pneumonia
Plan:
• Sputum sample for microscopy and culture (M&C)

• FBE, chest X-ray
• Chest physiotherapy
• Prothrombin ratio today (result in tomorrow)
• Review tomorrow
10/02/2014
Subjective:
• Brought in by son
• Quite a bad night
• Symptoms
• Pleuritic R-sided chest pain, febrile, dyspnoea
• Prothrombin ratio result 2.4 (target 2.5-3.5)
Objective:
• Unwell, tachypnoeic
• T: 380 C , P: 110, AF
• BP: 110/75
• Jugular venous pressure (JVP) not elevated

• R lower lobe dull to percussion with overlying crackles
• L basal crackles present
• Pansystolic murmur is louder
• M&C: gram-positive streptococcus pneumoniae, sensitive - clarithromycin &

erythromycin
• Amoxicillin resistant
• Chest X-ray: Opacity R lower lobe
• FBE: Leukocytosis 11.0 x 109 /L
Assessment: R lower lobar pneumonia
Plan:
• Urgent hospital admission. Spoke with Dr Roberts, admitting officer, Newtown
Hospital Ambulance transport organised
Writing Task:
• Using the information given in the case notes, write a letter of referral to Dr L Roberts,
the Admitting Officer at Newtown Hospital, 1 Main Street, Newtown, for advice, further
assessment and treatment.
Sample Test 1
LISTENING SUB-TEST – QUESTION PAPER

CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
MIDDLE NAMES: Passport Photo
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PROFESSION: Candidate details and photo will be printed here.
VENUE:
L
TEST DATE:
P
CANDIDATE DECLARATION
By signing this, you agree not to disclose or use in any way (other than to take the test) or assist any other person to disclose or use any OET
test or sub-test content. If you cheat or assist in any cheating, use any unfair practice, break any of the rules or regulations, or ignore any advice
M
or information, you may be disqualified and your results may not be issued at the sole discretion of CBLA. CBLA also reserves its right to take
further disciplinary action against you and to pursue any other remedies permitted by law. If a candidate is suspected of and investigated for
malpractice, their personal details and details of the investigation may be passed to a third party where required.
A
CANDIDATE SIGNATURE:
INSTRUCTIONS TO CANDIDATES S
TIME: APPROXIMATELY 40 MINUTES
DO NOT open this question paper until you are told to do so.
One mark will be granted for each correct answer.
Answer ALL questions. Marks are NOT deducted for incorrect answers.
At the end of the test, you will have two minutes to check your answers.
At the end of the test, hand in this Question Paper.
You must not remove OET material from the test room.
HOW TO ANSWER THE QUESTIONS
Part A: Write your answers on this Question Paper by filling in the blanks. Example: Patient: Ray Sands
Part B & Part C: Mark your answers on this Question Paper by filling in the circle using a 2B pencil. Example: A
B
C
SAMPLE
www.occupationalenglishtest.org
© Cambridge Boxhill Language Assessment – ABN 51 988 559 414
[CANDIDATE NO.] LISTENING QUESTION PAPER 01/12
N K
L A
B
SAMPLE

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

Extract 1: Questions 1-12
You hear a physiotherapist talking to a new patient called Ray Sands. For questions 1-12, complete the notes
with a word or short phrase that you hear.
You now have thirty seconds to look at the notes.
Patient Ray Sands

18 months ago • back injury sustained (lifting (1) )
1 year ago • sciatica developed
6 months ago • clear of symptoms
Last month • recurrence of symptoms
E
Patient’s description of symptoms
L
• pain located in (2)
• pain described as (3)
P
• loss of mobility
• problems sleeping
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• mentions inability to (4) as most frustrating aspect
A
• (5) sensation (calves)
• general numbness in affected area
S
Occupation • (6) (involves travel/some manual work)
Initial treatment • prescribed NSAIDs
• application of (7) (provided some relief)
Referrals • (8) (briefly)
• sports injury specialist for manipulation and exercise programme
Further treatment • epidural injections
• (9)
• electrical impulses
• decided not to try (10)
• patient attributes recovery to (11)
Previous diagnosis • sciatica probably related to (12)
• reports no history of pain in buttocks
SAMPLE

You hear a consultant dermatologist talking to a patient called Jake Ventor. For questions 13-24, complete
the notes with a word or short phrase that you hear.
Patient Jake Ventor
Reason for referral • skin lesion
Patient’s description of condition
• on the (13) of his left hand
E
• preceded by (14)
• then (15) form and join up
L
• surrounding erythema
P
• GP describes appearance of lesion as (16)
• normally resolves within two weeks
M
History of condition • first experienced in 1990s when living in China
• also had a lesion on his (17) – never recurred
A
there
• recurs regularly on different parts of his left hand
S
• not becoming more (18)
• no apparent link to general state of health, (19)

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

of recurrence
• reports no history of (21)
Information given • advised that (22) was unlikely to be effective
• told him to take care if the skin is (23)
Outcome • says his quality of life isn’t affected
• a (24) will be arranged
That is the end of Part A. Now look at Part B.
SAMPLE

Part B
In this part of the test, 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. A

B
Fill the circle in completely. Example: C
E
25. You hear a nurse briefing her colleague about a patient.
L
What does she warn her colleague about?
P
A The patient is allergic to some types of antibiotics.
B Care must be taken to prevent the patient from falling.
M
C Oxygen may be needed if the patient becomes breathless.
A
26. You hear the manager of a care home for the elderly talking to the nursing staff.
S
He says that errors in dispensing medication to patients usually result from
A interruptions while calculating dosages.
B a failure to check for patients’ allergies.
C administering drugs late in the day.
27. You hear part of a morning briefing on a hospital ward.
What is the plan for the patient today?
A Her emotional state will be carefully observed.
B She will be transferred to a more specialised unit.
C A social worker will come to see what help she needs.
SAMPLE

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

Part C
In this part of the test, 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.
A
Now look at extract one. B
E
You hear an interview with a cardiologist called Dr Jack Robson, who’s an expert on Chagas disease.
L
You now have 90 seconds to read questions 31-36.
P
31. Why does Dr Robson regard Chagas as a neglected disease?
M
A because of the social groups it mainly affects
B because patients often don’t realise they’re infected
A
C because its impact is severe in a relatively small number of cases
S
32. Dr Robson says that concerns over Chagas in the USA are the result of
A a rise in the number of people at risk of being infected with the disease.
B a greater awareness of how many people there have the disease.
C an increased prevalence of the insect which carries the disease.
33. A patient called Marisol recently asked Dr Robson to test her for Chagas because
A she was worried about the health of any children she might give birth to.
B she wanted to know whether it was safe for her to donate blood.
C she thought she had symptoms associated with the disease.
SAMPLE

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

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

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

N K
L A
B
SAMPLE

Sample Test 2
LISTENING SUB-TEST – QUESTION PAPER

CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
E
VENUE:
L
TEST DATE:
P
M
A
S
TIME: APPROXIMATELY 40 MINUTES
INSTRUCTIONS TO CANDIDATES
DO NOT open this question paper until you are told to do so.
At the end of the test, you will have two minutes to check your answers.
You must not remove OET material from the test room.
Part A: Write your answers on this Question Paper by filling in the blanks. Example: Patient: Ray Sands
Part B & Part C: Mark your answers on this Question Paper by filling in the circle using a 2B pencil. Example: A
B
C
SAMPLE
N K
L A
B
SAMPLE

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

You hear a gastroenterologist talking to a patient called Andrew Taylor. For questions 1-12, complete the notes
with a word or short phrase that you hear.
Patient Andrew Taylor
Background • has had (1) over long period
• reports a frequent (2) sensation in the last year
• most recently (3) has become a problem
E
• word used to describe symptoms – (4)
L
• pre-existing skin condition aggravated
P
• frequent (5) – patient didn’t initially link these to
bowel condition
M
Effects of condition on everyday life
• works as an (6)
A
• situation at work means patient is (7)
S
• complains of lack of (8)
• has noticed an increase in insomnia
Diet • claims to be consuming sufficient (9)
• claims to keep hydrated
• has experimented with excluding (10) from diet
• very slight reduction in caffeine intake
• has undergone (11) – no indications of anything

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

You hear a hospital neurologist talking to a new patient called Kathy Tanner. For questions 13-24, complete
the notes with a word or short phrase that you hear.
Patient Kathy Tanner
Background to condition
• experienced discomfort and a (13) feeling in neck

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

• treatment using (20) injections
- side effects included difficulties (21)
- reports treatment as increasingly ineffective
• supplemented by (22)
• experienced confusion and (23)
• analgesic relief: morphine self-administered via
(24)
SAMPLE

Part B
In this part of the test, you’ll hear six different extracts. In each extract, you’ll hear people talking in a different
healthcare setting.
For questions 25-30, choose the answer (A, B or 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. A

B
E
25. You hear an optometrist talking to a patient who’s trying contact lenses for the first time.
L
What is the patient concerned about?
P
A his blurred vision
B soreness in his eyes
M
C how to remove the lenses
A
26. You hear a nurse asking a colleague for help with a patient.
S
Why does the nurse need help?
A The patient’s condition has deteriorated.
B The patient is worried about a procedure.
C The patient is reporting increased pain levels.
27. You hear a senior nurse talking about a new initiative that has been introduced on her ward.
What problem was it intended to solve?
A patients’ confusion over information given by the doctor
B relatives not being able to discuss issues with the doctor
C patients not discussing all their concerns when meeting the doctor
SAMPLE

28. You hear two radiologists talking about the type of scan to be given to a patient.
They agree to choose the method which will
A allow them to see the whole of the appendix.
B probably give the most accurate results.
C have the fewest risks for the patient.
E
29. You hear part of a surgical team’s briefing.
L
The male surgeon suggests that the patient could
P
A require specialist equipment during surgery.
B benefit from a specific anaesthetic procedure.
M
C be at risk of complications from another health issue.
A
30. You hear a senior research associate talking about a proposal to introduce inter-professional, primary
S
healthcare teams.
What hasn’t been established about the teams yet?
A the best way for collaboration to take place
B the financial impact that they are likely to have
C the aspects of medical care they are best suited to
SAMPLE

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. A

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

34. What was Harry’s response to being diagnosed with prostate cancer?
A He found himself reacting in a way he hadn’t anticipated.
B He was unconvinced by the prognosis he was given.
C He immediately researched treatment options online.
35. What typical patient response to the illness does Sandra mention?
E
A an unwillingness to commence appropriate medication
a failure to seek advice regarding different treatment options
L
B
C a reluctance to talk about the embarrassing aspects of treatment
36.
M P
Sandra believes that community follow-up clinics are important because they
offer patients more personal aftercare.
A
B are proven to be less traumatic for patients.
S
C provide rapid treatment for patients developing new symptoms.
SAMPLE

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

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

N K
L A
B
SAMPLE

WANS000000
WRITING: ANSWER BOOKLET

CANDIDATE NAME:
D.O.B.: D D M M Y Y Y Y PROFESSION:
VENUE: TEST DATE:
Starting at the left, print your Candidate

Number and fill in the corresponding circle
below each number using a 2B pencil.
Example:
2 5 By signing this, you agree not to disclose or use in any way

(other than to take the test) or assist any other person to
disclose or use any OET test or sub-test content. If you cheat
or assist in any cheating, use any unfair practice, break any of
the rules or regulations, or ignore any advice or information, you
may be disqualified and your results may not be issued at the
sole discretion of CBLA. CBLA also reserves its right to take
further disciplinary action against you and to pursue any other
remedies permitted by law. If a candidate is suspected of and
investigated for malpractice, their personal details and details of
the investigation may be passed to a third party where required.
TIME ALLOWED
READING TIME: 5 MINUTES
WRITING TIME: 40 MINUTES
1. Reading time: 5 minutes
During this time you may study the writing task and notes. You MUST NOT write, highlight, underline or make any notes.
2. Writing time: 40 minutes
3. Use the back page for notes and rough draft only. Notes and rough draft will NOT be marked.
Please write your answer clearly on page 1 and page 2.
Cross out anything you DO NOT want the examiner to consider.
4. You must write your answer for the Writing sub-test in this Answer Booklet using pen or pencil.
5. You must NOT remove OET material from the test room.
www.oet.com
1
Please record your answer on this page within the lines provided.
(Only answers on Page 2 and Page 3 within the lines provided will be marked.)
2
Please record your answer on this page within the lines provided.
(Only answers on Page 2 and Page 3 within the lines provided will be marked.)
3
Space for notes and rough draft. Only your answers on Page 2 and Page 3 will be marked.
4
Listening Test
This test has three parts. In each part you’ll hear a number of different extracts. At the start
of each extract, you’ll hear this sound: --beep—
You’ll have time to read the questions before you hear each extract and you’ll hear each
extract ONCE ONLY. 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.
78 PRACTICE TEST 2
1
You hear a consultant endocrinologist talking to a patient called Sarah Croft. For questions 1-12,
complete the notes with a word or short phrase.
You now have 30 seconds to look at the notes.
Patient Sarah Croft
Medical history • hypertension (recently worsened)
• 3 years of corticosteroid treatment for (1)
General symptoms
• gradual weight gain, especially in stomach area
• (2) on face: embarrassing
• visible (3) between the

shoulders
• swollen ankles
• excessive and constant (4)
• backache
• periods are (5)
• extreme tiredness
Dermatological symptoms
• tendency to (6)
• wounds slow to heal, (7) on

thighs
• face appears red in colour, (8)

area on neck
• recent development of (9)
PRACTICE TEST 21 79
Psychological symptoms
• mildly depressed
• scared by new experience of (10)
• feels constantly (11)
• intermittent cognitive difficulties
Recommended tests
• further blood tests
• (12) test possibly
You hear an anaesthetist talking to a patient called Mary Wilcox prior to an operation. For questions
13-24, complete the notes with a word or short phrase.
Patient Mary Wilcox
Current medications
Reason for Medication Comments

medication
Thiazide
High blood both taken this morning with (14)
(13)
pressure
(15)
taken this morning
Heart attack
(16)
stopped taking this 7 days ago
80 PRACTICE TEST 2
1
Medical history • went to GP two years ago feeling (17)
– heart attack subsequently

diagnosed
• had two (18) inserted
Present condition
• alright with (19) and walking on

the flat
• has swelling in one ankle following operation for (20)
• denies (21)
• reports some (22) at night

(responds to medication)
Concerns expressed
• (23) following the procedure
• possible damage to crowns (both are (24)

)
PRACTICE TEST 21 81
Part B
In this part of the test, you’ll hear six different extracts. In each extract, you’ll hear people talking
in a different healthcare setting.
For questions 25-30, choose the answer (A, B or C) which fits best according to what you hear.
You’ll have time to read each question before you listen. Complete your answers as you listen.
Now look at question 25.
25. You hear two trainee doctors doing an activity at a staff training day.
What does the activity give practice in?
A writing case notes
B prioritising patients
C dealing with consultants
26. You hear a radiographer talking to a patient about her MRI scan.
What is he doing?
A clarifying the aim of the procedure
B dealing with her particular concerns
C explaining how the equipment works
27. You hear two nurses discussing an article in a nursing journal.
What do they agree about it?
A It’s likely to lead to changes in practice.
B It failed to reach any definite conclusion.
C It confirms what they were already thinking.
82 PRACTICE TEST 2
1
28. You hear two hospital managers talking about a time management course for
staff.
They think that few people have shown interest because
A there are so many alternatives on offer.
B they feel it’s not relevant to them.
C it hasn’t been publicised enough.
29. You hear an optometrist reporting on some research he’s been doing.
The aim of his research was
A to develop nanoparticles for transporting drugs all over the body.
B to find a way of treating infections caused by contact lenses.
C to use contact lenses to administer drugs over time.
30. You hear a consultant talking to a trainee about a patient’s eye condition.
What is the consultant doing?
A explaining why intervention may not be necessary
B suggesting the diagnosis is by no means certain
C describing a possible complication
PRACTICE TEST 21 83
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.
Now look at extract one.
You hear an interview with a neurosurgeon called Dr Ian Marsh who specialises in the treatment of
concussion in sport.
31. Dr Marsh says that one aim of the new guidelines on concussion is
A to educate young sportspeople in how to avoid getting it.
B to correct some common misunderstandings about it.
C to provide a range of specialist advice about it.
32. Dr Marsh makes the point that someone who has suffered a concussion will
A be unconscious for varying amounts of time after the event.
B need a medical examination before doing any further exercise.
C have to take precautions to avoid the risk of symptoms recurring.
33. Dr Marsh says returning to sport too early after a concussion is dangerous
because
A a subsequent episode can have a cumulative effect.
B there is a high risk of fatality in the event of a second one.
C the brains of younger people need time to return to normal size.
84 PRACTICE TEST 2
1
34. Dr Marsh suggests that the risk of sustaining a concussion in sports
A lies mainly in the choice of sports played.
B can be reduced by developing good playing technique.
C is greater when sports are played in less formal situations.
35. What is Dr Marsh’s view about providing medical support for youth sports
events?
A Some types of sport are risky enough to justify it.
B The organisers should be capable of dealing with any issues.
C Certain medical professionals should be encouraged to volunteer.
36. Dr Marsh thinks that developments in college football in the USA
A only really address an issue which is particular to that sport.
B are only likely to benefit the health of professional sports players.
C are a significant step forward in the prevention of concussion in all

sports.
PRACTICE TEST 21 85
You hear a presentation by a consultant cardiologist called Dr Pamela Skelton, who’s talking
about a research trial called SPRINT which investigated the effects of setting lower blood-
pressure targets.
37. Why was the SPRINT trial stopped before it was due to end?
A There were conclusive results earlier than expected.
B The high drop-out rate was likely to invalidate the data.
C Concerns were raised about possible effects on all participants.
38. A few participants aged over seventy-five left the trial because
A there was a negative impact on their daily life.
B they failed to take the required doses of medication.
C their health deteriorated due to pre-existing conditions.
39. A significant feature of measuring blood pressure in the trial was that
A the highest of three readings was recorded.
B the patient was alone when it was carried out.
C it was done manually by the participant at home.
86 PRACTICE TEST 2
1
40. How did the SPRINT trial differ from the earlier ACCORD study into blood pressure?
A SPRINT had fewer participants.
B SPRINT involved higher-risk patients.
C SPRINT included patients with diabetes.
41. Dr Skelton’s main reservation about the SPRINT trial is that
A it ignores the wider implications of lowered BP.
B its results go against the existing body of evidence.
C it was unduly influenced by pharmaceutical companies.
42. What impact does Dr Skelton think the SPRINT trial will have in the future?
A It will lead to universally applicable guidelines for BP levels.
B Increased attention will be given to the effect of lifestyle on BP.
C GPs will adopt a more active approach to lowering BP in the elderly.

END OF THE LISTENING TEST
PRACTICE TEST 21 87
READING SUB-TEST – TEXT BOOKLET: PART A
CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:

VENUE:
TEST DATE:
You must NOT remove OET material from the test room.
SAMPLE
[CANDIDATE NO.] READING TEXT BOOKLET PART A 01/04
88 PRACTICE TEST 2
Tetanus: Texts
Text A
Tetanus is a severe disease that can result in serious illness and death. Tetanus vaccination
protects against the disease.
Tetanus (sometimes called lock-jaw) is a disease caused by the bacteria Clostridium tetani.
Toxins made by the bacteria attack a person’s nervous system. Although the disease is fairly
uncommon, it can be fatal.
Early symptoms of tetanus include:
• Painful muscle contractions that begin in the jaw (lock jaw)
• Rigidity in neck, shoulder and back muscles
• Difficulty swallowing
• Violent generalized muscle spasms
• Convulsions
• Breathing difficulties
A person may have a fever and sometimes develop abnormal heart rhythms. Complications
include pneumonia, broken bones (from the muscle spasms), respiratory failure and cardiac
arrest.
There is no specific diagnostic laboratory test; diagnosis is made clinically. The spatula test is
useful: touching the back of the pharynx with a spatula elicits a bite reflex in tetanus, instead
of a gag reflex.
Text B
Tetanus Risk
Tetanus is an acute disease induced by the toxin tetanus bacilli, the spores of which are
present in soil.
A TETANUS-PRONE WOUND IS:
• any wound or burn that requires surgical intervention that is delayed for > 6 hours
• any wound or burn at any interval after injury that shows one or more of the following
characteristics:
–– a significant degree of tissue damage
–– puncture-type wound particularly where there has been contact with soil or organic
matter which is likely to harbour tetanus organisms
• any wound from compound fractures
• any wound containing foreign bodies
• any wound or burn in patients who have systemic sepsis
• any bite wound
• any wound from tooth re-implantation
Intravenous drug users are at greater risk of tetanus. Every opportunity should be taken to
ensure that they are fully protected against tetanus. Booster doses should be given if there is
any doubt about their immunisation status.
Immunosuppressed patients may not be adequately protected against tetanus, despite having
been fully immunised. They should be managed as if they were incompletely immunised.
PRACTICE TEST 2 89
Text C
Tetanus Immunisation following injuries
Thorough cleaning of the wound is essential irrespective of the immunisation history of the
patient, and appropriate antibiotics should be prescribed.
Immunisation Clean Wound Tetanus-prone wound

Status
Vaccine Human Tetanus
Vaccine Immunoglobulin
(HTIG)
Fully immunised1 Not required Not required Only if high risk2
Primary Not required Not required Only if high risk2
immunisation
complete, boosters
incomplete but up to
date
Primary Reinforcing dose Reinforcing dose Yes (opposite limb to
immunisation and further doses and further doses vaccine)
incomplete or to complete to complete
boosters not up to recommended recommended
date schedule schedule
Not immunised or Immediate dose of Immediate dose of Yes (opposite limb to
immunisation status vaccine followed by vaccine followed by vaccine)
not known/uncertain3 completion of full completion of full
5-dose course 5-dose course
Notes
1. has received total of 5 doses of vaccine at appropriate intervals
2. heavy contamination with material likely to contain tetanus spores and/or extensive
devitalised tissue
3. immunosuppressed patients presenting with a tetanus-prone wound should always be
managed as if they were incompletely immunised
90 PRACTICE TEST 2
Text D
Human Tetanus Immunoglobulin (HTIG)
Indications
–– treatment of clinically suspected cases of tetanus
–– prevention of tetanus in high-risk, tetanus-prone wounds
Dose
Available in 1ml ampoules containing 250IU
Prevention Dose Treatment Dose
250 IU by IM injection1
Or
500 IU by IM injection1 if >24 hours since injury/risk of heavy contamination/burns
5,000 – 10,000 IU by IV infusion
Or
150 IU/kg by IM injection1 (given in multiple sites) if IV preparation unavailable
1
Due to its viscosity, HTIG should be administered slowly, using a 23 gauge needle
Contraindications
–– Confirmed anaphylactic reaction to tetanus containing vaccine
–– Confirmed anaphylactic reaction to neomycin, streptomycin or polymyxin B
Adverse reactions
Local – pain, erythema, induration (Arthus-type reaction)
General – pyrexia, hypotonic-hyporesponsive episode, persistent crying
END OF PART A
THIS TEXT BOOKLET WILL BE COLLECTED
PRACTICE TEST 2 91
READING SUB-TEST – QUESTION PAPER: PART A
CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
VENUE:
TEST DATE:
TIME: 15 MINUTES
DO NOT open this Question Paper or the Text Booklet until you are told to do so.
Write your answers on the spaces provided on this Question Paper.
You must answer the questions within the 15-minute time limit.
At the end of the 15 minutes, hand in this Question Paper and the Text Booklet.
DO NOT remove OET material from the test room.
SAMPLE
[CANDIDATE NO.] READING QUESTION PAPER PART A 01/04
92 PRACTICE TEST 2
Part A
TIME: 15 minutes
• Look at the four texts, A-D, in the separate Text Booklet.
• For each question, 1-20, look through the texts, A-D, to find the relevant information.
• Write your answers on the spaces provided in this Question Paper.
• Answer all the questions within the 15-minute time limit.
• Your answers should be correctly spelt.
PRACTICE TEST 2 93
Tetanus: Questions
Questions 1-6
For each question, 1-6, decide which text (A, B, C or D) the information comes from.
You may use any letter more than once.
In which text can you find information about
1 the type of injuries that may lead to tetanus?
2 signs that a patient may have tetanus?
3 how to decide whether a tetanus vaccine is necessary?
4 an alternative name for tetanus?
5 possible side-effects of a particular tetanus

medication?
6 other conditions which are associated with tetanus?
Questions 7-13
Complete each of the sentences, 7-13, with a word or short phrase from one of the texts.
Each answer may include words, numbers or both.
Patients at increased risk of tetanus:
7 If a patient has been touching or earth, they are more

susceptible to tetanus.
8 Any lodged in the site of an injury will increase the

likelihood of tetanus.
9 Patients with fractures are prone to tetanus.
10 Delaying surgery on an injury or burn by more than

increases the probability of tetanus.
11 If a burns patient has been diagnosed with they are

more liable to contract tetanus.
12 A patient who is or a regular recreational drug user

will be at greater risk of tetanus.
94 PRACTICE TEST 2
Management of tetanus-prone injuries:
13 Clean the wound thoroughly and prescribe if

necessary, followed by tetanus vaccine and HTIG as appropriate.
Questions 14-20
Answer each of the questions, 14-20, with a word or short phrase from one of the texts. Each
answer may include words, numbers or both.
14 Where will a patient suffering from tetanus first experience muscle contractions?
15 What can muscle spasms in tetanus patients sometimes lead to?
16 If you test for tetanus using a spatula, what type of reaction will confirm the
condition?
17 How many times will you have to vaccinate a patient who needs a full course of
tetanus vaccine?
18 What should you give a drug user if you’re uncertain of their vaccination history?
19 What size of needle should you use to inject HTIG?
20 What might a patient who experienced an adverse reaction to HTIG be unable to

stop doing?
END OF PART A
THIS QUESTION PAPER WILL BE COLLECTED
PRACTICE TEST 2 95
READING SUB-TEST – QUESTION PAPER: PARTS B & C
CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:

VENUE:
TEST DATE:
TIME: 45 MINUTES
DO NOT open this Question Paper until you are told to do so.
HOW TO ANSWER THE QUESTIONS:

Mark your answers on this Question Paper by filling in the circle using a 2B pencil. Example: A
B
C
SAMPLE
[CANDIDATE NO.] READING QUESTION PAPER PARTS B & C 01/16
96 PRACTICE TEST 2
Part B
In this part of the test, there are six short extracts relating to the work of health professionals. For
questions 1-6, choose answer (A, B or C) which you think fits best according to the text.
1. Nursing staff can remove a dressing if
A a member of the surgical team is present.
B there is severe leakage from the wound.
C they believe that the wound has healed.
Post-operative dressings
Dressings are an important component of post-operative wound management. Any

dressings applied during surgery have been done in sterile conditions and should ideally
be left in place, as stipulated by the surgical team. It is acceptable for initial dressings to be
removed prematurely in order to have the wound reviewed and, in certain situations, apply
a new dressing. These situations include when the dressing is no longer serving its purpose
(i.e. dressing falling off, excessive exudate soaking through the dressing and resulting in a
suboptimal wound healing environment) or when a wound complication is suspected.
PRACTICE TEST 2 97
2. As explained in the protocol, the position of the RUM container will ideally
A encourage participation in the scheme.
B emphasise the value of recycling.
C facilitate public access to it.
Unwanted medicine: pharmacy collection protocol
A Returned Unwanted Medicine (RUM) Project approved container will be delivered by the
wholesaler to the participating pharmacy.
The container is to be kept in a section of the dispensary or in a room or enclosure in

the pharmacy to which the public does not have access. The container may be placed
in a visible position, but out of reach of the public, as this will reinforce the message that
unwanted prescription drugs can be returned to the pharmacy and that the returned
medicines will not be recycled.
Needles, other sharps and liquid cytotoxic products should not be placed in the container,
but in one specifically designed for such waste.
98 PRACTICE TEST 2
3. The report mentioned in the memo suggests that
A data about patient errors may be incomplete.
B errors by hospital staff can often go unreported.
C errors in prescriptions pose the greatest threat to patients.
Memo: Report on oral anti-cancer medications
Nurse Unit Managers are directed to review their systems for the administration of oral
anti-cancer drugs, and the reporting of drug errors. Serious concerns have been raised in a
recent report drawing on a national survey of pharmacists.
Please note the following paragraph quoted from the report:

Incorrect doses of oral anti-cancer medicines can have fatal consequences. Over
the previous four years, there were three deaths and 400 patient safety issues
involving oral anti-cancer medicines. Half of the reports concerned the wrong dosage,
frequency, quantity or duration of oral anti-cancer treatment. Of further concern is that
errors on the part of patients may be under-reported. In light of these reports, there is
clearly a need for improved systems covering the management of patients receiving
oral therapies.
PRACTICE TEST 2 99
4. What point does the training manual make about anaesthesia workstations?
A Parts of the equipment have been shown to be vulnerable to failure.
B There are several ways of ensuring that the ventilator is working effectively.
C Monitoring by health professionals is a reliable way to maintain patient

safety.
Anaesthesia Workstations
Studies on safety in anaesthesia have documented that human vigilance alone is
inadequate to ensure patient safety and have underscored the importance of monitoring
devices. These findings are reflected in improved standards for equipment design,
guidelines for patient monitoring and reduced malpractice premiums for the use of
capnography and pulse oximetry during anaesthesia. Anaesthesia workstations integrate
ventilator technology with patient monitors and alarms to help prevent patient injury in
the unlikely event of a ventilator failure. Furthermore, since the reservoir bag is part of
the circuit during mechanical ventilation, the visible movement of the reservoir bag is
confirmation that the ventilator is functioning.
100 PRACTICE TEST 2

5. In cases of snakebite, the flying doctor should be aware of
A where to access specific antivenoms.
B the appropriate method for wound cleaning.
C the patients most likely to suffer complications.
Memo to Flying Doctor staff: Antivenoms for snakebite
Before starting treatment:

• Do not wash the snakebite site.
• If possible, determine the type of snake by using a ‘snake-venom detection kit’ to test a bite
site swab or, in systemic envenoming, the person’s urine. If venom detection is not available
or has proved negative, seek advice from a poisons information centre.
• Testing blood for venom is not reliable.
• Assess the degree of envenoming; not all confirmed snakebites will result in systemic
envenoming; risk varies with the species of snake.
• People with pre-existing renal, hepatic, cardiac or respiratory impairment and those taking
anticoagulant or antiplatelet drugs may have an increased risk of serious outcome from
snakebite. Children are also especially at increased risk of severe envenoming because of
smaller body mass and the likelihood of physical activity immediately after a bite.
PRACTICE TEST 2 101

6. What was the purpose of the BMTEC forum?
A to propose a new way of carrying out cleaning audits
B to draw conclusions from the results of cleaning audits
C to encourage more groups to undertake cleaning audits
Cleaning Audits
Three rounds of environmental cleaning audits were completed in 2013-2014. Key personnel
in each facility were surveyed to assess the understanding of environmental cleaning from
the perspective of the nurse unit manager, environmental services manager and the director
of clinical governance. Each facility received a report about their environmental cleaning
audits and lessons learned from the surveys. Data from the 15 units were also provided to
each facility for comparison purposes.
The knowledge and experiences from the audits were shared at the BMTEC Forum in August
2014. This forum allowed environmental services managers, cleaners, nurses and clinical
governance to discuss the application of the standards and promote new and improved
cleaning practice. The second day of the forum focused on auditor training and technique with
the view of enhancing internal environmental cleaning auditing by the participating groups.
102 PRACTICE TEST 2

Part C
In this part of the test, there are two texts about different aspects of healthcare. For questions
7-22, choose the answer (A, B, C or D) which you think fits best according to the text.
Text 1: Does homeopathy ‘work’?
For many, homeopathy is simply unscientific, but regular users hold a very different view.
Homeopathy works by giving patients very dilute substances that, in larger doses, would
cause the very symptoms that need curing. Taking small doses of these substances
– derived from plants, animals or minerals – strengthens the body’s ability to heal and
increases resistance to illness or infection. Or that is the theory. The debate about its
effectiveness is nothing new. Recently, Australia’s National Health and Medical Research
Council (NHMRC) released a paper which found there were ‘no health conditions for
which there was reliable evidence that homeopathy was effective’. This echoed a report
from the UK House of Commons which said that the evidence failed to show a ‘credible
physiological mode of action’ for homeopathic products, and that what data were available
showed homeopathic products to be no better than placebo. Yet Australians spend at least
$11 million per year on homeopathy.
So what’s going on? If Australians – and citizens of many other nations around the world –
are voting with their wallets, does this mean homeopathy must be doing something right?
‘For me, the crux of the debate is a disconnect between how the scientific and medical
community view homeopathy, and what many in the wider community are getting out of it,’
says Professor Alex Broom of the University of Queensland. ‘The really interesting question
is how can we possibly have something that people think works, when to all intents and
purposes, from a scientific perspective, it doesn’t?’
Part of homeopathy’s appeal may lie in the nature of the patient-practitioner consultation. In
contrast to a typical 15-minute GP consultation, a first homeopathy consultation might take
an hour and a half. ‘We don’t just look at an individual symptom in isolation. For us, that
symptom is part of someone’s overall health condition,’ says Greg Cope, spokesman for the
Australian Homeopathic Association. ‘Often we’ll have a consultation with someone and find
details their GP simply didn’t have time to.’ Writer Johanna Ashmore is a case in point. She
sees her homeopath for a one-hour monthly consultation. ‘I feel, if I go and say I’ve got this
health concern, she’s going to treat my body to fight it rather than just treat the symptom.’
Most people visit a homeopath after having received a diagnosis from a ‘mainstream’
practitioner, often because they want an alternative choice to medication, says Greg Cope.
‘Generally speaking, for a homeopath, their preference is if someone has a diagnosis from a
medical practitioner before starting homeopathic treatment, so it’s rare for someone to come
and see us with an undiagnosed condition and certainly if they do come undiagnosed, we’d
want to refer them on and get that medical evaluation before starting a course of treatment,’
he says.
PRACTICE TEST 2 103

Given that homeopathic medicines are by their very nature incredibly dilute – and, some
might argue, diluted beyond all hope of efficacy – they are unlikely to cause any adverse
effects, so where’s the harm? Professor Paul Glasziou, chair of the NHMRC’s Homeopathy
Working Committee, says that while financial cost is one harm, potentially more harmful are
the non-financial costs associated with missing out on effective treatments. ‘If it’s just a cold,
I’m not too worried. But if it’s for a serious illness, you may not be taking disease-modifying
treatments, and most worrying is things like HIV which affect not only you, but people
around you,’ says Glasziou. This is a particular concern with homeopathic vaccines, he
says, which jeopardise the ‘herd immunity’ – the immunity of a significant proportion of the
population – which is crucial in containing outbreaks of vaccine-preventable diseases.
The question of a placebo effect inevitably arises, as studies repeatedly seem to suggest
that whatever benefits are being derived from homeopathy are more a product of patient
faith rather than of any active ingredient of the medications. However, Greg Cope dismisses
this argument, pointing out that homeopathy appears to benefit even the sceptics: ‘We might
see kids first, then perhaps Mum and after a couple of years, Dad will follow and, even
though he’s only there reluctantly, we get wonderful outcomes. This cannot be explained
simply by the placebo effect.’ As a patient, Johanna Ashmore is aware scientific research
does little to support homeopathy but can still see its benefits. ‘If seeing my homeopath
each month improves my health, I’m happy. I don’t care how it works, even if it’s all in the
mind – I just know that it does.’
But if so many people around the world are placing their faith in homeopathy, despite
the evidence against it, Broom questions why homeopathy seeks scientific validation.
The problem, as he sees it, lies in the fact that ‘if you’re going to dance with conventional
medicine and say “we want to be proven to be effective in dealing with discrete physiological
conditions”, then you indeed do have to show efficacy. In my view this is not about broader
credibility per se, it’s about scientific and medical credibility – there’s actually quite a lot of
cultural credibility surrounding homeopathy within the community but that’s not replicated in
the scientific literature.’
104 PRACTICE TEST 2

Text 1: Questions 7-14
7. The two reports mentioned in the first paragraph both concluded that homeopathy
A could be harmful if not used appropriately.
B merely works on the same basis as the placebo effect.
C lacks any form of convincing proof of its value as a treatment.
D would require further investigation before it was fully understood.
8. When commenting on the popularity of homeopathy, Professor Broom shows his
A surprise at people’s willingness to put their trust in it.
B frustration at scientists’ inability to explain their views on it.
C acceptance of the view that the subject may merit further study.
D concern over the risks people face when receiving such treatment.
9. Johanna Ashmore’s views on homeopathy highlight
A how practitioners put their patients at ease.
B the key attraction of the approach for patients.
C how it suits patients with a range of health problems.
D the opportunities to improve patient care which GPs miss.
10. In the fourth paragraph, it is suggested that visits to homeopaths
A occasionally depend on a referral from a mainstream doctor.
B frequently result from a patient’s treatment preferences.
C should be preceded by a visit to a relevant specialist.
D often reveal previously overlooked medical problems.
PRACTICE TEST 2 105

11. What particularly concerns Professor Glasziou?
A the risks to patients of relying on homeopathic vaccinations
B the mistaken view that homeopathic treatments can only do good
C the way that homeopathic remedies endanger more than just the user
D the ineffectiveness of homeopathic remedies against even minor illnesses
12. Greg Cope uses the expression ‘wonderful outcomes’ to underline
A the ability of homeopathy to defy its scientific critics.
B the value of his patients’ belief in the whole process.
C the claim that he has solid proof that homeopathy works.
D the way positive results can be achieved despite people’s doubts.
From the comments quoted in the sixth paragraph, it is clear that Johanna
13.
Ashmore is
A prepared to accept that homeopathy may depend on psychological factors.
B happy to admit that she was uncertain at first about proceeding.
C sceptical about the evidence against homeopathic remedies.
D confident that research will eventually validate homeopathy.
14. What does the word ‘this’ in the final paragraph refer to?
A the continuing inability of homeopathy to gain scientific credibility
B the suggestion that the scientific credibility of homeopathy is in doubt
the idea that there is no need to pursue scientific acceptance for

C
homeopathy
the motivation behind the desire for homeopathy to gain scientific

D
acceptance
106 PRACTICE TEST 2

Text 2: Brain-controlled prosthetics
Paralysed from the neck down by a stroke, Cathy Hutchinson stared fixedly at a drinking straw
in a bottle on the table in front of her. A cable rose from the top of her head, connecting her to
a robot arm, but her gaze never wavered as she mentally guided the robot arm, which was
opposite her, to close its grippers around the bottle, then slowly lift the vessel towards her
mouth. Only when she finally managed to take a sip did her face relax. This example illustrates
the strides being taken in brain-controlled prosthetics. But Hutchinson’s focused stare also
illustrates the one crucial feature still missing from prosthetics. Her eyes could tell her where the
arm was, but she couldn’t feel what it was doing.
Prosthetics researchers are now trying to create prosthetics that can ‘feel’. It’s a daunting
task: the researchers have managed to read signals from the brain; now they must write
information into the nervous system. Touch encompasses a complicated mix of information
– everything from the soft prickliness of wool to the slipping of a sweaty soft-drink can. The
sensations arise from a host of receptors in the skin, which detect texture, vibration, pain,
temperature and shape, as well as from receptors in the muscles, joints and tendons that
contribute to ‘proprioception’ – the sense of where a limb is in space. Prosthetics are being
outfitted with sensors that can gather many of these sensations, but the challenge is to get the
resulting signals flowing to the correct part of the brain.
For people who have had limbs amputated, the obvious way to achieve that is to route the
signals into the remaining nerves in the stump, the part of the limb left after amputation. Ken
Horch, a neuroprosthetics researcher, has done just that by threading electrodes into the
nerves in stumps then stimulating them with a tiny current, so that patients felt like their fingers
were moving or being touched. The technique can even allow patients to distinguish basic
features of objects: a man who had lost his lower arms was able to determine the difference
between blocks made of wood or foam rubber by using a sensor-equipped prosthetic hand.
He correctly identified the objects’ size and softness more than twice as often as would have
been expected by chance. Information about force and finger position was delivered from the
prosthetic to a computer, which prompted stimulation of electrodes implanted in his upper-arm
nerves.
As promising as this result was, researchers will probably need to stimulate hundreds or
thousands of nerve fibres to create complex sensations, and they’ll need to keep the devices
working for many years if they are to minimise the number of surgeries required to replace
them as they wear out. To get around this, some researchers are instead trying to give
patients sensory feedback by touching their skin. The technique was discovered by accident
by researcher Todd Kuiken. The idea was to rewire arm nerves that used to serve the hand,
for example, to muscles in other parts of the body. When the patient thought about closing his
or her hand, the newly targeted muscle would contract and generate an electric signal, driving
movement of the prosthetic.
PRACTICE TEST 2 107

However, this technique won’t work for stroke patients like Cathy Hutchinson. So some
researchers are skipping directly to the brain. In principle, this should be straightforward.
Because signals from specific parts of the body go to specific parts of the brain, scientists
should be able to create sensations of touch or proprioception in the limb by directly activating
the neurons that normally receive those signals. However, with electrical stimulation, all neurons
close to the electrode’s tip are activated indiscriminately, so ‘even if I had the sharpest needle in
the Universe, that could create unintended effects’, says Arto Nurmikko, a neuroengineer. For
example, an attempt to create sensation in one finger might produce sensation in other parts of
the hand as well, he says.
Nurmikko and other researchers are therefore using light, in place of electricity, to activate
highly specific groups of neurons and recreate a sense of touch. They trained a monkey to
remove its hand from a pad when it vibrated. When the team then stimulated the part of its
brain that receives tactile information from the hand with a light source implanted in its skull, the
monkey lifted its hand off the pad about 90% of the time. The use of such techniques in humans
is still probably 10–20 years away, but it is a promising strategy.
Even if such techniques can be made to work, it’s unclear how closely they will approximate
natural sensations. Tingles, pokes and vibrations are still a far cry from the complicated
sensations that we feel when closing a hand over an apple, or running a finger along a table’s
edge. But patients don’t need a perfect sense of touch, says Douglas Weber, a bioengineer.
Simply having enough feedback to improve their control of grasp could help people to perform
tasks such as picking up a glass of water, he explains. He goes on to say that patients who
wear cochlear implants, for example, are often happy to regain enough hearing to hold a phone
conversation, even if they’re still unable to distinguish musical subtleties.
108 PRACTICE TEST 2

15. What do we learn about the experiment Cathy Hutchinson took part in?
A It required intense concentration.
B It failed to achieve what it had set out to do.
C It could be done more quickly given practice.
D It was the first time that it had been attempted.
16. The task facing researchers is described as ‘daunting’ because
A signals from the brain can be misunderstood.
B it is hard to link muscle receptors with each other.
C some aspects of touch are too difficult to reproduce.
D the connections between sensors and the brain need to be exact.
17. What is said about the experiment done on the patient in the third paragraph?
A There was statistical evidence that it was successful.
B It enabled the patient to have a wide range of feeling.
C Its success depended on when amputation had taken place.
D It required the use of a specially developed computer program.
18. What drawback does the writer mention in the fourth paragraph?
A The devices have a high failure rate.
B Patients might have to undergo too many operations.
C It would only be possible to create rather simple sensations.
D The research into the new technique hasn’t been rigorous enough.
PRACTICE TEST 2 109

19. What point is made in the fifth paragraph?
A Severed nerves may be able to be reconnected.
B More research needs to be done on stroke victims.
C Scientists’ previous ideas about the brain have been overturned.
D It is difficult for scientists to pinpoint precise areas with an electrode.
20. What do we learn about the experiment that made use of light?
A It can easily be replicated in humans.
B It worked as well as could be expected.
C It may have more potential than electrical stimulation.
D It required more complex surgery than previous experiments.
21. In the final paragraph, the writer uses the phrase ‘a far cry from’ to underline
A how much more there is to achieve.
B how complex experiments have become.
C the need to reduce people’s expectations.
D the differences between types of artificial sensation.
22. Why does Weber give the example of a cochlear implant?
A to underline the need for a similar breakthrough in prosthetics
B to illustrate the fact that some sensation is better than none
C to highlight the advances made in other areas of medicine
D to demonstrate the ability of the body to relearn skills
END OF READING TEST

THIS BOOKLET WILL BE COLLECTED
110 PRACTICE TEST 2

WRITING SUB-TEST – TEST BOOKLET
CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
VENUE:
TEST DATE:
You must write your answer for the Writing sub-test in the Writing Answer Booklet.
SAMPLE
[CANDIDATE NO.] WRITING SUB-TEST TEST BOOKLET 01/04
PRACTICE TEST 2 111

OCCUPATIONAL ENGLISH TEST
WRITING SUB-TEST: MEDICINE
TIME ALLOWED: READING TIME: 5 MINUTES

Read the case notes below and complete the writing task which follows.
Notes:
You are a doctor at Stillwater Private Practice. You are examining a 70-year-old woman who believes she has
worsening arthritis.
Patient details
Name: Mrs Carol Potter
DOB: 30.12.1947
Address: 21 Gumtree Road
Stillwater
Medical history: 2008 Osteoarthritis (OA) − mostly of hands & knees

2015 Hypertension (HT) – well controlled
2016 Skin cancer removed
2016 Insomnia – 2 years, intermittent
Urinary tract infections (UTIs) – intermittent
Medications: Ramipril 5mg daily

Panadol Osteo (extended release paracetamol) 2 tablets t.d.s.
Temazepam 10mg nocte p.r.n.
Family history: Mother – breast cancer
Social background: Administrative assistant (retired)
Presenting complaint:  Pain in L knee with walking for last 12 months. Now quite severe − not relieved by
regular Panadol Osteo. Pain can even occur at rest after a long walk.
Treatment record
23.02.18
Subjective: No joint swelling/redness
No recent injury to knee
R knee − some pain on walking, not nearly as bad as L knee
On examination: Evidence of  ROM of L knee due to pain

No swelling
Tender to pressure along joint
Treatment: Referral for X-ray of L knee, blood tests

Review appointment to discuss results tomorrow
Prescribe pain relief – naproxen 250mg b.d.
16 www.occupationalenglishtest.org
112 PRACTICE TEST 2
24.02.18
Test results: • X-ray: Evidence of severe OA in L knee – osteophytes and loss of joint space
Patella appears normal
No evidence of fractures
• Blood: FBE, UEC (normal)
Assessment: Likely worsening OA
Treatment: Arrange physiotherapy

Analgesia
Referral for surgical consultation – ? knee joint replacement
Writing Task:
Using the information given in the case notes, write a letter of referral to Dr Waters, a surgeon at Stillwater Private Hospital, for
a surgical consultation. Address the letter to Dr Leigh Waters, Surgeon, Stillwater Private Hospital, 54 Main Street, Stillwater.
In your answer:
● Expand the relevant notes into complete sentences
● Do not use note form
● Use letter format
The body of the letter should be approximately 180–200 words.
PRACTICE TEST 2 113

www.occupationalenglishtest.org 17
WRITING SUB-TEST – ANSWER BOOKLET
CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
VENUE:
TEST DATE:
TIME ALLOWED
READING TIME: 5 MINUTES
1. Reading time: 5 minutes
During this time you may study the writing task and notes. You MUST NOT write, highlight, underline or make any notes.
2. Writing time: 40 minutes
3. Use the back page for notes and rough draft only. Notes and rough draft will NOT be marked.
Please write your answer clearly on page 1 and page 2.
Cross out anything you DO NOT want the examiner to consider.
4. You must write your answer for the Writing sub-test in this Answer Booklet using pen or pencil.
5. You must NOT remove OET material from the test room.
SAMPLE
[CANDIDATE NO.] WRITING SUB-TEST ANSWER BOOKLET 01/04
114 PRACTICE TEST 2

Please record your answer on this page.
(Only answers on Page 1 and Page 2 will be marked.)
L E
P
A M
S
SAMPLE
OET Writing sub-test – Answer booklet 1
[CANDIDATE NO.] WRITING SUB-TEST - ANSWER BOOKLET 02/04
PRACTICE TEST 2 115

Please record your answer on this page.
(Only answers on Page 1 and Page 2 will be marked.)
L E
P
A M
S
SAMPLE
OET Writing sub-test – Answer booklet 2
116 PRACTICE TEST 2

Space for notes and rough draft. Only your answers on Page 1 and Page 2 will be marked.
L E
P
A M
S
SAMPLE
PRACTICE TEST 2 117

SPEAKING SUB-TEST
CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
PROFESSION: Your details and photo will be printed here.
VENUE:
TEST DATE:
INSTRUCTION TO CANDIDATES
Please confirm with the Interlocutor that your roleplay card number and colour match the Interlocutor card before you begin.
Interlocutor to complete only
ID No: Passport: £ National ID: £ Alternative ID approved: £

Speaking sub-test:
ID document sighted? £ Photo match? £ Signature match? £ Did not attend? £

Interlocutor name:
Interlocutor signature:
SAMPLE
[CANDIDATE NO.] SPEAKING SUB-TEST 01/04
118 PRACTICE TEST 2

OET Sample role-play
Suburban General Practice
PATIENT You are a new patient to this practice. Following a week of epigastric pain (in the
stomach and abdominal area), your doctor ordered a barium meal test for you.
You have come back for the result. You are worried about the possibility of cancer.
You had a similar episode of pain five years ago but took the prescribed anti-ulcer
tablets for only two weeks.
• Express your anxiety about the condition. Could you have prevented the
current episode of illness by having completed a longer course of treatment five
years ago?
• Insist on knowing what a gastroscopy involves. You don’t like the sound of it at
all.
• Be difficult to reassure. You want to know all the possible causes of this pain,
including cancer or other non-malignant causes.
© Cambridge Boxhill Language Assessment Sample role-play

Suburban General Practice
DOCTOR The patient has a recurrence of epigastric pain. The barium meal which you
ordered shows an ulcer on the lesser curve of the stomach which may be
malignant. He/she is a new patient to your practice and you have no details of
previous epigastric pain.
• Explain the findings to the patient and the possibility of malignancy.
• Question the patient about previous episodes of epigastric pain.
• Advise that you will need to refer him/her urgently for a gastroscopy for a definite
diagnosis. Explain the procedure as simply as possible.
• Find out what information about the condition the patient wants now. Try to
reassure the patient by mentioning other possible, non-malignant causes (e.g.,
ulcer, indigestion, etc.).
PRACTICE TEST 2 119

Suburban Clinic
PARENT You are the parent of a young child who suffers from eczema (a skin condition).
You have brought the child to the doctor because you are worried about the
condition and what will happen in the future. You have heard a theory that eczema
is related to food allergies and you are inclined to believe it.
• When asked, explain that you want the doctor to explain exactly what eczema is
and if the child will grow out of it.
• Discuss the theory of food allergies with the doctor.
• Challenge the doctor if he/she is inclined to dismiss this theory.
• Finally agree to listen to the doctor's advice on managing the condition.

Suburban Clinic
DOCTOR A worried parent has brought his/her young child, who suffers from eczema,
to see you.
• Find out what the parent wants to know about eczema.
• Explain the condition, and talk about the prognosis, (e.g., it is connected with
inherited sensitive skin, it can be controlled but not cured, the child is likely to
grow out of it, etc.).
• Answer the parent's question about any possible relationship between eczema
and food allergies.
• Give advice on management of the condition. Advise the parent to make sure
the child avoids things that will irritate the skin (e.g., most soaps, wool next to
the skin, scratching and rubbing the skin, etc.).
120 PRACTICE TEST 2

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CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
VENUE:
TEST DATE:
TIME: 15 MINUTES
Write your answers in the spaces provided in this Question Paper.
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Part A
TIME: 15 minutes
• For each question, 1-20, look through the texts, A-D, to find the relevant information.
• Write your answers in the spaces provided in this Question Paper.
• Your answers should only be taken from Texts A-D and must be correctly spelt..
Cellulitis: Questions
Questions 1- 8
For each question, 1-8, decide which text (A, B, C or D) the information comes from. Write the letter A, B, C or D
in the space provided. You may use any letter more than once.
In which text can you find information about
1 treatment for cellulitis caused by less common bacteria?
2 a reason for drawing around the area affected by cellulitis?
3 a system for determining where and how best to treat patients with cellulitis?
4 symptoms that may be experienced before the infection is visible?
5 equipment for ensuring that patients’ legs are more comfortable in bed?
6 alternative medication for cellulitis patients who cannot tolerate one type of
antibiotics?
7 how to deal with the infection site after the swelling has begun to reduce?
8 who should be consulted regarding pharmacotherapy for cellulitis?
Questions 9-14
Answer each of the questions, 9-14, with a word or short phrase from one of the texts. Each answer may include
words, numbers or both. You should not write full sentences.
9 Which antibiotic formulation is not suitable for treatment of cellulitis?
10 Which pre-existing weight-related condition would prompt a Class 2 categorisation?
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11 What single dose of IV benzylpenicillin should be administered to a Class 4 patient?
12 What may be impaired if anti-inflammatories are given to patients who take ACE inhibitors?
13 What is the single dose of oral flucloxacillin recommended for the least serious category of cellulitis?
14 What is the maximum single dose of IV clindamycin recommended for a patient with Class 4 cellulitis?
Questions 15-20
Complete each of the sentences, 15-20, with a word or short phrase from one of the texts. Each answer may
include words, numbers or both.
15 It may be necessary to carry out of blisters caused

by cellulitis.
16 When prescribing anti-inflammatories, may be used as an

alternative to ibuprofen.
17 A patient may have been exposed to infection by swimming in surface water or
using .
18 Conditions such as or even metastatic cancer may be mistaken

for cellulitis.
19 Patients with exacerbating cellulitis, a compromised immune system, and those
with should be hospitalised.
20 Patients suffering from can experience repeat episodes of

cellulitis.
END OF PART A
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TEST DATE:
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Cellulitis: Texts
Text A
Cellulitis: definition and aetiology

Cellulitis is an acute bacterial infection of the dermis and subcutaneous tissue which presents with an acute
onset of red, painful, hot, swollen, and tender skin, sometimes with blister formation. Fever and nausea may
accompany or precede skin changes.
By far the commonest organisms that cause cellulitis are Streptococcus pyogenes and Staphylococcus
aureus. Other, less common organisms include Aeromonas hydrophila (caused by exposure to fresh water),
Pasteurella multocida and anaerobes (caused by mammalian bites), Vibrio vulnificus (caused by exposure to
salt water), and Pseudomonas aeruginosa (caused by use of hot tubs).
The leg is the most commonly affected site, with unilateral presentation the norm. Bilateral leg cellulitis can
occur but is extremely rare. Infection arises from an identifiable break in the skin from trauma.
Recurrent cellulitis is more common in people who have chronic lymphoedema, especially in those with a
history of venectomy for coronary artery bypass grafting, mastectomy, or pelvic surgery.
Text B
Severity of cellulitis
The Eron Classification system can help to guide admission and treatment decisions:
Class I There are no signs of systemic toxicity, and the person has no uncontrolled co-morbidities.
Class II The person is either systemically unwell or systemically well but with a co-morbidity, e.g.,
peripheral arterial disease, chronic venous insufficiency, or morbid obesity, which may
complicate or delay resolution of infection.
Class III The person has significant systemic upset such as acute confusion, tachycardia or
hypotension, or a limb-threatening infection due to vascular compromise.
Class IV The person has a severe life-threatening infection such as necrotizing fasciitis.
In suspected cases of cellulitis, immediately hospitalise anyone with Class III or IV. In addition, anyone who
is immunocompromised, has facial cellulitis, is very young (under 12 months) or elderly and frail, or whose
cellulitis is rapidly deteriorating must be hospitalised.
Note that many other common conditions, including deep vein thrombosis (DVT), share the same
symptoms (unilateral redness and/or swelling) as cellulitis. The same is also true for rare, serious conditions,
such as metastatic cancer.
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Text C
Suitable drug therapy for typical cellulitis

First line Second line
Class 1 Flucloxacillin 500 mg 4x/day PO Penicillin allergy:
Clarithromycin 300 mg 2x/day PO
Class 2 Flucloxacillin 1 g 4x/day IV Penicillin allergy:

or Clarithromycin 500 mg 2x/day IV
* Ceftriaxone 1 g 1x/day IV (OPAT only) or
(Must not be used in penicillin Clindamycin 600 mg 4x/day IV
anaphylaxis)
Class 3 Flucloxacillin 1 g 4x/day IV Penicillin allergy:
Clarithromycin 500 mg 2x/day IV
or
Clindamycin 600 mg 4x/day IV
Class 4 Benzylpenicillin 2.4 g 2-4 hourly IV
+ Ciprofloxacin 400 mg 2x/day IV
+ Clindamycin 600 mg–1.2 g 4x/day
(If allergic to penicillin use Ciprofloxacin and Clindamycin only)
NB: Discuss with local Medical Microbiology Service
Suitable drug therapy for atypical cellulitis
Risk Factor First line Penicillin allergy
Human bite Co-amoxiclav 625 mg 3x/day PO Clarithromycin 500 mg 2x/day PO
or Doxycycline 100 mg 2x/day PO
and Metronidazole 400 mg 3x/day PO
Cat/dog bite Co-amoxiclav 625 mg 3x/day PO Doxycycline 100 mg 2x/day PO
and Metronidazole 400 mg 3x/day PO
Exposure to Ciprofloxacin 750 mg 2x/day PO Ciprofloxacin 750 mg 2x/day PO

fresh water and Flucloxacillin 500 mg 4x/day PO and Clarithromycin 500 mg 2x/day PO
at site of skin
break
Text D
Management of the locally affected area

- Prescribe analgesia to ensure pain relief. Review the appropriateness of anti-inflammatory drugs,
and if initiating an anti-inflammatory is obligatory, use ibuprofen (1200 mg per day or less) or
naproxen (1000 mg per day or less).
- Take account of drug interactions; for example, co-prescribing anti-inflammatories with ACE
inhibitors or angiotensin receptor blockers may pose particular risks to renal function.
- Avoid the use of topical antibiotics as these are unsuitable for the management of any class of
cellulitis.
- Monitor temperature and consider hydration.
- Elevate the affected limb and use a bed cradle to avoid irritation or increased pain caused by
contact with sheets.
- Conduct pro-active management of blistering, including aseptic aspiration, but if in doubt, seek
specialist advice.
- There may be diffuse redness or a well-demarcated edge that can be marked with a pen
in order to monitor progress.
- Once the critical stage of swelling and redness has subsided, assess the patient
for compression bandaging.
END OF PART A
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CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:

VENUE:
TEST DATE:
TIME: 45 MINUTES

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Part B
In this part of the test, there are six short extracts relating to the work of health professionals. For questions 1-6,
choose the answer (A, B or C) which you think fits best according to the text. A
B
1. According to the notice, the course is only available to nurses who
A wish to apply for a hospital internship.
B are prepared to pay for the course themselves.
C are already employed in a related field.
NOTICE
Emergency Nurse Practitioner (ENP) Minor Injury Course
We are pleased to announce that the hospital's ENP service will be running a Minor Injury Course.
The aim of the course is to prepare experienced registered nurses working within emergency, primary
care and walk-in environments to provide a high level of autonomous care for patients presenting with
minor trauma.
The ENP Minor Injury Course structure has recently been changed. There will no longer be an additional
clinical placement, and course applicants will therefore be required to complete all their clinical
competencies in their own clinical setting with a designated mentor, with whom we will correspond in
advance of the course. Therefore, only applications from registered nurses working in a nursing role on a
permanent basis in a relevant area such as the emergency department or minor injuries unit within their
organisation can be considered and their place will need to be funded by their organisation, rather than
self-funded.
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2. The guideline about breast pumps
A restricts their removal from the ward.
B provides operating instructions.
C indicates times of unavailability.
Maternity Ward Guideline 4.3.7: Electric breast pumps
• All inpatient areas that care for infants of expressing or breastfeeding mothers have been allocated
electric breast pumps. These should stay on their allocated ward except for when they are
being cleaned. They are exclusively for use in the infants' ward area and should not be given
to parents to take to their own accommodation.
• In addition to the ward-based pumps, there are expressing rooms containing electric breast pumps
around the hospital. All the expressing rooms can be used by mothers of patients in any ward area as
well as by mothers visiting outpatients.
• Breast pumps are now all tagged to enable pumps to be tracked and found quickly.
• A breast pump can be shared between mothers on a ward but should be wiped down by the mother
after each use. Breast pumps are cleaned by the Hospital Sterilisation and Decontamination
Unit weekly.
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3. According to the policy, what must the Registered Nurse do when a patient is discharged?
A check the clarity of aftercare instructions
B liaise with other health professionals
C ensure easy accessibility to patient data
Hospital Discharge Policy 4.1.5 Registered Nurse
Registered Nurses will have the responsibility for ensuring advice on discharge is provided to patients
and, if required, relevant onward referrals are made including the booking of future outpatient
appointments. The Registered Nurse must ensure that all relevant documentation is complete and
accurate.
Registered Nurses will ensure effective handover (both verbal and written) of patients’ assessment
and on-going care needs. They will also be responsible (with the support of the discharge coordinator,
where appropriate) for day-to-day co-ordination of discharge and act as a point of contact and conduit
for effective communication for all members of the multi-disciplinary team. They must ensure that all
requirements to facilitate a safe discharge are in place: this may include dressings, medication, and any
equipment.
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4. This notice provides information about
A the potential dangers that NGTs pose to patients.
B the precautions to be followed during the procedure.
C the correct technique for inserting a nasogastric tube.
NOTICE
Nasogastric tube (NGT)
By inserting a nasogastric tube, you are gaining access to the stomach and its contents. This enables
you to drain gastric contents, decompress the stomach, obtain a specimen of the gastric contents, or
introduce a passage into the GI tract. This will allow you to treat gastric immobility and bowel obstruction,
and permit drainage in drug overdosage or poisoning. NG tubes can be used to aid in the prevention of
vomiting and aspiration and for assessment of GI bleeding. They can also be used for enteral feeding
initially.
The potential for contact with a patient's blood/body fluids while starting an NG is present and increases
with the inexperience of the operator. Gloves must be worn while starting an NG; and if the risk of
vomiting is high, the operator should consider face and eye protection as well as a gown.
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5. In this policy extract, what point is made about clinical guidelines?
A Their content must be approved by all relevant staff.
B They are a set of recommendations rather than regulations.
C Ignoring them for no reason is likely to result in disciplinary action.
Clinical Guidelines
The development, introduction and use of guidelines is intended to ensure consistent care to all patients
and reduce risks of errors and incidents through ensuring the whole clinical team is working in an
informed, consistent, and clearly understood way. The policy aims to ensure that clinical guidelines are
developed and agreed, keeping all key staff involved and informed as well as reflecting best practice. It
is important to recognise that Clinical Guidelines are not mandatory and are not a substitute for clinical
judgement. However, where guidelines are not followed, clinicians should be able to account for why a
decision not to adhere to them has been taken. In these situations, it is good practice to record this in
the patient notes. Clinicians also have a responsibility to report these instances to those responsible for
producing the guidelines in order that such instances can be reflected more accurately within them.
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6. The protocol instructs maternity staff administering Ferinject to
A temporarily discontinue prescribing iron tablets.
B avoid giving it to breastfeeding women.
C be alert for any negative reactions.
Protocol for the use of Ferinject during pregnancy
Ferinject (Iron III carboxymaltose) has 50 mg/ml of elemental iron. It is administered by slow IV injection
or infusion with no need for a test dose. It should be avoided in the first trimester, and it should be
administered with caution during the second and third trimesters in cases of severe anemia where iron
supplements are ineffective.
Less than 1% passes into breast milk, which is unlikely to be significant. While the rate of anaphylaxis with
this preparation is low, it does carry a risk of anaphylactoid reaction. It does not require any monitoring
except for a set of observations prior to administration.
Oral iron should be avoided for 5 days after the administration of Ferinject. A follow up full blood count
should be performed at 2-3 weeks (adapt to clinical scenario if necessary) and the GP notified of the
treatment and need for continuation of iron.
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Part C
In this part of the test, there are two texts about different aspects of healthcare. For questions 7-22, choose the
A
answer (A, B, C or D) which you think fits best according to the text. B
C
Fill the circle in completely. Example: D
Text 1: Planning for the future
The esteemed clinician-scientist Professor Robert Winston sparked debate recently. He avoids hiring graduates
who have achieved high first-class degrees to work in his laboratories, he said, because experience has taught him
that they are less likely to be well-rounded and good team players. Many hard-working and gifted students may
feel aggrieved by his approach, but it is refreshing to see public acknowledgement that recruitment strategies must
assess more than just academic ability. A similar debate has also resurfaced about medical school admissions, with
senior clinicians and medical educators reiterating the need for a holistic application system to identify the most
promising future doctors.
A prevailing problem is how to decide on a uniform description of the traits that should be sought in the doctors of
tomorrow. After all, graduates from medical school are expected to go on to pursue careers in specialties as diverse
as neurosurgery, dermatology, and microbiology. Clearly, these require different skills and personality types. So,
can one single recruitment strategy identify a generic set of desirable traits for all future doctors?
Boston University Medical School is confident that this is possible. Using applicants’ interviews, essays and letters
of reference to identify evidence of service engagement, cultural sensitivity and emotional resilience, they attempt
to match universally important traits with elements of applicant data that reveal or predict them.
The medical workforce, meanwhile, continues to evolve in response to the changing demographics and health
needs of the population. The Centre for Workforce Intelligence is the UK authority on workforce planning and
development and has recommended that reductions are needed in specialties such as general surgery, obstetrics
and gynaecology, and anaesthesia, and that increases in training posts for general practice should continue.
According to its analysis, an overall decrease of 167 entry-level training posts for specialties based at hospitals,
and an increase of 450 in general-practice training posts, would correct current imbalances. The UK Department of
Health has also vowed to tackle this specialty mismatch and has promised to make the two specialties currently
under most pressure, general practice and emergency medicine, more attractive to new doctors.
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With increasing superspecialisation, practitioners in secondary-care disciplines tend to be world experts in
narrow clinical areas. They may be enticed by the glamour of academia, but they often interact with relatively few
patients during their careers. Generalists, meanwhile, have a far greater volume of clinical interactions and form
relationships with countless patients. This has a different type of glamour, related to the unique opportunity to share
everyday patient experiences. Indeed, the best general practitioners are invariably those who have mastered their
unit of clinical interaction, the consultation. The very human skills of dealing with uncertainty, discussing patients’
rational and irrational concerns, and developing trust, are vital to maintaining high-quality care in general practice.
Perhaps the best way to attract doctors to this discipline is therefore to encourage the selection of future clinicians
who are likely to have these traits in the first place. Although Boston University Medical School’s admissions
system may not be perfect, its innovation shows that, with more time and thought, medical school recruitment can
be improved and made more holistic. It seems obvious that medical school admissions systems should be guided
by workforce requirements. Naturally, intellectual achievements will always be important, and the pace of modern
evidence-based medicine certainly demands bright and inquisitive minds. However, the problems of multimorbidity
and an ageing population are very real, and there can be little doubt that future health systems will require well-
rounded generalists who have the skills to deal with presentations across the biopsychosocial spectrum.
A holistic admissions process is likely to facilitate the recruitment of suitably skilled people, who will appreciate the
satisfaction of a lifetime building human relationships. So perhaps instead of coercing existing doctors towards
facing the generalist challenges, the UK Department of Health would be better advised to invest in the medical
school admissions process and re-evaluate recruitment to the profession altogether.
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7. What is the writer’s reaction to Professor Winston’s strategy?
A He approves of the idea behind it.
B He is surprised by the theory it is based on.
C He worries about the implications it may have.
D He is disappointed by the narrowness of its focus.
8. The writer’s purpose in the second paragraph is to highlight
A the personal qualities needed for a career in medicine.
B the difficulty of knowing which specialty fits each personality best.
C the extensive choice of career options open to medical graduates.
D the challenge of assessing candidates’ suitability for a medical career.
9. What does the word ‘them’ in the third paragraph refer to?
A people applying for places at medical school
B aspects of medical school applicants’ personalities
C documents relating to applications for medical school
D grades which applicants are likely to achieve at medical school
10. The fourth paragraph focuses on the
A predicted lack of qualified medical professionals in the UK.
B reasons why fewer doctors are choosing to go into general practice.
C ways to ensure the demand for certain medical professionals is met.
D need to maintain a broad range of specialties in the medical workforce.
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11. The expression ‘vowed to tackle’ is used to stress
A a commitment to a certain objective.
B an unwillingness to change direction.
C a reaction to some unexpected criticism.
D an acknowledgement of a miscalculation.
12. What point does the writer make about superspecialisation?
A Clinicians have little opportunity to develop certain valuable skills.
B Generalist practitioners are having to deal with an increasing workload.
C Specialists may be unaware of work carried out in other branches of medicine.
D Some specialties attract clinicians with less interest in direct contact with patients.
13. In the sixth paragraph, the writer says that medical schools should
A ensure that academic standards remain a priority.
B encourage graduates to become general practitioners.
C teach students how to build relationships with patients.
D favour applicants who possess good interpersonal skills.
14. What does the writer suggest about the UK Department of Health in the final paragraph?
A It underestimates the scale of the challenge.
B Its approach to solving the problem is misguided.
C Its grasp of the population’s healthcare needs is limited.
D It has misunderstood the underlying causes of the situation.
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Text 2: Open patient records
In the US, the expansion of patient access to electronic medical records has been accompanied by numerous
studies investigating the experiences of patients and clinicians. Starting from about 2000, the use of patient
portals to display test results spread rapidly, and in 2010, 100 primary care doctors volunteered to open their free
text entries to 10,000 of their patients. By 2019, more than 50 million patients in the US had access to what their
clinicians wrote about their medical care. In 2021, the US federal government mandated that patients should have
easy electronic access at no charge to all information held in their electronic health records. Today, patients can
use readily available patient portals to access all the information a clinician might use to make decisions about
their care in both inpatient and outpatient settings, including primary care and specialist notes, laboratory test
results, and imaging reports. So, what might doctors in other countries whose governments are in the process of
implementing transparent medical records learn from the US experience?
US clinicians anticipated increased workloads as, from about 2000, patients gained access to test results and, a
decade later, to visit notes. Primary care doctors worried about upset and confused patients contacting them or
asking time-consuming questions during visits, and requesting changes to what had been written. These concerns
were largely unrealised, and at the end of the year-long 2010 pilot, none of the participating doctors chose to turn
off access to notes. In fact, their healthcare organisations chose instead to expand access to notes written by all
clinicians. These results have been replicated in hundreds of provider organisations across the country, and follow-
up studies indicate that clinicians’ views of open notes become more positive over time.
Some studies suggest clinicians are changing the way they document in the wake of open medical records. In
one, around 37% of doctors reported spending at least ‘some’ more time writing notes, but preliminary inquiries
using the timestamps from electronic health records suggest that any increase in time spent in documentation
is miniscule (fractions of a second). It is likely that doctors learn to think differently about how to document,
particularly when new to the practice of open medical records. Such additional cognitive burden may make it feel as
if they are spending more time writing, even though direct measurements indicate no change. As doctors become
accustomed to writing in this way, such strain may well ease.
Clinicians worried initially about how transparent medical records may engender adversarial patient-clinician
relationships and increase doctors’ liability. Trusting relationships are known to diminish the risk of litigation, even
when errors occur, and the US’s overall experience suggests that open and transparent communication increases
trust among patients, families, and clinicians. The movement to encourage disclosure and apology when problems
arise, which has spread across US states in recent years, provides further reassurance. Studies indicate that
increased transparency, disclosure, and apology may decrease the chance that patients and families will file
lawsuits. Furthermore, insurers state that open medical records do not seem to increase the risk that patients will
allege malpractice.
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Further challenges accompanying the rollout of open medical records remain. Clinicians have concerns about
the wellbeing of their most vulnerable patients, such as those experiencing domestic violence. US regulations
allow clinicians to withhold information from the patient portal if they believe it might harm an individual patient or
another person. Yet it is unlikely that all doctors and patients are aware of this exception. Healthcare organisations
could help ensure the safety of such vulnerable patients by providing training to clinicians and patients. Electronic
health record vendors could also design provider functions that facilitate trauma informed care, including options to
create confidential notes and enhanced privacy settings that allow patients greater control over what information is
available on the portal.
Another issue currently under debate in the US is when test results should be released to patients. In the past,
with the common-sense expectation that clinicians would first communicate with patients, most health systems
chose to delay the release of some findings, such as pathology examinations, medical imaging reports, or cardiac
monitoring. In contrast, the new US rules mandate instantaneous release of virtually all results, regardless of
whether they suggest bad tidings.
Challenges such as these are not insolvable, but they will take a creative combination of cultural and technical
adaptations to resolve. All new medicines are accompanied by side effects that affect some patients adversely, and
for some patients, fully transparent records may be contraindicated. But in the US, the benefits of open medical
records for all involved seem to well outweigh the risks. Patients consistently report clinically meaningful effects,
and any potentially negative effects on practitioners have been limited and manageable.
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15. In the first paragraph we learn that, in the USA, allowing patients access to their own medical records
A has been driven by doctors.
B was prompted by targeted research.
C was made possible by advances in technology.
D happened over a relatively short period of time.
16. What point does the writer make about open access medical records in the second paragraph?
A Healthcare organisations decided to implement them more quickly than required.
B Doctors made incorrect assumptions about the effects they would have.
C Their implementation has affected doctors more than patients.
D Pilot studies on them didn’t go as expected.
17. What is the writer doing in the third paragraph?
A disputing the results of research into writing notes
B making suggestions about the best way to write notes
C offering a theory about doctors’ perceptions of writing notes
D exploring the role that experience plays in writing effective notes
18. In the writer’s opinion, the policy of open records has not led to an increase in lawsuits because
A knowing that patients can access their records means doctors feel compelled to apologise for errors.
B having access to information leads people to have greater confidence in their doctors.
C other changes in the US have made legal battles less attractive for patients.
D sharing knowledge means doctors can learn from the mistakes of others.
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19. In the fourth paragraph, the writer believes that ‘further assurance’ is being given to
A patients.
B families.
C clinicians.
D US states.
20. What point does the writer make about vulnerable patients?
A Current legislation is not robust enough to protect them.
B Keeping their data safe is not just the responsibility of doctors.
C They are insufficiently informed about the way open records may endanger them.
D Keeping information from them puts them more at risk than including it in their electronic records.
21. In the sixth paragraph, the writer suggests that
A there is some news which is best given by a doctor.
B some US health systems are trying to bypass a new rule.
C test results should be checked by a doctor before patients get access to them.
D new rules on access to results fail to distinguish between different types of test.
22. In the final paragraph, the phrase ‘creative combination’ is used to suggest that making open records
work
A is the responsibility of both patients and doctors.
B may require people and organisations to think in new ways.
C means accepting that different groups of patients will use them differently.
D will depend on people accepting that there are both risks and benefits to using them.
END OF READING TEST

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Sample Test 1

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VENUE:
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TEST DATE:
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TIME: 15 MINUTES
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Part A
TIME: 15 minutes
• For each question, 1-20, look through the texts, A-D, to find the relevant information.
• Your answers should only be taken from texts A-D and must be correctly spelt.
Fractures, dislocations and sprains: Questions
E
Questions 1-7
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procedures for delivering pain relief?
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2 the procedure to follow when splinting a fractured limb?
A
3 what to record when assessing a patient?
4 the terms used to describe different types of fractures?
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5 the practitioners who administer analgesia?
6 what to look for when checking an injury?
7 how fractures can be caused?
Questions 8-14
Answer each of the questions, 8-14, with a word or short phrase from one of the texts. Each answer may
include words, numbers or both. You should not write full sentences.
8 What should be used to elevate a patient’s fractured leg?
9 What is the maximum dose of morphine per kilo of a patient’s weight that can be given using
the intra-muscular (IM) route?
10 Which parts of a limb may need extra padding?
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11 What should be used to treat a patient who suffers respiratory depression?
12 What should be used to cover a freshly applied plaster backslab?
13 What analgesic should be given to a patient who is allergic to morphine?
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14 What condition might a patient have if severe pain persists after splinting, elevation and
repeated analgesia?
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Questions 15-20
A
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15 Falling on an outstretched hand is a typical cause of a of
the elbow.
16 Upper limb fractures should be elevated by means of a .
17 Make sure the patient isn’t wearing any on the part of the
body where the plaster backslab is going to be placed.
18 Check to see whether swollen limbs are or increasing

in size.
19 In a plaster backslab, there is a layer of closest to the skin.
20 Patients aged and over shouldn’t be given the higher

dosages of pain relief.
END OF PART A
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Sample Test 2

CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
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VENUE:
TEST DATE:
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TIME: 45 MINUTES

B
C
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Part B
B
1. The manual informs us that the Blood Pressure Monitor
A is likely to interfere with the operation of other medical equipment.
E
B may not work correctly in close proximity to some other devices.
C should be considered safe to use in all hospital environments.
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Instruction Manual: Digital Automatic Blood Pressure Monitor
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Electromagnetic Compatibility (EMC)
With the increased use of portable electronic devices, medical equipment may be susceptible to
A
electromagnetic interference. This may result in incorrect operation of the medical device and create a
potentially unsafe situation. In order to regulate the requirements for EMC, with the aim of preventing
S
unsafe product situations, the EN60601-1-2 standard defines the levels of immunity to electromagnetic
interferences as well as maximum levels of electromagnetic emissions for medical devices. This medical
device conforms to EN60601-1-2:2001 for both immunity and emissions. Nevertheless, care should be
taken to avoid the use of the monitor within 7 metres of cellphones or other devices generating strong
electrical or electromagnetic fields.
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2. The notice is giving information about
A ways of checking that an NG tube has been placed correctly.
B how the use of NG feeding tubes is authorised.
C which staff should perform NG tube placement.
NG feeding tubes
L E
P
Displacement of nasogastric (NG) feeding tubes can have serious implications if undetected. Incorrectly
positioned tubes leave patients vulnerable to the risks of regurgitation and respiratory aspiration. It is crucial
to differentiate between gastric and respiratory placement on initial insertion to prevent potentially fatal
M
pulmonary complications. Insertion and care of an NG tube should therefore only be carried out by a registered
doctor or nurse who has undergone theoretical and practical training and is deemed competent or is supervised
A
by someone competent. Assistant practitioners and other unregistered staff must never insert NG tubes or be
involved in the initial confirmation of safe NG tube position.
SAMPLE

3. What must all staff involved in the transfusion process do?
A check that their existing training is still valid
B attend a course to learn about new procedures
C read a document that explains changes in policy
E
'Right Patient, Right Blood' Assessments
The administration of blood can have significant morbidity and mortality. Following the introduction of the
L
'Right Patient, Right Blood' safety policy, all staff involved in the transfusion process must be competency
assessed. To ensure the safe administration of blood components to the intended patient, all staff must be
P
aware of their responsibilities in line with professional standards.
Staff must ensure that if they take any part in the transfusion process, their competency assessment is
M
updated every three years. All staff are responsible for ensuring that they attend the mandatory training
identified for their roles. Relevant training courses are clearly identified in Appendix 1 of the Mandatory
A
Training Matrix.
SAMPLE

4. The guidelines establish that the healthcare professional should
A aim to make patients fully aware of their right to a chaperone.
B evaluate the need for a chaperone on a case-by-case basis.
C respect the wishes of the patient above all else.
E
Extract from ‘Chaperones: Guidelines for Good Practice’
A patient may specifically request a chaperone or in certain circumstances may nominate one, but it will
L
not always be the case that a chaperone is required. It is often a question of using professional judgement
to assess an individual situation. If a chaperone is offered and declined, this must be clearly documented
P
in the patient’s record, along with any relevant discussion. The chaperone should only be present for the
physical examination and should be in a position to see what the healthcare professional undertaking
M
the examination/investigation is doing. The healthcare professional should wait until the chaperone has
left the room/cubicle before discussion takes place on any aspect of the patient’s care, unless the patient
A
specifically requests the chaperone to remain.
SAMPLE

5. The guidelines require those undertaking a clinical medication review to
A involve the patient in their decisions.
B consider the cost of any change in treatments.
C recommend other services as an alternative to medication.
E
Annual medication review
L
To give all patients an annual medication review is an ideal to strive for. In the meantime there is an
argument for targeting all clinical medication reviews to those patients likely to benefit most.
P
Our guidelines state that ‘at least a level 2 medication review will occur’, i.e. the minimum standard is a
treatment review of medicines with the full notes but not necessarily with the patient present. However, the
guidelines go on to say that ‘all patients should have the chance to raise questions and highlight problems
M
about their medicines’ and that ‘any changes resulting from the review are agreed with the patient’.
A
It also states that GP practices are expected to
• minimise waste in prescribing and avoid ineffective treatments.
S
• engage effectively in the prevention of ill health.
• avoid the need for costly treatments by proactively managing patients to recovery through
the whole care pathway.
SAMPLE

6. The purpose of this email is to
A report on a rise in post-surgical complications.
B explain the background to a change in patient care.
C remind staff about procedures for administrating drugs.
E
To: All Staff
L
Subject: Advisory Email: Safe use of opioids
P
In August, an alert was issued on the safe use of opioids in hospitals. This reported the
incidence of respiratory depression among post-surgical patients to an average 0.5%
M
– thus for every 5,000 surgical patients, 25 will experience respiratory depression.
A
Failure to recognise respiratory depression and institute timely intervention can lead to
cardiopulmonary arrest, resulting in brain injury or death. A retrospective multi-centre
S
study of 14,720 cardiopulmonary arrest cases showed that 44% were respiratory related
and more than 35% occurred on the general care floor. It is therefore recommended that
post-operative patients now have continuous monitoring, instead of spot checks, of both
oxygenation and ventilation.
SAMPLE

Part C
A
answer (A, B, C or D) which you think fits best according to the text. B
C
Text 1: Sleep deprivation
Millions of people who suffer sleep problems also suffer myriad health burdens. In addition to emotional distress
and cognitive impairments, these can include high blood pressure, obesity, and metabolic syndrome. ‘In the studies
E
we’ve done, almost every variable we measured was affected. There’s not a system in the body that’s not affected
by sleep,’ says University of Chicago sleep researcher Eve Van Cauter. ‘Every time we sleep-deprive ourselves,
L
things go wrong.’
P
A common refrain among sleep scientists about two decades ago was that sleep was performed by the brain in the
interest of the brain. That wasn’t a fully elaborated theory, but it wasn’t wrong. Numerous recent studies have hinted
at the purpose of sleep by confirming that neurological function and cognition are messed up during sleep loss, with
M
the patient’s reaction time, mood, and judgement all suffering if they are kept awake too long.
A
In 1997, Bob McCarley and colleagues at Harvard Medical School found that when they kept cats awake by playing
with them, a compound known as adenosine increased in the basal forebrain as the sleepy felines stayed up
S
longer, and slowly returned to normal levels when they were later allowed to sleep. McCarley’s team also found
that administering adenosine to the basal forebrain acted as a sedative, putting animals to sleep. It should come as
no surprise then that caffeine, which blocks adenosine’s receptor, keeps us awake. Teaming up with Basheer and
others, McCarley later discovered that, as adenosine levels rise during sleep deprivation, so do concentrations of
adenosine receptors, magnifying the molecule’s sleep-inducing effect. ‘The brain has cleverly designed a two-stage
defence against the consequences of sleep loss,’ McCarley says. Adenosine may underlie some of the cognitive
deficits that result from sleep loss. McCarley and colleagues found that infusing adenosine into rats’ basal forebrain
impaired their performance on an attention test, similar to that seen in sleep-deprived humans. But adenosine
levels are by no means the be-all and end-all of sleep deprivation’s effects on the brain or the body.
Over a century of sleep research has revealed numerous undesirable outcomes from staying awake too long. In
1999, Van Cauter and colleagues had eleven men sleep in the university lab. For three nights, they spent eight
hours in bed, then for six nights they were allowed only four hours (accruing what Van Cauter calls a sleep debt),
and then for six nights they could sleep for up to twelve hours (sleep recovery). During sleep debt and recovery,
researchers gave the participants a glucose tolerance test and found striking differences. While sleep deprived, the
men’s glucose metabolism resembled a pre-diabetic state. ‘We knew it would be affected,’ says Van Cauter. ‘The
big surprise was the effect being much greater than we thought.’
SAMPLE

Subsequent studies also found insulin resistance increased during bouts of sleep restriction, and in 2012, Van
Cauter’s team observed impairments in insulin signalling in subjects’ fat cells. Another recent study showed
that sleep-restricted people will add 300 calories to their daily diet. Echoing Van Cauter’s results, Basheer has
found evidence that enforced lack of sleep sends the brain into a catabolic, or energy-consuming, state. This is
because it degrades the energy molecule adenosine triphosphate (ATP) to produce adenosine monophosphate
and this results in the activation of AMP kinase, an enzyme that boosts fatty acid synthesis and glucose utilization.
‘The system sends a message that there’s a need for more energy,’ Basheer says. Whether this is indeed the
mechanism underlying late-night binge-eating is still speculative.
E
Within the brain, scientists have glimpsed signs of physical damage from sleep loss, and the time-line for recovery,
L
if any occurs, is unknown. Chiara Cirelli’s team at the Madison School of Medicine in the USA found structural
changes in the cortical neurons of mice when the animals are kept awake for long periods. Specifically, Cirelli and
P
colleagues saw signs of mitochondrial activation – which makes sense, as ‘neurons need more energy to stay
awake,’ she says – as well as unexpected changes, such as undigested cellular debris, signs of cellular aging that
are unusual in the neurons of young, healthy mice. ‘The number [of debris granules] was small, but it’s worrisome
M
because it’s only four to five days’ of sleep deprivation,’ says Cirelli. After thirty-six hours of sleep recovery, a period
during which she expected normalcy to resume, those changes remained.
A
Further insights could be drawn from the study of shift workers and insomniacs, who serve as natural experiments
S
on how the human body reacts to losing out on such a basic life need for chronic periods. But with so much of
our physiology affected, an effective therapy − other than sleep itself – is hard to imagine. ‘People like to define a
clear pathway of action for health conditions,’ says Van Cauter. ‘With sleep deprivation, everything you measure is
affected and interacts synergistically to produce the effect.’
SAMPLE

7. In the first paragraph, the writer uses Eve Van Cauter’s words to
A explain the main causes of sleep deprivation.
B reinforce a view about the impact of sleep deprivation.
C question some research findings about sleep deprivation.
D describe the challenges involved in sleep deprivation research.
E
8. What do we learn about sleep in the second paragraph?
L
A Scientific opinion about its function has changed in recent years.
P
B There is now more controversy about it than there was in the past.
C Researchers have tended to confirm earlier ideas about its purpose.
M
D Studies undertaken in the past have formed the basis of current research.
A
9. What particularly impressed Bob McCarley of Harvard Medical School?
S
A the effectiveness of adenosine as a sedative
B the influence of caffeine on adenosine receptors
C the simultaneous production of adenosine and adenosine receptors
D the extent to which adenosine levels fall when subjects are allowed to sleep
10. In the third paragraph, what idea is emphasised by the phrase ‘by no means the be-all and end-all’?
A Sleep deprivation has consequences beyond its impact on adenosine levels.
B Adenosine levels are a significant factor in situations other than sleep deprivation.
C The role of adenosine as a response to sleep deprivation is not yet fully understood.
D The importance of the link between sleep deprivation and adenosine should not be underestimated.
SAMPLE

11. What was significant about the findings in Van Cauter’s experiment?
A the rate at which the sleep-deprived men entered a pre-diabetic state
B the fact that sleep deprivation had an influence on the men’s glucose levels
C the differences between individual men with regard to their glucose tolerance
D the extent of the contrast in the men’s metabolic states between sleep debt and recovery
E
12. In the fifth paragraph, what does the word ‘it’ refer to?
L
A an enzyme
P
B new evidence
C a catabolic state
M
D enforced lack of sleep
A
13. What aspect of her findings surprised Chiara Cirelli?
S
A There was no reversal of a certain effect of sleep deprivation.
B The cortical neurons of the mice underwent structural changes.
C There was evidence of an increased need for energy in the brains of the mice.
D The neurological response to sleep deprivation only took a few hours to become apparent.
14. In the final paragraph, the quote from Van Cauter is used to suggest that
A the goals of sleep deprivation research are sometimes unclear.
B it could be difficult to develop any treatment for sleep deprivation.
C opinions about the best way to deal with sleep deprivation are divided.
D there is still a great deal to be learnt about the effects of sleep deprivation.
SAMPLE

Text 2: ADHD
The American Psychiatric Association (APA) recognised Attention Deficit Hyperactivity Disorder (ADHD) as a
childhood disorder in the 1960s, but it wasn’t until 1978 that the condition was formally recognised as afflicting
adults. In recent years, the USA has seen a 40% rise in diagnoses of ADHD in children. It could be that the disorder
is becoming more prevalent, or, as seems more plausible, doctors are making the diagnosis more frequently. The
issue is complicated by the lack of any recognised neurological markers for ADHD. The APA relies instead on a
set of behavioural patterns for diagnosis. It specifies that patients under 17 must display at least six symptoms of
inattention and/or hyperactivity; adults need only display five.
L E
ADHD can be a controversial condition. Dr Russell Barkley, Professor of Psychiatry at the University of
Massachusetts insists; ‘the science is overwhelming: it’s a real disorder, which can be managed, in many cases, by
P
using stimulant medication in combination with other treatments’. Dr Richard Saul, a behavioural neurologist with
five decades of experience, disagrees; ‘Many of us have difficulty with organization or details, a tendency to lose
things, or to be forgetful or distracted. Under such subjective criteria, the entire population could potentially qualify.
M
Although some patients might need stimulants to function well in daily life, the lumping together of many vague and
subjective symptoms could be causing a national phenomenon of misdiagnosis and over-prescription of stimulants.’
A
A recent study found children in foster care three times more likely than others to be diagnosed with ADHD.
S
Researchers also found that children with ADHD in foster care were more likely to have another disorder, such
as depression or anxiety. This finding certainly reveals the need for medical and behavioural services for these
children, but it could also prove the non-specific nature of the symptoms of ADHD: anxiety and depression, or an
altered state, can easily be mistaken for manifestations of ADHD.
ADHD, the thinking goes, begins in childhood. In fact, in order to be diagnosed with it as an adult, a patient must
demonstrate that they had traits of the condition in childhood. However, studies from the UK and Brazil, published
in JAMA Psychiatry, are fuelling questions about the origins and trajectory of ADHD, suggesting not only that it
can begin in adulthood, but that there may be two distinct syndromes: adult-onset ADHD and childhood ADHD.
They echo earlier research from New Zealand. However, an editorial by Dr Stephen Faraone in JAMA Psychiatry
highlights potential flaws in the findings. Among them, underestimating the persistence of ADHD into adulthood
and overestimating the prevalence of adult-onset ADHD. In Dr Faraone’s words, ‘the researchers found a group
of people who had sub-threshold ADHD in their youth. There may have been signs that things weren’t right, but
not enough to go to a doctor. Perhaps these were smart kids with particularly supportive parents or teachers who
helped them cope with attention problems. Such intellectual and social scaffolding would help in early life, but when
the scaffolding is removed, full ADHD could develop’.
SAMPLE

Until this century, adult ADHD was a seldom-diagnosed disorder. Nowadays however, it’s common in mainstream
medicine in the USA, a paradigm shift apparently driven by two factors: reworked – many say less stringent –
diagnostic criteria, introduced by the APA in 2013, and marketing by manufacturers of ADHD medications. Some
have suggested that this new, broader definition of ADHD was fuelled, at least in part, to broaden the market for
medication. In many instances, the evidence proffered to expand the definitions came from studies funded in whole
or part by manufacturers. And as the criteria for the condition loosened, reports emerged about clinicians involved
in diagnosing ADHD receiving money from drug-makers.
This brings us to the issue of the addictive nature of ADHD medication. As Dr Saul asserts, ‘addiction to stimulant
E
medication isn’t rare; it’s common. Just observe the many patients periodically seeking an increased dosage
L
as their powers of concentration diminish. This is because the body stops producing the appropriate levels of
neurotransmitters that ADHD drugs replace − a trademark of addictive substances.’ Much has been written about
P
the staggering increase in opioid overdoses and abuse of prescription painkillers in the USA, but the abuse of
drugs used to treat ADHD is no less a threat. While opioids are more lethal than prescription stimulants, there are
parallels between the opioid epidemic and the increase in problems tied to stimulants. In the former, users switch
M
from prescription narcotics to heroin and illicit fentanyl. With ADHD drugs, patients are switching from legally
prescribed stimulants to illicit ones such as methamphetamine and cocaine. The medication is particularly prone to
A
abuse because people feel it improves their lives. These drugs are antidepressants, aid weight-loss and improve
confidence, and can be abused by students seeking to improve their focus or academic performance. So, more
S
work needs to be done before we can settle the questions surrounding the diagnosis and treatment of ADHD.
SAMPLE

15. In the first paragraph, the writer questions whether
A adult ADHD should have been recognised as a disorder at an earlier date.
B ADHD should be diagnosed in the same way for children and adults.
C ADHD can actually be indicated by neurological markers.
D cases of ADHD have genuinely increased in the USA.
E
16. What does Dr Saul object to?
L
A the suggestion that people need stimulants to cope with everyday life
P
B the implication that everyone has some symptoms of ADHD
C the grouping of imprecise symptoms into a mental disorder
M
D the treatment for ADHD suggested by Dr Barkley
A
17. The writer regards the study of children in foster care as significant because it
S
A highlights the difficulty of distinguishing ADHD from other conditions.
B focuses on children known to have complex mental disorders.
C suggests a link between ADHD and a child’s upbringing.
D draws attention to the poor care given to such children.
18. In the fourth paragraph, the word ‘They’ refers to
A syndromes.
B questions.
C studies.
D origins.
SAMPLE

19. Dr Faraone suggests that the group of patients diagnosed with adult-onset ADHD
A had teachers or parents who recognised the symptoms of ADHD.
B should have consulted a doctor at a younger age.
C had mild undiagnosed ADHD in childhood.
D were specially chosen by the researchers.
E
20. In the fifth paragraph, it is suggested that drug companies have
L
A been overly aggressive in their marketing of ADHD medication.
P
B influenced research that led to the reworking of ADHD diagnostic criteria.
C attempted to change the rules about incentives for doctors who diagnose ADHD.
M
D encouraged the APA to rush through changes to the criteria for diagnosing ADHD.
A
21. In the final paragraph, the word ‘trademark’ refers to
S
A a physiological reaction.
B a substitute medication.
C a need for research.
D a common request.
22. In the final paragraph, what does the writer imply about addiction to ADHD medication?
A It is unlikely to turn into a problem on the scale of that caused by opioid abuse.
B The effects are more marked in certain sectors of the population.
C Insufficient attention seems to have been paid to it.
D The reasons for it are not yet fully understood.
END OF READING TEST

SAMPLE

N K
L A
B
SAMPLE

Sample Test 1
CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
Passport Photo
OTHER NAMES: Your details and photo will be printed here.
E
PROFESSION:
L
VENUE:
TEST DATE:
P
A M
S
SAMPLE

Fractures, dislocations and sprains: Texts
Text A
Fractures (buckle or break in the bone) often occur following direct or indirect injury, e.g. twisting, violence
to bones. Clinically, fractures are either:
• closed, where the skin is intact, or
• compound, where there is a break in the overlying skin
Dislocation is where a bone is completely displaced from the joint. It often results from injuries away from
the affected joint, e.g. elbow dislocation after falling on an outstretched hand.
Sprain is a partial disruption of a ligament or capsule of a joint.
Text B
E
Simple Fracture of Limbs
L
Immediate management:
• Halt any external haemorrhage by pressure bandage or direct pressure
P
• Immobilise the affected area
• Provide pain relief
Clinical assessment:
• Obtain complete patient history, including circumstances and method of injury
M
- medication history – enquire about anticoagulant use, e.g. warfarin
• Perform standard clinical observations. Examine and record:
A
- colour, warmth, movement, and sensation in hands and feet of injured limb(s)
• Perform physical examination
Examine:
S
- all places where it is painful
- any wounds or swelling
- colour of the whole limb (especially paleness or blue colour)
- the skin over the fracture
- range of movement
- joint function above and below the injury site
Check whether:
- the limb is out of shape – compare one side with the other
- the limb is warm
- the limb (if swollen) is throbbing or getting bigger
- peripheral pulses are palpable
Management:
• Splint the site of the fracture/dislocation using a plaster backslab to reduce pain
• Elevate the limb – a sling for arm injuries, a pillow for leg injuries
• If in doubt over an injury, treat as a fracture
• Administer analgesia to patients in severe pain. If not allergic, give morphine (preferable); if allergic
to morphine, use fentanyl
• Consider compartment syndrome where pain is severe and unrelieved by splinting and elevation or
two doses of analgesia
• X-ray if available
SAMPLE

Text C
Drug Therapy Protocol:

Authorised Indigenous Health Worker (IHW) must consult Medical Officer (MO) or Nurse Practitioner (NP).
Scheduled Medicines Rural & Isolated Practice Registered Nurse may proceed.
Drug Form Strength Route of Recommended dosage Duration

administration
Adult only:
IM/SC 0.1-0.2 mg/kg to a max. of
10 mg Stat
E
Further
Morphine Ampoule 10 mg/mL Adult only: doses on
IV Initial dose of 2 mg then MO/NP
L
(IHW may not 0.5-1 mg increments slowly, order
administer IV) repeated every 3-5
P
minutes if required to a
max. of 10 mg
Use the lower end of dose range in patients ≥70 years.
M
Provide Consumer Medicine Information: advise can cause nausea and vomiting, drowsiness.
Respiratory depression is rare – if it should occur, give naloxone.
A
Text D
S
Technique for plaster backslab for arm fractures – use same principle for leg fractures
1. Measure a length of non-compression cotton stockinette from half way up the middle finger to just
below the elbow. Width should be 2–3 cm more than the width of the distal forearm.
2. Wrap cotton padding over top for the full length of the stockinette — 2 layers, 50% overlap.
3. Measure a length of plaster of Paris 1 cm shorter than the padding/stockinette at each end. Fold the
roll in about ten layers to the same length.
4. Immerse the layered plaster in a bowl of room temperature water, holding on to each end. Gently
squeeze out the excess water.
5. Ensure any jewellery is removed from the injured limb.
6. Lightly mould the slab to the contours of the arm and hand in a neutral position.
7. Do not apply pressure over bony prominences. Extra padding can be placed over bony prominences if
applicable.
8. Wrap crepe bandage firmly around plaster backslab.
END OF PART A
SAMPLE

N K
L A
B
SAMPLE

Sample Test 2

CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
E
L
VENUE:
TEST DATE:
P
M
A
TIME: 15 MINUTES
S
SAMPLE

Part A
TIME: 15 minutes
• Write your answers on the spaces provided in this Question Paper.
E
Paracetamol overdose: Questions
L
Questions 1-7
P
For each question, 1-7, decide which text (A, B, C or D) the information comes from. Write the letter
A, B, C or D in the space provided. You may use any letter more than once.
M
1 the various symptoms of patients who have taken too much paracetamol?
A
2 the precise levels of paracetamol in the blood which require urgent intervention?
S
3 the steps to be taken when treating a paracetamol overdose patient?
4 whether paracetamol overdose was intentional?
5 the number of products containing paracetamol?
6 what to do if there are no details available about the time of the overdose?
7 dealing with paracetamol overdose patients who have not received adequate nutrition?
Questions 8-13
Answer each of the questions, 8-13, with a word or short phrase from one of the texts. Each answer
may include words, numbers or both. You should not write full sentences.
8 If paracetamol is used as a long-term painkiller, what symptom may get worse?
9 It may be dangerous to administer paracetamol to a patient with which viral condition?
10 What condition may develop in an overdose patient who presents with jaundice?
SAMPLE

11 What condition may develop on the third day after an overdose?
12 What drug can be administered orally within 10 - 12 hours as an alternative to acetylcysteine?
13 What treatment can be used if a single overdose has occurred less than an hour ago?
E
Questions 14-20
L
P
14 If a patient has taken metoclopramide alongside paracetamol, this may affect the
M
of the paracetamol.
A
15 After 24 hours, an overdose patient may present with pain in the .
S
16 For the first 24 hours after overdosing, patients may only have such symptoms as
17 Acetylcysteine should be administered to patients with a paracetamol level above the high-risk treatment
line who are taking any type of medication.
18 A non-high-risk patient should be treated for paracetamol poisoning if their paracetamol level is above
mg/litre 8 hours after overdosing.
19 A high-risk patient who overdosed hours ago should be given
acetylcysteine if their paracetamol level is 25 mg/litre or higher.
20 If a patient does not require further acetylcysteine, they should be given treatment categorised as
only.
END OF PART A
SAMPLE

N K
L A
B
SAMPLE

Sample Test 2

CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
E
L
VENUE:
TEST DATE:
P
M
A
TIME: 45 MINUTES
S

B
C
SAMPLE
Part B
B
1. This guideline extract says that the nurse in charge
A must supervise the opening of the controlled drug cupboard.
E
B should make sure that all ward cupboard keys are kept together.
C can delegate responsibility for the cupboard keys to another ward.
Medicine Cupboard Keys
P L
The keys for the controlled drug cupboard are the responsibility of the nurse in charge. They may
M
be passed to a registered nurse in order for them to carry out their duties and returned to the nurse
A
in charge. If the keys for the controlled drug cupboard go missing, the locks must be changed and
pharmacy informed and an incident form completed. The controlled drug cupboard keys should be kept
S
separately from the main body of keys. Apart from in exceptional circumstances, the keys should not
leave the ward or department. If necessary, the nurse in charge should arrange for the keys to be held in
a neighbouring ward or department by the nurse in charge there.
SAMPLE

2. When seeking consent for a post-mortem examination, it is necessary to
A give a valid reason for conducting it.
B allow all relatives the opportunity to decline it.
C only raise the subject after death has occurred.
E
Post-Mortem Consent
L
A senior member of the clinical team, preferably the Consultant in charge of the care, should raise the possibility
of a post-mortem examination with the most appropriate person to give consent. The person consenting will need
P
an explanation of the reasons for the post-mortem examination and what it hopes to achieve. The first approach
should be made as soon as it is apparent that a post-mortem examination may be desirable, as there is no need
M
to wait until the patient has died. Many relatives are more prepared for the consenting procedure if they have had
time to think about it beforehand.
S A
SAMPLE

3. The purpose of these notes about an incinerator is to
A help maximise its efficiency.
B give guidance on certain safety procedures.
C recommend a procedure for waste separation.
E
Low-cost incinerator: General operating notes
L
3.2.1 Hospital waste management
Materials with high fuel values such as plastics, paper, card and dry textile will help maintain high
P
incineration temperature. If possible, a good mix of waste materials should be added with each batch. This
can best be achieved by having the various types of waste material loaded into separate bags at source,
i.e. wards and laboratories, and clearly labelled. It is not recommended that the operator sorts and mixes
M
waste prior to incineration as this is potentially hazardous. If possible, some plastic materials should be
added with each batch of waste as this burns at high temperatures. However, care and judgement will be
A
needed, as too much plastic will create dense dark smoke.
SAMPLE

4. What does this manual tell us about spacer devices?
A Patients should try out a number of devices with their inhaler.
B They enable a patient to receive more of the prescribed medicine.
C Children should be given spacers which are smaller than those for adults.
E
Manual extract: Spacer devices for asthma patients
L
Spacer devices remove the need for co-ordination between actuation of a pressurized metered-dose
inhaler and inhalation. In addition, the device allows more time for evaporation of the propellant so that a
P
larger proportion of the particles can be inhaled and deposited in the lungs. Spacer devices are particularly
useful for patients with poor inhalation technique, for children, for patients requiring higher doses, for
nocturnal asthma, and for patients prone to candidiasis with inhaled corticosteroids. The size of the spacer
M
is important, the larger spacers with a one-way valve being most effective. It is important to prescribe a
spacer device that is compatible with the metered-dose inhaler. Spacer devices should not be regarded as
A
interchangeable; patients should be advised not to switch between spacer devices.
SAMPLE

5. The email is reminding staff that the
A benefits to patients of using bedrails can outweigh the dangers.
B number of bedrail-related accidents has reached unacceptable levels.
C patient’s condition should be central to any decision about the use of bedrails.
To:
Subject:
All Staff
Use of bed rails
L E
Please note the following.
M P
Patients in hospital may be at risk of falling from bed for many reasons including
A
poor mobility, dementia or delirium, visual impairment, and the effects of
treatment or medication. Bedrails can be used as safety devices intended to
S
reduce risk.
However, bedrails aren’t appropriate for all patients, and their use involves risks.
National data suggests around 1,250 patients injure themselves on bedrails
annually, usually scrapes and bruises to their lower legs. Statistics show 44,000
reports of patient falls from bed annually resulting in 11 de

deaths, while deaths due
to bedrail entrapment occur less than one every two years, and are avoidable if
the relevant advice is followed. Staff should continue to take great care to avoid
bedrail entrapment, but be aware that in hospital settings there may be a greater
risk of harm to patients who fall out of bed.
SAMPLE

6. What does this extract from a handbook tell us about analeptic drugs?
A They may be useful for patients who are not fully responsive.
B Injections of these drugs will limit the need for physiotherapy.
C Care should be taken if they are used over an extended period.
E
Analeptic drugs
L
Respiratory stimulants (analeptic drugs) have a limited place in the treatment of ventilatory failure in
patients with chronic obstructive pulmonary disease. They are effective only when given by intravenous
injection or infusion and have a short duration of action. Their use has largely been replaced by ventilatory
P
support. However, occasionally when ventilatory support is contra-indicated and in patients with
hypercapnic respiratory failure who are becoming drowsy or comatose, respiratory stimulants in the short
term may arouse patients sufficiently to co-operate and clear their secretions.
M
Respiratory stimulants can also be harmful in respiratory failure since they stimulate non-respiratory as
A
well as respiratory muscles. They should only be given under expert supervision in hospital and must be
combined with active physiotherapy. At present, there is no oral respiratory stimulant available for long-
S
term use in chronic respiratory failure.
SAMPLE

Part C
In this part of the test, there are two texts about different aspects of healthcare. For questions 7-22, choose
A
the answer (A, B, C or D) which you think fits best according to the text. B
C
Text 1: Patient Safety
Highlighting a collaborative initiative to improve patient safety
In a well-documented case in November 2004, a female patient called Mary was admitted to a hospital in Seattle,
E
USA, to receive treatment for a brain aneurysm. What followed was a tragedy, made worse by the fact that it
needn’t have occurred at all. The patient was mistakenly injected with the antiseptic chlorhexidine. It happened, the
L
hospital says, because of ‘confusion over the three identical stainless steel bowls in the procedure room containing
clear liquids — chlorhexidine, contrast dye and saline solution’. Doctors tried amputating one of Mary’s legs to save
P
her life, but the damage to her organs was too great: she died 19 days later.
M
This and similar incidents are what inspired Professor Dixon-Woods of the University of Cambridge, UK, to set
out on a mission: to improve patient safety. It is, she admits, going to be a challenge. Many different policies and
A
approaches have been tried to date, but few with widespread success, and often with unintended consequences.
Financial incentives are widely used, but recent evidence suggests that they have little effect. ‘There’s a danger
S
that they tend to encourage effort substitution,’ explains Dixon-Woods. In other words, people concentrate on the
areas that are being incentivised, but neglect other areas. ‘It’s not even necessarily conscious neglect. People have
only a limited amount of time, so it’s inevitable they focus on areas that are measured and rewarded.’
In 2013, Dixon-Woods and colleagues published a study evaluating the use of surgical checklists introduced in
hospitals to reduce complications and deaths during surgery. Her research found that that checklists may have
little impact, and in some situations might even make things worse. ‘The checklists sometimes introduced new
risks. Nurses would use the lists as box-ticking exercises – they would tick the box to say the patient had had
their antibiotics when there were no antibiotics in the hospital, for example.’ They also reinforced the hierarchies
– nurses had to try to get surgeons to do certain tasks, but the surgeons used the situation as an opportunity to
display their power and refuse.
Dixon-Woods and her team spend time in hospitals to try to understand which systems are in place and how they
are used. Not only does she find differences in approaches between hospitals, but also between units and even
between shifts. ‘Standardisation and harmonisation are two of the most urgent issues we have to tackle. Imagine
if you have to learn each new system wherever you go or even whenever a new senior doctor is on the ward. This
introduces massive risk.’
SAMPLE

Dixon-Woods compares the issue of patient safety to that of climate change, in the sense that it is a ‘problem
of many hands’, with many actors, each making a contribution towards the outcome, and there is difficulty in
identifying where the responsibility for solving the problem lies. ‘Many patient safety issues arise at the level of the
system as a whole, but policies treat patient safety as an issue for each individual organisation.’
Nowhere is this more apparent than the issue of ‘alarm fatigue’, according to Dixon-Woods. Each bed in an
intensive care unit typically generates 160 alarms per day, caused by machinery that is not integrated. ‘You have
to assemble all the kit around an intensive care bed manually,’ she explains. ‘It doesn’t come built as one like an
aircraft cockpit. This is not something a hospital can solve alone. It needs to be solved at the sector level.’
L E
Dixon-Woods has turned to Professor Clarkson in Cambridge’s Engineering Design Centre to help. ‘Fundamentally,
my work is about asking how we can make it better and what could possibly go wrong,’ explains Clarkson. ‘We
P
need to look through the eyes of the healthcare providers to see the challenges and to understand where tools and
techniques we use in engineering may be of value.’ There is a difficulty, he concedes: ‘There’s no formal language
of design in healthcare. Do we understand what the need is? Do we understand what the requirements are? Can
M
we think of a range of concepts we might use and then design a solution and test it before we put it in place? We
seldom see this in healthcare, and that’s partly driven by culture and lack of training, but partly by lack of time.’
A
Dixon-Woods agrees that healthcare can learn much from engineers. ‘There has to be a way of getting our two
sides talking,’ she says. ‘Only then will we be able to prevent tragedies like the death of Mary.’
SAMPLE

7. What point is made about the death of a female patient called Mary?
A It was entirely preventable.
B Nobody was willing to accept the blame.
C Surgeons should have tried harder to save her life.
D It is the type of incident which is becoming increasingly common.
E
8. What is meant by the phrase ‘effort substitution’ in the second paragraph?
L
A Monetary resources are diverted unnecessarily.
P
B Time and energy is wasted on irrelevant matters.
C Staff focus their attention on a limited number of issues.
M
D People have to take on tasks which they are unfamiliar with.
A
9. By quoting Dixon-Woods in the second paragraph, the writer shows that the professor
S
A understands why healthcare employees have to make certain choices.
B doubts whether reward schemes are likely to put patients at risk.
C believes staff should be paid a bonus for achieving goals.
D feels the people in question have made poor choices.
10. What point is made about checklists in the third paragraph?
A Hospital staff sometimes forget to complete them.
B Nurses and surgeons are both reluctant to deal with them.
C They are an additional burden for over-worked nursing staff.
D The information recorded on them does not always reflect reality.
SAMPLE

11. What problem is mentioned in the fourth paragraph?
A failure to act promptly
B outdated procedures
C poor communication
D lack of consistency
E
12. What point about patient safety is the writer making by quoting Dixon-Woods’ comparison with
L
climate change?
A The problem will worsen if it isn’t dealt with soon.
P
B It isn’t clear who ought to be tackling the situation.
C It is hard to know what the best course of action is.
M
D Many people refuse to acknowledge there is a problem.
A
13. The writer quotes Dixon-Woods’ reference to intensive care beds in order to
S
A present an alternative viewpoint.
B illustrate a fundamental obstacle.
C show the drawbacks of seemingly simple solutions.
D give a detailed example of how to deal with an issue.
14. What difference between healthcare and engineering is mentioned in the final paragraph?
A the types of systems they use
B the way they exploit technology
C the nature of the difficulties they face
D the approach they take to deal with challenges
SAMPLE

Text 2: Migraine – more than just a headache
When a news reporter in the US gave an unintelligible live TV commentary of an awards ceremony, she became
an overnight internet sensation. As the paramedics attended, the worry was that she’d suffered a stroke live on
air. Others wondered if she was drunk or on drugs. However, in interviews shortly after, she revealed, to general
astonishment, that she’d simply been starting a migraine. The bizarre speech difficulties she experienced are
an uncommon symptom of aura, the collective name for a range of neurological symptoms that may occur just
before a migraine headache. Generally aura are visual – for example blind spots which increase in size, or have a
flashing, zig-zagging or sparkling margin, but they can include other odd disturbances such as pins and needles,
E
memory changes and even partial paralysis.
L
Migraine is often thought of as an occasional severe headache, but surely symptoms such as these should tell
P
us there’s more to it than meets the eye. In fact many scientists now consider it a serious neurological disorder.
One area of research into migraine aura has looked at the phenomenon known as Cortical Spreading Depression
(CSD) – a storm of neural activity that passes in a wave across the brain’s surface. First seen in 1944 in the brain
M
of a rabbit, it’s now known that CSD can be triggered when the normal flow of electric currents within and around
brain cells is somehow reversed. Nouchine Hadjikhani and her team at Harvard Medical School managed to record
A
an episode of CSD in a brain scanner during migraine aura (in a visual region that responds to flickering motion),
having found a patient who had the rare ability to be able to predict when an aura would occur. This confirmed a
S
long-suspected link between CSD and the aura that often precedes migraine pain. Hadjikhani admits, however, that
other work she has done suggests that CSD may occur all over the brain, often unnoticed, and may even happen in
healthy brains. If so, aura may be the result of a person’s brain being more sensitive to CSD than it should be.
Hadjikhani has also been looking at the structural and functional differences in the brains of migraine sufferers. She
and her team found thickening of a region known as the somatosensory cortex, which maps our sense of touch
in different parts of the body. They found the most significant changes in the region that relates to the head and
face. ‘Because sufferers return to normal following an attack, migraine has always been considered an episodic
problem,’ says Hadjikhani. ‘But we found that if you have successive strikes of pain in the face area, it actually
increases cortical thickness.’
Work with children is also providing some startling insights. A study by migraine expert Peter Goadsby, who splits
his time between King’s College London and the University of California, San Francisco, looked at the prevalence
of migraine in mothers of babies with colic - the uncontrolled crying and fussiness often blamed on sensitive
stomachs or reflux. He found that of 154 mothers whose babies were having a routine two-month check-up, the
migraine sufferers were 2.6 times as likely to have a baby with colic. Goadsby believes it is possible that a baby
with a tendency to migraine may not cope well with the barrage of sensory information they experience as their
nervous system starts to mature, and the distress response could be what we call colic.
SAMPLE

Linked to this idea, researchers are finding differences in the brain function of migraine sufferers, even between
attacks. Marla Mickleborough, a vision specialist at the University of Saskatchewan in Saskatoon, Canada, found
heightened sensitivity to visual stimuli in the supposedly ‘normal’ period between attacks. Usually the brain comes
to recognise something repeating over and over again as unimportant and stops noticing it, but in people with
migraine, the response doesn’t diminish over time. ‘They seem to be attending to things they should be ignoring,’
she says.
Taken together this research is worrying and suggests that it’s time for doctors to treat the condition more
aggressively, and to find out more about each individual’s triggers so as to stop attacks from happening. But
E
there is a silver lining. The structural changes should not be likened to dementia, Alzheimer’s disease or ageing,
L
where brain tissue is lost or damaged irreparably. In migraine, the brain is compensating. Even if there’s a genetic
predisposition, research suggests it is the disease itself that is driving networks to an altered state. That would
P
suggest that treatments that reduce the frequency or severity of migraine will probably be able to reverse some of
the structural changes too. Treatments used to be all about reducing the immediate pain, but now it seems they
might be able to achieve a great deal more.
A M
S
SAMPLE

15. Why does the writer tell the story of the news reporter?
A to explain the causes of migraine aura
B to address the fear surrounding migraine aura
C to illustrate the strange nature of migraine aura
D to clarify a misunderstanding about migraine aura
E
16. The research by Nouchine Hadjikhani into CSD
L
A has less relevance than many believe.
P
B did not result in a definitive conclusion.
C was complicated by technical difficulties.
M
D overturned years of accepted knowledge.
A
17. What does the word ‘This’ in the second paragraph refer to?
S
A the theory that connects CSD and aura
B the part of the brain where auras take place
C the simultaneous occurrence of CSD and aura
D the ability to predict when an aura would happen
18. The implication of Hadjikhani’s research into the somatosensory cortex is that
A migraine could cause a structural change.
B a lasting treatment for migraine is possible.
C some diagnoses of migraine may be wrong.
D having one migraine is likely to lead to more.
SAMPLE

19. What does the writer find surprising about Goadsby’s research?
A the idea that migraine may not run in families
B the fact that migraine is evident in infanthood
C the link between childbirth and onset of migraine
D the suggestion that infant colic may be linked to migraine
E
20. According to Marla Mickleborough, what is unusual about the brain of migraine sufferers?
L
A It fails to filter out irrelevant details.
P
B It struggles to interpret visual input.
C It is slow to respond to sudden changes.
M
D It does not pick up on important information.
A
21. The writer uses the phrase ‘a silver lining’ in the final paragraph to emphasise
S
A the privileged position of some sufferers.
B a more positive aspect of the research.
C the way migraine affects older people.
D the value of publicising the research.
22. What does the writer suggest about the brain changes seen in migraine sufferers?
A Some of them may be beneficial.
B They are unlikely to be permanent.
C Some of them make treatment unnecessary.
D They should still be seen as a cause for concern.
END OF READING TEST

SAMPLE

N K
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B
SAMPLE

Sample Test 2
CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
Passport Photo
E
PROFESSION:
L
VENUE:
TEST DATE:
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A M
S
SAMPLE

Paracetamol overdose: Texts
Text A
Paracetamol: contraindications and interactions

4.4 Special warnings and precautions for use
Where analgesics are used long-term (>3 months) with administration every two days or more frequently, headache may
develop or increase. Headache induced by overuse of analgesics (MOH medication-overuse headache) should not be
treated by dose increase. In such cases, the use of analgesics should be discontinued in consultation with the doctor.
Care is advised in the administration of paracetamol to patients with alcohol dependency, severe renal or severe hepatic
impairment. Other contraindications are: shock and acute inflammation of liver due to hepatitis C virus. The hazards of
overdose are greater in those with non-cirrhotic alcoholic liver disease.
4.5 Interaction with other medicinal products and other forms of interaction
• Anticoagulants – the effect of warfarin and other coumarins may be enhanced by prolonged regular use of paracetamol
with increased risk of bleeding. Occasional doses have no significant effect.
• Metoclopramide – may increase speed of absorption of paracetamol.
• Domperidone – may increase speed of absorption of paracetamol.
• Colestyramine – may reduce absorption if given within one hour of paracetamol.
• Imatinib – restriction or avoidance of concomitant regular paracetamol use should be taken with imatinib.
A total of 169 drugs (1042 brand and generic names) are known to interact with paracetamol.
14 major drug interactions (e.g. amyl nitrite)
62 moderate drug interactions
93 minor drug interactions
A total of 118 brand names are known to have paracetamol in their formulation, e.g. Lemsip.
Text B
Procedure for acute single overdose

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

No Yes
Supportive treatment only Check AST/ALT, INR/PT, serum electrolytes, urea, creatinine, lactate, and
arterial pH and repeat every 24 hours
SAMPLE

Text C
Paracetamol poisoning – Emergency treatment of poisoning
Patients whose plasma-paracetamol
200
200 concentrations are above the normal
1.3
190 1.3 treatment line should be treated with
190
180
1.2
1.2 acetylcysteine by intravenous infusion
180
170 (or, if acetylcysteine cannot be used,
170 1.1
160 1.1 with methionine by mouth, provided the
Plasma-paracetamol concentration (mmol/litre)

160
Plasma-paracetamol concentration (mg/litre)
Plasma-paracetamol concentration (mmol/litre)

overdose has been taken within 10-12
Plasma-paracetamol concentration (mg/litre)
150 1
150 Normal treatment line 1
140 Normal treatment line hours and the patient is not vomiting).
140 0.9
130 0.9
130
120 0.8 Patients on enzyme-inducing drugs
120 0.8
110 (e.g. carbamazepine, phenobarbital,
110 0.7
100 0.7 phenytoin, primidone, rifampicin and St
100
90 0.6 John’s wort) or who are malnourished
90 0.6
80
(e.g. in anorexia, in alcoholism, or those
80
70 0.5
0.5 who are HIV positive) should be treated
70
with acetylcysteine if their plasma-
60 0.4
60 0.4 paracetamol concentration is above the
50
50
0.3
0.3 high-risk treatment line.
40
40
30 0.2
30 0.2
20
20 High-risk treatment line 0.1
10 High-risk treatment line 0.1
10
0 0
0 0
0 2 4 6 8 10 12 14 16 18 20 22 24
0 2 4 6 8 10 Time
12 14(hours)
16 18 20 22 24
Text D
Clinical Assessment
• Commonly, patients who have taken a paracetamol overdose are asymptomatic for the first 24 hours or just have
nausea and vomiting
• Hepatic necrosis (elevated transaminases, right upper quadrant pain and jaundice) begins to develop after 24
hours and can progress to acute liver failure (ALF)
• Patients may also develop:
• Encephalopathy • Renal failure – usually occurs around day three
• Oliguria • Lactic acidosis
• Hypoglycaemia
History
• Number of tablets, formulation, any concomitant tablets
• Time of overdose
• Suicide risk – was a note left?
• Any alcohol taken (acute alcohol ingestion will inhibit liver enzymes and may reduce the production of the toxin
NAPQI, whereas chronic alcoholism may increase it)
END OF PART A
SAMPLE

N K
L A
B
SAMPLE

Sample Test 3

CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
E
L
VENUE:
TEST DATE:
P
M
A
TIME: 15 MINUTES
S
SAMPLE
©C
Cambridge Boxhill Language Assessment – ABN 51 988 559 414

Part A
TIME: 15 minutes
• Look at the four texts A-D, in the separate Text Booklet.
• For each question 1-20, look through the texts, A-D, to find the relevant information.
Management of burns: Questions
E
Questions 1-5
L
For each question, 1-5, decide which text (A,, B,, C or D)) the information comes from. Write the letter
A, B, C or D in the space provided. You may use any letter more than once.
P
In which text can you find information about
1 age-related considerations for initial treatment of burns injuries?
M
2 the risks involved in certain treatments?
3 when to start thinking about specialist treatment options?
A
4 treatment informed by patient self-assessment?
S
5 how to categorise the severity of a burn?
Questions 6-13
Complete each of the sentences, 6-13, with a word or short phrase from one of the texts. Each answer may include
words, numbers or both.
6 Classification of burn injuries depends on the amount of
caused.
7 Patients recovering from third degree burns are likely to experience a great deal of shrinkage and
of their skin.
8 When evaluating mixed depth burns, you should take into account how the burn looks and whether
there is in the affected area.
9 You should cool burn injuries by taking off any or jewellery that
the patient is wearing.
SAMPLE

10 When cooling the wound, make sure that you don’t put the patient at risk
of .
11 The patient may require a booster, depending on when they
were last immunised.
12 You should consider leaving undisturbed, as these may help
prevent infection.
E
13 You should apply ointments containing to all deeper burns.
L
Questions 14-20
P
Answer each of the questions, 14-20, with a word or short phrase from one of the texts. Each answer may
M
14 In the case of mixed depth burns, what factor determines the local treatment to give?
A
15 What is the maximum number of tries recommended for attaching a drip at the scene of a burns
S
incident?
16 How much resuscitation fluid should a child receive per kilo over 20kg?
17 Before attaching a fluid resuscitation drip to a 9-year-old burns patient, what percentage of the body
needs to be affected?
18 What additional analgesic is recommended in the first instance for a patient with a moderate level of
pain?
19 What route should be used to administer ibuprofen to children?
20 After how long should a patient’s pain relief regime be re-evaluated?
END OF PART A
SAMPLE

N K
L A
B
SAMPLE

Sample Test 3

CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
E
L
VENUE:
TEST DATE:
P
M
A
TIME: 45 MINUTES

B
C
SAMPLE
Part B
choose the answer (A, B or C) which you think fits best according to the text. A
B
1. Doctors are advised to break patient confidentiality if
A failure to do so would put other people in danger.
E
B they inform the patient of their intention in advance.
C a patient refuses to disclose information relevant to their care.
Patient Confidentiality
P L
M
Confidentiality is central to trust between doctors and patients. Without assurances about confidentiality,
patients may be reluctant to seek medical attention or to give doctors the information they need in order
A
to provide good care.
However, faced with a situation in which a patient’s refusal to consent to disclosure leaves others
S
exposed to a risk so serious that it outweighs the patient’s and the public interest in maintaining
confidentiality, or if it is not practical or safe to seek the patient’s consent, information should be
disclosed promptly to an appropriate person or authority. The patient should be informed in advance that
the doctor will be disclosing the information, provided this is practical and safe, even if the doctor intends
to disclose without the patient’s consent.
SAMPLE

2. According to the guidance notes, all staff involved in transferring patients from critical to general care must
A obtain all necessary consent from any interested parties.
B ensure that the patient’s personal care plan is also transferred.
C make arrangements for ongoing co-operation once the transfer is complete.
E
Transfer of patients
1.15
L
The critical care area transferring team and the receiving ward team should take shared responsibility for
the care of the patient being transferred. They should jointly ensure that:
P
• there is continuity of care through a formal structured handover from critical care area staff to ward
. staff (including both medical and nursing staff), supported by a written plan;
M
• the receiving ward, with support from critical care if required, can deliver the agreed plan.
1.16
A
When patients are transferred to the general ward from a critical care area, they should be offered
information about their condition and encouraged to actively participate in decisions that relate to their
S
recovery. The information should be tailored to individual circumstances. If they agree, their family and
carers should be involved.
SAMPLE

3. The memo says failure to screen a patient for malnutrition may result in
A a change in overall health.
B a prolonged stay at the care facility.
C care providers being unaware of an issue.
E
Memo
To: Hospital staff
L
Re: Nutrition screening
P
This is to remind staff of the importance of nutrition screening to identify problems which may go unrecognised
and, therefore, remain untreated during the patient’s hospital stay. Nutrition screening should occur on
M
admission and then weekly during the patient’s episode of care; at least monthly in slower stream facilities; or if
the patient’s clinical condition changes.
A
All patients should have their weight and height documented on admission, and weight should continue to
be recorded at least weekly. Patients whose score is ‘at risk’ on a validated screening tool or whose clinical
S
condition is such that their treating team identifies them as at risk of malnutrition should be referred to a
dietitian for a full nutrition assessment and nutrition support as appropriate.
SAMPLE

4. This policy document states that nurses
A must sign a paper form if they want any new stock.
B can order medicines from the pharmacy in some cases.
C should speak to the pharmacist if a drug is needed urgently.
E
Stock requisitioning
If stock levels of a medicine are low, the nurse should firstly liaise directly with their ward-based team to
L
arrange urgent stock replenishment. If the ward-based team is unavailable, the nurse should complete
a request form online and email it to the pharmacy stores. Paper-based ordering systems are available
P
(e.g. the ward medicines requisition book); however these should not be relied on if ward stock is urgently
needed.
M
“At risk medicines” – Diazepam/Codeine Phosphate/Co-codamol – may only be ordered for stock when
a paper requisition is written. Paper-based requisitions should be complete, legible and signed, and then
A
sent to the pharmacy department.
Wards/clinical areas using Mediwell 365 cabinets will have orders transmitted automatically to Pharmacy
S
on a daily basis, as stock is used.
SAMPLE

5. The extract from the guidelines states that
A ICU staff can be seconded to other wards.
B only a consultant can refer a patient to the ICU.
C the ICU is fully responsible for a patient in their care.
E
6.2 Intensive Care Unit (ICU)
L
6.2.1 Unplanned admissions to the ICU need a referral at consultant level. In exceptional circumstances,
referrals will be discussed with the Ward Registrar looking after the patient if a delay in referral to ICU
P
would lead to the rapid deterioration of a patient.
6.2.2 All patients discussed with the ICU staff but not admitted remain under the care of the primary team
and as such they remain responsible for reviewing and escalating care should deterioration occur.
M
6.2.3 We encourage collaborative patient-centred care. However the ICU is defined as a closed unit.
A
This means that when patients are admitted into the ICU, they are under the care of the ICU team. It is
expected that members of the primary referring team will liaise daily with the ICU team to discuss the
patient’s management. However, it is up to the ICU team to make final decisions.
SAMPLE

6. When dealing with patients following a safety incident, staff must avoid
A saying anything until the facts have been established.
B speculating on the possible causes of the incident.
C contradicting what has been said by other staff.
Patient Safety Incidents
E
Information about a patient safety incident must be given to patients and/or their carers in a truthful
L
and open manner by an appropriately nominated person. Patients want a step-by-step explanation of
what happened that considers their individual needs and is delivered openly. Communication must also
P
be timely – patients and/or carers should be provided with information about what happened as soon
as practicable. It is also essential that any information given is based solely on the facts known at the
M
time. Healthcare staff should explain that new information may emerge as an incident investigation is
undertaken, and patients and/or their carers will be kept up-to-date with the progress of an investigation.
A
The Duty of Candour Regulations require that information be given as soon as is reasonably practicable
and be given in writing no later than 10 days after the incident was reported through the local systems.
SAMPLE

Part C
A
answer (A, B, C or D) which you think fits best according to the text. B
C
Text 1: Allergic to eating
Lucy Smith was strolling through Canberra last July. Within moments she couldn't stand, gripped by pain so severe
she feared she would pass out – the first sign of paralysing diarrhoea. This dramatic episode turned out to be
E
caused by a newly-acquired food allergy – to red meat. Food allergies affect one per cent of the adult population of
Australia. Most don’t hit with the same force as Lucy's, but the physical and mental impact can nonetheless turn a
L
person's life upside down, and may even be life-threatening. Lucy deduced that she was allergic to red meat, one
of the less common allergenic foodstuffs. Only after several further attacks of varying severity, was her suspicion
P
eventually confirmed by a specialist.
An allergy, according to immunologists, is the immune system over-reacting to a substance that would ordinarily
M
be considered benign. However the term 'allergy' is used more loosely by the general public. People say they
are allergic to a substance because it brings about some kind of adverse reaction in their bodies, some of which
A
can be severe and may resemble true allergic reactions, but unless the immune system itself is directly involved,
experts categorise it as 'intolerance'. Constant sneezing, itchy eyes or throat and inner ears, asthma, rashes, and
S
diarrhoea can all be signs of food allergies. Intolerance can bring on similar warning signs as well as things such as
headaches, bloating, and general lethargy. Over time, some allergy sufferers lose weight because there are so few
foods they can eat. Of course the social implications are huge too – eating is a major social event.
To diagnose a food allergy, immunologists use a 'skin-prick test' in which a drop of a commercially extracted
allergen is placed on the skin and the first couple of skin layers are pricked with a lancet. If a person is allergic,
the immune system is stimulated sufficiently to produce a mosquito bite-like bump within fifteen minutes. This
testing method is, however, somewhat unreliable in detecting intolerances, because, while not fully understood,
they operate via a different biological mechanism possibly involving chemicals in food irritating nerve endings
in the body. They are generally diagnosed by following an exclusion diet in which suspect foods are gradually
reintroduced and their effects monitored.
SAMPLE

According to paediatric immunology specialist Dr Velencia Soutter, around six to eight per cent of babies are
affected by allergy. While most children will outgrow them, some actually grow into them. The mechanisms that
provoke an allergy remain a grey area. Soutter says: 'It’s like throwing a match into a fireworks factory. Hit the right
place and you set off a chain reaction. Miss it and the match just fizzles out. That difference between lighting up or
fizzling out isn’t well understood.'
Broadly speaking, Dr Soutter says the ideal recipe for a food allergy is to be born of allergic parents and then
to have a high exposure to an allergenic foodstuff. But there are so many exceptions to this rule that other
forces are clearly at work, and who’s to say what 'high' exposure is anyway? In contrast, the so-called hygiene
E
hypothesis suggests too low an exposure to allergens is to blame. The idea is that today's clean environments
L
leave our immune systems with too little to do, encouraging them to turn on the wrong culprits. Clearly, the field of
immunology has only just scratched the surface of understanding.
P
Interesting flakes of information are gradually being peeled off that surface, however. There is evidence that
allergens can be transferred through a mother's breast milk to her child, and possibly also through the placenta.
M
Since the immaturity of babies' immune systems might make them more vulnerable to an inherited allergic
tendency, women in allergic families could be advised to avoid certain foods during pregnancy and breastfeeding. It
A
is possible, though, that some allergies or intolerances are purely imaginary and this can also have consequences
for children. One US study found that parents sometimes avoided foods to which they erroneously believed their
S
children were allergic, occasionally leaving the children severely underfed.
In Australia, the number of people with genuine and severe allergies is growing. Some doctors speculate whether
the increased amount of new chemicals in the environment and in food is perhaps damaging immune systems
− making them more prone to react adversely. Much more research needs to be done to provide evidence for
that hypothesis. Anecdotally though, some experts say that staying off processed foods resolves the problem in
a significant number of cases. Dr Soutter speculates that a rise in peanut allergy cases makes up the bulk of the
increase in food allergies. Greater exposure has probably allowed more peanut allergies to flourish, she thinks.
Peanut consumption per capita is rising. It's a common ingredient in Asian and vegetarian dishes, which have
grown in popularity, and the diet-conscious population is increasingly turning to nuts as a source of healthy fats.
SAMPLE

7. The case of Lucy Smith highlights the fact that food allergies
A may be difficult to diagnose in certain people.
B are relatively rare in the adult population.
C can cause debilitating symptoms.
D often require urgent treatment.
E
8. In the second paragraph, what point is made about food intolerances?
L
A Scientists continue to disagree about their root causes.
P
B The symptoms are indistinguishable from those of allergies.
C They can have an unpredictable impact on the person affected.
M
D The distinction between them and allergies is not widely appreciated.
A
9. The phrase ‘via a different biological mechanism’ in the third paragraph explains
S
A the way the skin-prick test works in diagnosing food intolerances.
B how the presence of food impurities impacts on the skin-prick test.
C why the skin-prick test may not accurately diagnose food intolerance.
D how food allergies are triggered by substances used in the skin-prick test.
10. Dr Soutter uses the image of a fireworks factory to illustrate that
A the factors triggering an allergic reaction still remain unclear.
B allergic attacks can occur suddenly any time in a person’s life.
C it’s difficult to foresee which family member an allergy will affect.
D the identification of a food allergy is basically a matter of chance.
SAMPLE

11. In the fifth paragraph, what point is made about the two hypotheses mentioned?
A They both appear to be credible.
B They directly contradict each other.
C They fail to define their terms adequately.
D They should both be studied in more depth.
E
12. What does the phrase ‘this rule’ in the fifth paragraph refer to?
L
A the likelihood of having an inherited allergy to certain foods
P
B the type of diet in which food allergies more commonly occur
C the degree of contact with allergens needed to trigger a reaction
M
D the order of events most commonly found prior to allergic attacks
A
13. What does the sixth paragraph suggest about the transference of allergies between mother and child?
S
A It is only possible with particular individuals.
B It can result in instances of malnourishment.
C It may be avoidable if certain precautions are taken.
D It is most likely to take place before the baby is born.
14. Dr Soutter suggests that the rise in cases of one allergy may be partly due to
A attempts to improve eating habits.
B changes in food manufacturing methods.
C the adoption of new agricultural practices.
D increased levels of harmful substances in the atmosphere.
SAMPLE

Text 2: Prenatal origins of heart disease
Heart disease is the greatest killer in the developed world today, currently accounting for 30% of all deaths in
Australia. A concept which is familiar to us all is that traditional risk factors such as smoking, obesity, and genetic
make-up increase the risk of heart disease. However, it is now becoming apparent that another factor is at play – a
developmental programming that is predetermined before birth, not only by our genes but also by their interaction
with the quality of our prenatal environment.
Pregnancies that are complicated by sub-optimal conditions in the womb, such as happens during pre-eclampsia or
E
placental insufficiency, enforce physiological adaptations in the unborn child and placenta. While these adaptations
are necessary to maintain viable pregnancy and sustain life before birth, they come at a cost. The biological trade-
L
off is reduced growth, which may in turn affect the development of key organs and systems such as the heart and
circulation, thereby increasing the risk of cardiovascular disease in adult life. Overwhelming evidence in more than
P
a dozen countries has linked development under adverse intrauterine conditions leading to low birth weight with
increased rates in adulthood of coronary heart disease and its major risk factors – hypertension, atherosclerosis
M
and diabetes.
The idea that a foetus’s susceptibility to disease in later life could be programmed by the conditions in the womb
A
has been taken up vigorously by the international research community, with considerable efforts concentrating on
nutrient supply across the placenta as a risk factor. But that is just part of the story: how much oxygen is available
S
to the foetus is also a determinant of growth and of the risk of adult disease. Dr Dino Giussani’s research group
at Cambridge University in the UK is asking what effect reduced oxygen has on foetal development by studying
populations at high altitude.
Giussani’s team studied birth weight records from healthy term pregnancies in two Bolivian cities at obstetric
hospitals and clinics selectively attended by women from either high-income or low-income backgrounds. Bolivia
lies at the heart of South America, split by the Andean Cordillera into areas of very high altitude to the west and
areas at sea-level to the east, as the country extends into the Amazon Basin. At 400m and almost 4000m above
sea-level, respectively, the Bolivian cities of Santa Cruz and La Paz are striking examples of this difference.
Pregnancies at high altitude are subjected to a lower partial pressure of oxygen in the atmosphere compared with
those at sea-level. Women living at high altitude in La Paz are more likely to give birth to underweight babies than
women living in Santa Cruz. But is this a result of reduced oxygen in the womb or poorer nutritional status?
SAMPLE

What Giussani found was that the high-altitude babies showed a pronounced reduction in birth weight compared
with low-altitude babies, even in cases of high maternal nutritional status. Babies born to low-income mothers at
sea-level also showed a reduction in birth weight, but the effect of under-nutrition was not as pronounced as the
effect of high altitude on birth weight; clearly, foetal oxygenation was a more important determinant of foetal growth
within these communities. Remarkably, although one might assume that babies born to mothers of low socio-
economic status at high altitude would show the greatest reduction in birth weight, these babies were actually
heavier than babies born to high-income mothers at high altitude. It turns out that the difference lies in ancestry.
The lower socio-economic groups of La Paz are almost entirely made up of Aymara Indians, an ancient ethnic
E
group with a history in the Bolivian highlands spanning a couple of millennia. On the other hand, individuals of
L
higher socio-economic status represent a largely European and North American admixture, relative newcomers
to high altitude. It seems therefore that an ancestry linked to prolonged high-altitude residence confers protection
against reduced atmospheric oxygen.
P
Giussani’s group also discovered that they can replicate the findings observed in Andean pregnancies in hen
M
eggs: fertilised eggs from Bolivian birds native to sea-level show growth restriction when incubated at high altitude,
whereas eggs from birds that are native to high altitude show a smaller growth restriction. Moving fertilised eggs
A
from hens native to high altitude down to sea-level not only restored growth, but the embryos were actually larger
than sea-level embryos incubated at sea-level. The researchers could thereby demonstrate something that only
generations of migration in human populations would reveal. What’s more, when looking for early markers of
S
cardiovascular disease, the researchers discovered that growth restriction at high altitude was indeed linked with
cardiovascular defects – shown by an increase in the thickness of the walls of the chick heart and aorta. This all
suggests the possibility of halting the development of heart disease at its very origin, bringing preventive medicine
back into the womb.
SAMPLE

15. What information can be found in the first paragraph?
A reference to some recent findings relating to heart disease
B indication of the greatest risk factor associated with heart disease
C mention of a misconception about the chief causes of heart disease
D figures showing the country with the highest mortality rate from heart disease
E
16. When the writer uses the word ‘cost’ in the second paragraph she is referring to
L
A overwhelming evidence.
P
B placental insufficiency.
C viable pregnancy.
M
D reduced growth.
A
17. In the third paragraph, what does the author suggest about the work of the international research
S
community on this subject?
A Their focus has been too narrow.
B Some of their studies may be flawed.
C There is nothing original about their research.
D They were overly keen to seize on a particular idea.
18. What was the aim of the study described in the fourth paragraph?
A to compare neonatal records between the UK and Bolivia
B to assess the relative significance of two risk factors for newborns
C to find a link between birth weight and predisposition to heart disease
D to determine the likelihood of high-altitude babies being carried to full term
SAMPLE

19. What assumption was proved wrong by the results of the study?
A Lower-income mothers generally give birth to lower weight babies.
B A baby born at high altitude will typically weigh less than one born at sea level.
C Levels of oxygen have a greater impact on birth weight than nutritional status does.
D There is a correlation between prenatal oxygen levels and predisposition to heart disease.
E
20. In the sixth paragraph, what is suggested about the inhabitants of La Paz?
L
A The altitude affects all socio-economic groups in a similar way.
P
B There is a high degree of ethnic diversity at all levels of society.
C Most residents have a shared ancestry going back two thousand years.
M
D Poorer residents have a genetic advantage over those with higher incomes.
A
21. The purpose of the information in the sixth paragraph is to provide
S
A an alternative approach to a puzzle.
B a confirmation of a hypothesis.
C an explanation for a finding.
D a solution to a problem.
22. What advantage of the research involving hen eggs is mentioned in the final paragraph?
A the availability of supplies
B the simplicity of the procedure
C the reliability of the data obtained
D the speed with which results are seen
END OF READING TEST

SAMPLE

N K
L A
B
SAMPLE

Sample Test 3
CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
Passport Photo
E
PROFESSION:
L
VENUE:
TEST DATE:
P
A M
S
SAMPLE

Management of burns: Texts
Text A
Burn depth
Burn injuries are classified according to how much tissue damage is present.
1 Superficial partial thickness burns (also known as first and second degree)
Present in most burn wounds. Injuries do not extend through all the layers of skin.
2 Full thickness burns (also known as third degree)

• Burn extends into the subcutaneous tissues
•
E
Underlying tissue may appear pale or blackened
• Remaining skin may be dry and white, brown or black with no blisters
L
• Healing associated with considerable contraction and scarring.
3 Mixed depth burns
P
Burns are frequently of mixed depth. The clinician should estimate the average depth by the appearance
and the presence of sensation.
Resuscitation should be based on the total of second and third degree burns, and local treatment should
M
be based on the burn thickness at any specific site.
A
Text B
S
Fluid resuscitation
If the burn area is over 15% of the TBSA (Total Body Surface Area) in adults or 10% in children, intravenous
fluids should be started as soon as possible on scene, although transfer should not be delayed by more
than two cannulation attempts. For physiological reasons the threshold is closer to 10% in the elderly (>60
years).
Suggested regimen for fluid resuscitation
Adults
Resuscitation fluid alone (first 24 hours)
• Give 3–4ml Hartmann's solution (3ml in superficial and partial thickness burns/4ml in full
thickness burns or those with associated inhalation injury) per kg body weight/% TBSA burned. Half
of this volume is given in the first 8 hours after injury and the remaining half in the second 16-hour
period
Children
Resuscitation fluid as above plus maintenance (0.45% saline with 5% dextrose):
• Give 100ml/kg for the first 10kg body weight plus 50ml/kg for the next 10kg body weight plus
20ml/kg for each extra kg
SAMPLE

Text C
Management for Burns

1. Assess the patient status: airway, breathing, circulation, IV access.
2. Assess the burn depth and extent. A sheet can be placed on burns during this time.
3. Cooling: Remove jewellery or hot clothing. Limit inflammation and pain by using cool water, cool
saline soaked gauze or a large sheet in the case of a large wound. Cool the wound not the patient,
taking care not to cause hypothermia.
4. Pain Control: Acetaminophen usually helpful but may need to use opiates such as codeine.
5. Check immunization status and update tetanus if necessary.
6. If possible, begin fluid resuscitation.
E
7. Debridement of blisters – there are some differences of opinion regarding breaking of blisters.
a. Some suggest leaving intact because the blister acts as a barrier to infection and others

L
debride all blisters.
b. Most agree that necrotic skin should be removed following blister ruptures.

8. Application of antibiotics in the form of ointment. Should always be used to prevent infection in any
P
non-superficial burns.
9. Apply suitable dressing to the wound area.
M
Text D
A
Adult Analgesic Guidelines
The following table provides recommended short term (<72 hours) oral analgesia guidelines for the
S
management of burn injuries. Aim for pain scores of 4 or less at rest. Analgesia should be reviewed after
72 hours and adjusted according to pain scores. Patient management should be guided by individual
case and clinical judgement.
Pain score elicited from patient (Scale 1 – 10)

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

• Paracetamol (15 mg/kg (max 90 mg/kg/day) orally or per rectum (PR))
• Non Steroidal Anti-Inflammatory Drugs
• naproxen 5 - 10 mg/kg (max 500 mg) 12-hrly orally or PR
• ibuprofen 2.5 - 10 mg/kg (max 600 mg) 6-8hrly orally
• Opioids (codeine 0.5 - 1 mg/kg orally)
END OF PART A SAMPLE


N K
L A
B
SAMPLE

Sample Test 4

CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
E
VENUE:
L
TEST DATE:
P
M
A
TIME: 15 MINUTES
S

Part A
TIME: 15 minutes
E
Managing diabetic foot ulcers: Questions
L
Questions 1-6
P
For each question, 1-6, decide which text (A, B, C or D) the information comes from. Write the letter A, B, C or
D in the space provided. You may use any letter more than once.
M
1 how often to change a dressing?
A
2 ensuring patients understand the consequences of tissue removal?
3 reasons for not choosing certain products?
S
4 the need to monitor a wound?
5 how common each kind of DFU is?
6 how good a dressing is at soaking up fluid?
Questions 7-14
Answer the following questions, 7-14, with a word or short phrase from one of the texts. Each answer may
7 What kind of DFU is it if a patient has lost all sensation?
8 If a patient’s DFU is beneath the nail, what kind is it likely to be?
9 What types of dressing should you avoid if a patient’s wound is infected?

10 If you need to fill a cavity, which dressings are best?
11 Which types of dressing may cause an inflammation of the skin?
12 If cost is an issue, which dressing is best?
E
13 Which two types of DFU often show signs of necrosis?
L
14 Which types of dressing provide moisture to a wound?
Questions 15-20
M P
Complete each of the sentences, 15-20, with a word or short phrase from one of the texts. Each answer
A
may include words, numbers or both.
S
15 Check that will still go on after the dressing has been applied.
16 The dressing should follow the shape of the wound so that there
is no .
17 Draw a line around any and ask the patient to get in touch if it
worsens.
18 You might need to involve a in the patient’s care if you cannot
detect a pulse in the foot.
19 To maintain good blood flow, leave free of tight bandages.
20 Make sure the wound is level, otherwise the won’t be able to

grow across it.
END OF PART A

N K
L A
B

N K
L A
B

N K
L A
B

N K
L A
B

N K
L A
B

Sample Test 4

CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
E
VENUE:
L
TEST DATE:
P
M
A
S

Managing diabetic foot ulcers: Texts
Text A
Assessing a diabetic foot ulcer
The clinical management of a diabetic foot ulcer (DFU) will depend on what type it is, and this must be
determined before a care plan is put into place.
Neuropathic Ischaemic Neuroischaemic
Sensation sensory loss painful degree of sensory loss

Callus/necrosis callus present and often necrosis (dead tissue) minimal callus
thick common prone to necrosis
Wound bed pink and granulating pale and sloughy, poor poor granulation
granulation
E
Foot temperature and warm with bounding cool with absent pulses cool with absent pulses
pulses pulses
L
Other dry skin and fissuring delayed healing high risk of infection
Typical location weight bearing areas tips of toes, nail edges margins of the foot and
P
of the foot such as and between the toes under toe nails
metatarsal heads, and lateral borders of
the heel and over the the foot
M
dorsum of clawed toes
Prevalence 35% 15% 50%
A
Text B
S
Applying dressings to DFUs:
• Avoid bandaging over toes as this may cause a tourniquet effect (instead, layer gauze over the toes
and secure with a bandage from the metatarsal heads to a suitable point on foot)
• Use appropriate techniques (e.g. avoiding creases and being too bulky) and take care when dressing
weight-bearing areas
• Avoid strong adhesive tapes on fragile skin
• Avoid tight bandaging at the fifth toe and the fifth metatarsal head (trim the bandage back)
• Ensure wound dead space is eliminated (e.g. use a dressing that conforms to the contours of the
wound bed)
• Remember that footwear needs to accommodate any dressing. Wounds should be cleansed at each
dressing change and after debridement with a wound cleansing solution or saline. Cleansing can
help remove devitalised tissue, re-balance the bioburden and reduce exudate to help prepare the
wound bed for healing.
For infected or highly exuding DFUs, inspect the wound and change the dressing daily, and then every
two or three days once the infection is stable. A different type of dressing may be needed as the status
of the wound changes. Patients should be encouraged to look out for signs of deterioration, such as
increased pain, swelling, odour, purulence or septic symptoms. In some cases (e.g. in the first few days of
antibiotic therapy) it is a good idea to mark the extent of any cellulitis with an indelible marker and tell
the patient to contact the footcare team immediately if the redness moves substantially beyond the line.

Text C
Debridement of DFUs
The first priority of management of foot ulceration is to prepare the surface and edges of a wound to
facilitate healing. If foot pulses are present, non-viable tissue should be removed from the wound bed
and surrounding callus removed. If foot pulses are absent, assessment and management of the peripheral
vasculature is mandatory before removal of non-viable or necrotic tissue is considered. Referral to a vascular
surgeon is suggested in this situation. Removal of non-viable tissue can be quickly and effectively accomplished
by local sharp debridement.
Sharp debridement should be carried out by experienced practitioners (e.g. a specialist podiatrist or
nurse) with specialist training and the plan and expected outcome discussed with the patient in advance.
Debridement should remove all devitalised tissue, callus and foreign bodies down to the level of viable
bleeding tissue. It is important to debride the wound margins as well as the wound base to prevent the ‘edge
E
effect’, whereby epithelium fails to migrate across a firm, level granulation base. Practitioners must explain
fully to patients the risks and benefits of debridement in order to gain their informed consent.
Text D
Dressings for DFUs Advantages
P L Disadvantages
M
Low-adherence simple, hypoallergenic, inexpensive minimal absorbency
Hydrocolloids absorbent, can be left for several concerns about use for infected
A
days, aid autolysis wounds, may cause maceration,
unpleasant odour
S
Hydrogels absorbent, aid autolysis, donate may cause maceration
liquid
Foams thermal insulation, good occasional dermatitis with
absorbency, conform to contours adhesive
Alginates highly absorbent, bacteriostatic, may need wetting before removal
hemostatic, useful for packing
deep wounds
Iodine preparations antiseptic, moderately absorbent iodine allergy, discolours wounds,
cost, not suitable in case of thyroid
disease or pregnancy
Silver-impregnated antiseptic, absorbent cost
END OF PART A

N K
L A
B

N K
L A
B

N K
L A
B

N K
L A
B

N K
L A
B

Sample Test 4

CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
E
VENUE:
L
TEST DATE:
P
M
A
TIME: 45 MINUTES

B
C
Part B
choose the answer (A, B or C) which you think fits best according to the text.
A
B
1. When disclosing distressing information to patients, staff must avoid
A the temptation to use simplistic language.
E
B directing their attention at family members.
C any approach which leads to misunderstandings.
Extract from a manual on surgery: disclosure
P L
M
The delivery of bad news is very difficult. Arrange to talk to the patient in the company of family,
preferably away from other patients. In some cultures, it is not common to give difficult news directly
A
to the patient. We must be aware that the norms and customs of our patients may not match our own.
Often we try to soften the delivery of bad news by saying too much and confusing the matter, or by
S
saying too little and leaving people with unanswered questions. Don’t say neoplasm if what you mean,
and what will be understood, is cancer. Be clear, allow people to understand and feel some of the impact
of the news, and then allow them to ask questions. It is often necessary to repeat the information to other
family members, or to the same people the next day.

2. The purpose of the guidelines for general practitioners is
A to remind them to write asthma action plans.
B to raise their awareness of the value of asthma action plans.
C to direct their discussions with patients about asthma action plans.
E
Policy guidelines for general practitioners: asthma action plans
L
An integral part of asthma management is the development of a written asthma action plan by the person
with asthma and/or their carer together with their doctor. An asthma action plan helps the person with
P
asthma and/or their carer recognise worsening asthma and gives clear instructions on what to do in
response.
M
The process of developing a written asthma action plan is important, as this should be a discussion of
A
the person’s individual asthma and its management. The written plan is a reminder of that discussion.
Written asthma action plans are one of the most effective asthma interventions available, and have been
S
shown to reduce hospital admission and emergency visits to general practice.

3. The guidelines on chemical waste disposal stress the need for staff to
A take appropriate safety precautions when handling chemicals.
B ensure that any chemicals in the hospital are properly documented.
C consult service providers before disposing of all hazardous chemicals.
E
Unknown and empty chemical waste container disposal
L
Unlabelled chemicals are increasingly difficult and very costly to dispose of and may require special
analysis in order to identify them. Furthermore, the hospital’s chemical waste contractor will now NOT
P
remove any unknown chemicals due to their risk level. Every effort should therefore be made to ensure
that all chemicals in use, in storage or being prepared for disposal are fully labelled and described.
M
If unidentified waste is discovered, you should immediately notify the hospital’s designated waste
contractor via the helpdesk and complete an incident form. All empty containers which have previously
A
contained chemicals for licensed disposal must be considered as Hazardous Waste until cleaned.

4. This memo is reminding pharmacists about
A the rationale for documenting incidents and errors.
B the procedure for investigating incidents and errors.
C the method for submitting incident and error reports.
Memo
E
To: All staff
L
Re: Pharmacy incidents and errors
P
Dispensing errors, other significant errors, omissions, incidents, or other non-compliances, including
complaints of a non-commercial nature arising both within and external to the pharmacy, may be the subject of
M
investigation. Pharmacists should therefore follow a risk management procedure, including appropriate record
keeping. The record is to show when the incident was recorded, when it occurred, who was involved (both actual
A
and alleged), the nature of the incident or complaint, what actions were taken and any conclusions. If contact
was made with third parties, such as government departments, prescribers, lawyers or professional indemnity
S
insurance companies, details of the conversation should be recorded. Regardless of how serious the incident
may appear, comprehensive detailed records need to be kept. The record should be kept for three years because
of the delayed nature of some forms of litigation.

5. What point is being made in this guideline about patients with multi-trauma?
A Staff should make it a priority to rule out spinal injuries.
B Spinal injuries are missed in a small but growing number of cases.
C There is evidence that immobilising a patient with spinal injuries is helpful.
E
Evaluation of potential spinal injuries
L
Amongst adult patients suffering high-energy multi-trauma, approximately 5% will suffer a significant
(i.e. mechanically unstable) vertebral column injury (VCI) and significantly less than 1% suffer a spinal
P
cord injury (SCI). The main risk from undiagnosed unstable VCI is that further neurological compromise
will occur. Balanced against this rare but potentially catastrophic risk is the fact that the majority of
trauma patients do not have a VCI, and prolonged application of spinal precautions and immobilisation
M
is associated with multiple complications including pressure sores, raised intracranial pressure or
ventilator associated pneumonia. Furthermore, the efficacy of these interventions in reducing secondary
A
neurological compromise is controversial. Therefore, patients in ICU should undergo spinal evaluation by
CT imaging and interpretation by a consultant radiologist within 24 hours of injury. If imaging is undertaken
S
out of hours, it is acceptable to continue spinal precautions overnight and review imaging early the next
day.

6. What does this update tell medical professionals about bovine insulin?
A It is being withdrawn due to the risks associated with its long-term use.
B Users may experience difficulties when switching to alternatives.
C Any side effects are more difficult to identify in older patients.
Memo
E
To: All staff
L
Re: Withdrawal of bovine insulin
P
Bovine insulin preparations will shortly be withdrawn due to limited availability of the active ingredient.
As people with insulin-treated diabetes who currently use bovine insulin preparations will continue to require
M
insulin treatment, they will need to be changed to alternative, acceptable preparations.
A
People using bovine insulins are likely to be older patients with long-standing diabetes. They may therefore
have absolute insulin deficiency. These individuals will be at risk of impaired awareness of hypoglycaemia,
S
predisposing them to severe hypoglycaemia.
Use of bovine insulin has been associated with the presence of insulin autoantibodies, which may impair the
action of insulin. Porcine, human or analogue insulins are likely to lower the glucose more than the same dose of
bovine insulins, and insulin dose titration may be difficult and unpredictable. People with bovine insulin-treated
diabetes are therefore a high-risk group.

Part C
answer (A, B, C or D) which you think fits best according to the text. A
B
C
Text 1: Conjunctive group therapy: a case study of an adult type I diabetes mellitus
patient
Diabetes mellitus (DM) is a chronic condition and a significant public health problem; complications are responsible
E
for high morbidity and in many cases premature mortality. Type 1 diabetes (DM1) has an early onset and insulin
injection is an integral part of the medical therapy of this condition. The onset of DM1 generates various biological
L
and psychological changes and may force patients to face complicated challenges, such as maintaining optimal
physical health, managing their condition, and dealing with possible comorbidities and unpredictable symptoms.
P
As a chronic condition, DM1 demands radical changes in lifestyle, in order for the patient to achieve effective
adjustment.
M
While patients’ individual differences play a significant role in the course of the condition, they will also share
several common psychological reactions to DM1, such as denial and stress over the diagnosis, prognosis, and
A
treatment of the condition, as well as depression. Consequently, DM1 treatment requires what has been termed
a biopsychosocial approach, combining medical monitoring and regimen compliance on the one hand, and
S
psychological intervention on the other. Group therapy for patients with physical illnesses is based on this model
and has been widely used in applied clinical research and practice. It has been used both for its effectiveness as
a therapeutic approach, and also because as a process it enables simultaneous treatment of a large number of
patients. Numerous studies have found group therapy to be an effective treatment for chronic conditions in general,
and more specifically for DM1.
Ella was a 30-year-old DM1 patient who participated in a 2-year Conjunctive Group Therapy (CGT) programme,
while receiving parallel medical treatment for DM1. Therapy was based on the principles of CGT, which involved
eight members including the patient and used non-guided topics of discussion as its basis. The rules and
regulations of the sessions were based on discretion, confidence and open expression. Each session lasted two
hours, and the group met twice per month. Ella’s participation in the group was based both on a referral from her
endocrinologist and her personal request for a psychotherapeutic intervention.

Although Ella’s participation in the group was voluntary, she initially displayed strong resistance to the process.
Nevertheless, as therapy progressed, Ella became actively involved by initiating group discussions and interacting
assertively with group members. She identified the role of DM1 in her life in relation to herself and her social
environment, and also managed to reflect on the group processes effectively. Combined with Ella’s natural ability to
express herself clearly, all this put her in a very strong position to focus on the issues that had previously impeded
her self-care. In time, therefore, she was able to modify her actions and so start to make progress regarding DM1
regulation.
Ella’s expectations of CGT treatment had been very low, as she thought that the group’s function would merely
E
be to soothe everyday distress caused by her condition. Moreover, she perceived diabetes as an external factor
L
that affected herself and her life, by compromising her health, dreams, actions and potential in general. In terms of
emotional state, Ella’s core feelings were a continuous and generalized stress and anxiety that developed from a
P
constant sense of threat. Ella had great difficulty in achieving a pattern of stable self-care and tended to attribute
this inconsistency to external factors, such as the physician or the regimen. Additionally, over the years, she had
dropped out of a variety of activities such as meeting friends, travelling and fulfilling academic obligations. Before
M
the intervention, she lived with her parents and felt dependent on them. She had also given up the choice of
creating a family of her own, attributing this decision to the unpredictability of DM1.
A
Gradually, as the intervention progressed still further, numerous changes were observed. First of all, diabetes
S
treatment became a more tangible target as Ella realized that the group had taught her new behaviours regarding
her condition and had helped her address critical questions related to it. The group also offered her a clear picture
of her dysfunctional behaviors, such as binge eating, which used to have a negative impact on her diabetes.
The previous generalized sense of worry was eliminated and she engaged in stress management, which also
decreased her sense of vulnerability. She gradually recognized her obligations concerning self-care and the amount
of control she could have over that; therefore, she managed to stabilize her behaviour in this regard. Furthermore,
she regained contact with lost friends and engaged in new relationships. She began travelling again and continued
her studies, which boosted her sense of self-worth. Overall, CGT helped Ella to redefine the role of diabetes in her
life, achieve reconciliation with it and so, finally, to integrate it into her everyday existence.

7. In the first paragraph, what aspect of DM1 is highlighted?
A the demanding treatment regime it entails
B the extent of the problems it causes society
C the degree of disruption it brings to patients’ lives
D the severity of medical complications it can lead to
E
8. The writer sees one benefit of a biopsychosocial approach as
L
A allowing medical professionals to conduct valuable research.
P
B focusing on the person as an individual rather than on the condition.
C addressing issues shared by many patients with persistent conditions.
M
D producing the most rapid improvements in patients with mental health issues.
A
9. In the third paragraph, we learn that the patient called Ella joined the CGT programme partly because
S
A her physician was disappointed with her response to medication.
B she had expressed an interest in having treatment of this kind.
C she felt the timings of the sessions were convenient for her.
D her treatment was not addressing her personal needs.
10. In the fourth paragraph, the writer says that Ella benefitted from CGT by learning to
A take charge of situations effectively.
B articulate her feelings in front of others.
C alter her approach to managing her condition.
D suppress her negative thoughts about diabetes.

11. The phrase ‘all this’ in the fourth paragraph refers to changes in
A Ella’s own personality.
B Ella’s behaviour in the group.
C Ella’s acceptance of her diabetes.
D Ella’s belief in the aims of programme.
E
12. In the fifth paragraph, what does the writer say about Ella’s attitude before she started CGT?
L
A She felt she had been repeatedly let down by family and friends.
P
B She was worried that she was developing psychological problems.
C She was upset by the prospect of being unable to have any children.
M
D She blamed others for her inability to look after herself on a daily basis.
A
13. In the final paragraph, the writer says that Ella ultimately benefitted from CGT by
S
A coming to accept that she could live with her condition.
B gaining insights into other behaviours typical of her condition.
C learning to focus on the day-to-day treatment of the condition.
D becoming aware of the way her condition had impacted on others.
14. What does the word ‘that’ in the final paragraph refer to?
A Ella’s obligations to the group
B the stability of Ella’s behaviour
C a recognition that Ella was vulnerable
D Ella’s ability to manage her own condition

Text 2: Alzheimer’s from a new angle
As chairman of the department of neurology and neurological sciences at Stanford University School of Medicine,
Dr Frank Longo knows how destructive Alzheimer's can be. The disease was discovered in 1906, but despite more
than a century of research, including the testing of over 200 new drugs in the past two decades, there are still no
real treatments. As Longo says, ‘We've cured Alzheimer's in mice many times, why can't we move that success to
people?’. He’s referring to numerous promising compounds that have eliminated the amyloid plaques associated
with Alzheimer's in animals. However, if ongoing trials continue to go the way he hopes, his new drug, called
LM11A-31, could be a critical part of finally making that happen.
L E
For decades, scientists have focused on trying to get rid of the hallmark feature of Alzheimer's: the sticky protein
plaques of amyloid that they have dealt with so well in mice. If they could get rid of that in humans too, the thinking
P
went, they could eliminate the disease, or at least lessen its severity. LM11A-31, however, doesn't directly attack
amyloid. ‘We're sceptical about what is actually causing Alzheimer's,’ Longo says, referring to those protein
plaques. ‘Most people are working at the edges of the problem, but we're going right after the core of it.’
M
LM11A-31 isn't designed to eliminate every clump of amyloid, but rather to keep brain cells strong, safeguarded
against neurological onslaughts, whether they're the effects of amyloid or other factors involved in Alzheimer's. It's
A
a less orthodox approach, but if it works, it could be a turning point.
S
Under a microscope, Longo displays before-and-after slides of some brain neurons from mice. On the before slide,
the normally orderly and uniform cells are in disarray. They're dying, slowly being choked off from their supply of
nutrients by amyloid plaques that start to accumulate in the Alzheimer's-afflicted brain. In the after slide, the cells
look normal. The difference, Longo says, is LM11A-31. For brain cells, their molecular connections to other neurons
are their lifeline. It's like their version of a social networking site, as they continually bombard other neurons with
status updates. But when the cells are assaulted by something like amyloid, these communications are threatened,
ultimately leading to the death of the cells.

Longo has a diagram of the signals passed among brain nerves that are triggered by amyloid proteins. These can
ultimately lead neurons to deteriorate. There are 14 in total, and so far he's found that LM11A-31 can halt at least
ten. There are even signs that LM11A-31 might help people whose brains are already damaged by amyloid. ‘The
general assumption was that the damage to brain neurons was irreversible,’ says Longo. ‘What our studies show
is that in mice, there is a significant amount of damage that is reversible,’ he says. ‘If approved [for human use],
these could be the first drugs that will change the course of the disease rather than just treat its symptoms’, says
James Hendrix of the Alzheimer's Association. But the reality is that it's not clear yet whether the changes seen
from LM11A-31 restored any lost memory. Brain experts are eagerly awaiting Longo's next series of studies for the
answer to that question. So far, not everyone is convinced. ‘To bring back neurons that have been destroyed by
E
plaques and tangles – to me that still seems almost like science fiction,’ says Hendrix.
L
Still, there's no denying the potential of compounds like LM11A-31 and the need to think about new ways to
P
attack the disease. Some experts are convinced that if people live long enough, some form of dementia, most
likely Alzheimer's, is inevitable, although figuring out which patients can benefit from which types of treatments,
and when, is still an open question. Although this hypothesis is unpalatable to many medical professionals,
M
it's a proposition that even the US government is starting to appreciate. In 2011, Congress created a National
Alzheimer's Plan to coordinate and accelerate the development, testing and approval of new drugs to treat the
A
disease. And the Alzheimer's Association will soon issue a consensus statement on how to move promising drug
candidates to human testing as quickly as possible.
S
If and when viable treatments become available, part of the puzzle will include figuring out who they should be
given to, and when. The idea of applying amyloid PET scans to everyone on their 65th birthday isn’t going to run,
given that they currently cost several thousand dollars each. But some type of risk score, as we now have for heart
disease, isn’t far off. There’s no doubt that we need to think beyond amyloid and encourage patients to participate
in trials testing non-amyloid strategies as well. In an ideal world, you'd want to design a therapeutic regimen based
on the different components contributing to each patient’s dementia issues. LM11A-31 may well become the first
drug in that cocktail.

15. In the first paragraph, it’s suggested that Dr Longo feels
A annoyed that certain Alzheimer’s treatments are not approved for human use.
B concerned that the Alzheimer’s drug LM11A-31 may prove ineffective.
C surprised that so little is still known about what causes Alzheimer’s.
D frustrated by the lack of progress towards treating Alzheimer’s.
E
16. Longo’s phrase ‘working at the edges of the problem’ reveals his feeling that other researchers
L
A are distracted by their success with animals.
P
B are refusing to recognise a key feature of Alzheimer’s.
C are afraid to admit the problems they have encountered.
M
D are focusing on some of the less relevant aspects of Alzheimer’s.
A
17. In the second paragraph, what point does the writer make about the drug LM11A-31?
S
A It is effective even in the most severe cases.
B It is a product of previous research into amyloids.
C It works regardless of the actual cause of the disease.
D It provides little protection against other neurological conditions.
18. With the reference to social-networking sites, the writer is illustrating
A how important it is that neurons in the brain are in constant contact.
B how quickly disease can spread from one brain cell to another.
C how easy it is to disrupt communication in the brain.
D how complex the connections in the brain are.

19. In the fourth paragraph, we learn that according to Longo, LM11A-31 blocks certain
A signals.
B neurons.
C brain nerves.
D amyloid proteins.
E
20. What reservation about the drug LM11A-31 is expressed in the fourth paragraph?
L
A Restoration of neurons may only be short-term.
P
B Research by Longo’s team may have been biased.
C Results from trials on mice may not be replicated in humans.
M
D Reversal of damage may not have any effect on the patient’s memory.
A
21. According to the writer, which group is reluctant to accept that dementia is inevitable?
S
A patients
B the US government
C medical professionals
D the Alzheimer’s Association
22. In the final paragraph, what does the writer think will start to happen soon?
A Other non-amyloid-focused treatments for Alzheimer’s will emerge.
B Drug regimens for Alzheimer’s will be targeted to individuals.
C A prediction tool for Alzheimer’s will be developed.
D All over 65s will be tested for Alzheimer’s.
END OF READING TEST


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OET SAMPLE TEST

ROLEPLAYER CARD NO. 1 MEDICINE

Local Medical Clinic

• Say you’d like to know how much physical activity is advisable.

© Cambridge Boxhill Language Assessment SAMPLE TEST

OET SAMPLE TEST

Local Medical Clinic

• Find out reason for visit.

© Cambridge Boxhill Language Assessment SAMPLE TEST

OET SAMPLE TEST

Local Medical Clinic

• Say if it is diabetes, you’d like to know how it would be treated.

© Cambridge Boxhill Language Assessment SAMPLE TEST

OET SAMPLE TEST

Local Medical Clinic

• Find out how patient is feeling (any symptoms, concerns, etc.).

© Cambridge Boxhill Language Assessment SAMPLE TEST

© Cambridge Boxhill Language Assessment SAMPLE TEST

OET SAMPLE TEST

• Confirm child is ready to be discharged. Find out about parent’s concerns.

© Cambridge Boxhill Language Assessment SAMPLE TEST

OET SAMPLE TEST

• Find out reason for patient’s visit.

Today's Date - 15.08.12

• Regular checkup, Family man, wife, two sons aged 5 and 3

• Parents alive - father age 71 diagnosed with prostate cancer 2002.

• Mother age 68 hypertension diagnosed 2002.

• Works long hours - no regular exercise

• Light drinker 2-3 beers a week

• BP - 165/90 , P - 80, regular

• Cardiovascular and respiratory examination - normal

• Height - 173 cm , Weight - 85 kg

• Advise re weight loss, smoking cessation

• Request PSA test before next visit

• Reduced smoking to 10 per day

• Attends gym twice a week,

• complains of discomfort urinating

• DRE - hardening and enlargement of prostate

• Review BP, smoking reduction in 2 months

4001 Ask to be informed of the outcome.

Today's Date - 12/09/17

• Regularly works 55 - 60 hr a week

• Married with twin boys aged 6 months

• Non-smoker and social drinker

• Mother is a diabetic on metformin

• Asthma since childhood - on steroid inhaler

• O/E - overweight , BMI - 32

• Gait - normal, has lumbar lordosis

• Mild weakness in L hand

• Feeling better, no new complaints, no worsening of pins and needles sensation

• Has been walking 30 minutes 3 times a week

• Weight loss 3kg

• c/o worsening headaches for 3 days, dizziness, nausea, blurred vision

• Could not read 2 lines of eye chart

• Mild weakness and loss of sensation in medial aspects of L hand

• Reflexes: Elbow-normal, Wrist- no reflexes

Diagnosis: Subdural haematoma

45 years old, married 2 children

Past history - Migraines

• presents with abdominal pain

• epigastric pain radiating to R side 1 hour after dinner

• associated nausea, no vomiting / regurgitation

• pain constant for 1 hour

• no change bowel habits, no fever, no dysuria