Oet Listening and Reading Guide

Study guide for OET © IRS Group 2018 1
2 Study guide for OET © IRS Group 2018

Study Guide
for OET
with 5 Practice test

“Patients in their journey through the health care system are
entitled to be treated with respect and honesty, and to be involved
wherever possible in decisions about their treatment.”
(Kennedy, 2001)
Study Guide for

Occupational English Test
5 Practice test included
Milen Jacob
First Published: 2018

Copyright: IRS Group
Kottayam | Kochi | Hyderabad
www.irsgroup.in

Occupational English Test
Test format
OET is an international English language test that assesses the language communication skills of
healthcare professionals who seek to register and practise in English-speaking countries such as
Australia, New Zealand, the UK and Ireland.
OET is a test developed for 12 healthcare professions: Nursing, Medicine, Pharmacy, Dentistry,
Physiotherapy, Radiography, Speech Pathology, Dietetics, Occupational Therapy, Optometry, Po-
diatry, and Veterinary Science
OET assesses all four language skills - listening, reading, writing and speaking - with an emphasis
on communication in a healthcare environment.
There is a separate sub-test for each skill area. The Listening and Reading sub-tests are designed
to assess the ability to understand spoken and written English in contexts related to general health
and medicine. The sub-tests for Listening and Reading are common to all professions.
The Writing and Speaking sub-tests are specific to each profession and are designed to assess
the ability to use English appropriately in a relevant professional context.
The four components of OET

Paper (duration) Content Shows candidates can:
Listening 3 tasks follow and understand a range of health related
(approx. 45 minutes) Common to all 12 professions spoken materials such as patient consultations
and lectures.
Reading (60 minutes) 3 tasks read and understand different types of text on
Common to all 12 professions health-related subjects.
Writing (45 minutes) 1 task write a letter in a clear and accurate way which
Reading time: 5 minutes Specific to each profession is relevant for the reader.
Writing time: 40 minutes
Speaking 2 tasks effectively communicate in a real-life context

(20 minutes) Specific to each profession through the use of role-plays.

Listening
The listening sub-test is 45 minutes long.
The listening sub-sub-test is the first test on the test day and is for about 45 minutes.
The Listening sub-test consists of three parts, with 42 questions.
The listening sub-test is the same for all professions.
The topics are of generic medical interest, accessible to candidates across all professions.
Each part consists of a variety of recorded audio extracts, testing different listening skills. There
will be pauses throughout the test to allow candidates to read questions or write their answers.
Candidates will hear each recording once and are expected to write their answers while listening.
Part A - Consultation extracts

This part assesses candidates’ ability to understand, interpret and record detailed or specific infor-
mation. There would be an increased focus on patient centred language, and thus this part differs
from a typical structured consultation. You will listen to two recorded health professional-patient
consultations and you will complete the health professional’s notes using the information you hear.
There will be 12 questions in each consultation.
Duration : 15 minutes (for 2 consultations)
Tasks : structured note completion
Marks : 24
Part B - Short workplace extracts

Part B consist of 6 short dialogues or monologues in work place settings that tests the candidate’s
ability to listen for gist, detail, and course of action.
Duration : 10 minutes (for all 6 questions)
Tasks : three option multiple-choice questions
Marks : 6
Part C - Presentation extracts

In part C, you will listen to two different extracts and you will answer six multiple-choice questions
for each extract. The extracts could be monologues or interviews with healthcare professional.
Duration : 15 minutes (for 2 extracts)
Tasks : three option multiple-choice questions
Marks : 12

Reading
The reading sub-test is for 60 minutes.
The Reading sub-test consists of three parts:
Part A – expeditious reading task
Part B – multiple-choice questions.
The topics are of generic medical interest and are therefore accessible to candidates across all
professions.
Part A : Expeditious reading task

Part A assesses your ability to locate specific information from four short texts in a quick and
efficient manner. The four short texts relate to a single healthcare topic, and you must answer 20
questions in the allocated time period.
Duration : 15 minutes
Tasks : matching, sentence completion and short answer questions.
Marks : 20
Part B and C: Careful reading tasks

Part B assesses your ability to identify the detail, gist or main point of six short texts sourced from
the healthcare workplace (100-150 words each). The texts might consist of extracts from policy
documents, hospital guidelines, manuals or internal communications, such as emails or memos.
For each text, there is one three-option multiple-choice question.
Part C assesses your ability to identify detailed meaning and opinion in two texts on topics of
interest to healthcare professionals (800 words each). For each text, you must answer eight four-
option multiple choice questions.
Duration : 45 minutes
Tasks : Part B: 3 option multiple choice questions
Part C: 4 option multiple choice questions
Marks : 22

Practice test 1

Listening test

Extract 1: Questions 1 - 12
You hear a psychologist talking to a client called Candice May. For questions 13-24, complete the notes
with a word or short phrase.
You now have thirty seconds to look at the notes.
Patient : Candice May
Reason for appointment : tension due to relationship issues
(1) ________________________________ in the workplace
makes her (2) ________________________________
Background to the condition: experiencing difficulties for the last (3) _____________________
mother is sick for the last 3-4 months
no treatment taken
Present condition : (4) _______________________________ is bit of difficult
doesn’t have (5) _______________________________ to talk to
priorities dealing with issues with (6) _______________________
thinks she is putting a lot of pressure on him
Advice offered : (7) ________________________________ on the relationship area
Further enquiries : (8) __________________________ of counselling sessions
(9) ______________________________ involved for extra sessions
Session schedule : can (10) _____________________________ as long as required
difficult to provide set time
(11) ___________________________ book a session for next week
can focus on the (12) ________________________ of relationship

Extract 2: Questions 13-24
You hear a psychologist talking to a client called Jane Speirs. For questions 13-24, complete the notes
with a word or short phrase.
Patient : Jane Speirs
Description of the condtion: feeling (13) ________________________________
(14) ________________________________ in the muscles
unable to play netball
Early symptoms : started few weeks ago with a (15) _____________________________
(16) ________________________________ head
no treatment taken
can’t do (17) ________________________________ really
Further details : (18) _______________________________ fine
weight steady
no temperature with cold
(19) ________________________________ regular

Diagnosis : (20) ________________________________ around the body
enlarged spleen
suspected (21) ________________________________

red throat
Management : (22) __________________________ to confirm diagnosis
test for (23) ________________________________
Advice given : adequate rest
no specific remedies
body cures itself
(24) ___________________________ diet and fluid intake
follow up at the end of week
That is the end of Part A.

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 a health recommendation on free sugar reduction
What does the expert call for
A Reduction in determination of ill health

B Prevent the onset of the condition
C Eradication of non-communicable illness
26. You hear a health expert talk on pregnancy in women with epilepsy
What impact does seizure have on childbirth?
A Associated risks with delivery are unlikely

B Substantial risk of post partum bleeding
C Mother will remain seizure free for a year
27. You hear an advice on codeine use by an advanced practice pharmacist.
The speaker focuses on the biophysical model to
A explain the normal action of the drug

B reveal the addictive responses seen
C convey the working of analgesics

28. You hear a registered nurse talk on advantages of aged care channel
How does the channel benefit as a resource
A it aids in training and developing

B it helps in preparing new recruits
C it supplements other equipment
29. You hear a doctor discuss on carT-cell therapy
The new immunotherapy involves
A increasing the intensity of resistance

B altering cell structure of pathogens
C understanding the patient’s genetics
30. You hear a patient handover by two nurses
Detail observation of the patient outlines
A cessation of smoking two years ago

B constancy maintained in oxygen saturation
C daily independent performing of ADLs
That is the end of Part B. Now look at Part C.

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 to 42, choose the answer (A, B or C) which fits best according to what you hear.
Complete your answers as you listen.
Now look at extract one.
Extract 1: Questions 31 to 36
You hear a lecture on migraine by Dr Benjamin Durette.

You now have 90 seconds to read questions 37-42.
31. As per the doctor’s opinion, what may be the cause of migraine?
A Hormonal changes affecting the body

B Oedema of blood vessels inside the brain
C Aura that precedes the onset of headache
32. According to the doctor, why is aura benign?
A Since there is a difficulty in focussing eye sight

B Only rarer forms affect both sensation and speech
C The time duration during which the conditon lasts
33. What according to the doctor is visually the most widely relieving method?
A Effective sleep until the headache subsides

B Vomiting to reduce the chances of regurgitation
C Wait until the headache weans itself away

34. How can hormonal fluctuations be thought to be a trigger according?
A Lack of sleep even if the difference is marginal

B Around half of the women likely experience while menstruating
C The onset of the condition during sudden exercise.
35. Why does the speaker think ice treatment can reduce the impact?
A Blood vessels become swollen with blood and dilate

B It cools the blood vessels therapy resulting in relief
C It contracts the vessels and reduces the blood flow
36. According to the doctor, what can be administered to sporadic migraine?
A Relaxation techniques that include bio feedback.

B Prophylactic medication which is taken regularly
C Over the counter pain relievers like aspirin or ibuprufen

You hear a doctor talking about innovations in neuromuscular medicine.
37. How did Dr Jeffry become a neuromuscular expert?
A The general neurology training that he started out with

B The fellowship he specialised in neuromuscular medicine
C His background in neurology and the fellowship combined
38. What best describes a typical day of the doctor?
A conducting a variety of procedures such as electromyography

B could be seeing a lot of patients or performing procedures
C seeing patients with rare conditions and serious prognosis
39. What was an exciting development regarding ALS?
A The discovery of genetic biomarkers that can be tested easily

B Ice bucket challenges helped raise funds required for research
C better understanding of its progresses in a particular patient
40. What should be a physician’s priority for an ALS patient
A Rely on treatments that really benefit patients overcome the disorder

B alleviate associated problems so that patients can lead normal lives
C help patients communicate better by helping them not to lose voices
41. What does Dr consider as one of the most under recognised problems with ALS
A How the disorder affects patient’s mental disposition

B The devastation that the diagnosis has on the patient
C The lack of social support that is required for patients

42. What can patients with diabetic neuropathy expect in the future
A Better pain medication to reduce the pain associated

B Exciting research on drugs that patients are familiar with
C Introduction of newer drugs with greater effectiveness
That is the end of Part C.
You now have two minutes to check your answers.
END OF THE LISTENING TEST.

Reading test
Variations in HIV testing: Texts
Text A
What is an ELISA?
An ELISA or enzyme-linked immunosorbent assay, is a method used in the laboratory to aid in the diagnosis
of a wide range of diseases. This test is performed on blood or urine and is used for measuring the amount
of a particular protein or substance in these bodily fluids, such as infectious agents, allergens, hormones or
drugs.
This test relies on the interaction between components of the immune system called antigens and antibod-
ies. Antibodies are proteins produced by the body to identify and neutralise any foreign substances that may
be encountered, such as viruses and bacteria. The substances to which antibodies are produced are known
as the antigens as they stimulate an immune response.
What is the test used for?
ELISAs are used for numerous types of tests in the laboratory which can assist in the diagnosis of many
different conditions.
It is most commonly requested if it is suspected you have been exposed to viruses such as HIV and Hepatitis
B or C, or bacteria and parasitic infections such as Toxoplasmosis, Lyme disease and Helicobacter pylori. It
can also measure levels of antibodies to see if you have been vaccinated against certain diseases such as
mumps and rubella.
Other uses of the ELISA include:
• Measuring certain hormone levels such as HCG in the pregnancy test, thyroid hormones
• Detecting dust and food allergies
• Detection of illicit drugs such as cocaine and methamphetamines.
• Measuring antibodies which are produced in auto-immune conditions such as Lupus and rheuma-
toid arthritis.
Some kits are also available for the general public to use for example; the home pregnancy test is based on
the ELISA principle and detects the presence of a hormone known as human chorionic gonadotrophin (hCG)
which is excreted in the urine of a pregnant woman.

Text B
How accurate are different types of HIV tests?
Modern HIV tests are extremely accurate. There are a variety of different HIV tests and your healthcare worker
should explain which test you will be given and how you will get your result. Normally, testing involves taking a
small sample of blood from either your finger or your arm, or a sample of oral fluid.
How long an HIV test takes to give you an accurate result depends on the type of test you are taking. If you are
taking a rapid test, you will be given your results within 20 minutes. Other types of tests will be sent to a
laboratory and you may have to wait for the result which may take between a few days to a few weeks for you
to receive a final result.

Text C
Baseline risk-assessment
How to identify those at risk of HIV
PrEP is indicated for those at greater risk of HIV acquisition and therefore comprehensive history taking and
risk assessment, including both sexual and drug taking histories, are required to identify those most likely to
benefit.
Clinicians will need to make pragmatic decisions with patients about future HIV risk, their need for PrEP and
individual-level assessment of the benefit versus potential harms of PrEP. At a population level, given limited
resources and a desire to achieve the maximum impact of PrEP, clinicians should use clinical criteria and
recommendations as outlined in these guidelines, along with local and national criteria for NHS or clinical
trial eligibility to provide PrEP to those at highest risk of HIV acquisition.
It is well recognised that there are other risk behaviours and vulnerability factors that increase the risk of HIV
acquisition and these should be taken into consideration on a case-by-case basis by clinicians when
considering eligibility for PrEP and assessing HIV risk. Although this lacks a clear evidence base, the writing
group has considered this in terms of those who are ‘high risk’, and therefore PrEP would be recommended,

Text D
Summary table of recommendations for PrEP
Recommend PrEP
(i) HIV-negative MSM and trans women who report condomless anal sex in the previous 6 months and on-
going condomless anal sex.
(ii) HIV-negative individuals having condomless sex with partners who are HIV positive, unless the partner
has been on ART for at least 6 months and their plasma viral load is <200 copies/mL.
Consider PrEP on a case-by-case basis
PrEP may be offered on a case-by-case basis to HIV-negative individuals considered at increased risk of HIV
acquisition through a combination of factors that may include the following:
Population-level indicators Clinical indicators

• Heterosexual black African men and women • Rectal bacterial STI in the previous year
• Recent migrants to the UK • Bacterial STI or HCV in the previous year
• Transgender women • Post-exposure prophylaxis following sexual expo-
• People who inject drugs sure (PEPSE) in the previous year; particularly
where repeated courses have been used
• People who report sex work or transactional sex
Sexual behaviour/sexual-network indicators Drug use

• High-risk sexual behaviour: reporting condomless • Sharing injecting equipment
sex with partners of unknown HIV status, and • Injecting in an unsafe setting
particularly where this is condomless anal sex or
• No access to needle and syringe programmes or
with multiple partners
opioid substitution therapy
• Condomless sex with partners from a population
group or country with high HIV prevalence
Sexual health autonomy
• Condomless sex with sexual partners who may fit
Other factors that may affect sexual health autonomy
the criteria of ‘high risk of HIV’ detailed above
• Inability to negotiate and/or use condoms (or
• Engages in chemsex or group sex
employ other HIV prevention methods) with sexual
• Reports anticipated future high-risk sexual
partners
behaviour
• Coercive and/or violent power dynamics in relation-
• Condomless vaginal sex should only considered
ships (e.g. intimate partner/domestic violence)
high risk where other contextual factors or vulner-
• Precarious housing or homelessness, and/or other
abilities are present
factors that may affect material circumstances
• Risk of sexual exploitation and trafficking

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.
Variations in HIV testing: Questions
Questions 1-7
For each of the questions 1-7, decide which text (A,B, C or D) the information comes from. You may use any
letter more than once.
1. Time taken to receive 4th generation antigen tests ________________________________
2. Factors that are observed to affecting sexual autonomy ________________________________
3. The differing conditions that are diagnosed with ELISA test ________________________________
4. Talking to patients about pragmatic decisions on future ________________________________
5. Antibodies are the substances produced for antigens ________________________________
6. PrEP for partners from a high HIV risk population group ________________________________
7. Health care worker should explain the test given ________________________________
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. Your answers should be correctly spelled.
8. What does an ELISA test measure for in pregnancy?
___________________________________________________________________________
9. How is acquisition considered for HIV negative individuals?
___________________________________________________________________________
10. How long does it take to receive results of a rapid test?
___________________________________________________________________________
11. What are the examples of autoimmune conditions detected by ELISA?
___________________________________________________________________________

12. What kind of histories are required to identify those who need PrEP ?
___________________________________________________________________________
13. How long will it take to detect HIV with self-testing kits?
___________________________________________________________________________
Complete each of the sentences, 14 – 20, with a word or short phrase from one of the texts. Each answer may
include words, numbers or both. Your answers should be correctly spelled.
14. Particular _________________________________________ are measured for diagnosis of an ELISA test.
15. People who engage in _________________________________________ sex falls under population level indicators.
16. HIV tests involve taking sample from _________________________________________ or the arm for detailed blood study.
17. _________________________________________ for PrEP must be considered on the basis of vulnerability factors for HIV.
18. Interaction between components of _________________________________________ is relied on for ELISA test results.
19. _________________________________________ of self testing kits is satisfactory but requires further medical scrutiny.
20. Individuals who have _________________________________________ with HIV positive partners must be recommended
PrEP.

Part B
In this part of the test, there are four 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.
1. The changes in standards as per the revised protocol was necessitated due to
A more evidence of associated risks seen

B inconsistent responses to new findings
C protocols that prioritize peadiatricians only
Executive Summary
Intravenous fluids are important components of appropriate care for hospitalised children. Reports in the
medical literature and warnings issued in other countries have highlighted the risks associated with use of
low sodium content fluids. The importance of appropriate glucose content has also been identified, and
emerging evidence suggests risks associated with high chloride. Individual or facility based responses to
the changing literature, along with the interim recommendations of a national expert group convened under
the auspices of Children’s Healthcare Australasia (CHA), have led to variable practices across NSW Health
hospitals with consequent inconsistencies and risks. The NSW Chief Paediatrician was tasked to engage
clinical experts, HealthShare and a range of other partners in the development of statewide standards
across all NSW facilities. The resultant Standards for Paediatric IV Fluids: NSW Health addresses fluid
content, bag size, labelling, administration, procurement and storage. A succinct Statement of the Stan-
dards presents the key messages and related actions on a single page.

2. The guidelines on CDCT aims to enumerate the
A importance of eliciting personal preference

B morbidity rates noticed in clinical observations
C conservative estimates of procedural effectiveness
Updates on early lung cancer detection with Low-Dose Helical

Computed Tomography
Key Discussion Points for the Process of Shared Decision Making Related to Screening for Early Lung
Cancer Detection With Low-Dose Helical Computed Tomography
• Benefit: Screening with LDCT has been shown to substantially reduce the risk of dying from lung cancer
• Limitations: LDCT will not detect all lung cancers or all lung cancers early, and not all patients who have
a lung cancer detected by LDCT will avoid death from lung cancer
• Harms: There is a significant chance of a false-positive result, which will require additional periodic
testing and, in some instances, an invasive procedure to determine whether or not an abnormality is lung
cancer or some nonlung-related incidental finding; <1 in 1000 patients with a false-positive result expe-
riences a major complication resulting from a diagnostic workup; death within 60 d of a diagnostic
evaluation has been documented but is rare and most often occurs in patients with lung cancer
• Individuals who value the opportunity to reduce their risk of dying from lung cancer and who are willing
to accept the risks and costs associated with having an LDCT and the relatively high likelihood of the
need for further tests, even tests that have the rare but real risk of complications and death, may opt to
be screened with LDCT every year.

3. The evaluation and management exercise requires students to
A perform in the presence of a billing physician

B document services accorded in the medical record
C record significant decision making exercises involved
Evaluation and Management Documentation Provided by Students

Any contribution and participation of a student to the performance of a billable service (other than review of
systems and/or past family/social history which are not separately billable, but are taken as part of an E/
M service) must be performed in the physical presence of a teaching physician or the physical presence of
a resident in a service that meets the requirements in this section for teaching physician billing. Students
may document services in the medical record; however, the teaching physician must verify in the medical
record all student documentation or findings, including history, physical exam, and/or medical decision
making. The teaching physician must personally perform (or re-perform) the physical exam and medical
decision making activities of the E/M service being billed and may verify any student documentation of
them in the medical record rather than re-documenting this work.

4. On suspecting a disorder it is important to
A convey the gist of the problem

B articulate the symptoms with patient
C focus on associated illness outcomes
How to approach the consultation

• Adopt a non-judgmental approach through what is said and not said. Listen and understand the patient’s
version of reality, however bizarre it may appear, in order to discover more about what is going on in their
world
• Ask focused questions if psychosis is suspected and do not too readily dismiss symptoms as the results
of depression, anxiety, or substance misuse
• Avoid arguing with the patient—for example, by saying, “Of course there aren't devils under the bed.” It
works better to say, “I understand that this is how it appears to you, but this is how it appears to me”
• Be true to the person as they were when well. Remember hostility can be a symptom of the illness
• Avoid diagnostic labels at too early a stage; instead, focus the discussion around the patient’s symptoms
and experiences
• Avoid using stigmatising language. For example, some patients prefer “a person who experiences schizo-
phrenia” rather than “schizophrenic”

5. The statutory catalogue informs
A appropriate dispensation of information is legal

B judicious consideration is required for data sharing
C consent of the individual must be maintained
Restricted sharing of information

There are circumstances where it is not permissible to make information publicly available, however it may
be permissible and appropriate to share that information with other organisations so that they may make
reasonable use of it. Such restricted sharing of information may include sharing information to support the
delivery of care for individuals, for managing systems of care for a population or for other purposes.
1. Under common law, any restricted sharing of information must not identify any individual unless
there is a legal means and purpose to do so. Permissible legal means will include cases when:
a. the person that the information is about has consented, or
2. b. there is a statutory basis for disclosure or court order, or
3. c. there is a public interest justification for disclosure, or
4. d. there is another basis in law for disclosure.

6. The health guide advices individuals to
A prepare for long term wellness plan

B entrust a confidant for future care
C use informed choices for later care
Advance Care Planning

Advance care planning is a helpful way for people of all ages to prepare for the future. Both healthy people
and people with health conditions do advance care planning.
Advance care planning is:
• Making decisions now about the types of health care you would and would not want to receive if you
become very sick or injured and couldn’t speak for yourself in the future
• Choosing a person you want to make decisions for you if you’re unable to do so for yourself. This person
is called a health care agent
• Talking with your doctors and loved ones about the types of health care you want to receive so they’ll
respect and honor your values and health care goals
• Writing down your health care goals in MyCare, an advance directive. This form guides your health care
providers as to what types of health care you want. It also helps your loved ones understand your wishes
in case they have to make health care decisions for you

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: Pancreatic cancer: gradual rise, increasing relevance
Pancreatic cancer is the 10th most frequently occurring cancer but the fifth most common cause of cancer
death in Australia, as is also seen in other developed regions of the world. A gradual increase in incidence has
been observed since the 1980s in almost all age groups in both sexes. Increases have been attributed only to
trends in smoking, which is considered causal, with local published data suggesting a lag of about 30 years
between smoking trends and incidence. However, being overweight and obesity may also have contributed, in
part, to incidence trends.
In developed countries, only about 50%–70% of cases of pancreatic cancer are histologically confirmed
based on review of the primary tumour, because pancreatic biopsy procedures have been associated with
significant risks and are often avoided. But improvements in imaging modalities, particularly endoscopic
ultrasound and pancreas-specific computed tomography, and magnetic resonance imaging protocols, together
with endoscopically guided biopsy procedures, are likely to have led to some of the increase in incidence
through improved detection.
In 2011, the latest year for which results are available, 5-year survival from pancreatic cancer was 5.2% in
Australia and 7.3% in the United States (among patients on selected Surveillance, Epidemiology and End
Results Program registers) with modest improvements observed over the past several decades. Five-year
survival from pancreatic cancer was about 3% in the mid1980s in both places. Between 1987 and 2007 in
Australia there was only a 6% drop in mortality from pancreatic cancer in both sexes (in those aged less than
75 years), compared with decreases in mortality of 34% from lung cancer, 47% from bowel cancer and 28%
from all cancers overall. Current projections suggest that within 10 years, pancreatic cancer will be the
second-highest cause of cancer death in the US as mortality and survival from the other four leading causes
of cancer death (lung, bowel, prostate, and breast cancers) improves. If these trends are reflected in Australia,
it would be anticipated that pancreatic cancer will become one of the leading causes of cancer mortality there
also.
Complete resection of the primary tumour currently offers the only hope of cure. Beyond the setting of high-
risk families, screening to identify precursor or early invasive lesions is not feasible for two main reasons.
First, endoscopic ultrasound is invasive and can only be used in specialised settings, so does not meet
criteria for a population screening test. Second, the positive predictive value of screening is limited by the low
population prevalence of pancreatic cancer. Attempts to categorise the population using known risk factors,
including several known single nucleotide polymorphisms, have not yet identified population subgroups at
sufficiently high risk to warrant screening.

An avenue to optimise outcomes for patients is to ensure that all receive high-quality care in the most
appropriate setting. There is evidence from the US that not all patients with potentially resectable tumours are
offered surgery. Detailed data are not currently available for Australia, but it appears that there is similar
underutilisation of surgery there. It is thus important that all patients without metastatic disease are reviewed
by a multidisciplinary team in a major centre to determine the resectability of their pancreatic tumours. In
addition, it is of great consequence that resections be performed in hospitals that carry out a large number of
these procedures annually, as this has been shown to improve survival.
In conclusion, while the rise in pancreatic cancer incidence is slow, as the population ages, more people will
be affected with this disease. The burden of pancreatic cancer relative to other cancer types is likely to
increase. A multilevel approach is needed to control pancreatic cancer, including reducing the prevalence of
risk factors such as smoking and obesity, identifying effective biomarker screening tools and populations in
whom screening or early detection might be feasible, discovering new treatment modalities and ensuring that
all patients have access to optimal care.

Text 1: Questions 7 - 14
7. Opinion gauged from paragraph one on the eighties is that
A a rise in pancreatic cancer has occurred in all age groups.

B the rate of pancreatic cancer has risen in most age groups.
C the rate of pancreatic cancer has swiftly risen in all groups.
D the rate of pancreatic cancer rose in almost all age groups.
8. For developing pancreatic cancer, it is suggested in paragraph 1 that ……
A smoking trends have been attributed as the key factor.

B smokers lag by thirty years behind the incidence and trends.
C smoking and obesity combined is the exclusive cause.
D smokers have to wait a timespan of 30 years to get cancer.
9. From paragraph 2, what is suggested on pancreatic biopsy procedures?
A historically risky, leading to a detection rate of 50 to 70%.

B often avoided which has led to a 50 to 70% confirmation rate.
C are usually avoided due to being too risky to ever undertake.
D have contributed to the microscopic amount of confirmation rates.
10. The improvements in technology as is mentioned in paragraph 2 ……
A have contributed little to detection rates of pancreatic cancer.

B have detected more incidences of pancreatic cancer.
C have led to the increase in early detection of most cancers.
D have detected the abrupt increase of pancreatic cancer.

11. The word modest in paragraph 3 could NOT be replaced by ……
A Minor
B Marked
C Meagre
D Moderate
12. The figures for pancreatic cancer from the passage indicate
A a considerable decline in mortality rates for between 87-07.

B improved mortality rates within the next 10 years
C it will become the leading cause of cancer mortality.
D a highly probable rise in mortality rates in the near future.
13. In paragraph 4, the word ‘categorise’ could be replaced by
A Justify
B Classify
C Rectify
D Objectify
14. The author’s use of language in paragraph 6, is best described as ……
A Dismissive
B Biased
C Objective
D Disapproving

Text 2: Role of oral health on overall well-being
The relationship between oral health and diabetes (Types 1 and 2) is well known and documented. In the last
decade, however, an increasing body of evidence has given support to the existence of an association between
oral health problems, specifically periodontal disease, and other systemic diseases, such as those of the
cardiovascular system. Adding further layers of complexity to the problem is the lack of awareness in much
of the population of periodontal disease, relative to their knowledge of more observable dental problems, as
well as the decreasing accessibility and affordability of dental treatment in Australia. While epidemiological
studies have confirmed links between periodontal disease and systemic diseases, from diabetes to autoimmune
conditions, osteoporosis, heart attacks and stroke, in the case of the last two the findings remain cautious
and qualified regarding the mechanics or biological rationale of the relationship.
Periodontal diseases, the most severe form of which is periodontitis, are inflammatory bacterial infections
that attack and destroy the attachment tissue and supporting bone of the jaw. Periodontitis occurs when
gingivitis is untreated or treatment is delayed. Bacteria in plaque that has spread below the gum line release
toxins which irritate the gums. These toxins stimulate a chronic inflammatory response in which the body, in
essence, turns on itself, and the tissues and bone that support the teeth are broken down and destroyed.
Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected.
As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this
destructive process only has very mild symptoms. Eventually, however, teeth can become loose and may
have to be removed.
The current interest in the relationship between periodontal disease and systemic disease may best be
attributed to a report by Kimmo Mattila and his colleagues. In 1989, in Finland, they conducted a case-control
study on patients who had experienced an acute myocardial infarction and compared them to control subjects
selected from the community. A dental examination was performed on all of the subjects studied, and a dental
index was computed. The dental index used was the sum of scores from the number of carious lesions,
missing teeth, and periapical lesions and probing depth measures to indicate periodontitis and the presence
or absence of pericoronitis (a red swelling of the soft tissues that surround the crown of a tooth which has
partially grown in). The researchers reported a highly significant association between poor dental health, as
measured by the dental index, and acute myocardial infarction. The association was independent of other risk
factors for heart attack, such as age, total cholesterol, high-density lipoprotein triglycerides, C peptide,
hypertension, diabetes, and smoking.
Since then, researchers have sought to understand the association between oral health, specifically periodontal
disease, and cardiovascular disease (CVD) – the missing link explaining the abnormally high blood levels of
some inflammatory markers or endotoxins and the presence of periodontal pathogens in the atherosclerotic
plaques of patients with periodontal disease. Two biological mechanisms have been suggested. One is that
periodontal bacteria may enter the circulatory system and contribute directly to atheromatous and thrombotic
processes. The other is that systemic factors may alter the immunoflammatory process involved in both
periodontal disease and CVD. It has also been suggested that some of these illnesses may in turn increase
the incidence and severity of periodontal disease by modifying the body’s immune response to the bacteria
involved, in a bi-directional relationship.

However, not only is ‘the jury out’ on the actual mechanism of the relationship, it also remains impossible to
say whether treating gum disease can reduce the risk of cardiovascular disease and improve health outcomes
for those who are already sufferers. Additional research is needed to evaluate disease pathogenesis. Should
the contributing mechanisms be identified, however, it will confirm the role of oral health in overall well-being,
with some implications of this being the desirability of closer ties between the medical and the dental professions,
and improved public health education, not to mention greater access to preventive and curative dental treatment.
In time, periodontal disease may be added to other preventable risk factors for CVD, such as smoking, high
blood cholesterol, obesity and diabetes.

15. According to paragraph 1, periodontal disease is unknown to many Australians because ……
A dental treatment is no longer affordable.

B the problem has a high degree of complexity.
C information on dental problems is inaccessible.
D it is not as prominent as other dental issues.
16. ‘Epidemiological’ in the first paragraph is used to denote
A causative
B scientific
C plagiarised
D controlled
17. According to paragraph three, the 1989 study in Finland ……
A prompted further interest in the link between oral health and systemic disease.
B did not take into account a number of important risk factors for heart attacks.
C concluded that people with oral health problems were likely to have heart attacks.
D was not considered significant when it was first reported but is very major now.
18. The relationship between dental hygeine and heart attacks as is expressed in paragraph three is
A inconclusive
B coincidental
C evident
D inconsequential

19. As per paragraph three, the dental index was primarily used to
A indicate whether periodontis was present

B assess the overall oral health of patients.
C establish whether pericoronitis was present.
D predict the onset of acute myocardial infarction.
20. According to paragraph four, the viewpoint expressed is that
A cardiovascular disease could actually exacerbate periodontal disease.

B periodontal disease could modify the body’s immune response.
C there is a bi-directional relationship between periodontal disease and bacteria.
D systemic factors may contribute directly to atheromatous processes.
21. If the processes by which gum disease affects CVD, there will be ……
A less need for doctors and dentists to work in conjunction.

B a reduced emphasis on other preventable risk factors for CVD.
C a concomitant link between smoking and periodontal disease.
D more support for dental care in the public health system.
22. The expression the jury (is) out in paragraph 5 means that a definitive conclusion is ……
A imminent.
B impossible.
C without any merit
D yet to be attained.
END OF READING TEST

THIS BOOKLET WILL BE COLLECTED

Practice test 2

Listening test

Extract 1. Questions 1 -12
You hear a doctor talking to Tom Levin, a patient with some concerns. For questions 1-12, complete the
notes with a word or a short phrase.
Patient : Tom Levin
Developments before : kept it under control from the gap year

admission recurred towards the end of the (1) __________________________
period
started to put a bit (2) __________________________
to push themselves, some people took (3) _____________________
observed (4) __________________________ building up
Effects of elevated mood : felt that it was his (5) __________________________

started to enjoy the opportunity
Client’s reasoning : did not (6) __________________________ to the best of his ability
and hence did not achieve the first
Further description : felt like he was let off the (7) __________________________
substance abuse took a hold
was before the (8) _________________________ were announced
used a lot of cocaine and (9) __________________________
Predominant thoughts : wanted himself to be the person (10) __________________________

wanted to know
thought he was the man (11) _________________________ the town
Defense Mechanism : did not have to deal with the symptoms during the
university
let it take (12) __________________________ of him

You hear a pediatrician called Dr Thomas talking to the mother of a toddler called Ethan. For questions
13-24, complete the notes with a word or short phrase.
Patient : Ethan Lucas
Description of the condtion: started on (13) ________________________________

red patches (14) ________________________________ and on legs
had (15) ________________________________
went (16) ________________________________
Past visit : blood tests done

viral infection confirmed
called the doctor because rashes turned
(17) ________________________________
: baby was very fuzzy
Possible severe condition : patches could be fatal if (18) ________________________________

found to be negative
Diagnosis : rash goes away and reappers when rubbed

child is alert
(19) ________________________________ ; an allergic reaction
could be response to virus or (20) ________________________

child not very ill
Medication suggested : (21) ________________________________ or benadryl

basic anti-allergy medicines
prednizone may be prescribed if condition worsens
makes children (22) _______________________________and irritable
Duration of illness : could last for 7 to 10 days
Possible trigger factors : (23) ________________________ taken
food such as peanuts or (24) ______________________________

should stop food, if it triggers allergy
That is the end of Part A. Now look at Part B.

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.
25. You hear a doctor explain gastroscopy to a patient.
What is the purpose of the doctor’s explanation?
A to make the patient sign the consent form before the procedure
B to reduce the patient’s fear of side effects before the procedure
C to explain possible side effects before signing the consent form
26. You hear a doctor checking a patient’s details with a colleague.
What aspect is the doctor focusing on?
A the patient’s detailed identity

B the patient’s drug administration
C the patient’s overall progress
27. You hear a dentist talking to a patient about implant surgery.
What has the patient misunderstood about the proposed treatment?
A which tooth would be replaced

B the extent of surgery required
C how much it would cost

28. Yo hear a sports nutritionist talk on challenges in routine work
What must they be wary of?
A adopting to opinion flouted by the sportsperson

B contradictory messages being circulated around
C struggles faced by athletes for optimum BMI
29. You hear a surgeon conducting a debriefing meeting with his team
What problem are they going to follow up immediately?
A procedures not running to schedule

B equipment not being readily available
C paperwork not being dealt with efficiently
30. You hear a nurse handing over to a colleague at the end of her shift.
What does the incoming nurse need to do for the patient?
A contact the doctor about his pain management

B arrange for him to be taken for physiotherapy
C set up some monitoring of his mental acuity

Part C
You hear an interview with Dr Larry Appel regarding low GI diet.

31. What was the reason for the second study?
A to find the effect of salt on blood pressure

B to identify the effect of salt on blood pressure
C to scrutinise ethe effect of fruit and vegetable diet
32. What was the finding of the omnicarb study?
A low glycaemic index was helpful

B signals that are related to LDL
C no effects of low glycaemic index
33. What was gauged from the study on comparision of diets?
A low glycaemic index has no effect on risk factors

B insulin resistance showed a difference in control diet
C LDL cholesterol increased in a low - GI diet

34. What does the researcher think of the way ahead?
A study of confounding nutrients that travel together

B benefits could be attributed to other aspects
C finding that low glycaemic food are fibre rich
35. What does the doctor think is crucial for obesity?
A cutting back on episodes of calorie consumption

B inexpensive methods to keeping individuals engaged
C tools that assist people to keep track by monitoring
36. What in the speaker’s vies is the reason for chronic kidney disease?
A fluctuation in the body’s acid - base balance

B unchecked consumption of an adverse diet
C accumulated kidney damage due to ageing
Now look at extract two.

You hear a gastroenterologist called Catherine Frenette talking about new treatment options for
liver cancer.
37. Why does the interviewer describe the numbers as shocking
A incidence has been hugely higher in the past decade

B unresectable liver cancer was detected in the past decade
C underlying liver conditions mutated into liver cancer
38. How does Dr Frenette see alcohol-induced cirrhosis leading to liver cancer
A reducing it should be a primary focus on the fight against liver cancer

B fatty liver developed from alcoholism is leading to more liver cancer
C unlike popular perception, alcoholism is not the leading trigger factor
39. Why are most liver cancers treated by liver doctors and not cancer doctors?
A there are not many treatment options available for liver cancers yet
B liver cancers typically have an underlying liver condition behind it
C the best treatment options are surgical including transplantations
40. Why is it harder to diagnose liver cancer unlike other cancers?
A the symptoms are all over the place and hence not possible to diagnose
B liver conditions reveal fewer symptoms until they have progressed much
C they symptoms for liver diseases and liver cancer are radically varied

41. How does the doctor regard liver function test?
A she considers it to be simple lab test that should be done more often
B she feels that test reports can sometimes be confusing and is unreliable
C she is critical about primary care doctors not conducting the test annually
42. Why does the doctor think that liver cancer doesn’t get the attention despite being a major
concern?
A patients do not present due to the social stigma associated with liver problems
B liver cancer is ranked the fifth most common cause of cancer related deaths
C it is one of the few cancer deaths that is contrastingly increasing in frequency
THAT IS THE END OF THE LISTENING TEST

Reading test
Tuberculosis: Texts
Text A
Tuberculosis
Tuberculosis is an infectious disease caused in most cases by a micro-organism called Mycobacterium tuber-
culosis. The micro-organisms usually enter the body by inhalation through the lungs. They spread from the
initial location in the lungs to other parts of the body via the blood stream, the lymphatic system, the airways or
by direct extension to other organs.
• Pulmonary tuberculosis is the most frequent form of the disease, usually comprising over 80% of cases. It is
the form of tuberculosis that can be contagious.
• Extra-pulmonary tuberculosis is tuberculosis affecting organs other than the lungs, most frequently pleura,
lymph nodes, spine and other bones and joints, genitourinary tract, nervous system, abdomen or virtually any
organ. Tuberculosis may affect any part of the body, and may even become widely disseminated throughout
the whole body.
Tuberculosis develops in the human body in two stages. The first stage occurs when an individual who is
exposed to micro-organisms from an infectious case of tuberculosis becomes infected and the second is
when the infected individual develops the disease.

Text B
Diagnosis of tuberculosis
The most frequent symptoms of pulmonary tuberculosis are:

• persistent cough for 2 weeks or more: every patient presenting with this symptom should be desig-
nated a tuberculosis suspect;
• sputum production, which may be blood-stained (haemoptysis), shortness of breath and chest pain;
• loss of appetite and loss of weight, a general feeling of illness and tiredness, night sweats and fever.
Any patient presenting with any of these symptoms should be suspected of having tuberculosis. If the patient is,
or was, in contact with a patient with infectious tuberculosis, such a person is even more likely to be suffering
from tuberculosis. © IRS Group
Symptoms of extra-pulmonary tuberculosis depend on the organ involved. Chest pain from tuberculosis pleu-
risy, enlarged lymph nodes and sharp angular deformity of the spine are some of the presenting symptoms or
signs of extra-pulmonary tuberculosis.
Symptoms of extra-pulmonary tuberculosis depend on the organ involved. Chest pain from tuberculosis pleu-
risy, enlarged lymph nodes and sharp angular deformity of the spine are some of the presenting symptoms or
signs of extra-pulmonary tuberculosis.
Tuberculosis cases are most likely to be found among:

• patients who present themselves on their own initiative at a health facility with symptoms suggesting
tuberculosis;
• those (especially children and young adults) living in the same household with smear-positive pa-
tients;
• those infected with HIV;
• those found to have an abnormality that has the appearance of tuberculosis when a chest radiograph
has been taken for clinical investigation of a sick patient.
Confirmation of the diagnosis:

There are several tests available to diagnosis TB. some of these are:
• Mantoux Test: This involves injecting a small amount of tuberculin into the skin in the lower part of the
arm. Then the person must return after 48 to 72 hours to have a trained health care worker look at
their arm and examine for hard area or swelling
• TB culture Test : Culture test involve studying bacteria by growing them on different substances. Bacte-
ria are usually contained in a sputum sample taken from suspected person.
• Chest X-ray: If a person has had bacteria which have caused inflammation in the lungs, an abnormal
shadow may be visible on an X-ray.

Text C
First line tuberculosis drugs and its dosage in adults
Drugs Daily dose Preparation Side effects

in mg/kg (range)
Isoniazid 4-6 Tablets(50,100,300 mg)

Aqueous IV/IM solution Burning sensation,
(100mg/ml) Vomiting,Jaundice,
Confusion
Rifampicin 8-12 Capsule(150,300mg) Anorexia, Nausea,

Aqueous IV solution Itching, Purpura,
shock
Pyrazinamide 20-23 Tablet(500 mg) Joint pain,

Jaundice,vomiting
Ethambutol 15-25 Tablet(100 and 400 mg) Visual Impairment
Streptomycin 12-18 IM Injection Dizziness
For drug-resistant TB, a combination of antibiotics called fluoroquinolones and injectable medications such as
amikacin, kanamycin or capreomycin are generally used for 20-30 months.
Text D
Tuberculosis: Lifestyle Management
• People with active TB disease should stay away from work and school until the doctor says it’s safe to return,
in order to avoid infecting others.
• Cover the mouth with a tissue when coughing and sneezing, then seal the tissue in a bag to throw it away.
• Make sure the patient’s room has adequate ventilation, so that the exhaled bacteria are carried away.
• People with active disease need to tell their doctor or health professionals about anyone they have had close
contact with, such as family, friends. © IRS Group
• Take all the medications on right time. If patient stop taking medications or skip some doses, the risk of
developing drug resistant TB is high.

Part A
Time: 15 minutes
Tuberculosis: Questions
Questions 1-6
In which text can you find information about

1. Measures to prevent the spread of disease ________________________________
in household setting
2. Indicators of the disease ________________________________
3. How tuberculosis advances in individals ________________________________
4. Patients under risk ________________________________
5. Investigations to be done ________________________________
6. Tuberculosis treatment after exposure ________________________________
7. Mode of transmission of tuberculosis ________________________________
Questions 7-14
Answer each of the questions, 8-14, with a word or short phrase from one of the texts. Each answer may
include words, numbers or both.
8. Which is the drug used for TB skin test?
________________________________________________________________
9. What is the maximum dose of streptomycin per kilo of a patient’s weight?

________________________________________________________________
10. Which bacteria causes tuberculosis?

________________________________________________________________
11. How long does a patient have to take medication for drug-resistant TB?
________________________________________________________________
12. Which type of tuberculosis spreads from infected person to others?

________________________________________________________________

13. What needs to be ensured to remove breathe out bacteria from a room?
________________________________________________________________
14. What threat follows the stoppage of TB medications?

________________________________________________________________
Questions 15-20
Complete each of the sentences, 15-20, with a word or a short phrase from one of the texts. Each answer may
15. The disease advances beyond the _____________________________ to affect various areas.
16. The signs of extra-pulmonary disease is based on the involved _______________________
17. Mantoux test checks for hard area and .

_____________________________
18. Inflammation of lungs as a result of presence of bacteria may be evident on ___________________________.
19. _____________________________ is suspected on patients who visit the health sector on their own interest.
20. Four-drug regimen falls under _____________________________ tuberculosis drugs.
END OF PART A
THIS QUESTION PAPER WILL BE COLLECTED

Part B
1. The standard procedure for health surveillance must include
A tests that require biological monitoring

B formulation of tests for close scrutiny
C constant testing to check for irregularities
Health Surveillance
As part of the monitoring system, health surveillance should be undertaken if appropriate. The health of
employees exposed to hazardous substances can be affected through absorption into the body. The
absorption route can be inhalation, by ingestion, through the skin or a combination of these. When inside
the body the substances are metabolised. Metabolites can target various organs of the body which can
thereby be harmed. Health surveillance therefore requires biological monitoring. At its simplest this could
be a skin inspection ensuring no dermatitic changes have occurred as a result of exposure to an irritant,
through to lung function tests and urine, breath or blood analysis. The criteria used to decide which type of
surveillance is appropriate depend on whether a test is available. Tributyl tin oxide was once used as a
timber preservation treatment; however, it was not known how it was metabolized in the body and therefore
no appropriate test existed. The potential for it to cause harm could not be eradicated and, as many
occupational diseases have a long latency period - up to 40 years for asbestosis, for example - tributyl tin
oxide was withdrawn from use.

2. The manual promotes ‘airborne precautions’ for the
A use of an elaborate plan to prevent any infection

B ease to monitor adherence of preventive methods
C strength of protection against communicable sickness
Airborne Precautions
Airborne precautions prevent transmission of infectious disease that are spread by airborne droplets (= 5
microns) that remain infectious and suspended in air for long periods of time over long distances and can
be widely dispersed by air currents. Airborne precautions include:
Private room with monitored negative pressure ventilation of 6-12 air exchanges per hour; airborne infec-
tion isolation room (AIIR) preferred © IRS Group
Discharge of air to the outside or HEPA-filtered before recirculation

Door and windows much be kept closed at all times
Respiratory protection (usually an N-95 mask) for susceptible persons must be worn prior to entering
room and removed after leaving room
Droplet mask on patient when leaving room if tolerated; follow respiratory hygiene/cough etiquette
Limit transport to essential purposes only
If possible, non-immune healthcare workers should not care for patients with vaccine-preventable air-
borne diseases

3. The extract ails to give information about
A work practices that reduce the risk of injuries

B the need to specify and follow regulations at work
C the importance of risk assessment and control measures
The six pack

Six new sets of regulations were produced in response to the European Parilament Framework Directive.
These are
Management of health and safety at work
Manual handling operations © IRS Group
Personal protective equipment at work
Health and safety (display screen equipment)
Provision and use of work equipment
Workplace (Health, safety and welfare)
While each set of regulations focuses on specific aspects of the workplace, they all have a common
theme. They reinforce the need for risk assessment, introducing control meaures and follow-up monitoring
and review systems. However, for the first time the idea of a ‘competent person’ is introduced. The em-
ployer is required to appoint one or more competent persons to assist in undertaking the measures needed
to comply with the relevant statutory provisions. This person must be knowledgeable about the risks to
health and safety within that workplace.

4. The extract conveys the need to
A develop patient-centred healthcare service skills

B adopt approaches to achieve excellence in practice
C inculcate skills required by practice developers
Characteristics, Qualities and Skills

Whilst the primary role and function of practice development is the promotion and facilitation of patient-
centred health care services within a department and organization, there had been little work undertaken
examining the systems and processes involved in achieving this. The importance of capturing was to be
clearer about the approaches taken to develop excellence in practice at different organizational levela and
in addition, differentiate the skills and activities inherent in those working in practice development that still
are predominantly nurses. Garbett & McCormack’s substantial study analysing the cocept of practice
development formed the basis for further description and postulation of the characteristics, qualities and
skills of practice developers that remains ongoing.

5. What does the regulation outline?
A prevention of similar injuries to employees ahead

B reporting of grievous injuries for acknowledgement
C analysis of the incident and its proper redressal
The reporting of injuries

Employers are required to report to the HSE (or local authority for retail premises) certain injuries, diseases
or dangerous occurrences that have stemmed from work activities. The enforcing authority must be notified
immediately.
The aim of the regulations is to provide information to the HSE for epidemiological purposes. Analysis of the
information may suggest a pattern of disease or injury associated with a particular industry. Action can be
taken to establish the cause of the risk and its prevention. The HSE has also published literature that is
available for healthcare professionals on request.

6. The extract on randomised control trials on HIV infers
A presence of foreskin is a major precipitating factor

B circumcision performed by certain devices are safe
C immune systems are weak in males are uncircumcised
Male circumcision and HIV infection

A randomized controlled trial is the gold standard for scientific studies, and three such trials conclusively
determined that male circumcision reduces female-to-male HIV transmission by about 60% Responding
to this evidence, in March 2007, the World Health Organization and UNAIDS issued recommendations on
male circumcision and HIV prevention. The primary target cells through which HIV enters the body are
immune system target cells with CD4 receptors, including Langerhans cells. These cells are present in
high density in the epithelium of the inner foreskin and are close to the surface . The highly vascularized
foreskin mucosa and the mucosa at the frenulum are prone to tearing and bleeding during intercourse.
These microinjuries allow easy entry of HIV into the bloodstream. Important note about device-based
surgical methods In 2013, the World Health Organization stated that the male circumcision devices it
prequalifies are efficacious, safe and acceptable as additional methods of male circumcision for HIV pre-
vention among healthy men. Providers who perform circumcisions using device-based surgical methods
should be appropriately trained and competent in these of the specific device.

Part C
Text 1: “Miracle” jab makes fat mice thin
After a four-week course of treatment with a protein called ob, the fat simply falls off, leaving vastly overweight
mice slim, active and sensible eaters. If the protein has the same effect on people, it could be the miracle cure
millions have been waiting for. That, at least, is the theory. But sceptics warn that too little is known about the
way the human version of the ob protein works to be sure that extra doses would help people to lose weight.
But when the results of the tests were leaked last week, Amgen, the Californian biotechnology company
which owns the exclusive rights to develop products based on the protein, saw an overnight jump in its share
prices.
Last December, a team led by Jeffrey Friedman and his colleagues at the Howard Hughes Medical Institute at
the Rockefeller University, New York discovered a gene which they called ob. In mice, a defect in this gene
makes them grow hugely obese. Humans have an almost identical gene, suggesting that the product of the
gene – the ob protein – plays a part in appetite control. The ob protein is a hormone, which Friedman has
dubbed leptin. In April, Amgen, which is based in Thousand Oaks, California, paid the institute $20 million for
exclusive rights to develop products based on the discovery. Amgen will carry out safety tests on the protein
in animals next year, and hopes to begin clinical trials on people within a year.
The excitement began last week when the journal Science published the findings of three groups which have
been working on the protein. The results in obese mice with a defective gene that prevents them making the
protein were dramatic. Mary Ann Pelleymounter and her colleagues at Amgen gave obese mice shots of the
protein every day for a month. Those on the highest dose lost an average of 22 per cent of their weight. Before
treatment, these mice overate, had lower metabolic rates than normal, lower temperatures, and raised levels
of insulin and glucose in their blood” says Pelleymounter. “The protein brought all these back to normal
levels,” she says.
More significantly, in terms of the potential for a human slimming drug, the treatment also worked on normal
mice, which lost what little spare fat they had. They lost between 3 and 5 per cent of their bodyweight, almost
all of it in the form of fat, according to Pelleymounter. This is important because no one has identified a
mutation in the human ob gene that might lead to obesity, suggesting that whatever the cause of obesity, the
ob protein might still help people lose weight. Friedman and his team carried out similar experiments. In just
one month, their obese mice shed around half their body fat. In the average obese mouse, fat makes up about
60 per cent of body weight. Treated mice lost their appetite. Within a few days they were eating about 40 per
cent as much as untreated animals. Their fat practically melted away, falling to 28 per cent of their body
weight after a month. In normal mice, treatment reduced the amount of fat from an average of 12.22 per cent
of body weight to a spare 0.67 per cent.

Friedman and Pelleymounter believe that the protein, which is produced by fat cells, regulates appetite. “We
think it’s something like a circulating hormone to tell the brain there are normal amounts of fat, or too much,
in which case the brain turns down your appetite,” says Pelleymounter. The experiments also show that
treated mice have an increased metabolic rate, suggesting that they burn fat more efficiently. Their appetites
decrease – and they are less sluggish, becoming as active as normal mice.
The third group of researchers from the Swiss pharmaceuticals company Hoffmann-La Roche, are more
sceptical about how significant the ob protein might be in treating obesity. From their studies, they conclude
that the protein is just one of many factors that control appetite and weight. “This is a very important signal,
but it’s one of several,” says Arthur Campfield, who led the team. Campfield doubts whether the ob protein
alone will have much effect in overweight humans. His team hopes to unravel the whole signalling system that
regulates weight, and is particularly keen to find the receptor in the brain that responds to the ob hormone.
Hoffman-La Roche, excluded by the Amgen licence deal from developing products based on the ob protein
itself, hopes to develop pills that interfere with the message pathways in appetite control.
Stephen Bloom, professor of endocrinology at London’s Hammersmith Hospital, agrees. “I think the work with
ob is a major advance, but we’ve not got the tablet yet. That will come when people have made a pill that
stimulates the ob receptor in the brain so it switches off appetite.” Even Pelleymounter at Amgen cautions
against overoptimism at this stage. “We don’t know whether it would be true that people would lose weight,
but you can predict from mice that it would have some positive effect,” she says. “However, I don’t think obese
people should hold out for this. They should carry on with their exercises and dieting.”

7. The first paragraph puts forward to the reader that
A a protein treatment has caused mice to lose weight dramatically

B a protein treatment for mice cannot be adapted for use in humans
C scientists agree that a new protein treatment makes people lose weight
D a scientific method of making obese people slim has been developed
8. According to Friedman and his colleagues, the ob protein
A may be transformed from mice to humans

B may be a factor in appetite control
C is produced by the ob hormone
D is mainly found in obese mice
9. What according to paragraph two does dubbed refer to
A written
B named
C defined
D proved
10. A study by Mary Ann Pellymounter and her colleagues found that
A the ob protein caused subjects in the study to decrease their metabolic rate
B the ob protein cased people to lose about twenty percent of their weight
C a deficiency in the ob protein had caused obesity in the subjects
D a defective ob gene resulted in the production of the ob protein

11. According to the Friedman and Pelleymounter studies, treatment with ob protein
A may be useful only for people with a defective ob gene

B may be useful for anyone who wants to lose weight
C is effective only on mice with a defective ob gene.
D will not be effective on people who want to lose weight
12. What does sluggish in paragraph five denote?
A strong
B lazy
C slow
D sick
13. The research from Hoffman-La Roche are less confident of the protein’s importance because
A it has not been trialled yet on human beings

B the trials done on mice were rather inconclusive
C it does not have a significant role in weight loss
D it is not the only factor involved in appetite control
14. In conclusion, the article suggests that
A a treatment for obesity in humans will be developed from the ob protein

B scientists will soon have more knowledge about the ob receptor in the brain
C the results of the study of mice will lead to weight loss pills for humans
D despite the results of the study of mice, the benefits for humans is unknown

Text 2: The search for cholesterol-free fats
Butter, as anyone who has not been living in a cave for the past ten years has probably heard, contains a lot
of saturated fat, which increases the levels of cholesterol in the blood. Margarine, on the other hand, is made
from vegetable oils, which contain cholesterol-lowering polyunsaturated fat. So switching to a diet with only
vegetable fats should lower cholesterol levels, right? ‘Wrong,’ says Margaret A Flynn, a nutritionist at the
University of Missouri. When she performed the experiment with a group of 71 faculty members – switching in
both directions – she found that ‘basically it made no difference whether they ate margarine or butter.’ The
reason, according to a growing group of nutritionists, could be partially hydrogenated fats. Recent studies
suggest that such fats might actually alter cholesterol levels in the blood in all the wrong ways, lowering the
‘good’ high-density lipoprotein and increasing the ‘bad’ low-density lipoprotein.
Partially hydrogenated fats are made by reacting polyunsaturated oils with hydrogen. The addition of hydrogen
turns the oils solid, and some of their polyunsaturated fat is turned into trans monounsaturated fats.
Monounsaturated fat is generally perceived as good, but things are not so simple. ‘Trans monounsaturates
act in the body like saturated fats,’ says Fred A Kummerow, a food chemist at the University of Illinois at
Urbana-Champaign. ‘Almost all naturally occurring monounsaturated fat is of the cis variety, which is more
like polyunsaturated fat.’ Flynn’s study is not the first to raise questions about trans fatty acids. Ten years
ago a Canadian government task force noted the apparent cholesterol-raising effects of trans fats and requested
margarine manufacturers to reduce the amounts – which can easily be done by altering the conditions of the
hydrogenation reaction.
Last August two Dutch researchers, Ronald P Mensink and Martijn B Katan, published a study in the New
England Journal of Medicine that showed eating a diet rich in trans fats increased low-density lipoprotein and
decreased levels of high-density lipoprotein. In an editorial accompanying the study, Scott M Grundy, a lipid
researcher at the University of Texas Southwestern Medical Center at Dallas, wrote that the ability of trans
fatty acids to increase low-density lipoprotein ‘in itself justifies their reduction in the diet.’ Grundy called for
changes in labelling regulations so that cholesterol-raising fatty acids, including trans monounsaturates, are
grouped together. James I Cleeman, co-ordinator of the National Cholesterol Education Program, disagrees.
‘To raise a red flag is premature,’ he says. ‘Mensink’s audience is the research community – the public
needs useable simplifications.’ Cleeman points out that the subjects in Mensink and Katan’s study ate
relatively large amounts of trans fats. He believes more typical consumption levels should be investigated
before any change in recommendations is warranted.
Furthermore, Cleeman notes that studies like Flynn’s are hard to interpret because subjects were allowed to
eat as they pleased. Flynn’s study, published this month in the Journal of the American College of Nutrition,
found considerable variability among subjects in their blood lipid profiles. ‘The only way to study the question
properly is in a metabolic ward,’ Cleeman says. ‘Trans fats are a wonderful example of an issue that’s not
ready for prime time.’ Edward A Emken, a specialist on trans fats at the Agricultural Research Service in
Peoria, Illinois, also downplays the concern but for different reasons. Although Mary G Enig, a nutritional
researcher at the University of Maryland, has estimated American adults consume 19 grams of trans fat per
day, Emken thinks that figure is too high. According to his calculations, eliminating trans fatty acids from the

diet will for most people make only a tiny change in lipoprotein levels. ‘If you’re hypercholesterolaemic, it
could be important, but if you’re not, then it is not going to affect risk at all,’ he concludes.
Emken, together with Lisa C Hudgins and Jules Hirsch, has performed a study to be published in the American
Journal of Clinical Nutrition that finds no association between levels of trans fats in fat tissue in humans and
their cholesterol profiles. To Emken, that suggests trans fats are not a major threat for most people.
Nevertheless, trans fats seem destined for more limelight. ‘How can one defend having cholesterol and saturated
and unsaturated fats listed on food labels but not allow public access to trans information when such fats
behave like saturates?’ asks Bruce J Holub, a biochemist at the University of Guelph in Ontario. ‘At the very
least, one has to ask whether cholesterol-free claims should be allowed on high-trans products.’

15. What is ‘wrong’ as made out from paragraph one?
A Switching to a diet with traditional vegetable fats

B Commonly held perception of polyunsaturated fat
C The method adopted by the experimental group
D available information regarding hydrogenated fats
16. M A Flynn’s finding is supported by the proposition that
A butter lowers high-density lipoprotein while margarine increases low-density lipoprotein

B butter contains just as much partially hydrogenated fat as margarine does
C trans monounsaturates behave similar to most naturally occurring monounsaturates
D trans monounsaturated fat increases the cholesterol level
17. The passage points out that
A eating butter is not as dangerous for cholesterol levels as was previously thought
B cholesterol levels in humans can be noticeably reduced by cutting out animal fats
C eating margarine is s healthier option than eating butter
D the benefits of using only vegetable fats in the human diet are arguable
18. In paragraph three, what is meant by ‘to raise a red flag’?
A to warn of dire consequences

B to criticize existing methods
C to express unfounded concern
D to ignore prevalent signs

19. James I Cleeman is stated to
A agree with Grundy’s recommendation for relabelling

B dispute Mensink and Katan’s research into the effects of eating trans fats
C want Mensink and Katan’s work discussed outside the research community
D want to wait any longer before warning the public
20. Cleeman is of the view that
A Flynn’s study is not very valuable because she is hard to understand

B trans fats should now be discussed and debated by interested members of the public
C Flynn’s study was not sufficiently rigorous
D Flynn’s subjects should have had more food of a more vaied nature
21. On American consumption of trans fats, Edward Emken
A believes that a reduction in this figure could be achieved quite easily

B is not very concerned about trans fat intake levels for most people
C does not think that they should consume so much in trans fats
D thinks that people should eliminate trans fats from their diets
22. The passage summarises that,
A Emken, in a study published has challenged other researchers’ claims

B the levels of trans fats tissue in humans and their cholesterol profiles are not connected
C the issue of trans fat is likely to receive more, rather than less, attention in future
D food products should be labelled with their trans information in addition to current information
END OF READING TEST


Practice test 3

Listening test

You hear Dr Daniel talking to Samara, a patient preparing for a surgery. For questions 1-12, complete the
Patient : Samara Cox
Reason for visit : Pre-operative discussion
Surgery :joint (1) ______________________________
On the day of surgery : Morning - patient taken to (2) ____________________
Surgeons manipulate the patient
patient taken to (3) ____________________
antibiotics administered
patient set up for (4) ____________________ monitoring
patient rolled up in (5) ____________________ position
Short-term restrictions : limited activity allowed
patient should limit (6) ____________________ standing or

walking to about 30 minutes
avoid repetitive (7) _______________________
Long-term restrictions : avoid things that are (8) ____________________ to the back
avoid certain aerobic exercises
should not do extreme yoga postures
Mobility issues : surgery aims to limit (9) _________________________
mobility will improve after surgery.
Pain management : patient to start (10) _______________________ start by afternoon
pre-operative pain will be gone
: post-operative pain remains and is more

(11) _______________________ than pre-operative pain
pain (12) _______________________ less by next morning

You hear Dr Mark talking to a George Hill, a patient who has eye problems. For questions 13-24, complete the
Patient : George Hill
Description of symptoms : Redness in the (13) ______________________________ of the eye
On the day of surgery (14) ____________________ conjunctivitis
More tears than usual
Thick yellow discharge that (15) ____________________ over

the eyelashes, especially after sleep
Itchy and (16) ____________________
Blurred vision, More sensitive to light
Stuffy or runny nose
Causes An allergic reaction to (17) ____________________
A common cold
Diagnosis : (18) _________________________ done in the lab
Recommendations : Through history collection
Always keep the eyes clean
: Wash or change the (19) _______________________ every day

until the infection goes away
Don’t touch or rub the infected eye
Don’t wear and never share eye make up,
(20) _______________________ or contact lenses
Don’t put a (21) _______________________ over the eye as it may

worsen the infection
Protect the eyes from dirt, especially from the

(22) _______________________
Give adequate rest to the eyes
Apply (23) _______________________ eye drops
Stay away from work for a few days
An (24) _______________________ will help to clear the symptoms

within a few days

Part B
healthcare setting.
25. You hear an oncologist explain thyroid scan and uptake
What is the focus on the talk?
A help patients decide whether they should go for a thyroid scan or not
B explain the procedure in detail and preparation to be done in advance
C reassure that the scan is a safe procedure without major side effects
26. You hear a delivery on hospital discharge meeting
What role is most crucial for physiotherapists
A explaining how to undergo full rehabilitation

B examining the extent of mobility after surgery
C encouraging the patient to perform exercise daily
27. You hear a professional talking on a code blue system
What does he say is the distinctive feature of the system
A increased power output from the tool

B customisation to specific standards
C identification of the source of call.

28. You hear a brief on when to do direct speech therapy for preschool stuttering
How long must pass before a thorough diagnosis
A when the child is distressed about stuttering

B after 6 months from observation of disorder
C as precipitating factors increase in intensity
29. You hear an update on the change in criteria for glaucoma
To qualify for the conditon © IRS Group
A the patient must have more than 25mm of mercury

B it must be a co-morbidity of neuromuscular disease
C the level should fall within the adequate category
30. You hear a health policy statement on structured reporting in a cardiac cath lab
What aim does the speaker state
A accessing information to improve patient quality

B utlising consistent information for quality care
C compiling documents to improve routine work

Part C
You hear an associate professor Stacy Carter talking on overdiagnosis.

31. Why is having a definition to overdiagnosis important?
A results in an absence of conviction when communicating

B lack of clarity affects policies and the general public
C lack of efficiency if several meanings do exist
32. What does she fear about too much medicine
A it results in difficulty to recuperate

B it is detrimental to overall health
C allocation must be based on need
33. What is the fundamental aspect of overdiagnosis?
A identifying areas of benefit from treatment

B trying to balance the effects of both
C locating the harm of too much medicine
34. Which perspective must be taken into account?
A Primarily from the patient

B chiefly based on a consensus
C of the clinicians treating it

35. How must the issue be addressed?
A by covering all basic social needs

B by recognising the motives behind it
C by identifying inherent social factors
36. The narrow sense meant by the speaker is
A having a set of special parameters

B rethinking the diagnostic categories
C bordering the definitive boundaries

You hear an interview with Tom Clarke, a science expert on break through in breast cancer
research
37. What does Mr Clarke say about the new technology
A they are beneficial for personalised care of patients

B they are tailored to the requirements of the patient
C it redefines the spectrum of identifying varying diseases
38. What does the study prove, according ot the speaker?
A treatment course for a specific condition can be mentioned

B large studies are plausible for respective conditions
C breast cancer falls broadly into ten main genetic groups
39. What is the speaker’s view on breast cancer tumor types?
A present understanding of treatment is flawed

B certain conditions have positive outcomes
C it can ensure appropriate treatment
40. Why does the speaker advocate a ‘more tailored approach’?
A due to complexities in the treatment

B because of the many facets of illness
C since the condition is a sum total of disease

41. How do the advanced tests the doctors?
A increase the tools for diagnosis

B prevent the development of conditions
C ascertain the treatment type required
42. What does Mr Clarke ask to be wary of?
A the tests will take more time to be available

B the clinical study has been performed already
C newly diagnosed women can participate in it

Reading test
Deep Vein Thrombosis : Texts
Text A
Descriptors
Deep vein thrombosis occurs when a blood clot (thrombus) forms in one or more of the deep veins in the
body, usually in the legs. It can cause leg pain or swelling, but may occur without any symptoms. Deep vein
thrombosis is a serious condition because blood clots in the veins can break loose, travel through the
bloodstream, and obstruct the lungs, blocking blood flow. Although it usually affects the leg veins, DVT can
occur in the upper extremities, cerebral sinuses, hepatic, and retinal veins.
Common symptoms include pain, especially throbbing cramp like feeling, swelling and tenderness in one of
your legs (usually your calf), a heavy ache in the affected area, warm skin in the area of the clot, red skin,
particularly at the back of your leg below the knee.
Text B
Causes of Deep Vein Thrombosis

Anyone can develop DVT, but it becomes more common in those with age above 40. As well as age, there
are also a number of other risk factors, including:
• having a history of DVT or pulmonary embolism
• having a family history of blood clots
• being inactive for long periods – such as after an operation or during a long journey
• blood vessel damage – a damaged blood vessel wall can result in the formation of a blood clot
• having certain conditions or treatments that cause your blood to clot more easily than normal –
such as cancer (including chemotherapy and radiotherapy treatment), heart and lung disease, thrombo-
philia and Hughes syndrome
• being pregnant – your blood also clots more easily during pregnancy
• being overweight or obese
The combined contraceptive pill and hormone replacement therapy (HRT) both contain the female hor-
mone oestrogen, which causes the blood to clot more easily. If taking either of these, the risk of develop-
ing DVT is slightly increased.

Text C
Nursing Intervention for Deep Vein Thrombosis:
Various nursing intervention for deep-vein thrombosis are in the following:

1. Assess for and reports sign and symptoms of Deep Vein Thrombosis.
2. Keep the affected leg elevated and comfortable position.
3. Keep the head up of bed.
4. Immobilize the patient and initiate bed rest to reduce risk of clot mobilization.
5. Administer anticoagulants as ordered to reduce the risk of additional clotting.
6. Carefully calculate heparin dose.
7. Use infusion pump to administer intravenous heparin.
8. Do not mix the heparinized solution with other medications.
9. Discourage positions that compromise blood flow.
10. Administer analgesics (Morphine) as ordered to manage pain.
11. Apply warm compress to affected leg using a 2-hour-on, 2-hour-off schedule around the clock.
12. Provide elastic compression stocking as it not only increase blood flow, but also reduce swelling and
pain.
13. Administer oxygen as ordered in order to maintain tissue perfusion.
14. Check and monitor any sign of bleeding.
15. Check any sign of complication (Pulmonary embolism).
16. Obtain lab orders to monitor APTT, PT and INR.
17. Ensure intake of vitamin-k rich food including green, leafy vegetable.
18. Instruct patient to keep nasal mucosa hydrate and moist.
19. Ensure a minimum intravenous fluid intake of 2500ml per day for proper hydration unless contraindi-
cated to prevent increase blood viscosity.
20. Provide adequate knowledge to patient pertaining to warfarin therapy.
21. Check any sign of excessive bleeding complication of warfarin therapy.
22. Be aware of the signs of excessive bleeding, such as frequent and bilateral epitasis, hematuria (blood
in the urine) and deep tissue bruising (purpura).
23. Advise the patient to take care when brushing teeth in order to reduce risk of bleeding gums.

Text D
Pharmacological Therapy
AMost DVT medications are anticoagulant drugs. Anticoagulants interfere with some part of the body’s
process that causes blood clots to form. This process is called the clotting cascade.
Newer anticoagulants
Drug name Brand name Oral pill or injectable solution
Apixaban Eliquis Oral
Dabigatran Pradaxa Oral
Dalteparin Fragmin Injectable
Edoxaban Savaysa Oral
Enoxaparin Lovenox Injectable
Fondaparinux Arixtra Injectable
Rivaroxaban Xarelto Oral
Two older anticoagulants used to help prevent and treat DVT are heparin and warfarin. If a patient takes
either of these drugs, the healthcare provider will need to monitor the patient often.
END OF PART A
THIS TEXT BOOKLET WILL BE COLLECTED

Part A
Time: 15 minutes
Deep Vein Thrombosis : Questions
Questions 1-7

1. Warning signs of deep vein thrombosis ________________________________
2. Hormone that increases the risk of DVT ________________________________
3. Definition for clotting cascade ________________________________
4. What does it feel when there is a blood clot ________________________________
5. Care for DVT patients ________________________________
6. Common drug regimen ________________________________
7. Factors that increase the danger of DVT ________________________________
Questions 8-14
8. What is the drug used for pain management?
________________________________________________________________
9. What is the complication of warfarin therapy?

________________________________________________________________
10. Which age group is at the risk of developing DVT more?

________________________________________________________________
11. What does the DVT pain feel like?

________________________________________________________________
12. Where does thrombus most commonly form?

________________________________________________________________
13. Which category does heparin and warfarin belong to?

________________________________________________________________
14. Which type of drugs are used to treat deep vein thrombosis?
________________________________________________________________
Questions 15-20
15. Improving the flow of blodd and decreasing swelling and pain is the advantage of
_____________________________ .
16. The complication of DVT is _______________________
17. Blood clot obstructs the lungs and thereby block the _____________________________ .
18. The female hormone present in contraceptive pill and HRT is _____________________________ .
19. Injectable solution of dalteparin is available by the name ____________________________ .
20. Deep tissue bruising is termed as _____________________________ .
END OF PART A

Part B
1. What is the primary purpose of obtaining a patient’s consent for the review?
A to give patients the liberty to participate or withdraw from the service

B to enable the accredited pharmacist to access relevant information
C to ensure that the information is safeguarded with security measures
Patient’s rights, confidentiality and consent

It is the consumer’s decision to participate in the Home Medicines Review (HMR) process and they may
elect to withdraw from the service at any time. Consent of the consumer is obtained by the GP when
initiating the HMR referral. The consent allows consumer information to be given to the accredited pharma-
cist conducting the HMR. All information gathered throughout the HMR service should be respected and
safeguarded acknowledging the consumer’s right to privacy and confidentiality. This includes all informa-
tion acquired in the course of providing the HMR service, exchanged with other health professionals,
discussed on the phone or in the pharmacy or stored as a result of the review. Confidentiality needs to be
maintained through the development of secure files (either electronic or in a secure filing cabinet). This
includes ensuring that any consumer information that is transmitted electronically uses encrypted or
secure electronic messaging to enhance security. At no time should consumer information be shared with
unauthorised people, relatives or other health care providers without the consent of the consumer or their
representative. Consumer consent needs to be obtained for medication reviews to be conducted and the
associated sharing of necessary information between health care providers. The HMR service provider
should confirm that appropriate consent has been obtained from the consumer before the HMR service is
commenced.

2. What does the guideline try to regulate
A the number of hours of work permissible

B uneven working hours for different professions
C intensity of the work done in stipulated time
Working time regulations

As a general guide, these regulations state that workers cannot be forced to work for more than 48 hours
on average, and limits young workers’ hours to 8 hours a day or 40 hours a week. From 1 August 2018,
junior doctors’ hours will also be restricted. The number of hours should be averaged out over a 17-week-
period. Besides working time limits, the regulations cover working at night, health assessments for night
workers, time off, rest breaks at work and paid annual leave. There are provisions for workers to come to an
‘opt-out’ agreement with their employers for defined periods, should the nature of the work make this
necessary. These guidelines are governed by the Department of Trade and Industry and also the National
Health Service.

3. The note emphasises the significance of the difference by
A indicating the contrasting purposes

B highlighting the informational value
C exhibiting the distinction in outcome
Aggregated versus disaggregated data

To ensure that services reach people in need and that no one is left behind, strategic information needs to
be usable in a way that helps the people, places and situations where interventions are needed. As building
blocks of strategic information, data can be combined or separated for different uses. Aggregated data are
combined from many sources (for example, client records, registers and surveys) and summarized for a
specific purpose, such as reporting or statistical analysis. When aggregated data are separated again
according to a specific variable they become disaggregated. Disaggregated data can inform decision-
making and planning so that interventions more effectively reach targeted groups.

4. The standard procedure for health surveillance must include
A tests that require biological monitoring

B formulation of tests for close scrutiny
C constant testing to check for irregularities
Health Surveillance
As part of the monitoring system, health surveillance should be undertaken if appropriate. The health of
employees exposed to hazardous substances can be affected through absorption into the body. The
absorption route can be inhalation, by ingestion, through the skin or a combination of these. When inside
the body the substances are metabolised. Metabolites can target various organs of the body which can
thereby be harmed. Health surveillance therefore requires biological monitoring. At its simplest this could
be a skin inspection ensuring no dermatitic changes have occurred as a result of exposure to an irritant,
through to lung function tests and urine, breath or blood analysis. The criteria used to decide which type of
surveillance is appropriate depend on whether a test is available. Tributyl tin oxide was once used as a
timber preservation treatment; however, it was not known how it was metabolized in the body and therefore
no appropriate test existed. The potential for it to cause harm could not be eradicated and, as many
occupational diseases have a long latency period - up to 40 years for asbestosis, for example - tributyl tin
oxide was withdrawn from use.

5. Needle stick injuries must be handled by
A following the laid out steps for complete care

B primarily completing any critical procedures
C exercising caution and refraining from routine
What to do if there is a needle-stick (sharps) injury
Despite best efforts, needle-stick (sharps) injuries do occur. The injured health care worker must balance
his/ her risks with the safety of the client. The following guidelines can help health care workers address
needlestick (sharps) injuries: As soon as it is safe to do so (with regard to client safety), the health care
worker with the needle-stick (sharps) injury should stop what he/she is doing, remove gloves, and wash
both hands and the area of the needle-stick (sharps) injury with soap and plenty of water. No antiseptics or
scrubbing brushes should be used. If the provider is in the middle of a procedure, then another qualified
provider should take over and complete the procedure. If no other qualified provider is present, then the
injured provider should ensure that any critical step is complete, wash both hands and the area of the
needle-stick injury, change gloves, and then complete the procedure. Should inform senior staff or manag-
ers at the clinic and follow clinic protocols for managing the needle-stick (sharps) injury.

6. What does the circular convey?
A information on managing blood borne pathogens

B the policy implementation required for personnel
C preventative measures to reduce pathogenic risk
Managing Occupational Exposure To Blood Borne Pathogens,

Hepatitis And Hiv Through Post-Exposure Prophylaxis
Health care workers are at increased risk of accidental exposure to bloodborne pathogens—such as
hepatitis B and C viruses and HIV. A minimum approach to health and safety practices for health care
providers and waste workers includes the following:
• implementation of standardized management approaches
• compulsory vaccination for the hepatitis B virus for all health care workers, including cleaners and staff
who handle medical waste © IRS Group
• provision of sharps disposal boxes for safe disposal of used needles, syringes and other sharps •
compliance with hand hygiene standards
• availability of appropriate personal protective equipment—mask, face shield or goggles, rubber apron and
utility gloves (at the bare minimum, every health care worker handling waste should have a face shield and
utility gloves)
• appointment of a clinic staff member or designated staff to additional or dedicated responsibility for
infection control, including waste management
Immediately after any needle-stick (sharps) injury, the person injured should—as soon as it is safe to do
so—hand over his/her duties to another provider and wash the area with plenty of soap and water. Antisep-
tics or caustic agents, such as bleach, should not be used. Flush any exposed mucous membranes with
plenty of water. The clinic should have a system to quickly report any needle-stick (sharps) injuries to the
nearest health facility that provides post-exposure prophylaxis services so that this can be given to the
injured health care worker according to the national guidelines.

Part C
Text 1: Non-invasive prenatal testing: the new era in reproductive medicine
In some countries, it is routine practice to offer pregnant women screening for foetal chromosomal and
structural abnormalities, and, if serious anomalies are diagnosed, the option of terminating the pregnancy.
Screening for chromosomal abnormalities commenced in the 1960s and was initially restricted to women
whose pregnancies were considered to be of increased risk because of an obstetric history of aneuploidy or
advanced maternal age. Over the past five decades, prenatal chromosome screening (PCS) has been expanded
to encompass the entire obstetric population. However, the commonly used aneuploidy screening tests are
plagued by high false-positive rates, typically 4%–5%. Confirmation of an increased screening risk for aneuploidy
involves diagnostic tests such as amniocentesis or chorionic villus sampling, each associated with low but
definite risks of pregnancy loss.
Many women are reluctant to proceed with a diagnostic test after a positive aneuploidy screening result, and
the ability to assess foetal genetic material without directly sampling the amniotic fluid or placenta has long
been a goal of prenatal diagnosis. The recent development of non-invasive prenatal testing (NIPT), a high-level
screening test using cell-free foetal DNA, offers the opportunity to markedly reduce the requirement for invasive
testing while potentially also increasing detection rates of chromosomal anomalies, in particular of trisomy
21. In addition, NIPT may be offered earlier in pregnancy than standard aneuploidy screening and diagnostic
techniques.
Although initially used in pregnancies at high risk for aneuploidy, recent data indicate that NIPT is also a
robust screening test in lower-risk pregnancies. NIPT is now the most sensitive and specific screening test for
the common trisomies, with detection rates greater than 99% for trisomy 21 and false-positive rates of less
than 0.5%. The performance characteristics for trisomies 13 and 18 and the sex chromosome anomalies are
lower than for trisomy 21, although the sensitivity is still typically greater than 90%.
NIPT is not without its limitations. Failure to obtain a result occurs in routine clinical practice in about 3%–4%
of tests, usually due to a low cell-free foetal DNA fraction, which is detectable in the maternal bloodstream,
typically because the sample was collected too early in the pregnancy or because of maternal obesity. False-
positive results have been associated with confined placental mosaicism, the death of a co-twin, maternal
malignancy and maternal mosaicism. Detection rates appear to be lower and the chances of not obtaining a
result are higher in twin than in singleton pregnancies.
Ethical questions, ever present and never fully resolved when discussing prenatal testing, will come more
sharply into focus with the broader introduction of NIPT into obstetric practice. A woman and her partner have
two options after trisomy 21 has been diagnosed: continuation or termination of the pregnancy. The option of
termination is widely regarded in our society as part of the couple's reproductive health rights. If the diagnosis
is made earlier, and termination methods that are less stressful and safer for the woman and more acceptable
to medical staff are available, there could be greater pressure to undergo testing (and termination, when
abnormalities are detected) than is currently the case.

What message does this then send to people with trisomy 21 in our community and their families? The same
arguments would apply to other non-lethal chromosomal anomalies, such as Turner syndrome. Of even
greater consequence would be the ability to discover the sex of the foetus at an early stage. Sex-based
termination, widespread in some parts of Asia, is believed to be uncommon in developed countries, but this
situation could change were the sex known much earlier in pregnancy. The wider introduction of NIPT must be
accompanied by appropriate increases in the provision of genetic counselling services for women and of
education for health care providers.

7. Paragraph one indicates that termination of pregnancy is
A commonly practised in some countries

B a possibility in some countries
C routine practice in most countries
D often carried out for serious anomalies
8. Prenatal chromosome screening has
A confirmed an increase in screening risk

B resulted in significant loss of fetal life
C been observed to be used in all pregnancies
D commonly shown an increased sign of abortion
9. Paragraph two concludes that NIPT may
A slightly lessen the requirement for invasive testing

B marginally increase requirement for invasive testing
C dramatically decrease the need for invasive testing
D significantly increase the need for invasive testing
10. Paragraph three suggests that for lower-risk aneuploidy detection
A NIPT is proving reliable for finding strong and durable lower-risk rates
B NIPT is considered to be a strong and reliable screening process
C NIPT is considered a significantly reliable robotic testing format
D NIPT mainly finds aneuploidy in lower-risk screening processes

11. In paragraph four, it is assumed that carrying twins
A may lead to false-positive results, as can maternal mosaicism

B is included in the list of concerns involving false-positive readings
C gives a substantial drop in NIPT data of singleton pregnancies
D proves a greater risk in acquiring unreliable detection rates from NIPT
12. The phrase ‘will come more sharply into focus,’ in paragraph 5 means ethical questions
A will be visually clear and free from debate for all people.
B will become a topic of greater discussion and debate among people.
C will become a topic of much hostile criticism among the community.
D will rise quickly into focus and force complacency among the community
13. Which of the following best describes the author’s use of the term non-lethal in paragraph six?
A unimpressive
B dangerous
C unintentional
D nonnoxious
14. The final paragraph professes
A NIPT will cause sex-based termination to increase in developed countries.

B Counselling and education must be given prior to introducing NIPT.
C Sex-based termination is an obsolete problem throughout Asia.
D Education and counselling services should coincide with introducing NIPT

Text 2: Caring means Curing
In the paediatric intensive care unit at the University of California San Francisco (UCSF) Medical centre, four
nurses are clustered around the bed of an unconscious 7-year-old Cambodian boy who was hit by a truck
several days earlier. A plastic respirator tube snakes out of his mouth, and other tubes and wires connect him
to IV drips, evacuation bags, and a series of monitors that provide second-by-second displays of his heart and
respiratory rhythms. His right leg, bent at the knee, is held up in traction. His face is so swollen that visitors
find it too grueling to stare for too long. He is sedated to shield him from what would be excruciating agony and
to stave off any further threat of injury.
Janet Craig, a nurse educator based in the paediatric intensive care unit is comforting the boy’s family as they
keep an anxious bedside vigil. As they talk, a sudden commotion diverts Craig’s attention. She rushes
towards the room of another patient, hastily explaining that this 17-year-old girl has been a frequent visitor to
the ICU. She was born with a congenital heart defect that has required a number of surgeries, and recently
she may have suffered a heart attack. Five days earlier surgeons had implanted a permanent pacemaker, but
also decided that a heart transplant would be necessary if she were to survive over the long term.
In such an hour of intense activity, and in the time she spends each day attending to complex cases such as
those in the ICU, Janet Craig, an intensive care nurse for over 14 years, tries her utmost to embody the very
heart of the nursing profession – that unique relationship between caring and curing. In hospitals and communities
throughout the world, nursing staff are treating not only the patient’s complex physical needs but their interlinked
emotional needs as well. While doctors focus on limb, heart, or lung, nurses carry out the medical regimens
that physicians prescribe, as well as monitoring intricate human needs.
Nurses take care of patients 24 hours a day, 7 days a week. If a patient with a broken leg complains of chest
pain, it is the nurse’s duty to inform the physician of a suspected pulmonary embolism. If a patient with
metastatic breast cancer comes in for chemotherapy and complains of dizziness, shivering, and simply not
feeling like herself, the nurse will alert the oncologist to the possibility that the cancer may have travelled to
the brain. In addition to following the physicians’ treatment plan, nurses establish treatment plans of their
own. They assess patients’ basic needs and do for them what they cannot do alone; they help educate
people about how to cope with a disease or the aftermath of surgery; they become deeply involved – as
patient advocates – in helping patients and families make informed decisions about major surgery and
termination of life-support systems. All of these responsibilities should make nurses major participants in the
evolving debate about national health care. Yet to most of the public and policy-makers, they remain almost
invisible.
Real health care involves far more than paying physicians to intervene when disease is well established or
financing dazzling research into potential ‘cures.’ It involves education in disease prevention and health
maintenance from childhood through old age, as well as providing skilled nursing care in hospitals when
patients are acutely ill. A truly humane system would not push futile treatment on patients with terminal
diseases, but would permit them to die in comfort and with dignity. A genuinely economical health-care
system would finance a cohesive network of long-term care to be provided outside of big hospitals in the home
and the community.

To create a new health-care system, nurses need to be far more assertive in promoting their profession and its
achievements. They also need advocates and allies – among patients, families, politicians and businessmen
– who understand that high-quality health care is dependent not only on technology, surgery and the promise
of cure but also on the efforts of those nurses providing the care necessary for cure to be possible at all.

15. In paragraph one, what is meant by the use of the word ‘clustered’?
A Anxious
B Silent
C Motionless
D Gathered
16. the use of sedatives as mentioned in paragraph one are
A given needlessly for the particular situation

B to immobilise him and numb the pain
C to prevent the respiratory tube from moving
D not needed as he is unconscious
17. The objective of nurse educator is to
A keep a bedside vigil with the patient’s relatives

B maintain a level of support befitting the situation
C take charge of the emergency situation taking place
D remedy the immediate danger to the 17-year-old-girl
18. In paragraph three, the author’s view is that
A doctors should solely treat the physical needs of the patient

B nurses only focus on the emotional and human needs of patients.
C nurses undergo a grueling regimen of physical prescriptions.
D doctors tend to deal with the physical aspects of the patient.

19. According to paragraph four, current debates on health care have
A completely excluded nurses and their insight into the health industry.
B left policy-makers and the public no alternative but to exclude nurse
C evolved without proper input from nurses
D remained nearly invisible to policy-makers and the public
20. As per paragraph five, complete healthcare involves
A disease prevention and humane system

B providing funds for probable cure
C permitting people to die with dignity
D health education and skilled care
21. The opinion put forth by the final paragraph is that
A Confident nurses are unnecessary for a positive view of their profession.

B Nurses need politicians support for new technological advancements.
C The promise of cure does not guarantee successful surgeries.
D Nursing as a whole is as imperative as other dependent factors.
22. Which word can be best described for the term “futile” in paragraph five?
A expensive
B flashy
C needless
D unprofitable
END OF READING TEST


Practice test 4

Listening test

You hear a nurse talking to Elizabeth, a patient who requires follow-up care.
For questions 1-12, complete the notes with a word or a short phrase.
Patient : Elizabeth Campbell

Reason for the visit : referral to (1) __________________________ health nurse
pain in the back
experienced discomfort and (2) ____________________ in the back
used pain relief oinments to relive the symptoms.
Treatment history : pain started one and a half years ago
was (3) _______________ a pain killer.
hospitalised © IRS Group for 2 days.
12 months ago : underwent blood tests and (4) _________________________ test.
6 months ago (5) _________________________ was found.
surgery to remove a (6) _______________________ of the bone
Recent pain control (7) _________________________ 3 times a day
alternative modalities of pain relief
smokes (8) _______________________ (dope)
Mental status : seems (9) __________________ and anxious because of tumour
considered (10) _______________________ because of bouts of

depression
Assessment & follow-up : arrange for (11) _______________________
alternative therapies - accupressure, accupuncture

and (12) ___________________
see a specialist

You hear Dr Juvenita talking to a Griffith Alexander, a patient with back problems. For questions 13-24, complete the
Patient : Griffith Alexander
Patient’s condition : back spasm
Presenting symptoms (13) ____________________ , not sleeping well
exhausted with discomfort
Treatment options : (14) ____________________ for the back pain spasm, medication
for pain.
exercises and heating pad © IRS Group
back pain gets better with the (15) ____________________
Patient’s request : needs an (16) ____________________ since he is concerned
might have a (17) _________________________ or slipped disc

that requires attention
Explanation given : has (18) _______________________ that reveals other than a back
spasm
No red flags to be concerned about
(19) ___________________ treatment is enough for most patients
Patient’s concern : been over a week, will be (20) _______________________ ,

disabled for life
will be informed if something is wrong
(21) _______________________ from the machine may ease the

condition
Advice offered : MRI is an (22) _______________________ study, not a treatment

mode
MRIs may cause harm if its unrequired
most patients get better within (23) _______________________

with the prescribed treatment
Patient’s response : consider an MRI if other (24) _______________________ present

Part B
healthcare setting.
25. You hear a nurse manager instructing a batch on clinical formalities.
What is the instructor trying to convey?
A standard procedure for medication administration

B methods to improve clinical skill and performance
C checklists prepared for a physician’s appointment
26. You hear an extract of a nurse talking about ‘confidence in profession’.
What does the seminar emphasise
A acknowledge the mistake that was committed

B composed and calm admittance of any errors
C understanding that the situation can be overcome
27. You hear a doctor talking about aboriginal mental health
Why did the psychologist say culture bound prevention does not exist?
A because it is not researched thoroughly yet

B since it has not been exposed to it earlier
C due to the lack of evidence to support it

28. You hear a pharmacist telling a patient about some medication.
Why does she give a verbal explanation of the side effects?
A to highlight their severity

B to ensure the patient understands
C to allow the patient to raise any concerns
29. You hear two nurses discussing about a patient during handover
What was administered to him?
A Stiches on the right shoulder

B morphine and antibiotic drip
C dosage to prevent blood clot
30. You hear a mental health specialist talking about therapeutic interventions
Treatment mode that worked best was by
A assisting the patient overcome sheer solitude

B understanding the person’s cognitive complexities
C empowering the patient by active listening

Part C
You hear a presentation on treating scoliosis by a physiotherapist called John Booker.

31. What general point does John make about physiotherapy
A It allows patients to opt for a less invasive form of treatment.

B It tends to be used in conjunction with other forms of treatment.
C It places more emphasis on prevention than other forms of treatment.
32. John suggests that before treating a patient with scoliosis, the physiotherapist needs
A to develop a treatment plan based on a description of the symptoms.

B to establish whether the cause of the condition has been identified.
C to determine which of the two main types is being presented.
33. John feels that once scoliosis is confirmed, the priority for the multi-disciplinary team
should be
A to determine the severity of the condition.

B to agree how exercises will complement medication.
C to ensure that the patients’ pain is being well managed.

34. The second phase in John’s preferred treatment plan for scoliosis focuses on
A using new techniques on various joints in the body.

B regaining full movement in the affected part of the spine.
C ensuring the patient has realistic aims regarding the likely outcome.
35. John believes that success in the final phase of treatment depends on
A handing long-term responsibility over to the patient.

B ongoing co-operation between physiotherapist and patient.
C practical assistance supplied by practitioners in other professions.
36. John suggests that patients with mild to moderate scoliosis often
A find the demands of physiotherapy too challenging.

B express doubts about the effectiveness of physiotherapy.
C lack the motivation to gain any benefit from physiotherapy.

You hear an interview with Dr Michael Greger, an expert on vegan diet.
37. What is the biggest progress to vegan diet as per the doctor.
A clinics operating on plant-based diet

B surge in plant-based nutrition movement
C Palpable changes in health sector
38. Why does the doctor think a change is inevitable?
A majority of the illnesses are largely preventable

B there is a degree of control on human longevity
C risk factors to health have been precipitating
39. The doctor believes sufficient randomised control trials are in existance because
A it does not have the backing of corporate budget

B many people are dying due to preventable illnesses
C it was published in a medical journal two decades ago
40. Why does the expert feel the need to publish resources
A doctors had monopoly over health industry

B access to information by the masses
C to address immediate health concerns

41. Doctor Michael thinks of a conflict of interest in USDA because
A they refrain from taking measures that are unviable

B the message is to eat more fruits and vegetables
C medical professionals must frame dietary guidelines
42. What is the primary barrier faced by doctors?
A big pharma companies sponsor mainstream medical associations

B they are not paid enough to communicate with patients
C the defeciency of knowledge from medical schools

Reading test
Schizophrenia: Texts
Text A
Assess Symptoms and Establish a Diagnosis.
Establish an accurate diagnosis, considering other psychotic disorders in the differential diagnosis because of
the major implications for short- and long-term treatment planning. If a definitive diagnosis cannot be made but
the patient appears prodromally symptomatic and at risk for psychosis, evaluate the patient frequently.
Reevaluate the patient’s diagnosis and update the treatment plan as new information about the patient and his
or her symptoms becomes available. © IRS Group
Identify the targets of each treatment, use outcome measures that gauge the effect of treatment, and have
realistic expectations about the degrees of improvement that constitute successful treatment.
Consider the use of objective, quantitative rating scales to monitor clinical status (e.g., Abnormal Involuntary
Movement Scale [AIMS], Structured Clinical Interview for DSM-IV Axis I Disorders [SCID], Brief Psychiatric Rating
Scale [BPRS], Positive and Negative SyndromeScale [PANSS]).

Text B
Assistance in Organising Confusing Experiences

ABC model
The ABC model, which was originally developed by Ellis and Harper,12 can be used to give the patient a
way of organizing confusing experiences. It involves slowly and thoroughly moving the patient through the
various steps using Socratic questioning to clarify the links between the emotional distress the patient is
experiencing and the beliefs he holds (Table). It includes the following steps:
• Based on a scale of 0 to 10, the patient rates the intensity of distress.
• The consequence (C) is assessed and divided into emotional and behavioral Cs.
• The patient gives his own explanation as to what activating events (As) seemed to cause C; and
the therapist ensures that the factual events are not “contaminated” by judgments and interpretations.
• The therapist provides feedback to the patient to acknowledge the A-C connection.
• The therapist assesses the patient's belief, evaluations, and images and communicates to the
patient that a personal meaning is lacking in the A-C model; simple examples can be provided to facilitate
understanding.
• The patient's own belief (B), which is actually the cause of C, is then discussed; often, this can
be rationalized, and a B such as “nobody will like me if I tell them about my voices” can be disputed and
changed to “I can't demand that everyone likes me. Some people will and some won't...Maybe some
friends might find it interesting.” This may lead to a change in C, ie, less sadness and isolation.

Text C

Text D
Goals of Treatment
• Minimize stress on the patient and provide support to minimize the likelihood of relapse.
• Enhance the patient’s adaptation to life in the community.
• Facilitate continued reduction in symptoms and consolidation of remission, and promote the process
of recovery.
If the patient has achieved an adequate therapeutic response with minimal side effects, monitor response
to the same medication and dose for the next 6 months.
Assess adverse side effects continuing from the acute phase, and adjust pharmacotherapy accordingly
to minimize them.
Continue with supportive psychotherapeutic interventions.
Begin education for the patient (and continue education for family members) about the course and out-
come of the illness and emphasize the importance of treatment adherence.
To avoid gaps in service delivery, arrange for linkage of services between hospital and community treat-
ment before the patient is discharged from the hospital.
For hospitalized patients, it is frequently beneficial to arrange an appointment with an outpatient psychia-
trist and, for patients who will reside in a community residence, to arrange a visit before discharge.
After discharge, help patients adjust to life in the community through realistic goal setting without undue
pressure to perform at high levels vocationally and socially.

Part A
Time: 15 minutes
Schizophrenia: Questions
Questions 1-7
letter more than once. © IRS Group

1. Facilitating continued deduction in symptoms ________________________________
2. The various steps using socratic questioning ________________________________
3. Gauging the effect of treatment to establish diagnosis ________________________________
4. The rating scales used to monitor clinical status ________________________________
5. Administration routes © IRS Group for giving drugs ________________________________
6. Advantages of haloperidol medication for treatment ________________________________
7. Division into emotional and behavioural Cs ________________________________
Questions 8-14
8. What must be arranged for, to avoid gaps between hospital and community
________________________________________________________________
9. What was the ABC model developed to © IRS Group assist

________________________________________________________________
10. What does the therapist provide to acknowledge the A-C connection?
________________________________________________________________
11. What can be used to gauge the effect of treatment?

________________________________________________________________
12. What must be done if the patient appears problematically symptomatic?

________________________________________________________________
13. How long will a sublingual administration of asenapine take to peak plasma concentration?
________________________________________________________________
14. Which drugs are examples of slow acting orally disintegrating tablets?
________________________________________________________________

Questions 15-20
15. A disadvantage of inhaled medication is that it requires _____________________________.
16. _____________________________ route of administration of midazolam ensures rapid absorption.
17. It is advised to _____________________________ the patient’s diagnosis and update the treatment plan.
18. The ABC Model helps to clarify _____________________________ from the beliefs the patient holds.
19. Assitance in understanding © IRS Group can be facilitated by providing ______________________ .
20. After discharge, patients must be allowed to perform without _____________________________.

Part B
1. The extract from the circular is intended to
A. give information on compiling private prescriptions

B. remind the staff of particulars to be included
C. instruct the doctors of methods to standardise procedures
Record keeping
A record must be kept of every DCA EPP prescription only medicine (POM) supplied. Record to be kept in
a bound book or electronically.
• Particulars to be recorded:
— Date of supply
— Name, © IRS Group
quantity and pharmaceutical form and strength of the medicine
— Date on the prescription
— Name and address of the prescriber
— Name and address of the patient
• Entry must be made on the day of supply, or if that is not reasonably practical, on the next following day.
• The record must be retained for a period of 2 years from the date of last entry in the book/electronic register.
• Prescription token must be referenced accordingly and filed in a chronological order, and retained for a
period of 2 years from the date of supply.

2. The report on homeless patients suggests that issues can be addressed by
A. assuring help required from a GP or dentist

B. registering the identity of those uncovered
C. adhering to the laid down structure of identification
The issues of looking after homeless patients in General

Practice
In 2014 Homeless Link reported that 90% of the homeless people they surveyed were registered with a
GP. However many responded that they were not receiving the help they needed for their health prob-
lems, and 7% had been refused access to a GP or dentist in the previous 12 months. In some cases
these refusals were due to having missed a previous appointment or because of behaviour. Others
reported that they were refused access if they did not have identification or proof of address. The Health
and Social Care Act introduced statutory duties on the health department to “have regard to the need to
reduce inequalities” in access to and outcomes achieved by services. Many practices request multiple
forms of identification and proof of address when registering new patients. This can be useful for them to
ensure identity and contact details. The General Medical Services Contracts Regulations state that
practices may only refuse an application to go on their list if they have reasonable grounds for doing so
which do not relate to the applicant’s race, gender, social class, age, religion, sexual orientation, ap-
pearance, disability or medical condition.

3. What does this advisory intend to convey?
A. The requirement for monitor of malnourished patients.

B. Primary route for providing external nutritional support
C. Identification and management of malnourished patients.
Step to contain malnourishment
Malnutrition is a state in which a deficiency of energy, protein and/or other nutrients causes measurable
adverse effects on tissue/body form, composition, function or clinical outcome. It is vital to identify
patients at risk of malnutrition as nutritional support is advantageous in malnourished patients. A nutri-
tional screening tool can help identify the patient. A useful malnutrition Universal Screening Tool has
been developed by the Malnutrition Advisory Group.
Enteral nutrition should be the first-line route for the provision of nutritional support. If the gut works,
enteral feeding should be used. © IRS Group

4. The directive on discharge plan outlines the
A. Approach to be considered on the length of the stay

B. Need for the patients choice in the duration of stay
C. Use of systems to estimate the course of admission
Discharge or transfer protocols update
Most patients want to know how long they are likely to stay in hospital, and to be provided with informa-
tion about their treatment and when they are likely to be discharged. This helps them achieve their goals
and plan for their own transfer. The exceptions to this are intensive care and high-dependency units,
where setting an expected date should be delayed until the patient is transferred to the ward. Predicting
a patient’s length of stay can be undertaken in two ways. It can be based on actual performance in the
ward or unit, or on benchmarking information. It is essential that the ward or unit understands and uses
the adopted system to give a valid and sustainable approach. The Department of Health’s discharge
guidance states that: “Estimated date of discharge is based on the expected time required for tests and
interventions to be completed, the integrated care pathway and the time it is likely to take for the patient
to be clinically stable and fit for discharge.”

5. In the prospectus for infection prevention, what are control professionals required to do?
A. Prepare an exhaustive analysis and control an outbreak

B. Chart a course to apply policies that cuts an infection
C. Implement practices that are best suited for individuals
Infection prevention and control professional
A person whose primary training is in either nursing, medical technology, microbiology, or epidemiology
and who has acquired specialized training in infection control. Responsibilities may include collection,
analysis, and feedback of © IRS Group infection data and trends to healthcare providers; consultation
on infection risk assessment, prevention and control strategies; performance of education and training
activities; implementation of evidence-based infection control practices or those mandated by regulatory
and licensing agencies; application of epidemiologic principles to improve patient outcomes; participa-
tion in planning renovation and construction projects (e.g., to ensure appropriate containment of con-
struction dust); evaluation of new products or procedures on patient outcomes; oversight of employee
health services related to infection prevention; implementation of preparedness plans; communication
within the healthcare setting, with local and state health departments, and with the community at large
concerning infection control issues; and participation in research.

6. In view of the circular published, what is the hospital trying to address
A. services required by the midwives for intensive care

B. support required for full term pregnant mothers
C. objectives that are vital for quality maternal care
Commitment and Support by Governing Body
In view of the necessity for Zamboanga City Medical Center

• to continuously control maternal death;
• to continuously provide quality and safe maternal care service; and
• to collaborate with the Department of Health on the control of maternal deaths to meet the Millenium
Development Goal,
the undersigned representing the governing body and top management of Zamboanga City Medical
Center hereby wholeheartedly commit to lead and to provide support in establishing and developing a
Maternal Death Control Management System in Zamboanga City Medical Center starting October 13,
2018. We also hereby authorize the Zamboanga City Medical Center Maternal Death Control Manage-
ment System Team to administer the program. This Manifestation of Commitment and Support by the
governing and top management by the Zamboanga City Medical Center shall be renewed every three
years.

Text 1: The Chemistry and Physics Behind the Perfect Cup of Coffee
We humans seem to like drinks that contain coffee constituents (organic acids, Maillard products, esters and
heterocycles, to name a few) at 1.2 to 1.5 percent by mass (as in filter coffee), and also favor drinks containing
8 to 10 percent by mass (as in espresso). Concentrations outside of these ranges are challenging to execute.
There are a limited number of technologies that achieve 8 to 10 percent concentrations, the espresso machine
being the most familiar.
There are many ways, though, to achieve a drink containing 1.2 to 1.5 percent coffee. A pour-over, Turkish,
Arabic, Aeropress, French press, siphon or batch brew (that is, regular drip) apparatus – each produces
coffee that tastes good around these concentrations. These brew methods also boast an advantage over their
espresso counterpart: They are cheap. An espresso machine can produce a beverage of this concentration:
the Americano, which is just an espresso shot diluted with water to the concentration of filter coffee. There are
two families of brewing device within the low-concentration methods – those that fully immerse the coffee in
the brew water and those that flow the water through the coffee bed.
From a physical perspective, the major difference is that the temperature of the coffee particulates is higher in
the full immersion system. The slowest part of coffee extraction is not the rate at which compounds dissolve
from the particulate surface. Rather, it’s the speed at which coffee flavor moves through the solid particle to
the water-coffee interface, and this speed is increased with temperature.
A higher particulate temperature means that more of the tasty compounds trapped within the coffee particulates
will be extracted. But higher temperature also lets more of the unwanted compounds dissolve in the water,
too. The Specialty Coffee Association presents a flavor wheel to help us talk about these flavors – from green/
vegetative or papery/musty through to brown sugar or dried fruit. © IRS Group
The water-to-coffee ratio matters, too, in the brew time. Simply grinding more fine to increase extraction
invariably changes the brew time, as the water seeps more slowly through finer grounds. One can increase
the water-to-coffee ratio by using less coffee, but as the mass of coffee is reduced, the brew time also
decreases. Optimization of filter coffee brewing is hence multidimensional and trickier than full immersion
methods.
Every coffee enthusiast will rightly tell you that blade grinders are disfavored because they produce a seemingly
random particle size distribution; there can be both powder and essentially whole coffee beans coexisting.
The alternative, a burr grinder, features two pieces of metal with teeth that cut the coffee into progressively
smaller pieces. They allow ground particulates through an aperture only once they are small enough.
There is contention over how to optimize grind settings when using a burr grinder, though. One school of
thought supports grinding the coffee as fine as possible to maximize the surface area, which lets you extract
the most delicious flavors in higher concentrations. The rival school advocates grinding as coarse as possible
to minimize the production of fine particles that impart negative flavors. Perhaps the most useful advice here
is to determine what you like best based on your taste preference.
Finally, the freshness of the coffee itself is crucial. Roasted coffee contains a significant amount of CO2 and
other volatiles trapped within the solid coffee matrix: Over time these gaseous organic molecules will escape
the bean. Fewer volatiles mean a less flavorful cup of coffee. Most cafes will not serve coffee more than four
weeks out from the roast date, emphasizing the importance of using freshly roasted beans.

7. The favorable concentration of drinks by mass in espresso include
A 3 percent by mass
B 8 percent by mass
C 12 percent by mass
D 1.3 percent by mass
8. What can be the advantage of other brew methods over espresso
A They produce a favorable concentration

B The methods are cheaper
C The other brew methods produce tastier coffee
D The other methods are advantageous
9. What can be the meaning of "counterpart"
A Neighbor
B Enemy
C Coequal
D Sibling
10. Higher temperature can help easy extraction even though
A More tastier compounds get trapped

B Unwanted compounds gets dissolved in the water
C The brewing gets trickier
D The speed gets increased with temperature
11. What can be true with respect to optimization of filter coffee brewing
A Water-coffee ration can be less of importance

B Full immersion methods gets less trickier and multidimensional
C Simple grinding does not changes brew time
D The relevance of optimization is null

12. A burr grinder features
A Seemingly random particle size distribution

B Coexistence of powder and whole coffee beans
C A progressive grinding of coffee into smaller pieces
D Blade grinders are © IRS Group completely disfavored
13. What can be “contention”
A Approval
B Disagreement
C Harmony
D Plea
14. Less flavorful cup of coffee can be due to
A The gaseous organic molecules that escape the bean over time
B The volatiles that get trapped into the beans over time
C The freshly roasted beans have significant amount of CO2
D Cafes serve coffee that can be containing more volatiles

Text 2: Difficult-to-treat depression
Depression remains a leading cause of distress and disability worldwide. In one country’s survey of health
and wellbeing in 1997, 7.2% of people surveyed had experienced a mood (affective) disorder in the previous 12
months. Those affected reported a mean of 11.7 disability days (when they were “completely unable to carry
out or had to cut down on their usual activities owing to their health”) in the previous 4 weeks. There was also
evidence of substantial under treatment: amazingly 35% of people with a mental health problem had a mental
health consultation during the previous 12 months. Of those with a mental health problem, 27% (i.e., three-
quarters of those seeking help) saw a general practitioner (GP). In the 2007–08 follow-up survey, not much
had changed: 12-month prevalence rates were 4.1% for depression, 1.3% for dysthymia and 1.8% for bipolar
disorder. These disorders were associated with significant disability, role impairment, and mental health and
substance use co-morbidity. Again, there was evidence of substantial unmet need, and again GPs were the
health professionals most likely to be providing care.
While general practitioners (GPs) have many skills in the assessment and treatment of depression, they are
often faced with people with depression who simply do not get better, despite the use of proven therapies, be
they psychological or pharmacological. This supplement aims to address some of the issues that GPs face
in this context. GPs are well placed in one regard, as they often have a longitudinal knowledge of the patient,
understand his or her circumstances, stressors and supports, and can marshal this knowledge into a coherent
and comprehensive management plan. Of course, GPs should not soldier on alone if they feel the patient is
not getting better.
In trying to understand what happens when GPs feel “stuck” while treating someone with depression, a
qualitative study was undertaken that aimed to gauge the response of GPs to the term “difficult-to-treat
depression”. It was found that, while there was confusion around the exact meaning of the term, GPs could
relate to it as broadly encompassing a range of individuals and presentations. Thus, the term has face validity,
if not specificity. More specific terms such as “treatment-resistant depression” are generally reserved for a
subgroup of people with difficult-to-treat depression that has failed to respond to treatment, with particular
management implications.
One scenario in which depression can be difficult to treat is in the context of physical illness. Depression is
often expressed via physical symptoms, but the obverse is that people with chronic physical ailments are at
high risk of depression. Pain syndromes are particularly tricky, as complaints of pain require the clinician to
accept them as “legitimate”, even if there is no obvious physical cause. The use of analgesics can create its
own problems, including dependence. Patients with comorbid chronic pain and depression require careful and
sensitive management and a long-term commitment from the GP to ensure consistency of care and support.
It is often difficult to tackle the topic of depression co-occurring with borderline personality disorder (BPD).
People with BPD have, as part of the core disorder, a perturbation of affect associated with marked variability
of mood. This can be very difficult for the patient to deal with, and can feed self-injurious and other harmful
behaviour. Use of mentalisation-based techniques is gaining support, and psychological treatments such as
dialectical behaviour therapy form the cornerstone of care. Use of medications tends to be secondary, and
prescription needs to be judicious and carefully targeted at particular symptoms. GPs can play a very important
role in helping people with BPD, but should not “go it alone”, instead ensuring sufficient support for themselves
as well as the patient.

Another particularly problematic and well known form of depression is that which occurs in the context of
bipolar disorder. Firm data on how best to manage bipolar depression is surprisingly lacking. It is clear that
treatments such as unopposed antidepressants can make matters a lot worse, with the potential for induction
of mania and mood cycle acceleration. However, certain medications (notably, some mood stabilisers and
atypical antipsychotics) can alleviate much of the suffering associated with bipolar depression. Specialist
psychiatric input is often required to achieve the best pharmacological approach. For people with bipolar
disorder, psychological techniques and long-term planning can help prevent relapse. Family education and
support is also an important consideration.

15. Paragraph one aims to convey that
A each surveyed participant in 1997 reported 11.7 disability days.

B those with an affective disorder performed their typical duties as normal.
C a large proportion of mental health consultations were provided by a GP.
D 35% having a mental health consultation is a great improvement.
16. What is signified from the statistics of 2007-2008?
A Comparable findings for the several mental illnesses mentioned.

B The rate of depression had fallen considerably.
C Disability days had declined from the 1997 statistics.
D The level of treatment provided had improved somewhat.
17. What information is expressed in paragraph two?
A GPs are in an advantageous position

B GPs should not force a pointless plan
C GPs must address the issues when faced
D GPs are likely to have required skills
18. According to paragraph 3, the term ‘difficult-to-treat depression’ has
A relatability to its broader meaning

B an unidentifiable and misunderstood meaning
C full value and is specific in its meaning
D full value but is not specific in its meaning

19. Paragraph 4 implies that physical ailments are a difficult area because
A clinicians do not generally believe all apparent physical symptoms

B clinicians must decipher what is valid and what is improbable
C clinicians observe the patient for any legitimacy of mental problems
D clinicians only recognise legitimate complaints of comorbid chronic pain
20. According to paragraph 5, people with BPD s
A have a stable mood making it difficult to diagnose.

B have mood fluctuations which are key to the disorder.
C have rapid mood swings which are clearly identifiable.
D have limited support from the health service.
21. In paragraph 6, the author’s use of ‘surprisingly lacking’ is
A to portray a tone of doubt that it is truly lacking.

B because of the scarcity of bipolar disorder in modern times.
C due to the established prevalence of bipolar disorder.
D to enable readers to understand and feel the author’s skepticism.
22. Reducing symptoms associated with BPD is achieved by
A psychological techniques and long term planning

B treatments requiring unopposed antidepressant use
C medications including use of atypical antipsychotics
D therapies like family education and support groups
END OF READING TEST


Practice test 5

Listening test

You hear a doctor talking to a patient called Graham, a patient with breathing difficulty.
For questions 1-12, complete the notes with a word or short phrase.
Patient : Graham
Reason for presenting : trouble with (1) ________________________
Description of symptoms : experiences wheezing and breathlessness
(2) ________________________ a lot (3 weeks)
white (3) ________________________ - thought it was a cold
(4) ______________________ getting worse as weeks progressed
very worried when he is (5) _______________________ able to

take breath.
(6) ________________________ are more frequent now
worse at night and in the morning
(7) ________________________ did not go for work yesterday
chest tightness without pressing pain
Precipitating factors : no known (8) ________________________ to dust
no known use of drugs
Further factors : work has been intense
(9) ________________________ has made him anxious
Points to consider : (10) ________________________ had anything like this before
has no other known medical conditions
first time being (11) ________________________
sister and mother has (12) ________________________

You hear a doctor talking to a client called Barbara Roberts, a patient with psychosomatic disorder.
For questions 13-24, complete the notes with a word or short phrase. © IRS Group
Patient : Barbara Roberts
Age : 58 years
Difficulties experienced : terrible trouble with the stomach
(13) ________________________ nearly all the time
often times, feels (14) ________________________
swings between (15) ______________________ and constipation
cramping feeling (16) ________________________
passes very smelly wind
Onset of the condition : about (17) ________________________ ago
Previous treatment and : started with (18) ________________________
investigation took other medications including (19) ________________________
gastroscopy was performed
(20) ________________________ also administered
Assessment of : feels (21) _______________________ pain, can’t be all in the head
insight thought it was an infection that had not cleared
sometimes wonders if its an (22) ________________________
Treatment options : try to bring back few (23) ____________________________
(24) ________________________ between the tablets that are

helping and ones that aren’t
wait for 2-3 months for results to show
keep an eye on the symptoms

Part B
healthcare setting.
25. You hear a nurse manager speak to his team.
What needs to be focused on
A effectively pacing the week ahead

B attending to the patient regularly
C ensuring the completion of procedures
26. You hear a doctor discussing with a patient the complications of a surgical procedure
The risks associated with the procedure are
A benign and can be corrected

B uncommon and problem free
C varied but usually infrequent
27. You hear the head of a unit discussing patient details
Observation made on the patient is
A satisfactory according to the results

B encouraging for further treatment
C stable as per ongoing treatment

28. You hear a nurse brief about behavioural nursing
What is the purpose of the extract
A to identify shortcomings in children

B to share school nursing experience
C to highlight a shortage of expertise
29. You hear a scientist deliver a talk on physical activities for children
What does he advocate
A repetitive activities for specific areas

B minimise overuse of certain parts
C must play in a variety of sports
30. You hear a talk by a nurse anasthetist
How do the mannequins respond to procedure
A by alerting the nurses if vitals fluctuate

B by being versatile to the presenting process
C by mimicking the changes in ill patients

Part C
You hear a talk on suicide prevention by a social researcher Mary Todd.

31. Mary describes the purpose of secondary suicide prevention is as
A reduce the number of new cases

B bring down the attempts in an area
C minimise the attempts by the suicidal
32. Secondary suicide prevention is understated because
A it is only starting to be applied in practice

B suicide is difficult to predict due to complexity
C recent events lead to increased suicide
33. Mary talks on the importance of suicide assessment because
A psychiatric illness is a major contributing factor

B it enables in the identification of the risk factors
C it helps develop diagnosis and treatment methods

34. What must be done for subjective rating of severity of depression
A physicians should not hesitate to ask on suicidal ideation

B clinicians need to overcome obstacles in providing care
C additional information should be incorporated into assessment
35. Mary feels that suicide rates may be reduced by interventions like
A legal restrictions that reduce access to harmless substances

B psychological follow up and other methods including telephonic
C therapies that address repetition of suicide thoughts and behaviours
36. What is the increasing concern with digital media covering suicide
A there are still many gaps in the research

B it glamorises suicide among the vulnerable
C it provides accessible information for an attempt

You hear an interview with Samantha Solon, a lead scientist on diet that boosts the ‘miracle
hormone’
37. Samantha feels that prospects for are high because?
A it has been proven effective for longevity

B the effects of administration are long term
C varied indicators of health can be influenced
38. What does the study of diet in mice identify
A an influence on metabolic rate

B effective way for increasing the hormone
C the animals showed an increase in weight
39. Samantha opines the influence of protein is
A minimal without high carbohydrate

B in tandem with the carbohydrates
C optimal with high carbohydrate
40. According to the expert, evidence from paradoxical conditions are
A that reduced protein intake is crucial

B teased apart for clarity on findings
C studied for influence of insulin variation

41. What can be done to harness the potential of the hormone?
A modify the diet and nutritional guidelines

B administration by means of chronic injection
C develop a mimetics for increased effectiveness
42. What can be said with certainty as per the expert
A everyone is in a race for an answer

B the dynamics can not be explained now
C no one knows the mechanism of action

Reading test
Inguinal Hernia : Texts
Text A
Inguinal Hernia
An inguinal hernia is a protrusion of the intestine or bladder through the inguinal canal, often into the groin or
scrotum. It is a very common problem. The pain related to inguinal hernia worsen when coughing, exercising or
during bowel movements. The protrusion may not be visible, particularly in overweight patients, however, a
bulging area may occur in the area of the hernia, and may become markedly bigger when the patient is asked
to bear down.It is common among men than in women.
The cause of inguinal hernias depends on the type of inguinal hernia. The causes can range from mere birth
defects to the inclusion of external forces. Weakness within the abdominal wall, stress from bowel movements
or urination and activities such as lifting, exercising,sneezing, coughing, extensive weight gain create a hernia-
tion within the abdomen.

Text B
Indirect versus direct inguinal hernias
© IRS Group
Direct inguinal hernia develop over time due to straining and is caused by weakness in abdominal
muscles whereas indirect hernia is caused by a defect in the abdominal wall.

Text C
How are inguinal hernias treated?

Repair of an inguinal hernia via surgery is the only treatment for inguinal hernias and can prevent incar-
ceration and strangulation. The two main types of surgery for hernias are
• Open hernia repair. During an open hernia repair, a health care provider usually gives a patient
local anesthesia in the abdomen with sedation; however, some patients may have
o sedation with a spinal block, in which a health care provider injects anesthetics around the
nerves in the spine, making the body numb from the waist down
o general anesthesia
• The surgeon makes a cut in the groin, moves the hernia back into the abdomen, and reinforces
the abdominal wall with stitches (herniorrhaphy). Usually the surgeon also reinforces the weak area
in abdominal wall with a synthetic mesh or “screen” to provide additional support (hernioplasty). This
procedure requires a single incision except in cases where hernias are on both sides.
• Laparoscopic hernia repair. A surgeon performs laparoscopic hernia repair with the patient under
general anesthesia. The surgeon makes several small, half-inch incisions in the lower abdomen and
inserts a laparoscope—a thin tube with a tiny video camera attached. The camera sends a magnified
image from inside the body to a video monitor, giving the surgeon a close-up view of the hernia and
surrounding tissue. While watching the monitor, the surgeon repairs the hernia using synthetic mesh
or “screen.”
People who undergo laparoscopic hernia repair generally experience a shorter recovery time than those
who have an open hernia repair.Surgery to repair an inguinal hernia is quite safe, and complications
are uncommon. However, the health care provider should assess for any of the following symptoms
• redness around or drainage from the incision
• fever
• bleeding from the incision
• pain that is not relieved by medication or pain that suddenly worsens

Text D
Nursing Interventions
• Place the patient in the Trendelenburg’s position to reduce pressure on the hernia site.
• Apply truss only after the hernia has been reduced. For best results, apply it in the morning
before the patient gets out of bed.
• Assess the skin daily and apply powder to prevent irritation.
• Watch for and immediately report signs of incarceration and strangulation.
• Closely monitor vital signs and provide routine preoperative preparation.
• Administer IV fluids and analgesics for pain as ordered.
• Control fever with acetaminophen.
• A person with an inguinal hernia may be able to prevent symptoms by eating high-fiber foods.This
may help prevent the constipation and straining that cause some of the painful symptoms of a
hernia.
Postoperative interventions:
• Provide routine postoperative care.
• Do not allow the patient to cough.
• Encourage deep breathing and frequent turning.
• Apply ice bags to the scrotum to reduce swelling and relieve pain; elevating the scrotum on
rolled towels may also help to alleviate swelling.
• Administer analgesic as prescribed.
• In males, a jock strap or suspensory bandage may be used to provide support.
END OF PART A
THIS TEXT BOOKLET WILL BE COLLECTED

Part A
Time: 15 minutes
Inguinal Hernia : Questions
Questions 1-6

1. Rationale for inguinal hernia ________________________________
2. What happens during surgery ________________________________
3. Care before and after surgery ________________________________
4. Potential complications post operatively ________________________________
5. Forms of inguinal hernia ________________________________
6. Recovering from inguinal hernia repair ________________________________
Questions 7-14
7. Which is the site of incision for open hernia repair?
________________________________________________________________
8. What medication is used to control fever caused by hernia?

________________________________________________________________
9. Which group is at the risk of developing direct inguinal hernia?

________________________________________________________________
10. Which device is used to view the internal body in laparoscopic surgery?
________________________________________________________________
11. What is the type of hernia repair surgery where a mesh patch is sewn over the weakened region?
________________________________________________________________
12. Which surgery needs less recovery time?

________________________________________________________________

13. Who is more prone to develop inguinal hernias?
________________________________________________________________
14. Which position is recommended to relieve crushing on the point of hernia?

________________________________________________________________
Questions 15-20
15. The food that is rich in _____________________________ aids in hindering symptoms.
16. Inorder to numb the lower part of the body a drug is injected in the spine over the _______________________
17. The deformityin indirect inguinal hernia is not _____________________________ as it is in the back of fibers of
the external oblique muscle.
18. The _____________________________ associated with inguinal hernia is typically exacerbated by common
activities.
19. Open surgery usually requires one large incision instead of several small incisions as in
_____________________________ surgery for hernia repair.
20. In direct inguinal hernia defect in the abdominal wall is felt on top of the _____________________________
END OF PART A

Part B
1. Priority during physical examination must be given to
A informed consent of the patient

B appropriate length of the test
C full comfort experienced by them
Sexual boundaries in the doctor-patient relationship

Best practice during consultation Physical examination
You should only conduct a physical examination if it is clinically warranted. You must obtain the patient’s
consent before conducting a physical examination. You must also obtain the patient’s consent prior to
the start of the consultation if an observer or chaperone attends the consultation.
Make sure the patient is aware that they should voice any feelings of discomfort or pain and that they
can ask you to stop the examination at any time.
If the consultation involves a physical examination that requires the patient to remove their clothes, you
should provide an appropriate place to undress. This is an area where the patient can undress in private,
out of view of anyone else, including you.
You should not require a patient to undress unnecessarily or stay undressed for unnecessary lengths of
time. For example, the patient only needs to uncover the part of the body that is being examined, and
should be allowed to cover it again as soon as you have finished. When another person is present during
a consultation.
You or your patient may want another person present during a consultation.

2. The advice below can best be applied to a healthcare setting by
A the inclusion of nurses in governance structures

B providing relevant information to patients in their native language
C redesigning projects according to advisory group recommendations
Working with patients and consumers
Partnerships with consumers can come in many forms. Some examples include:
• working with consumers to check that the health information is easy to understand
• using communication strategies and decision support tools that tailor messages to the consumer
• including consumers in governance structures to ensure organisational policies and processes meet
the needs of consumers
• involving consumers in critical friends groups to provide advice on safety and quality projects
• establishing consumer advisory groups to inform design or redesign projects.

3. The notice is giving information about
A differential management of infants using glucose

B How to check an infant’s blood glucose level
C The ideal glucose concentration in infants with clinical signs
Management of documented hypoglycemia in breastfeeding

infants
A. Infants with no clinical signs
1. Continue breastfeeding (approximately every 1 to 2 hours) or feed 3 to 10 mL/kg of expressed breast

milk or substitute nutrition.
2. Recheck blood glucose concentration before subsequent feedings until the value is acceptable and
stable.
3. Avoid forced feedings.
4. If glucose remains low despite feedings, begin intravenous glucose therapy.
5. Breastfeeding may continue during IV glucose therapy.
6. Carefully document response to treatment.
B. Infants with clinical signs or plasma glucose levels 20 to 25 mg/dL (1.1 to 1.4 mmol/L)
1. Initiate intravenous 10% glucose solution.
2. Do not rely on oral or intragastric feeding to correct extreme or symptomatic hypoglycemia.
3. The glucose concentration in symptomatic infants should be maintained 45 mg/dL (2.5 mmol/L).
4. Adjust intravenous rate by blood glucose concentration.
5. Encourage frequent breastfeeding.
6. Monitor glucose concentrations before feedings as the IV is weaned until values stabilize off intrave-
nous fluids.
7. Carefully document response to treatmenti

4. The information sheet recommends
A regular auditing to ensure pain management program efficacy

B indicators to use in pain management program audits
C at least 50% change as being clinically important
Audit of pain management programs: Methods
It is recommended to conduct an audit of 20 or more sequential patients undertaking a pain manage-

ment program. Data collection should include simple demographic and program data as well as data
(pre and post program with a minimum three month interval between data sets) regarding changes in:
• Healthcare utilisation.
• Depression/anxiety/stress.
• Pain self efficacy.
• Pain catastrophising.
Percentage change in individual patients has been suggested (rather than average percentage change
across the population audited) as average percentage change is very sensitive to outliers and small
audits may therefore be significantly influenced by average percentage change.
The Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) recom-
mends considering clinical important change (as distinct from statistically significant change) on the
following basis:
• Minimal benefit 10-20 per cent change.

• Moderately important benefit at least 30 per cent change.
• Substantially important benefit at least 50 per cent change.

5. The purpose of the guideline is to
A prevent medicare claims being paid for public patients

B specify when services can be billed to Medicare
C ensure healthcare professionals don’t falsify claims
Guideline for substantiating claims for diagnostic imaging and

pathology services rendered to emergency department patients
of public hospitals
Public hospitals are funded under an arrangement with the Australian Government to provide free public
hospital services to eligible patients. This includes diagnostic imaging and pathology services provided
to public hospital emergency department patients. A patient who presents to a public hospital emer-
gency department should be treated as a public patient. If that patient is subsequently admitted they
may elect to be treated as a private patient for those admitted services. For a Medicare claim to be paid
for a patient in a public hospital, the patient must be admitted as a private patient at the time the service
was rendered. Where a service for a patient in a public hospital has been billed to Medicare, the hospital
or rendering practitioner may be asked to substantiate these claims.
Documents you may use include:
• the form which the patient (or next of kin, carer or guardian) - has signed indicating that the
patient has elected to be admitted as a private patient, and
• patient records - that show the patient was admitted as a private patient at the time the service was
rendered

6. Healthy ageing according to the information guide is
A functional ability that enables well being

B holistic health which is shaped by environment
C wholesome potential of an individual to exist
What is Healthy Ageing?
Every person – in every country in the world – should have the opportunity to live a long and healthy life.
Yet, the environments in which we live can favour health or be harmful to it. Environments are highly
influential on our behaviour, our exposure to health risks (for example air pollution, violence), our access
to quality health and social care and the opportunities that ageing brings. Healthy Ageing is about
creating the environments and opportunities that enable people to be and do what they value throughout
their lives. Everybody can experience Healthy Ageing. Being free of disease or infirmity is not a require-
ment for Healthy Ageing as many older adults have one or more health conditions that, when well
controlled, have little influence on their wellbeing. WHO defines Healthy Ageing “as the process of
developing and maintaining the functional ability that enables wellbeing in older age”. Functional ability
is about having the capabilities that enable all people to be and do what they have reason to value.

Part C
In this part of the test, there will be a text 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: Seasonal Influenza Vaccination and the H1N1 Virus
As the novel pandemic influenza A (H1N1) virus spread around the world in late spring 2009 with a well-
matched pandemic vaccine not immediately available, the question of partial protection afforded by seasonal
influenza vaccine arose. Coverage of the seasonal influenza vaccine had reached 30%– 40% in the general
population in 2008–09 in the US and Canada, following recent expansion of vaccine recommendations.
The spring 2009 pandemic wave was the perfect opportunity to address the association between seasonal
trivalent inactivated influenza vaccine (TIV) and risk of pandemic illness. In an issue of PLoS Medicine,
Danuta Skowronski and colleagues report the unexpected results of a series of Canadian epidemiological
studies suggesting a counterproductive effect of the vaccine. The findings are based on Canada's unique near-
real-time sentinel system for monitoring influenza vaccine effectiveness. Patients with influenza-like illness
who presented to a network of participating physicians were tested for influenza virus by RT-PCR, and information
on demographics, clinical outcomes, and vaccine status was collected. In this sentinel system, vaccine
effectiveness may be measured by comparing vaccination status among influenza-positive “case” patients
with influenza- negative “control” patients. This approach has produced accurate measures of vaccine
effectiveness for TIV in the past, with estimates of protection in healthy adults higher when the vaccine is well-
matched with circulating influenza strains and lower for mismatched seasons. The sentinel system was
expanded to continue during April to July 2009, as the H1N1 virus defied influenza seasonality and rapidly
became dominant over seasonal influenza viruses in Canada.
The Canadian sentinel study showed that receipt of TIV in the previous season (autumn 2008) appeared to
increase the risk of H1N1 illness by 1.03- to 2.74-fold, even after adjustment for the comorbidities of age and
geography. The investigators were prudent and conducted multiple sensitivity analyses to attempt to explain
their perplexing findings. Importantly, TIV remained protective against seasonal influenza viruses circulating in
April through May 2009, with an effectiveness estimated at 56%, suggesting that the system had not suddenly
become flawed. TIV appeared as a risk factor in people under 50, but not in seniors—although senior estimates
were imprecise due to lower rates of pandemic illness in that age group. Interestingly, if vaccine were truly a
risk factor in younger adults, seniors may have fared better because their immune response to vaccination is
less rigorous.
The Canadian authors provided a full description of their study population and carefully compared vaccine
coverage and prevalence of comorbidities in controls with national or province-level age-specific estimates—
the best one can do short of a randomized study. In parallel, profound bias in observational studies of vaccine
effectiveness does exist, as was amply documented in several cohort studies overestimating the mortality
benefits of seasonal influenza vaccination in seniors.

Given the uncertainty associated with observational studies, we believe it would be premature to conclude
that TIV increased the risk of 2009 pandemic illness, especially in light of six other contemporaneous
observational studies in civilian populations that have produced highly conflicting results. We note the large
spread of vaccine effectiveness estimates in those studies; indeed, four of the studies set in the US and
Australia did not show any association whereas two Mexican studies suggested a protective effect of 35%–
73%.
The alleged association between seasonal vaccination and 2009 H1N1 illness remains an open question,
given the conflicting evidence from available research. Canadian health authorities debated whether to postpone
seasonal vaccination in the autumn of 2009 until after a second pandemic wave had occurred, but decided to
follow normal vaccine recommendations instead because of concern about a resurgence of seasonal influenza
viruses during the 2009–10 season. This illustrates the difficulty of making policy decisions in the midst of a
public health crisis, when officials must rely on limited and possibly biased evidence from observational data,
even in the best possible scenario of a well-established sentinel monitoring system already in place.
What happens next? Given the timeliness of the Canadian sentinel system, data on the association between
seasonal TIV and risk of H1N1 illness during the autumn 2009 pandemic wave will become available very
soon, and will be crucial in confirming or refuting the earlier Canadian results. In addition, evidence may be
gained from disease patterns during the autumn 2009 pandemic wave in other countries and from immunological
studies characterizing the baseline immunological status of vaccinated and unvaccinated populations. Overall,
this perplexing experience in Canada teaches us how to best react to disparate and conflicting studies and
can aid in preparing for the next public health crisis.

7. The question of partial protection against H1N1 arose
A before spring 2009

B during Spring 2009
C after spring 2009
D during 2008-09
8. According to Danuta Skowronski
A the inactivated influenza vaccine may not be having the desired effects.
B Canada’s near-real-time sentinel system is unique.
C the epidemiological studies were counterproductive
D the inactivated influenza vaccine has proven to be ineffective.
9. The vaccine achieved higher rates of protection in healthy adults when
A it was supported by physicians.

B the sentinel system was expanded.
C used in the right season.
D it was matched with other current strains.
10. Which one of the following is closest in meaning to the word prudent in paragraph 3?
A anxious
B cautious
C busy
D confused
11. The Canadian sentinel study demonstrated that…..
A age and geography had no effect on the vaccine’s effectiveness.

B vaccinations on senior citizens is less effective than on younger people.
C the vaccination was no longer effective.
D the risk of H1N1 seemed higher among people who received the TIV vaccination.
12. Which of the following sentences best summarises the writers’ opinion regarding the uncertainty
associated with observational studies?
A More studies are needed to determine whether TIV increased the risk of the 2009 pandemic.
B It is early to tell whether the risk of catching the 2009 pandemic illness increased due to TIV.
C Studies show that there is no association between TIV and increased risk of 2009 pandemic.
D Civilian populations are less at risk of catching the 2009 pandemic illness.
13. Which one of the following is closest in meaning to the word alleged in paragraph 6?
A reported
B likely
C suspected
D possible
14. Canadian health authorities did not postpone the Autumn 2009 seasonal vaccination because…
A of a fear seasonal influenza viruses would reappear in the 2009-10 season.

B there was too much conflicting evidence regarding the effectiveness of the vaccine.
C the sentinel monitoring system was well established.
D observational data may have been biased.

Text 2: Addiction to prescription
Addiction to prescription pain killers is soaring, with the number of Victorians being treated in hospital emergency
departments more than doubling in the past five years. Health experts say the crisis is partly driven by
suburban white-collar patients who get hooked after being prescribed opiate-based pills such as morphine
and oxycodone for chronic pain.
With an ageing population fuelling a jump in conditions such as arthritis, they fear addiction to pain killers will
rise further. Since 1991, there has been a 40-fold rise in morphine tablet use in Australia, while use of
oxycodone has quadrupled.
Medical professionals are now so concerned about pain killers abuse that 70 leading GPs, physiotherapists,
chiropractors, and pain-management specialists convened a national pain summit in Melbourne last week.
The experts backed by the college of anaesthetists, the college of General Practitioners and the college of
Physicians, will present Prime Minister Kevin Rudd with a plan to tackle the crisis before the end of the year.
The clinical director of alcohol and drug services at Southern and Eastern Health, Dr Matthew Frein, will tell
the annexe Australian drugs conference in Melbourne this week that the number of pain killer addicts going to
the Monash Medical Centre and Dandenong Hospital Emergency Departments jumped from about 150 in
2005 to 300 so far this year. In the same period, there has been a corresponding drop in hospital visits heroin
abuse.
This shift, which Dr. Frein believes is mirrored at hospitals across Victoria, is partly due to former heroin users
switching to cheaper prescription drugs and has been compounded by a short age of heroin and underfunding
of methadone programmes.
The problem was also being fuelled by people being prescribed pain medication after orthopaedic surgery or
major injuries. When the drugs failed to work, the dosage was increased. “That can often become a battle
against pain that the doctor and patient can never win,” he said. “The jury’s not out on whether this is a major
problem for drug treatment services – the jury’s back in. This is becoming the bread and butter of what we
do”. Dr. Frein said he believed Australia could go the same way as the United States where abuse of
prescription pain killers is soaring. Richard Smith from addiction, the Raymond Hader Clinic, said Australians
were already the highest per capita users of analgesics (paracetamol and aspirin) in the world. He said pill-
popping had been “normalised” by Hollywood’s widespread use of prescription medication. Singer Michael
Jackson was believed to be addicted to pain killers at the time of his death, and actor Heath Ledger died from
an accidental overdose of prescription drugs including oxycontin. Dr. Smith said: “we recently saw a woman
with two young kids. She had a back injury and was advised to have operations, putting in braces... She
ended up with serious pain from the operations and was getting some serious medication. The withdrawal
symptoms are the same as heroin if not worse”. Dr. Frein said addicted patients often “Doctor-shopped” to
get a new prescription or told their GP they had lost the first one. When refused, they often went to an
emergency department.
Morphine and oxycodone are scheduled 8 substances, requiring a permit before being prescribed. Strict
criteria should be met before a prescription is offered to minimise the risk of dependency, but there are
concerns that busy GPs are overprescribing instead of offering alternatives such as psychological therapy
and relaxation techniques. Dr Penelope Briscoe of the Australian and New Zealand college of anaesthetists
said medication reduced pain by only about 30% and failed to work for 2 out of 3 patients.
John Ryan, chief of harm-reduction group annexe warned: “One of the complications of pharmaceutical use is
half life. It means people can take a drug and think they’ve cleared it from their system because they don’t feel
any effects but its still there and it puts them at risk of overdose”.

15. The author states that
A People treated in hospital EDs has risen dramatically in the past five years
B The number of EDs in Victoria have more than doubled in the past five years
C The number of prescription painkillers has doubled in the past five years.
D Victorians requiring hospitalisation for addiction has risen by more than 100% in the past
five years
16. According to this journalist
A Medical experts will be reporting to an Australian Drugs Conference later in October, 2009
B Health (including pain) specialists arranged an Australia-wide seminar in Melbourne
C Medical experts and others will present a plan to solve the crisis by the end of 2009.
D A Clinical Director asserts that the number of addicts has doubled during the past year.
17. The idea expressed by Bread and butter in paragraph five is
A doctors pay too much attention to pain

B judgement on the procedure is reserved
C such means of treatment are unrestrained
D consequences of administration are numerous
18. What does Doctor-shopped in the fifth paragraph refer to
A visiting many doctors for prescriptions

B bargaining with medics for relievers
C using the same prescription over again
D choosing the professional on pills given

19. According to Richard Smith:
A Australians are the biggest users of analgesics in the world

B Australians were following in the footsteps of Hollywood celebrities
C People with back injuries get relief from strong pain killers
D Paracetamol and aspirin were popular forms of painkillers in the U.S.
20. The article refers to addicted patients
A who should be asking for other alternatives rather than a prescription for painkillers
B using a variety of strategies to get prescriptions filled.
C going from one doctor to another to get a prescription filled.
D pressuring overworked GP’s to write out another prescription.
21. Reported statistics shows that
A 30% of patients received pain relief from painkillers

B In two thirds of patients, painkillers had better effect than nothing at all.
C Patients using painkillers reported a 30% reduction in pain
D Painkillers were successful in 66% of patients.
22. The paragraph that starts with “This shift, which Dr Frei believes’ which refers to
A Painkiller addicts now attend Dandenong Hospital rather than Monash Medical
B The overall increase in addict numbers with previous figures
C As painkiller addict numbers have risen, there’s been a decrease in heroin abusers
D As painkiller addict numbers have risen, there’s been a decrease in heroin users
END OF READING TEST


ANSWER KEY
LISTENING SUB-TEST 1-5

READING SUB-TEST 1-5

LISTENING SUB-TEST 1
PART A: QUESTIONS 1 - 12
1 pressure
2 upset
3 3 months / three months
4 communication
5 anyone
6 partner
7 focus
8 number
9 money
10 continue
11 will
12 topic
13 tired
14 aches and pains
15 cold
16 blocked up
17 anything
18 appetite
19 bowel habits
20 scattered glands
21 glandular fever
22 blood tests
23 anemia
24 keep up

PART B: QUESTIONS 25 - 30
25 A reduction in determination of ill health

26 A associated risks with delivery are unlikely
27 C convey the working of analgesics
28 B it helps in preparing new recruits
29 B altering cell structure of pathogens
30 C daily independent performing of ADLs
PART C: QUESTIONS 31 - 36
31 A Hormonal changes affecting the body

32 B Only rarer forms affect both sensation and speech
33 A Effective sleep until the headache subsides
34 B Around half of the women likely experience while menstruating
35 C It contracts the vessels and reduces the blood flow
36 C Over the counter pain relievers like aspirin or ibuprufen
37 C His background in neurology and the fellowship combined

38 B could be seeing a lot of patients or performing procedures
39 A The discovery of genetic biomarkers that can be tested easily
40 B alleviate associated problems so that patients can lead normal lives
41 C The lack of social support that is required for patients
42 C Introduction of newer drugs with greater effectiveness

READING SUB-TEST 1
1 B
2 D
3 A
4 C
5 A
6 D
7 B
8 HCG / Human Chorionic Gonadotropin
9 combination of factors
10 20 minutes / twenty minutes
11 lupus and rheumatoid arthritis
12 sexual and drug taking (history)
13 3 months / three months (after exposure)
14 protein
15 transactional
16 finger
17 eligibility
18 immune system
19 reliability
20 condomless sex

1 B inconsistent responses to new findings

2 C conservative estimates of procedural effectiveness
3 A perform in the presence of a billing physician
4 B articulate the symptoms with patient
5 A appropriate dispensation of information is legal
6 C use informed choices for later care
7 B the rate of pancreatic cancer has risen in most age groups.

8 A smoking trends have been attributed as the key factor.
9 B often avoided which has led to a 50 to 70% confirmation rate.
10 B have detected more incidences of pancreatic cancer.
11 B Marked
12 D a highly probable rise in mortality rates in the near future.
13 B Classify
14 C Objective
15 D it is not as prominent as other dental issues

16 A causative
17 A prompted further interest in the link between oral health and systemic disease
18 C evident
19 B assess the overall oral health of patients
20 A cardiovascular disease could actually exacerbate periodontal disease
21 D more support for dental care in the public health system.
22 D yet to be attained

1 university
2 more
3 ritalin
4 momentum
5 time
6 perform
7 leash
8 exam results
9 MDMA
10 everyone
11 about
12 hold
13 Tuesday
14 (right) across (his) belly
15 runny nose
16 camping
17 purple / purplish
18 meningococcus
19 hives
20 immune response
21 claritin
22 grumpy
23 medication
24 eggs / strawberries / shell fish

25 C to explain possible side effects before signing the consent form

26 B the patient’s drug administration
27 B the extent of surgery required
28 B contradictory messages being circulated around
29 A procedures not running to schedule
30 C set up some monitoring of his mental acuity
31 A to find the effect of salt on blood pressure

32 C no effects of low glycaemic index
33 C LDL cholesterol increased in a low - GI diet
34 B benefits could be attributed to other aspects
35 B inexpensive methods to keeping individuals engaged
36 B unchecked consumption of an adverse diet
37 A incidence has been hugely higher in the past decade

38 C unlike popular perception, alcoholism is not the leading trigger factor
39 B liver cancers typically have an underlying liver condition behind it
40 B liver conditions reveal fewer symptoms until they have progressed much
41 A she considers it to be simple lab test that should be done more often
42 A patients do not present due to the social stigma associated with liver problems

READING SUB-TEST 2
1 D
2 B
3 A
4 B
5 B
6 C
7 A
8 tuberculin
9 18 mg
10 myobacterium tuberculosis
11 20 - 30 months
12 pulmonary tuberculosis
13 (adequate) ventilation
14 drug resistant TB
15 lungs
16 organ
17 swelling
18 X ray
19 tuberculosis
20 first line

1 B formulation of tests for close scrutiny

2 B ease to monitor adherence of preventive methods
3 B the need to specify and follow regulations at work
4 C inculcate skills required by practice developers
5 A prevention of similar injuries to employees ahead
6 A presence of foreskin is a major precipitating factor
7 A a protein treatment has caused mice to lose weight dramatically

8 B may be a factor in appetite control
9 B named
10 C a deficiency in the ob protein had caused obesity in the subjects
11 B may be useful for anyone who wants to lose weight
12 C slow
13 D it is not the only factor involved in appetite control
14 D despite the results of the study of mice, the benefits for humans is unknown
15 B Commonly held perception of polyunsaturated fat

16 D trans monounsaturated fat increases the cholesterol level
17 D the benefits of using only vegetable fats in the human diet are arguable
18 C to express unfounded concern
19 A agree with Grundy’s recommendation for relabelling
20 C Flynn’s study was not sufficiently rigorous
21 B is not very concerned about trans fat intake levels for most people
22 C the issue of trans fat is likely to receive more, rather than less, attention in future

1 fixation
2 pre-operative area
3 surgery site
4 neuromuscular
5 prone
6 prolonged
7 bending over
8 jarring
9 micro motion
10 physical therapy
11 tolerable
12 markedly
13 white
14 swollen
15 crusts
16 burning eyes
17 pollen
18 eye examination
19 pillow case
20 eye drops
21 patch
22 irritants
23 over the counter
24 antihistamine

25 B explain the procedure in detail and preparation to be done in advance

26 B examining the extent of mobility after surgery
27 B customisation to specific standards
28 B after 6 months from observation of disorder
29 C the level should fall within the adequate category
30 B utlising consistent information for quality care
31 C lack of efficiency if several meanings do exist

32 A it results in difficulty to recuperate
33 C locating the harm of too much medicine
34 B chiefly based on a consensus
35 C by identifying inherent social factors
36 A having a set of special parameters
37 B they are tailored to the requirements of the patient

38 A treatment course for a specific condition can be mentioned
39 C it can ensure appropriate treatment
40 C since the condition is a sum total of disease
41 C ascertain the treatment type required
42 A the tests will take more time to be available

READING SUB-TEST 3
1 A
2 B
3 D
4 A
5 C
6 D
7 B
8 morphine
9 bleeping
10 above 40
11 throbbing cramp
12 leg
13 older anticoagulants
14 anticoagulants
15 stockings
16 pulmonary embolism
17 blood flow
18 oestrogen
19 lovenox
20 purpura

1 B to enable the accredited pharmacist to access relevant information

2 A the number of hours of work permissible
3 A indicating the contrasting purposes
4 B formulation of tests for close scrutiny
5 A following the laid out steps for complete care
6 C preventative measures to reduce pathogenic risk
7 B a possibility in some countries

8 C been observed to be used in all pregnancies
9 C dramatically decrease the need for invasive testing
10 B NIPT is considered to be a strong and reliable screening process
11 D proves a greater risk in acquiring unreliable detection rates from NIPT
12 B will become a topic of greater discussion and debate among people.
13 D nonnoxious
14 D Education and counselling services should coincide with introducing NIPT
15 D Gathered
16 B to immobilise him and numb the pain
17 B maintain a level of support befitting the situation
18 D doctors tend to deal with the physical aspects of the patient.
19 C evolved without proper input from nurses
20 D health education and skilled care
21 D Nursing as a whole is as imperative as other dependent factors.
22 D unprofitable

1 district
2 stiff feeling
3 prescribed
4 barium meal
5 tumour
6 small part
7 pethadine
8 marijuana
9 depressed
10 suicide
11 counselling (session)
12 yoga
13 unbearable pain
14 something
15 treatment
16 MRI
17 pinched nerve
18 nothing
19 conservative
20 unable to work
21 magnetism
22 imaging
23 4 - 6 weeks
24 symptoms

25 A standard procedure for medication administration

26 C understanding that the situation can be overcome
27 B since it has not been exposed to it earlier
28 B to ensure the patient understands
29 C dosage to prevent blood clot
30 B understanding the person’s cognitive complexities
31 B It tends to be used in conjunction with other forms of treatment.

32 B to establish whether the cause of the condition has been identified.
33 C to ensure that the patients’ pain is being well managed.
34 B regaining full movement in the affected part of the spine.
35 A handing long-term responsibility over to the patient.
36 B express doubts about the effectiveness of physiotherapy.
37 C Palpable changes in health sector

38 C risk factors to health have been precipitating
39 C it was published in a medical journal two decades ago
40 C to address immediate health concerns
41 A they refrain from taking measures that are unviable
42 C the defecienty of knowledge from medical schools

READING SUB-TEST 4
1 D
2 B
3 A
4 A
5 C
6 C
7 B
8 linkage of services
9 organising confusing experiences
10 feedback
11 outcome measures
12 evaluate frequently
13 0.5 to 1.5 hours
14 olanzapine, resperidone, aripoprazole
15 patient cooperation
16 itranasal
17 reevaluate
18 emotional distress
19 simple examples
20 undue pressure

1 A give information on compiling private prescriptions

2 C adhering to the laid down structure of identification
3 C Identification and management of malnourished patients.
4 A Approach to be considered on the length of the stay
5 A Prepare an exhaustive analysis and control an outbreak
6 C objectives that are vital for quality maternal care
7 B 8 percent by mass
8 B The methods are cheaper
9 C Coequal
10 B Unwanted compounds gets dissolved in the water
11 B Full immersion methods gets less trickier and multidimensional
12 C A progressive grinding of coffee into smaller pieces
13 B Disagreement
14 A The gaseous organic molecules that escape the bean over time
15 C a large proportion of mental health consultations were provided by a GP.

16 A Comparable findings for the several mental illnesses mentioned.
17 A GPs are in an advantageous position
18 A relatability to its broader meaning
19 B clinicians must decipher what is valid and what is improbable
20 B have mood fluctuations which are key to the disorder.
21 C due to the established prevalence of bipolar disorder.
22 C medications including use of atypical antipsychotics

1 breathing
2 coughing
3 phlegm
4 started
5 not
6 attacks
7 nearly
8 allergy
9 mortgage
10 never
11 ill
12 eczema
13 (terrible) discomfort
14 bloated
15 diarrhoea
16 sometimes
17 4 years / four years
18 muscle relaxants
19 imodium
20 barium enema
21 real
22 ulcer
23 reassurable things
24 decide

25 C ensuring the completion of procedures

26 C varied but usually infrequent
27 C stable as per ongoing treatment
28 C to highlight a shortage of expertise
29 C must play in a variety of sports
30 B by being versatile to the presenting process
31 C minimise the attempts by the suicidal

32 A it is only starting to be applied in practice
33 B it enables in the identification of the risk factors
34 A physicians should not hesitate to ask on suicidal ideation
35 C therapies that address repetition of suicide thoughts and behaviours
36 C it provides accessible information for an attempt
37 C varied indicators of health can be influenced

38 B effective way for increasing the hormone
39 C optimal with high carbohydrate
40 B teased apart for clarity on findings
41 A modify the diet and nutritional guidelines
42 C no one knows the mechanism of action

READING SUB-TEST 5
1 A
2 C
3 D
4 C
5 B
6 D
7 the groin
8 acetaminophen
9 old age
10 laproscope
11 open hernia repair
12 laproscopic
13 men
14 Trendelenberg’s
15 fibre
16 nerves
17 palpable
18 symptoms
19 laproscopy
20 pubic tubercle

1 A informed consent of the patient

2 B providing relevant information to patients in their native language
3 A differential management of infants using glucose
4 B indicators to use in pain management program audits
5 A prevent medicare claims being paid for public patients
6 A functional ability that enables well being
7 B during Spring 2009

8 A the inactivated influenza vaccine may not be having the desired effects
9 D it was matched with other current strains.
10 B cautious
11 D the risk of H1N1 seemed higher among people who received the TIV vaccination
12 B It is early to tell whether the risk of catching the 2009 pandemic illness increased
due to TIV.
13 C suspected
14 A of a fear seasonal influenza viruses would reappear in the 2009-10 season.
15 D Victorians requiring hospitalisation for addiction has risen by more than 100% in
the past five years
16 B Health (including pain) specialists arranged an Australia-wide seminar in Melbourne
17 C such means of treatment are unrestrained
18 D choosing the professional on pills given
19 A Australians are the biggest users of analgesics in the world
20 C going from one doctor to another to get a prescription filled.
21 C Patients using painkillers reported a 30% reduction in pain
22 C As painkiller addict numbers have risen, there’s been a decrease in heroin abusers


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Study guide for OET © IRS Group 2018 1

2 Study guide for OET © IRS Group 2018

Study guide for OET © IRS Group 2018 3

Study Guide for

First Published: 2018

4 Study guide for OET © IRS Group 2018

The four components of OET

Speaking 2 tasks effectively communicate in a real-life context

Study guide for OET © IRS Group 2018 5

Part A - Consultation extracts

Duration : 15 minutes (for 2 consultations)

Tasks : structured note completion

Part B - Short workplace extracts

Duration : 10 minutes (for all 6 questions)

Tasks : three option multiple-choice questions

Part C - Presentation extracts

Duration : 15 minutes (for 2 extracts)

Tasks : three option multiple-choice questions

6 Study guide for OET © IRS Group 2018

Part A : Expeditious reading task

Tasks : matching, sentence completion and short answer questions.

Part B and C: Careful reading tasks

Tasks : Part B: 3 option multiple choice questions

Part C: 4 option multiple choice questions

Study guide for OET © IRS Group 2018 7

Study guide for OET © IRS Group 2018 9

Study guide for OET © IRS Group 2018 11

Patient : Candice May

Reason for appointment : tension due to relationship issues

(1) ________________________________ in the workplace

makes her (2) ________________________________

mother is sick for the last 3-4 months

Present condition : (4) _______________________________ is bit of difficult

doesn’t have (5) _______________________________ to talk to

priorities dealing with issues with (6) _______________________

thinks she is putting a lot of pressure on him

Advice offered : (7) ________________________________ on the relationship area

Further enquiries : (8) __________________________ of counselling sessions

(9) ______________________________ involved for extra sessions

Session schedule : can (10) _____________________________ as long as required

difficult to provide set time

(11) ___________________________ book a session for next week

can focus on the (12) ________________________ of relationship

12 Study guide for OET © IRS Group 2018

Patient : Jane Speirs

Description of the condtion: feeling (13) ________________________________

(14) ________________________________ in the muscles

unable to play netball

Early symptoms : started few weeks ago with a (15) _____________________________

(16) ________________________________ head

can’t do (17) ________________________________ really

Further details : (18) _______________________________ fine

no temperature with cold

(19) ________________________________ regular

suspected (21) ________________________________

test for (23) ________________________________

Advice given : adequate rest

body cures itself

(24) ___________________________ diet and fluid intake

follow up at the end of week

That is the end of Part A.

Study guide for OET © IRS Group 2018 13

Now look at question 25.