Answer keys:
- First-degree Atrioventricular Block
- Pacemaker Placement
- Nauseated And Light Headed
- Carotid Dopplers
- Proscar 5 Mg
- Synthroid 0.2 Mg
- Respiratory Rate 16
- Ii Through Xii Are Intact
- Iliopsoas Bilaterally
- Vibration And Proprioception To The Middle Of Feet
- Transient Ischemic Attack.
- Lumbar Stenosis
- Codman-hakim Shunt
- Coughing, Straining, And Sneezing
- Motrin 800 Mg Twice A Day
- Frontal Region Of Head
- Feeling Of Ringing In The Ears
- Intermittent Blurry Vision
- Extraocular Movements
- Farther Down From The Shunt Reservoir
- Little Bit Of Dry Blood
- Shunt Adjustment Back After An Mri
- PseudotumorCerebri Without Papilledema
- Skull X-ray
- B
- C
- A
- A
- B
- C
- C
- A
- B
- A
- C
- B
- C
- A
- C
- A
- B
- C
How much did you score? Please share in the comments. See you again!
View the listening transcript:
:00[Music]
0:14part a for questions 1 to 24 complete the notes with the information you hear
0:21now look at the notes for extract one extract one questions one to twelve
0:28you hear a doctor talking to a patient called polina for questions 1 to 12
0:34complete the following notes with a word or short phrase you have 30 seconds to
0:40look at the notes
1:10hello good morning doctor good morning tell me what’s your problem well i have a history of first degree atrial
1:17ventricular block and had a pacemaker placement i feel this problem of
1:22decreased eye vision last time the problem lasted for about five minutes
1:28that occurred four weeks ago when i was driving the car then how did you manage to drive
1:34well i was able to pull the car over to the side of the road without much trouble during that time i felt nauseated and
1:41light-headed when i approached the clinic at that time and received a ct scan corrupted doppler’s echocardiogram
1:50and neurological evaluation all of which were unremarkable i couldn’t have an mri
1:56due to the pacemaker placement okay did that occur again no doctor any lesions
2:03or change in vision headaches change in gait or other neurological issues no
2:08doctor do you have any back pain bowel or bladder incontinence or frank lower
2:13extremity weakness no doctor what’s your age 57 doctor do you drink or smoke i
2:21don’t smoke but i drink alcohol only on some special occasions
2:26any past illness or surgeries i had pacemaker placement for atrial
2:31ventricular block and i had bilateral knee replacement three years ago and
2:37have some pain in my knees what medications are you taking i have recently started on plavix suggested by
2:45primary care doctor other than that baby aspirin 81 milligrams per day proscar 5
2:52milligrams gd and synthroid 0.2 milligrams daily are you allergic to any
2:58medication no doctor well your physical examination shows your blood pressure at
3:03134 over 80. your heart rate 60 respiratory rate 16 and weight is 244
3:11pounds cranial nerves 2 through 12 are intact and you have normal bulk and tone
3:17throughout there’s no cogwheeling there is some minimal weakness at the r4 plus
3:22or five and possibly trace weakness at the quadriceps negative five or five
3:28you have decreased sensation to vibration and proprioception and vibration there
3:34is no dysmetria or tremor noted his romberg is negative
3:40you have developed transient ensemic attack the character of his brief episode of visual loss is concerning for
3:47compromise of the posterior circulation differential diagnosis include
3:52hyperprofusion stenosis and dissection you have lumbar stenosis the symptoms
3:58are very mild and consist mainly of some mild proximal upper extremity weakness and very mild gait instability you have
4:06to get a ct angiogram to evaluate the integrity of the cerebrovascular system
4:14extract two questions 13-24 you hear a physician talking to a
4:20patient called mrs emeline pethick for questions 13-24 complete the following
4:26notes with a word or short phrase you now have 30 seconds to look at the
4:31notes
5:03hello good morning doctor good morning tell me what’s your problem well i have
5:08a codman shunt set at 90 millimeters h2o
5:13recently i’m getting acute onset of headaches and it’s worsening day by day
5:19i am unable to sleep the pain is constant and is worse with coughing straining and sneezing as well as
5:26standing up what’s your age 40 doctor did you take any medicines then yeah
5:32i’ve tried taking immatrics as well as motrin 800 milligrams twice a day
5:38but it has not provided much relief although the pain is generalized it is
5:43quite intense in the frontal region of head i get a feeling of ringing in the
5:48ears i have been experiencing intermittent blurry vision and dimming lights as well do you drink or smoke no
5:56doctor well i’ve reviewed your diagnosis reports your physical exam reports show
6:02blood pressure at 153 over 86 pulse at 63 and respiratory rate 16
6:09cranial nerves intact for extraocular movements the shut site is clean dry and intact
6:16you have a small three millimeter to four millimeter round scab that was noted farther down from her shunt
6:22reservoir it looks like there’s a little bit of dry blood there the worsening headaches
6:28are secondary to shunt adjustment back after an mri you have pseudotumor cereby without
6:34papillodemma and migraine headaches well your shunt back program to 90
6:40millimeter h2o last time was after confirmation of an x-ray however it
6:45seems the picture of the x-ray last time was not most desirable therefore i’m
6:50planning the shunt back to 90 millimeter h2o again tomorrow so you have to have another skull x-ray
6:57to confirm the shunt back program to 90 millimeter h2o that is the end of part a
7:05now look at part b in this part of the test you will hear six different
7:10extracts in each extract you’ll hear people talking in a different healthcare environment for questions 25 to 30
7:18choose the answer a b or c which fits best according to what you hear
7:23you will have time to read each question before you listen to the audio complete the answers as you listen to the audio
7:32now look at the question 25. you hear a discussion between a doctor and nurse
7:38about different complications following heart attack
7:56hello doctor what types of complications are expected following heart attack well
8:02there are two types of complications that can occur following a heart attack the first problem occurs pretty much
8:08straight away and the second complication occurs later on immediate complications following a
8:14heart attack are arrhythmias is the immediate complications in which the heart beats irregularly either too fast
8:21or too slowly cardiogenic shock is when the patient’s blood pressure drops suddenly therefore the heart cannot
8:28supply adequate blood for the body to function properly hypoxemia is the condition when the
8:34oxygen levels in the blood become too low pulmonary edema occurs when the fluid accumulates in and around the
8:41lungs deep vein thrombosis occurs when the deep veins of the legs and pelvis
8:46develop blood clots that either block or interrupt the flow of blood in the vein myocardial rupture occurs when the heart
8:53attack damages the wall of the heart that has an increased risk of a heart wall rupture
8:59ventricular aneurysm is when a heart chamber called a ventricle forms a bulge
9:09question 26 you hear the discussion between two doctors about the impacts of
9:15acute kidney injury
9:32what are the impacts of acute kidney injury doctor acute kidney injury is a
9:37common and severe complication of surgery especially cardiac surgery often the complication is associated
9:44with higher rates of morbidity mortality and cardiovascular events longer
9:49hospital length of stay and higher cost during stage one there will be an
9:54increase in serum creatinine of 1.5 to 1.9 times baseline an absolute increase
10:02of at least 0.3 milligrams per deciliter or urine output of less than 0.5
10:07milliliters per kilogram per hour for 6 to 12 hours during stage 2 of acute kidney injury
10:14there will be an increase in serum creatinine of 2.0 to 2.9 times baseline
10:20or urine output less than 0.5 milliliters per kilogram per hour for 12
10:25or more hours during stage 3 of the condition there will be an increase in serum creatinine
10:31of three times baseline an absolute increase of at least four milligrams per deciliter initiation of renal
10:38replacement therapy urine output less than 0.3 milliliters per kilogram per hour for 24 hours or more or anuria for
10:4612 or more hours
10:54question 27 you hear a discussion between two doctors about acquired
10:59melanocytic nevvy
11:16hello doctor what are acquired melanocytic navy acquired melanocytic
11:22nevi are clumps of melanocytes that originate during childhood but manifest during 30 to 40 years of age
11:29junctional nevi form macules with the skin markings becoming slightly more prominent they are circular flat lesions
11:36with a uniform brown coloration they have litiginous cells which are round or
11:41oval or spindle shaped dermal nebu are raised pale brown or
11:46skin colored lesions and often hairy having focal globules and fine vessels
11:52or pale areas pseudohorn cysts may be seen the cells are epithelid with
11:58amphophyllic cytoplasm and the melanin is in granules compound nevi may be
12:04raised with a wart-like surface in certain cases and are usually lighter brown than junctional nevi are they have
12:10round or oval globals of pigment and these may form cobblestone patterns
12:21question 28 you hear a discussion between a doctor and nurse about amblyopia
12:42hello doctor can you explain what is an amblyopia well amblyopia is the medical
12:49term for lazy eye that refers to a condition in children where the vision in one eye fails to develop adequately
12:56this usually affects ability of the child to see using the weaker eye in strabismic amblyopia a squint
13:04develops due to a mismatch between the muscles that support the position of the eyes
13:09therefore the brain ignores the eye that is not straight and relies on the images
13:14generated by the stronger eye in a condition called anti-somitropic amblyopia the refractive error is
13:21greater in one eye than the other eye therefore the brain ignores the more farsighted eye and relies instead on the
13:28eye that provides a clearer picture however the weaker eye remains straight therefore the defect may go unnoticed by
13:35the parents or primary care doctor in the condition called deprivation or occlusion amblyopia one eye is deprived
13:42of vision due to the development of a blockage such as a cataract the ocular media becomes opaque
13:49preventing visual information from reaching the brain
13:58question 29 you hear a discussion about mille area
14:17hello doctor what is malieria well miliaria is the conditions associated with sweat
14:24retention in the skin when the flow of sweat is obstructed the sweat stays trapped within the skin
14:31instead of moving out from the sweat glands to the surface of the skin developing various symptoms and signs
14:37including skin lesions miliary crystalline also called pseudomena describes sweat duct
14:44obstruction in the uppermost epidermis where the sweat is retained to form subcornial vesicles these clear
14:51non-inflamed fluid-filled blisters and papules rupture easily and even light
14:56rubbing can cause them to break miliaria rubra also called prickly heat
15:02and refers to the retention of sweat that moves into the middle layers of the epidermis and the upper dermis resulting
15:09in itching and redness around the sweat pores miliaria pustulosa occurs when the
15:14melaria rubra develops as inflamed pustules miliaria profunda occurs when
15:20the sweat moves from the ducts into the dermis hard flesh-colored painful papules
15:25develop that are much larger and more deeply located than the papules seen in miliaria rubra
15:37question 30 you hear a lecture about different type of stents
15:56we see today what is stent and what are the different types of stents
16:02stent is a splint that is placed inside a duct blood vessel or canal temporarily
16:08to aid healing or relieve an obstruction primarily they are used to keep narrowed
16:13blood vessels open and patent to allow sufficient blood flow or bodily fluid
16:20coronary stents are a tubular mesh-like device that do not have any embedded
16:25medications in them drug-eluting stents are coated with medications to prevent inflammation and
16:32retinosis of the artery on a long-term basis a urinary stent is used to hold open the
16:39ureter in cases where it is narrowed your readers are long tubes that carry urine from the kidneys to the bladder
16:45where it is stored until it is emptied and prostatic stent is used to open up
16:52the narrowing caused by an enlarged prostate pushing against the urethra preventing the normal outflow of urine
16:58peripheral vascular stents are used to keep blood vessels outside the coronary arteries open
17:05stent grafts are tubular devices made up of a special fabric that is supported by
17:10a rigid metal stent these are mainly used for vascular surgeries such as to
17:16repair abdominal aortic aneurysm stents can also be used to keep the food
17:21pipe of the esophagus open in case of esophageal constriction and biliary
17:26stents can be used to maintain adequate drainage of bile into the intestine
17:35that is the end of part b now look at part c
17:40part c in this part of the test you’ll hear two different extracts in each extract
17:46you’ll hear health professionals talking about specific aspects of their work
17:51for questions 31 to 42 choose the answer a b or c which fits best according to
17:58what you hear complete the answers as you listen to the audio
18:03now look at extract one extract one questions 31-36
18:11you hear the discussion between a senior doctor and junior doctors on epidermal
18:16nevi you have 90 seconds to read questions 31-36
19:52hello doctor can you please explain different types of epidermal navy
19:57epidermal nevi are categorized based on their clinical features by the site of
20:02occurrence and their extent of spread however mostly they are categorized
20:08based on the epidermal cell that predominates in the lesion in certain patients multiple epidermal
20:14nevy occur along with systemic abnormalities and they form the epidermal nevis syndromes
20:21based on the occurrence patterns epidermal nevi are categorized differently despite the similarity in
20:27their microscopic appearance nevis varicosis occurs as a single or
20:32multiple lesions but always localized nevis urineous latteris occurs as a
20:37linear pattern of lesions ichthyosis histrix are generalized lesions however
20:43epidermal nevi are also classified by their cell of origin nevis sebaceous are
20:49quite common and are made up of sebaceous glands with or without hair follicles they’re found commonly on the
20:56scalp but also on the extremities or trunk and are pale yellow in color with
21:01a smooth hairless surface they are present in infants though they may manifest only after puberty or in
21:08childhood one fourth of the cases eventually give rise to tumors and are mostly benign
21:14often it is connected with the occurrence of schimel penning syndrome phacomatosis pigmento caricottaca
21:21didamos a plastic sebaceous and scalp syndrome carotenosinic epidermal nevis
21:26are also called non-organized epidermal never and are quite common among this
21:32group of lesions they follow the lines of blasco and begin as brownish macules
21:38thicken and darken with age to become plaques they may be defined as linear or
21:43varicose based on their appearance other variants include the epidermolytic epidermal nervous the acantholytic
21:50epidermal nervous and the systemized epidermal nevis nevis comedonicus are formed of
21:57proliferated dilated keratinized follicles often inflamed or showing signs of infection as a result of
22:03blockage forming blackheads and pitting is often seen it may be associated with
22:09brain abnormalities bone defects and cataracts the angora hair nevis is
22:14remarkable for the long and soft white hair like angora wool that grows from it
22:20it may be associated with other defects of the brain and bones the becker nevis
22:25is a dark patch of hairy skin that appears like a checkerboard shape becoming larger and darker after puberty
22:32due to androgen dependent nature often it is found on the upper part of the back or on the shoulders it is linked
22:39with other skeletal muscular defects forming the becker nevis syndrome inflammatory linear varicose epidermal
22:46nevis is linear and forms plaques usually unilateral they are usually pruritic and appear
22:53inflamed and hyperkeratotic the first appearance is after six months
22:58of age porocherotic ecron nevis appears as warty keratotic popular lesions mostly
23:06on the palms and soles but in some cases they may appear all over the skin
23:21now look at extract two questions 37-42
23:27you hear the discussion of a physician with junior doctors on different types of gang green
23:33you have 90 seconds to read questions 37-42
25:08hello doctor can you explain different types of gangrene well the term gangrene refers to the
25:15death of tissues due to lack of blood supply and deeper invasion of infected
25:20tissues which are broadly classified into two categories dry and wet gangrene
25:26although there are many types of gangrene all types of gangrene manifest either as dry or wet form
25:34in the dry gangrene there is obstruction or slowing of blood flow into the organ
25:39or part of the body that is affected peripheral parts like toes fingers nose
25:45tip earlobes etc are commonly involved often dry gangrene is seen in patients
25:51of type 1 and type 2 diabetes where long term high blood sugar damages the small
25:57arteries and blood vessels that supply blood to the end parts of the body such
26:02as fingers and toes resulting in obstruction and slowing of blood flow and ultimately gangrene
26:09in patients with dyslipidemia or high cholesterol there is a risk of cholesterol deposition and lipids called
26:16plaques within the blood vessels in the peripheries such as fingers and toes
26:21this leads to decrease in the blood vessel diameters by narrowing of the lumen resulting in formation of gangrene
26:29patients with peripheral arterial disease develop fatty acid deposits or develop narrowing of peripheral blood
26:35vessels certain conditions include scleroderma and raynaud’s disease where the blood supply is restricted to leg or
26:43hand muscles resulting in gangrene dry gangrene is usually identified by
26:48cold painless and dry and shriveled up affected part however there will be
26:53healthy skin surrounding them the area affected appear mummified
26:59what gangrene occurs due to infection and invasion of bacteria into deeper
27:04tissues after injuries foot ulcers frostbites or burns there is excessive swelling of the
27:10affected part due to release of the toxins from the invading bacteria resulting in blockage of the blood
27:17supply and worsening of the infection as the white blood cells cannot reach the area affected via blood vessels
27:25wet gangrene spreads much quicker than dry gangrene and may result in life-threatening complications like
27:31septic shock wet gangrene appears discolored or black and often with acute
27:37and excruciating pain there are black blisters and foul-smelling pus beneath the thin skin at the area
27:45since the infection is associated with discharge of pus it is called wet gangrene
27:51gas gangrene is caused by bacteria called clostridium that is found in
27:56spores present in the soil gas gangrene was a common cause of death
28:01in the wars the gangrene is caused by the toxins released by the bacteria
28:07gas gain green is further categorized into three types traumatic gas gain
28:12green occurring after injury non-traumatic gas gangrene recurrent gas
28:17gangrene caused by c perfringens species of bacteria necrotizing fasciitis is a deep tissue
28:25infection caused by bacteria like staphylococcus or streptococcus
28:30the bacteria spreads deep into the skin and into the tissues and attacks the
28:35soft tissue and the fascia which is a sheath of tissue covering the muscle
28:40this can occur in an extremity following a minor trauma or due to the opportunity
28:46for the bacteria to enter the body such as surgery the necrotizing fasciitis
28:51infection known as flesh eating bacteria is most common with minor trauma a mixed
28:57bacterial infection is often the cause after surgery internal gangrene is caused when blood
29:04supply to an internal organ is hampered usually by pressure from another organ or growth for instance in hernia there
29:12is an abdominal opening where the intestine may get blocked and the blocked area turns gangrenous noma or
29:19cancrum oris affects the face fournier’s gangrene is a rare but
29:24life-threatening condition affecting the penis and genitalia this disease has been shown to have a
29:30predilection for patients with diabetes as well as long-term alcohol misuse
29:36however the disease can also affect patients with non-obvious immune compromise
29:41the development and progression of the four nearest gangrene is often fulminating and can quickly cause
29:47multiple organ failure and mortality due to such potential complications it
29:53is crucial to diagnose the disease process as early as possible death rate is very high despite
30:00antibiotics and aggressive debridement and broadly accepted as the standard treatment mullany’s synergistic gangrene
30:07is a rare type seen in patients after surgery mullany’s synergistic gangrene
30:13is caused by s aureus and streptococcus organisms one of the recognizable
30:18symptoms is the presence of extremely painful lesions that usually form in the second week after surgery or minor
30:25trauma
30:37that is the end of part c you now have two minutes to check your answers
30:58[Music]
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