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0:00extract one questions 1 to 12 for questions 1 to 12 complete the
0:08notes with a word or a short phrase you now have 30 seconds to look at the
0:28notes
0:48good morning doctor good morning Mr Jonathan tell me about your problem I am
0:54having severe and recurrent jaw pain doctor there’s also numbness tingling
0:59along the jaw jaw teeth and tongue how long have you had these problems for the past 6 months I even
1:07consulted a dentist but the dental evaluations are normal I was also diagnosed with a throat infection last
1:13week and I was prescribed avalox which I’ve almost completed I am taking cough drops and trying to increase fluids oh I
1:22see do you drink or smoke no doctor but I used to chew tobacco for about 30
1:28years but I’ve recently stopped okay moreover I’ve also lost the
1:34sensation of taste the numbness is on the left lateral tongue and jaw that extends from the angle of the jaw to my
1:41lip doctor recently I’ve gained about 20 pounds of weight and that maybe due to
1:46decreased activity do you get headaches yes doctor about twice in a month do you
1:53experience any fever or chills no doctor do you have any tooth pain especially
1:59especially while biting no doctor have you had any jaw popping no doctor any
2:06spasm of the jaw that is trismus no doctor I’ve stopped chewing
2:12tobacco and I’m using nicar gum now doctor oh okay what’s your age now 50
2:19years have you ever had any surgery yes pertinent for hernia repair surgery what
2:26medications are you taking at the moment Tylenol and I’m on n gum are you
2:31allergic to any medicine yes I’m allergic to coding I used to feel dizzy or laded when I took
2:38cing H your blood pressure is 138 over
2:4382 pulse 64 normal temperature
2:4898.3 and your weight is 191 lbs your oral cavity is normal with good moisture
2:55you have a slightly decreased sensation to your left jaw that extends to the left lateral tongue and left intcal
3:03mucosa the fiberoptic naseros scapy reveals a moderately deviated nasal
3:10septum to the left large inferior terminates you have developed persistent
3:17parasthesia of the left manual teeth and tongue possibly neoplasm within the mandible you have also developed hypog
3:24Gia with loss of taste in dry mouth syndrome called xerostomia I would
3:30suggest you have a CT of your head including sinuses and mandible so that I
3:36can evaluate and make sure you have not develop neoplasm take plenty of fluids and come and see me again when you get
3:42your diagnos
3:50reports extract two questions 13 to 24 for questions 13 to 24 complete the
3:58notes with a word or a short phrase you may have 30 seconds to look at the
4:28notes
4:34hello doctor good morning good morning may I find out what the problem is I’ve
4:40been experiencing the symptoms of heart failure for the past year doctor although it appears okay in general I
4:46feel a lot of stress and fatigue I’ve also noticed shortness of breath with exertion I am getting attacks of severe
4:53shortness of breath and coughing that usually occurs while I’m sleeping I have developed edema and had a mild leg
4:59swelling a while ago do you have severe chest pain called angina palpitations or
5:04syncope no doctor but I feel some irregularity in my pulse over the past
5:0910 months these symptoms have been gradually worsening over the past year I’ve gained about 20 kilograms in weight
5:15doctor what’s your age 63 doctor have you had any previous illnesses I had W
5:22inal Heria surgery 7 years ago I had trauma to my right thumb do you have
5:28diabetes metis a heart murma no doctor do you smoke or drink I don’t smoke but
5:34I drink tell me about your family history any endless my mother’s alive at
5:4092 my father died at 76 of a heart attack are you taking any
5:46medications yes doctor aspirin 81 milligrams daily and choria epoxide and
5:52clidinium combination pill at 5 Mig or 2 and2 Mig one tablet daily for stress Are
5:59you a allergic to any medicines no doctor okay well according to my comprehensive cardiovascular examination
6:06your blood pressure is 120 over 70 in each arm seated your pulse is 80 beats
6:13per minute and regular your breathing is two times per minute and that is
6:18unlabored lungs are clear to oscilation and percussion the first and second
6:23heart sounds are normal you have a fourth heart sound and a soft systolic
6:28murmur the precordial impulse is enlarged your electrocardiogram shows
6:33sinus rhythm with left ventricle hypertrophy your Peak oxygen consumption
6:39was 19.7 milliliters per kilogram of body mass per minute which is consistent
6:44with mild cardiopulmonary disease laboratory data shows your thyroid stimulating hormone
6:511.33 your glucose is 97 and creatine 0.9
6:57potassium is 4.3 I reviewed your echocardiogram thoroughly that shows a
7:03dilated cardiomyopathy with ejection fraction of 15% your poststress ejection
7:09fraction is 33% and left ventricular cavity appears enlarged this appears to
7:15be a newly diagnosed dilated cardiomyopathy of Uncertain ideology and
7:21dyslipidemia I’m going to prescribe Angiotensin converting enzyme inhibitor
7:26linil 2.5 mg daily and a bait blocker covered a low
7:323.125 mg twice daily in addition you could benefit from a loop diuretic
7:38boside 20 mgram daily I don’t think you need a defibrillator right now and after
7:453 months of medication I want you to go on an echocardiogram if your left ventricular function has not improved
7:52then you would benefit from a prophylactic use of an implantable cardioverter defibrillator so continue
7:59continue with these medications and meet me after a period of 3 months thank you
8:12doctor that is the end of part A now look at Part B Part B in this part of the text you
8:21will hear six different extracts in each extract you will hear people talking in
8:27different healthc care settings for questions 25 to 30 choose the answer a b
8:35or c which fits best according to what you hear you’ll have time to read each
8:41question before you listen complete your answers as you listen now look at
8:47question 25 Now read the
8:58question
9:06hello doctor can you please explain azotemia to me azotemia is a kind of
9:12nephrotoxicity that occurs when there’s nitrogen in our blood ureia occurs when there’s urine in your blood when excess
9:19nitrogen becomes toxic to our system and results in ureia or uremic syndrome if
9:25untreated azotemia can lead to acute renal failure when fluid isn’t flowing
9:31enough through the kidneys prerenal azotemia occurs creating high levels of
9:36UA and serum creatine concentration this is the most common type of azotemia and
9:43can be reversed usually intrinsic azotemia is caused due to sepsis
9:49infection or disease acute tubular necrosis is the most common type of
9:55intrinsic azotemia postrenal azotemia is is caused by an obstruction in the urinary tract
10:02postrenal azotemia can also occur with pre-renal
10:13azotemia question 26 Now read the
10:28question
10:40hello doctor what is a billy Rubin blood level as a result of breakdown of red
10:46blood cells Billy Rubin is released into the blood Billy Rubin is used by the liver to make bile generally a small
10:53amount of Billy Rubin is present in the blood the increased level of Billy Rubin in blood could be symptom of a liver or
11:00blood problem a common cause of increased Billy Rubin is Gilbert Syndrome a deficiency in an enzyme as
11:08the Billy Rubin levels in the blood get higher the white part of our eyes called scare may turn yellow also our skin may
11:17appear yellowish this is called ioris or
11:27jaundice question 27 Now read the
11:49question hello doctor who really has celiac disease and who doesn’t well
11:54according to findings about 40% of people worldwide may have a a genetic susceptibility to develop celiac disease
12:02where they react to gluten in their diet however what I feel is about 1% develop
12:09celiac disease those people do very well on a gluten-free diet avoid wheat oats
12:15and Rye however gluten is very tough to digest therefore it’s very gassy so I
12:21think people who buy gluten-free foods are really avoiding gassiness but I
12:26think most people are not really bothered by gluten a simple blood test can help identify those with celiac
12:33disease but simply avoiding foods to get rid of celiac disease is well worth
12:45continuing question 28 Now read the
12:57question
13:07Precision medicine is an emerging strategy for disease treatment based on the individual variability in genes
13:14environment and the lifestyle of each patient allowing healthc Care Professionals and researchers to deliver
13:20precise treatment strategies for specific diseases in specific types of patients it isn’t contrary to a one-
13:27siiz fits-all approach in which general treatment strategies are followed with less consideration for the differences
13:34between patients although the term Precision medicine may be relatively new the concept has been a part of health
13:40care for many years for instance a person who requires a blood transfusion is not given blood from a randomly
13:47selected donor instead the donor’s blood type is matched to the patient to reduce the risk of
13:53complications however the role of the Precision medicine in patient treatment is relatively Limited
14:06question 29 Now read the
14:25question in most people with alopecia AR hair falls out in small round patches
14:32leaving round shaped areas of bare skin often this patchy hair loss occurs on
14:37the scalp however it can affect other parts of the body as well rarely the hair loss involves the entire sculp a
14:45condition called alopecia totalis or else even the whole body becomes hairless a condition called alopecia
14:52universalis there are also other forms of alopecia ariata that occur very
14:58rarely with which have different patterns of hair loss however the hair usually grows back after several months
15:05though it may fall out
15:15again question 30 Now read the
15:27question
15:36a genetic condition called cytochrome SE oxidase deficiency affects several parts
15:41of the body including the skeletal muscles the brain the heart or the liver
15:46usually the symptoms and signs begin before 2 years of age however appear at
15:52a later stage in mildly affected individuals the severity of the disease
15:57varies widely among among affected patients even among those who belong to the same family patients with mild
16:04cytochrome C oxidase deficiency tend to have myopathy and hypotonia with no
16:10other related health issues more severely affected patients have problems in multiple body systems including encom
16:18myopathy hypertrophic cardiomyopathy another possible feature of this condition is an enlarged liver
16:25called hepatomegaly that may result in liver fail many patients with cytochrome C oxidase
16:31deficiency have a specific group of features known as lay syndrome that
16:36include movement problems loss of mental function eating difficulties
16:41hypertrophic cardiomyopathy and brain
16:56abnormalities that is the end of part Part B now look at part
17:05C part C in this part of the text you’ll hear two different extracts in each
17:12extract you’ll hear health professionals talking about aspects of their work for
17:17questions 31 to 42 choose the answer a b
17:23or c which fits best according to what you hear comp complete the answers as
17:29you listen now look at extract one extract one questions 31 to
17:3836 you may have 90 seconds to read questions 31 to
17:5736
19:06the samples of tissue cells can be taken from almost any part of the body depending on the type of tumor and its
19:12location the method of taking samples is determined for instance the methods
19:18followed for brain biopsies is entirely different for skin biopsies certain
19:23types of biopsies involve the removal of an entire organ which are only performed
19:28by surgeons however other types of biopsies remove tumor samples using a
19:34thin needle or through an endoscope in this session I’m going to explain the most common types of biopsies used in
19:41cancer diagnosis needle biopsy fine needle biopsy or fine needle aspiration
19:47and core needle biopsy or core aspiration are the two types of needle biopsies fine needle aspiration is
19:55performed using a thin Hollow needle effect fix to a syringe to pull out small pieces of tissue and a small
20:02amount of fluid from the tumor in case the tumor is deep inside the body and
20:07cannot be felt then the needle can be guided while watching on an Imaging tool such as an ultrasound or CT scan the
20:15main advantages of fine needle aspiration are that there is no need to cut the skin and in some cases the
20:22diagnosis is made on the same day however the disadvantage is that
20:27sometimes it becomes impossible to remove enough tissue for a detailed diagnosis although fine needle
20:34aspiration is a type of biopsy it is also classified as a cytology test
20:39however in a core biopsy the needles are slightly larger than those used in fine needle aspiration in a core biopsy a
20:48small cylinder of tissue is removed at times special vacuum tools are used to
20:53get larger core biopsies from breast tissue however diagnosing core biopsy
20:58samples take longer than fine needle aspiration biopsies therefore the results also take longer excisional or
21:07incisional biopsy in this type of biopsy the surgeon cuts through the skin to remove the complete tumor called an
21:14excisional biopsy or a part of a large tumor called an incisional biopsy in an
21:20endoscopic biopsy is a flexible thin lighted tube with a lens or a video
21:25camera affixed at the end allowing The Physician to look into the internal parts of the body tissue samples are
21:32also taken out through the endoscopic biopsy different types of endoscopes are used to look at specific parts of the
21:39body for instance one kind of endoscopy is used to look at the inside of the
21:45throat sinuses and nose laparoscopic thorascopic and
21:51mediastinoscopy although laparoscopy is much like endoscopy it uses a slightly a
21:57laparoscope to look inside the abdomen and remove tissue samples similar procedures are followed to look inside
22:03the chest these are called thoros scopy and mediastinoscopy laparatomy and
22:10thoracotomy laparatomy is a kind of surgery where vertical cut is made from upper to lower abdomen to remove samples
22:18this may be performed when the suspected area could not be diagnosed with other simpler tests there are many ways to
22:25perform a biopsy the skin based on the type of suspected skin tumor shave
22:30biopsies remove the outer layers of the skin for certain basil cell or squamous
22:36cell skin cancers however they aren’t used for the suspected melanomas of the
22:41skin as discussed earlier punch biopsies or excisional biopsies are used to
22:47remove deeper skin layers and are diagnosed How Deeply a melanoma has gone into the skin Sentinel lymph node
22:53mapping and biopsy helps the surgeon to know which lymph nodes to remove for biopsy Sentinel node mapping and biopsy
23:01is a common way to diagnose whether a cancer such as melanoma or breast cancer
23:07has spread to the lymph nodes this can detect the lymph nodes that drain lymph fluid from where the cancer originated
23:14if the cancer is metastasized these lymph nodes are usually the primary parts to
23:26affect
23:38now look at extract two extract two questions 37 to 42 you now have 90
23:46seconds to read questions 37 to
23:5642
25:27cose Acoma is a type of cancer that forms from the cells that line blood vessels or lymph it usually looks like
25:34tumors on the skin or on mucose or surfaces such as inside the mouth
25:39however kosis sacoma tumors can also develop in other parts such as in the lymph nodes digestive tract or the lungs
25:48the abnormal cells of capos sucoma form red purple or brown tumors or blotches
25:54on the skin these affected areas are known as lesions often the skin lesions
26:00of kosis sakom appear on the face or legs however usually they cause no
26:07symptoms certain lesions on the groin area or legs may cause a painful
26:12swelling on the legs and feet kosis saroma can cause severe problems or even
26:18become life-threatening when the lesions are in the digestive tract liver or lungs for instance kosi ciroma can cause
26:27bleeding while tumors in the lungs may cause trouble breathing the different
26:32types of kosi saroma are defined by the different populations it develops in
26:37however the changes within the kosi sucoma cells are very similar epidemic
26:42kosi sucoma or AIDS related kosis saroma the most common type of kosis saroma in
26:49the US is epidemic or AIDS related kosis saroma this type of kosis saroma
26:56develops in people who are infected infected with HIV however a HIV infected
27:02person does not necessarily have AIDS the virus may be present in the body for
27:07a long time often many years before causing any illness the disease called
27:13AIDS outbreaks when the virus completely damages the immune system resulting in certain types of infections or other
27:19medical complications including kosi sucoma when HIV damages the immune
27:26system patients and infected with a certain virus are more likely to develop kosis saroma kosis saroma is considered
27:34an AIDS defining illness that is when kosi saroma occurs in the patients
27:39infected with HIV that patient officially has AIDS in the US treating
27:45HIV infection with highly active anti-retroviral therapy has resulted in
27:51fewer cases of epidemic kosi saroma yet certain patients develop symptoms of Kos
27:57suoma in the first few months of Highly active anti-retroviral therapy for HIV patients highly active
28:06anti- retroviral therapy can often progress the kosi suoma development
28:12however kosi suoma can occur in people whose HIV is well under control with
28:18highly active anti-retroviral therapy once kosis sakom develops it is
28:24still essential to continue highly active anti retro viral therapy in the regions where highly active
28:30anti-retroviral therapy is not accessible kosi saroma in AIDS patients
28:35can advance quickly classic or Mediterranean capos sakom occurs mainly in older people of
28:43Mediterranean Middle Eastern and Eastern European Heritage Classic kosi saroma is
28:49more common in men than in women patients have one or more lesions on their ankles legs or the soles of the
28:56feet compared to to other types of kosi saroma the lesions and classic kosi
29:01saroma do not grow quickly and new lesions do not form as often the immune
29:07system of patients with classic kosi saroma is not as weak as it is in those
29:12who have epidemic AOS saroma but it may become weaker than normal when this
29:18occurs people who already have aapos suoma Associated herpes virus infection are
29:26more likely develop kosis sakom endemic kosis sakom or African kosis suoma
29:34endemic kosis sakom occurs in people in Equatorial Africa kosi sakom Associated
29:41herpes virus infection is very common in Africa therefore the risk of kosi sakom
29:47very high probably there are other factors in this region that weaken the immune system such as malnutrition
29:54malaria and other chronic infections which may also contribute to the development of kosi saroma endemic kosi
30:02saroma incurs in younger people under 40 rarely an aggressive form of endemic
30:07kosi saroma is seen in children before puberty this type of kosi sarcoma
30:13usually affects the lymph nodes and other organs and can progress quickly latrogenic kosis suoma or transplant
30:22related kosis sakom when kosis sakom develops in patients who immune systems
30:28have been damaged after an organ transplant it is known as otogenic capos
30:34saroma or transplanted related kosis suoma most transplant patients should
30:39take drugs to keep their immune system from rejecting the new organ but by weakening the immune system of the body
30:46these drugs increase the chance that patients infected with the herpes virus will develop kosi saroma discontinuing
30:54such immunosuppressive drugs or l lowering the dose often makes kosis
30:59Aroma lesions go away or get
31:07smaller that is the end of part C you now have 2 minutes to check your
31:15answers that is the end of this listening test thank you very much for
31:20practicing this test with lifestyle training center you can now check in the
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