Part A Extract 1: Questions 1 to 12

1.         Acne

2.         Oral contraceptive pill.

3.         Penicillin

4.         Alesse-28, 20 mcg-0.10 mg

5.         Stress disorder

6.         Caffeine

7.         Keratotic Papule

8.         Tetracycline 250 Mg

9.         Oral antibiotic

10.       Doxycycline

11.       Antioxidants

12.       Spearmint

Extract 2: Questions 13 to 24

13.       Margaret Nicholson

14.       Frequent Headaches

15.       Persistent Cough

16.       5 Pounds

17.       Urine Test

18.       Streptococcus Pneumoniae

19.       Legionella

20.       Levofloxacin 750 Mg

21.       7 to 14 Days

22.       Prevnar 13

23.       Yoghurt

24.       Lean Meat

Part B

25.       C

26.       B

27.       B

28.       B

29.       B

30.       C

Part C EX 1

31.       A

32.       B

33.       C

34.       B

35. C

36. B

Part C EX 2

37. B

38. A

39. B

40. C

41. B

42. B

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Test transcript

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

0:47hello doctor yes Miss Alyssa what’s your problem I’m getting acne from

0:53continually washing the area around my chin right Temple and left temple and

0:58the condition is still worsening what’s your age

1:0419 how old were you when you started your period well it was when I was

1:1013 and can you describe the length of your cycle once in 24 days and it lasts

1:17for almost 6 days would you describe the flow as light or

1:24thick hm it’s light do you use any

1:31medication yeah I take the oral contraceptive pill are you allergic to any

1:38drugs yes allergic to penicillin I feel difficulty in

1:44breathing what are the medicines you are taking H Ali 28 20

1:52mcg10 milligram tablet is anyone in your family prone to

1:58any disease yeah my mom has stress disorder and

2:06anxiety do you smoke or drink I don’t smoke but I drink

2:13socially you drink caffeine yeah four servings a

2:19day hm your diagnosis report shows you have symptoms of periodic reing of face

2:26acne problems and allergies in a diagnosis of epican and apocrine glands shows no evidence of hyperhydrosis chrom

2:33hydrosis or Brom hydrosis but your face shows keratic papule I would suggest you

2:39go for antibiotic therapy take a tetracycline 250 MGR capsule I would

2:44also suggest you take an oral antibiotic therapy with doicy 100 milligrams a

2:50day doctor why does the acne occur acne is a skin condition that

2:57happens when your hair follicles become clogged with oil in dead skin cells it often results in blackheads or pimples

3:04whitee heads and often appears on the face chest forehead chin shoulders and upper back and shoulders most acne is

3:12most common among teenagers like you the Androgen hormones increase during

3:17puberty causing the sebaceous glands to enlarge and secrete more sebum hormonal changes during pregnancy and the use of

3:24oral contraceptives also impact sebum secretion moreover low amounts of Androgen circulate in the blood can

3:31still worsen acne medications such as drugs containing corticosteroids testosterone or lithium worsens the

3:38disease which food should I avoid doctor certain dietary factors such as skim

3:45milk and carbohydrate foods such as Bagels bread and potato chips worsen

3:51acne can you recommend any effective foods for acne you must stop eating

3:57processed sugar caffeine dairy product products and processed foods and you should include foods that are rich of

4:03antioxidants anti-inflammatory compounds and other acne fighting nutrients foods

4:09such as blueberries sweet potatoes green tea carrots cilantro spearmint oats apples barley and mustard

4:18greens okay thank you doctor thank

4:28you extract two questions 13 to 24 for

4:35questions 13 to 24 complete the notes with a word or a short phrase you may

4:41have 30 seconds to look at the

4:58notes

5:16good morning I’ve got an appointment with Dr Gonzalez at 8:30 okay please be

5:23seated let me check with your record in the meantime please sign in and be

5:28seated H Margaret Nicholson I’m here follow me

5:35to room number three please here we are what’s the reason for your visit

5:40today well lately I’ve been feeling really tired and often I get frequent headaches and an upset stomach moreover

5:48I’ve been getting a persistent cough for like the last three weeks when did these symptoms

5:55start I started feeling tired all the time about two months ago then a few

6:00days after that the headache started I got the upset stomach long before feeling the

6:06tiredness are you taking any medications only vitamins what vitamins

6:13are you taking I am taking vitamin C and a multivitamin tablet

6:19daily okay let me examine your Vital

6:24Signs how am I doing everything is normal no high temperature and your

6:30blood pressure is also normal please wait for a moment here thank you

6:36doctor I see here that you have started feeling tiredness two months ago and

6:41then frequent headaches you’re also suffering with an upset stomach and a persistent cough did you run a fever as

6:50well no doctor let me perform a quick physical

6:55checkup take a deep breath hold your breath for a for a moment and

7:01exhale repeat this again have there been any changes in

7:06your diet or your weight recently my diet is the same as usual however I lost

7:125 lbs very recently did you ever suffer from

7:18insomnia well it is pretty hard for me to fall asleep I also wake up often during the night do you drink or

7:27smoke no doctor

7:32well recently the ownership has changed and I had to work a lot of overtime at late hours even during the weekends I

7:38think you suffering from pneumonia other than that I do not see any other problem the reason could be

7:45probably the stress at your workplace that causes headaches upset stomach and sleeplessness for now try to relax

7:52yourself and start doing exercises meet me again after you receive all the medical diagnosis reports I’m going to

8:00prescribe medicines for bacterial pneumonia are you allergic to any

8:05medicine not to my knowledge I want you to do a blood test and urine test to identify the bacteria streptococus

8:12pneumoni and Legionella pneumophila is it something serious doctor not at all I

8:18doubt that could be bacterial pneumonia take lolicin 750 migrs orally every 24

8:25hours for 7 to 14 days I want know my cholesterol level

8:30when will I get the medical reports doctor you will get the medical results in 2 weeks don’t stress yourself

8:36everything will be okay can pneumonia be prevented doctor

8:42in most of the cases pneumonia can be prevented you can have a vaccine to

8:47defend against pneumonia once you get all these medical investigation reports I would suggest prear 13 pneumonia

8:54vaccine that is very effective against 13 types of bacterial pneumonia

8:59what food should I include in my diet doctor have plenty of fruit juice and fresh fruits yogurts milkshakes

9:06smoothies eat plenty of full cream milk or yogurt or even ice cream with light

9:12meals of lean meat fish or eggs and cooked vegetables thank you Doctor you

9:18are

9:26welcome that is the end of part a now look at Part

9:32B Part B in this part of the text you will hear six different extracts in each

9:39extract you will hear people talking in different Healthcare settings for

9:44questions 25 to 30 choose the answer a b

9:49or c which fits best according to what you here you’ll have time to read each

9:55question before you listen complete your answers as you listen now look at

10:02question 25 Now read the

10:20question skin cancers are caused by the abnormal cells that are capable enough

10:26to invade and spread to other parts of the body generally skin cancers are classified as melanoma or non-melanoma

10:33skin cancers such as basil cell carcinoma in squamous cell carcinoma in

10:39addition to less common types of tumors such as Merkel cell carcinoma lymphomas

10:45kosi saroma or hair and sweat gland tumors skin cancer symptoms include

10:50alterations in the appearance of a mole or spot on the skin or the developing of a new spot or lump on the skin it may

10:57also cause symptoms in signs such as itching skin ulcerations scaling

11:02swelling or bleeding

11:10Etc question 26 Now read the

11:27question depression is a sickness involving the body thoughts and mood that severely

11:34impacts the way a person sleeps eats behaves and the way one feels about oneself depressive disorders are

11:42categorized by pervasive mood swings that severely affect all aspects of an individual’s daily activities a

11:48depressive disorder is not just a mood swing but it is more of a case of persistent sadness certain symptoms of

11:55depression include feelings of worthlessness helpless lessness hopelessness guilty feeling lack of

12:02Interest irritability loss of appetite loss of energy self-loathing Sleep

12:07Disorders

12:16Etc question 27 Now read the

12:27question

12:39doctor should Frailty be considered before any operation in an older person Frailty is not just a phrase but a

12:45health metric that should be performed before the surgery to any older person I think the Frailty score is a very good

12:52concept it may dictate the objective of the surgery the Frailty score concept relates to the inexorable decline of

12:59physiological Reserve that is a normal consequence of the aging process we must consider that a healthy 60-year-old will

13:06not be as fit as a healthy 40-year-old individual when faced with the necessity to have surgery the Frailty concept

13:13really is more objective Frailty can be simply evaluated with a walking test

13:19such as a very slow walk at speed or an inability to walk very far giving a good

13:24approximation both patient and loved ones should consider the consequen of surgery before the procedure begins

13:31especially in the

13:37frail question 28 Now read the

13:57question doctor could you please explain to me the severity of epidermis Bosa in

14:03Children Well epidermal losis Bosa is a rare genetic condition in children the

14:09genes that cause epidermal losis Bosa may be present in other family members as well there are four major categories

14:16of epidermal losis Bosa in the case of epidermal Bosa Simplex there will be

14:22blistering mainly on the hands and feet with little scarring or without scarring at all when it becomes severe the

14:29patient will have more widespread blistering and other severe medical conditions like blistering in the mouth

14:34and digestive tract in the patients with milder junctional epidermal losis Bosa

14:40there will be limited blistering that often improves with age patients may also have hair loss and abnormal

14:46fingernails and toenails children are prone to have growth and malnutrition

14:52issues the scarring type of D trophic epidermal losis Bosa especially in mild cases the blistering is primarily found

14:59on elbows feet and hands when the disease becomes severe there is a higher

15:05risk of developing skin cancer as the patient gets older in the case of Kindler syndrome the patients have an

15:11increased sensitivity to sunlight in addition to

15:20blistering question 29 Now read the

15:27question

15:42clonus is a neurological condition that is suffered when the controlling nerve of the muscles are damaged causing

15:48involuntary muscle contractions often clonus spasms Ur in a rhythmic pattern

15:54symptoms are very common in a few muscles such as knees ank ankles wrist calves jaw biceps damaged nerves results

16:03in misfire leading to muscle tightness involuntary contractions and pain clonus

16:08causes a muscle pulse for an extended period that can result in muscle

16:20fatigue 30 Now read the

16:27question

16:42doctor I feel that a solution should be devised to cope with delirium in patients in ICU what do you think hopal

16:50has been used for a long time in patients in ICU in an attempt to prevent delirium a very severe and sometimes

16:57persistent acute confusion according to a recent study haloperidol

17:02is ineffective delirium is extremely prominent since it’s strongly associated

17:07with cognitive impairments for a long term significantly medications are the

17:12means that patients approach often However unfortunately it’s

17:17demonstrated that medications aren’t the right approach always or at least the

17:23haloperidol nevertheless for delirium there’s not going to be a miracle in terms of medication

17:39that is the end of Part B now look at part

17:47C part C in this part of the text you’ll hear two different extracts in each

17:54extract you’ll hear health professionals talking about aspects of the they work

17:59for questions 31 to 42 choose the answer a b or c which fits best according to

18:08what you hear complete the answers as you listen now look at extract one

18:16extract one questions 31- 36 you may have 90 seconds to read

18:23questions 31 to 36

19:55role of diabetes in the endstage renal disease of late diabetes has become the

20:02primary cause of endstage renal disease worldwide this is due to the fact that diabetes especially Diabetes Type 2 is

20:09increasing approximately 45% of new patients receiving Dialysis in the US are diabetic early diagnosis of diabetes

20:18and early intervention are crucial to prevent the progression towards renal failure seen in a significant percentage

20:24of type 2 diabetic patients and in many type 1 diabet ICS the presence of micro

20:30Alam minura is the early clinical evidence of diabetic neuropathy defined as the appearance of low but abnormal

20:37levels of albumin in the urine the characteristics of diabetic neuropathy are a decline in glomular filtration

20:44ratio Progressive increase in protein Ura hypertension and a high risk of

20:50cardiovascular morbidity therefore the evidence of micro albam and Ura should trigger diagnosis for possible vascular

20:57diseases and aggressive intervention to cope with all cardiovascular risk factors in diabetics type 1 and two the

21:04natural history of diabetic neuropathy progresses slowly over the years in type

21:101 diabetes micro albam menura occurs after 5 years and the endstage renal

21:15disease develops in 50% of type 1 diabetics whereas type 2 diabetics has a

21:21more variable course very few patients with micro alaman Ura progress to Advan

21:26renal disease with without intervention approximately 20% of patients of type 2 diabetes develop an end-stage renal

21:33disease however due to the increased number of type 2 diabetes patients compared to type 1 diabetes the maximum

21:40number of patients on dialysis are type 2 diabetics there are many factors which account for the pathophysiological of

21:47diabetic neuropathy primarily anatomical and structure changes in the kidney result in increased glomerular capillary

21:54pressure in diabetes which is associated with hyper filt ation at the glomerulus the next factor is the

22:01glucose that can increase the formation of advanced glycosilation and products by inversely binding to proteins in

22:08kidneys and circulation over the years these formed Advanced glycosilation and products which stimulate the growth in

22:15fibrotic factors contributing to overall renal damage thirdly ngot tensin 2

22:21contributes to the advancement of diabetic neuropathy by narrowing the ephrine arterial in the glumer sub

22:28subsequently resulting in higher glomerular capillary pressures while diagnosing diabetic

22:34neuropathy early investigation of glucose intolerance in diabetes to distinguished patients who are at risk

22:40for developing micro alamin Ura is suggested especially if they have other risks for type 2 diabetes such as lipid

22:48central obesity abnormalities or hypertension therefore the investigation

22:53of micro alamin Ura presence should be performed at diagnosis in patients with

22:59type 2 diabetes whereas in patients with type 1 diabetes since micro alamin Ura

23:05rarely occurs with short-term type 1 diabetes the diagnosis should begin after 5 years of disease according to

23:12the findings the microvascular complications developed During the prepubertal period of diabetes therefore

23:18clinical judgment should be demonstrated when individualizing these suggestions the object of diabetic

23:25neuropathy therapy involves multic clinical approaches tight glycemic control is the Keystone in the

23:31prevention and management of diabetic neuropathy the United Kingdom perspective diabetes study and diabetes

23:38control and complications trial have established that an intensive diabetes therapy can consider can considerably

23:45decrease the risk of micro alamin Ura and neuropathy development nonetheless

23:51blood pressure control is another Keystone in prevention and treatment in addition to glycemic control the

23:57significance of blood pressure control irrespective of what agent is used cannot be emphasized enough in diabetes

24:04both for slow progression of neuropathy and for preventing cardiovascular morbidity according to the recent joint

24:11National Committee guidelines blood pressure and diabetics is reduced to less than 130 over 80 mmhg it is very

24:18crucial for doctors and patients to understand early on the three or more agents ngot tensin receptor blockers or

24:25ensin converting enzyme Inhibitors are considered firstline agents in patients

24:31with co-c committ hypertension and diabetes diuretics might be added as a second line agent in many cases after

24:38Angiotensin blockade in diabetes di hydropod a class of calcium channel

24:44blockers may be considered as the third or fourth line agents in diabetics only

24:50after initiation of angot tensin blockade and diuretics there are also other non-pharmaceutical suggestions

24:57such as diary restriction of protein intake restrictions of protein to8 G per

25:02kilogram weight per day in patients with overt neuropathy or even 6 gam per

25:08kilogram weight per day is recommended in the case of declining glom rural filtration ratio moreover it is very

25:14essential to stick to a low sodium diet in diabetic neuropathy since many diabetics with renal disease are salt

25:21sensitive therefore restricting salt intake will certainly help in reaching blood pressure goals with secondary

25:27benefits of regression of left ventrical hypertrophy decreased stroke risk and reduction in protein Ura a recommended

25:34low sodium diet of 2.3 G daily in patients with diabetes in either hypertension or protein Ura moreover

25:42avoiding nephrotoxin agents such as radio contrast media non-steroidal anti-inflammatory drugs is highly

25:49recommended last but not least annual diagnosis of micro alamin nuura in

25:54diabetics will allow the detection of neuropathy at an early stage stage improv glycemic control and intensive

26:01anti-hypertensive treatment will ultimately slow down the progression of diabetic

26:16neuropathy now look at extract two extract two questions 37 to 42 you now

26:24have 90 seconds to read questions 37 to 4

26:5622

28:01Alpha and beta phemia phemia is a hereditary disease of

28:06the red blood cells called aryes the disease is classified as

28:12hemoglobinopathy the genetic disorder results in the composition of an abnormal hemoglobin molecule the blood

28:18cells are prone to Mechanical injury and die easily many patients with phemia

28:23require periodic blood transfusions for their survival the thammi ins are

28:28classified based on the infection chain of the globin molecule the production of alpha globin is deficient in Alpha

28:35globin thymia while betaglobin is defective in beta Thalia Alpha thalmans lead to excess

28:42gamma chains in newborns and excess beta chain production in adults the excess beta chains produce unstable tetramers

28:49with abnormal oxygen disassociation curves alphal globin has four genetic

28:55locai the more of these Loi are effective or affected by the mutation the more serious the manifestation of

29:01the disease will be missing one locai or abnormal Gene makes a child a silent Alpha thymian carrier silent Alpha

29:09thymia carriers develop no symptoms or signs of the disease however are able to pass thymia onto their children missing

29:16two loai or mutated genes is a condition called Alpha thymia minor or having Alpha Thalia trait in this condition the

29:24red blood cells may be smaller than normal called microcytosis and at times may have very mild anemia the condition

29:32of missing three loai or mutated genes is called hemoglobin H disease symptoms

29:37and signs will be moderate to severe in the case that all four locai are affected the fetus cannot survive once

29:43outside the uterus resulting in still birth with hydrops Fatalis even if it is

29:49born alive it will die shortly after birth beta thymia occurs when the gene

29:55that controls the secretion of beta globin is defective beta thymia can result in anemia ranging from mild to

30:02severe and is very common in people of African South Asian and Mediterranean descent alphal globin along with

30:08betaglobin is one of the proteins that composes hemoglobin betaglobin is made on chromosone 11 beta Thalia is

30:15classified into three major categories depending on the number of mutated beta globin genes and the intensity of the

30:21mutations beta Thalia trait or beta phalia minor occurs when one of the beta

30:27genes are mutated typically patients with this condition have very mild signs and symptoms that don’t require any

30:34treatment however they can pass on phemia to their children usually the patients are mildly anemic and their red

30:40blood cells are smaller than normal a condition called microcytosis beta phalia major occurs

30:47when both of the beta globin genes are altered and the mutations are severe this is the most severe condition of

30:54beta Thalia children with beta Thalia a major often appear healthy immediately

30:59after birth but start developing symptoms within the subsequent 2 years of their life this condition results in

31:05severe symptoms with life-threatening anemia requiring periodic blood transfusions mutations of both the

31:12betaglobin genes may also result in beta Thalia intermediate however the

31:17mutations are less severe than beta Thalia major patients with this condition usually have moderately severe

31:24anemia and at times require periodic blood trans trans

31:37fusions that is the end of part C you now have 2 minutes to check your

31:47answers that is the end of this listening test thank you very much for

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