1. With Heartbeat Sounds
2. Weird Sounds In Left Ear
3. Left Nephrectomy
4. Mastoidectomy
5. Excedrin

6. Codeine And Penicillin
7. Mastoidectomy Scar On Left Ear
8. Eustachian Tube Disorder
9. Normal Pressure Hydrocephalus
10. Deviated Nasal Septum

11. Nasacort Aq Nasal Spray
12. Myringotomy Or Ear Tube Placement
13. After Removing The Sweaty Socks
14. Frequent Ear Infections
15. Surgical Ear Tubes

16. Accessing Adhesive Tape
17. Maternal Aunt Has Migraines
18. Dorsalis Pedis Artery
19.Posterior Tibial Artery Pulse
20. Varicosities

21. Erythema And Scaling
22. Muscle Strength Is 5/5
23. Koh Test Shows No Visible Microbes
24. Griseofulvin 250 Mg

25. B
26. A
27. C
28. C
29. A

30. B
31. A
32. C
33. C
34. A
35. B
36. A

37. B
38. C
39. B
40. A
41. C
42. A

RONGOMANI WHENUAOET READINGOET SPEAKINGOET ROLE PLAYSOET LETTER WRITINGOET LISTENING

Listening transcript

0:14for questions 1 to 24 complete the notes with the information you hear now look at the notes for extract one

0:22extract one questions one to twelve you hear a doctor talking to a patient

0:28called rongamai whenua for questions 1-12 complete the following notes with a word or short

0:35phrase you now have 30 seconds to look at the notes

1:13hello doctor good morning good morning what’s your problem well

1:18i have a headache and pulsatile tinnitus for the past three months i’ve been

1:23getting severe headaches and almost daily i’m getting pulsations in the head with

1:28heartbeat sounds exactly at which point of your head do you feel pain on top of my head are you getting nausea

1:36or vomiting associated with the headaches no doctor is there any previous history

1:41of headaches no doctor but apart from last three months

1:46what’s your age 44 doctor when i speak on the phone i get weird sounds in my left ear i get

1:54pulsating sounds only in left ear when did this problem start actually well

1:59actually the ear pulsations began following a flight trip to my native place

2:04is there any drop or change in hearing no doctor but i had dizzy episodes in the past

2:12with nausea being imbalanced at times is there any change in your vision

2:17no doctor well do you smoke or drink i do not consume alcohol but i used to

2:23smoke one pack a day and now i have completely stopped it have you had any previous illness or

2:29surgeries i had skin cancer on my arm and back i am a kidney donor so i had a left

2:36nephrectomy c-sections mastoidectomy laparoscopy and

2:42temporal arthritis what medications are you taking tylenol excedrin

2:49and a multivitamin and probiotic are you allergic to any medicine yes to codeine and penicillin tell me

2:56your family history of illness well my father has a cancer hypertension and

3:01heart disease your physical examination shows your blood pressure at 120 over 78 pulse 64

3:09and regular and the temperature is 97.4 cardiovascular tests shows regular heart

3:15rate and rhythm without murmur there is an old mastoidectomy scar on your left ear weber exam is midline

3:22grossly hearing is intact you have pulsatile tinnitus left ear with eustachian tube disorder

3:29as the etiology there’s also a possibility of normal pressure hydrocephalus deviated naval

3:35septum dizziness probably due to possible mean yard disease i would recommend you to start a 2 gram

3:42less sodium diet i am ordering a carotid ultrasound study as part of the workup and evaluation

3:48since your disease is related to eustachian tube i’m prescribing nasocort aq nasal spray one spray each nostril

3:55daily you use the hearing protection devices at all times i will recheck you in three

4:01weeks if the pulsatile tinnitus does not improve then i would recommend other treatments including mirinotomy or ear

4:08tube placement you have to undergo for an audio and tympanogram prior to the treatment

4:13procedure

4:25extract 2 questions 13 to 24 you hear a physician talking to a

4:31patient called sampanguida for questions 13 to 24 complete the following notes

4:36with a word or short phrase you now have 30 seconds to look at the notes

5:12hello doctor good morning good morning what’s your problem well doctor i have itchy red rash on my

5:20feet okay what’s your age 21 doctor tell me if you have developed any

5:25associating symptoms or signs it is tingling persistently doctor

5:31since how long have you had this problem for the past four weeks

5:37exactly on which part of your foot you are getting this problem right great toe right second toe right

5:44third toe and right fourth toe often the onset of itching starts after

5:50removing sweaty socks do you drink or smoke i do not smoke but i do drink have you

5:56had any diseases in the past well i had chickenpox and frequent ear

6:01infections you had any surgeries as well i have surgical ear tubes

6:07do you take any medications no doctor are you allergic to any medicine or substances

6:13well i get a severe rash when i access adhesive tape any of your family members have any

6:19history of illness my paternal grandmother is having cataracts and my maternal aunt has

6:25migraines well your physical examination reports show blood pressure 110 over 64.

6:32respiratory rate is 18 heart rate is 66 and temperature is 98.6

6:38lower extremities is warm to cool proximal to distal the dorsalis pedis artery pulse palpable

6:45bilateral posterior tibial artery pulse palpable bilateral no edema observed

6:52varicosities are not observed right great toe right second toe right third toe and right fourth toenail show

6:58erythema and scaling muscle strength is 5 out of 5 for all groups tested

7:04muscle tone is normal inspection and palpation of bones joints and muscles is unremarkable

7:10you have developed tinea pedis a fungal culture of skin from right toes

7:16koh test shows no visible microbes i’m prescribing loturman af one percent

7:22cream to apply four times a day ingrecio fulvin 250 milligrams po once

7:28in eight hours for four weeks

7:41that is the end of part a now look at part b

7:52part b in this part of the test you will hear six different extracts in each extract you’ll hear people

7:58talking in a different healthcare environment for questions 25 to 30 choose the answer

8:04a b or c which fits best according to what you hear you will have time to read each question

8:11before you listen to the audio complete the answers as you listen to the audio

8:16now look at question 25 you hear a discussion about different types of different types of kidney

8:22cancers now read the question

8:42hello doctor can you brief me about different types of kidney cancers well like any other cancer kidney cancer

8:49starts when the normal cells in one or both kidneys mutate and grow aggressively forming a tumor or mass

8:57which can be benign or malignant kidney cancers that have originated

9:02elsewhere and metastasized to the kidney are clear cell adenocarcinoma

9:08transitional cell carcinoma from the bladder renal lymphoma inverted papilloma

9:14carcinosarcoma teratoma and carcinoid tumor of the renal pelvis

9:20renal cell carcinoma is the most common type of kidney cancer that accounts for 80 to 85 percent of all cases

9:28this develops within the microscopic filtering systems of the kidney which are the tiny tubes that carry the urine

9:35to formation transitional cell carcinoma also known as urothelial carcinoma usually begins

9:42in the area where urine collects before moving to the bladder pathologically this cancer is similar to

9:48bladder cancer and is treated like bladder cancer kidney sarcoma is a rare form of kidney

9:54cancer that is usually treated with surgery and chemotherapy sarcomas may be large and usually does

10:01not spread wilm’s tumor is a common type of kidney cancer that occurs among children and is

10:08treated differently than kidney cancers in adults common treatments for wilms tumors are

10:14radiation therapy and chemotherapy squamous cell carcinoma

10:19juxtaglomerular cell tumor or renanoma bellini duct carcinoma mesoblastic

10:26nephroma mixed epithelial stromal tumors or other types of kidney cancers

10:38question 26 you hear the discussion between two doctors about types of perforations during

10:45endoscopic retrograde colangio pancreatography

10:50now read the question

11:07doctor can you explain the types of perforations during endoscopic retrograde colangio cholangiopancreatography

11:15well although perforation is an unusual complication of endoscopic retrograde

11:21cholangiopancreatography the diseases of the duodenum and common

11:27bile duct can increase the risk of perforation during endoscopic retrograde

11:34cholangiopancreatography there are four types of perforations during endoscopic retrograde colangio

11:41pancreatography based on etiology inside of perforation

11:46type 1 is perforation of the lateral or medial duodenal wall

11:51caused due to excessive pressure from the endoscope or its acute angulation

11:56type 2 perforation is peri-ampullary injury often associated with

12:02sphincterotomy or difficulty accessing the biliary tree type 3 perforation is injury to the

12:08common bile duct or pancreatic duct caused by instrumentation

12:13type 4 perforation is the presence of retroperitoneal free air with no

12:19evidence of actual perforation this is usually an incidental finding and is of little or no clinical

12:24consequence

12:32question 27 you hear a discussion between two doctors about clinical manifestations of

12:39alpha-1 antitrypsin deficiency now read the question

13:02hello doctor what are the clinical manifestations of alpha-1 anti-trypsin deficiency well alpha-1 anti-trypsin

13:09deficiency is associated with two major clinical manifestations emphysema resulting from the loss of the

13:16proteolytic protection of the lung by alpha-1 antitrypsin the toxic loss of function

13:22other clinical manifestations of alpha-1 antitrypsin deficiency include pentacolitis and an association with

13:29cytoplasmic antineutrophil cytoplasmic antibody positive vasculitis

13:41question 28 you hear a discussion between a doctor and a nurse about autoimmune liver

13:47disease now read the question

14:07hello doctor what are the autoimmune liver disease well autoimmune hepatitis primary

14:13biliary cirrhosis and primary sclerosing cholangitis are the three most common forms of

14:19autoimmune liver disease autoimmune hepatitis is characterized by high levels of serum alanine amino

14:26transferase and esparta amino transferase whereas primary biliary cirrhosis and primary sclerosing

14:33cholangitis are associated with predominant elevations of alkaline phosphatase since they are

14:40cholestatic disorders primary biliary cirrhosis and autoimmune hepatitis are associated with

14:46autoantibodies in the serum such as antinuclear antibody smooth muscle antibody and anti-mitochondrial

14:53antibody primary sclerosing cholangitis usually affects the extra hepatic biliary system

15:00thus if it is present abnormalities can be seen on imaging

15:10question 29 you hear a discussion about brain chemicals involved in mood regulation

15:16now read the question

15:36hello doctor what are the brain chemicals involved in mood regulation well basically there are three molecules

15:43chemically known as monoamines that are involved in mood regulation

15:48serotonin has been coined the brain’s feel-good chemical norepinephrine is another

15:53neurotransmitter connected with depression and how alert the feelings are a low level of norepinephrine is

15:59considered to be associated with the brain fog that many people with depression experience

16:04whereas low levels of dopamine in a part of the brain called the substantia

16:10associated with parkinson’s disease but there is much more to dopamine in the frontal lobes of the brain it is

16:16associated with complex thinking and problem solving in fact it is considered that the stimulatory effects of chemicals such as

16:23nicotine and cocaine are related to their effects on the dopamine mediated reward centers in the brain

16:36question 30 you hear a discussion about different types of gastric juices

16:41now read the question

17:01hello doctor what are the different types of gastric juices well the food we swallow mixes with gastric juices

17:08secreted by special glands in the lining of the stomach they include the cardiac glands at the

17:13top part of the stomach the auxintic glands in the main part of the stomach and the plyoric glands in the antrum or

17:20lowest part of the stomach therefore each of the glands contains cells that produce specific components

17:27that are called the gastric juices next cells produce bicarbonate and mucus

17:33parietal cells generate hydrochloric acid chief cells produce pepsinogen and

17:40enteroendocrine cells generate various hormones hydrochloric acid is a strong acid

17:46secreted by the parietal cells and it lowers the ph level of the stomach to around two

17:52hydrochloric acid converts pepsinogen into pepsin and breaks various nutrients

17:57apart from the food we eat it also destroys bacteria that comes along with a food

18:03gastric lipase is another digestive enzyme made by the chief cells

18:08it helps break down short and medium chain fats amylase is also found in gastric juices

18:14but it isn’t made by the stomach this enzyme comes from saliva and

18:19travels along the bolus into the stomach amylase breaks down carbohydrates but

18:25doesn’t have much time to work on the stomach because the acidity stops it intrinsic factor is secreted by the

18:32parietal cells and is necessary to absorb vitamin b12 this is essential for healthy nervous

18:39system function and blood cell production finally the gastric juices contain water and mucus

18:46the mucus is secreted by the neck cells and helps coat and protect the stomach lining from the acid environment

19:04that is the end of part b now look at part c

19:15part c in this part of the test you’ll hear two different extracts in each extract you’ll hear health

19:21professionals talking about specific aspects of their work for questions 31 to 42 choose the answer

19:28a b or c which fits best according to what you hear complete the answers as you listen to

19:35the audio now look at extract one extract one questions 31 to 36

19:43you hear the discussion between a senior doctor and junior doctors on differential blood tests

19:49you have 90 seconds to read questions 31 to 36.

21:26hello doctor what is a differential blood test well a differential blood test enables the physician to determine

21:32how many white blood cells are in the body there are five types of white blood cells and the test also shows how many

21:39of each type of white blood cells are present the results provide details about the condition of a patient’s

21:44immune system and its response to diseases who requires a differential blood test doctor

21:51a differential blood test helps diagnose a range of acute or chronic conditions

21:56and often this is ordered when trying to confirm a diagnosis such as for any signs of acute illness such as the flu

22:02or urinary tract infection or else they may be looking for a chronic condition such as an autoimmune

22:08disorder or one that affects the bone marrow the bone marrow is responsible

22:13for producing white blood cells so changes in white blood cell counts can indicate the functioning of bone marrow

22:20a differential blood test may be ordered if a patient has symptoms such as body aches chills fever a headache pain or

22:27particularly in the bones although a differential blood test can indicate problems with the white blood cells it will not be the only test that

22:34is used to make a complete diagnosis the five types of white blood cells are neutrophils are the most common type of

22:41white blood cells which are responsible for destroying bacteria in injured or infected tissue

22:47monocytes also destroy bacteria causing chronic infections and a role in repairing damaged tissues

22:53eosinophils are responsible for treating infections caused by parasites and they also control the immune system response

22:59to allergic reactions mesophylls are the least common type of white blood cell and their function is

23:05yet to be defined however they may play a role in allergic reactions

23:10there are three types of lymphocytes b lymphocytes generate antibodies to attack specific viruses bacteria and

23:17other foreign invaders t lymphocytes help to identify cells that require an immune response

23:23the third type called a natural killer cells destroy cancer cells and viruses

23:29therefore each type of white blood cell plays an essential role in the immune system when a differential blood test result is

23:35received it should also contain a reference range of normal values from the laboratory to evaluate if the white blood cell levels

23:42are low normal or high overall an increased level of white blood cell count the normal level may

23:48indicate the presence of an infection typically normal values for neutrophils are between two thousand five hundred

23:55and six thousand cells a person with a very low neutrophil count will have fewer than one thousand

24:00cells a condition called neutropenia while the results of a differential blood test will give details about all

24:07five types of white blood cells a doctor will usually focus on just one or two types

24:12depending on the type of cell high or low levels can indicate different issues such as a high level of basophil count

24:19can indicate certain types of leukemia including chronic myeloid leukemia it can also be an indication of severe

24:26allergic reactions patients with inflammatory disorders such as rheumatoid arthritis or

24:32ulcerative colitis may also have high basal fill counts typically a low basal fill count does

24:38not indicate a medical condition however allergic reactions stress steroid use and hyperthyroidism can

24:45result in a basophil count a high eosinophil count is caused due to an allergic reaction such as asthma

24:52eczema or a reaction to a medication inflammatory disorders such as celiac

24:57disease or inflammatory bowel disease can also cause high eosinophil count

25:02usually eosinophils are present in such a low quantity that low readings do not tend to indicate any health condition

25:09however stress or steroid use can also cause a low eosinophil count a high

25:14lymphocyte count can indicate an acute viral infection such as chickenpox herpes or hepatitis

25:20or else a lymphocyte count may be high due to a bacterial infection such as tuberculosis or pertussis

25:27condition such as lymphocytic leukemia or lymphoma a low lymphocyte level can indicate an

25:32autoimmune disorder such as lupus or rheumatoid arthritis the presence of tuberculosis hiv

25:38hepatitis or the flu can also cause a lymphocyte count to be low a high monocyte count is caused due to

25:44chronic infections such as tuberculosis or a fungal infection the presence of a condition such as

25:50endocarditis inflammatory bowel disease monocytic leukemia juvenile

25:56myelomonocytic leukemia scleroderma or rheumatoid arthritis can also cause a

26:01count to be high most physicians do not consider a single low monocyte count as significant

26:07however low monocyte results on several tests can indicate hairy cell leukemia or bone marrow damage

26:13a high level of neutrophil count can be an indication of an acute bacterial infection inflammation tissue death

26:20stress on the body or chronic leukemia the neutrophil count may also become high when the person is in the last

26:26trimester of pregnancy a neutrophil count may be low after an adverse drug reaction or chemotherapy treatments

26:32illnesses such as myelodysplastic syndrome autoimmune disorders bone marrow cancers and aplastic anemia can

26:39also cause low neutrophil counts a differential blood test is one of the different lab tests that is used to

26:45confirm a diagnosis of an infection or illness

26:59now look at extract two questions 37 to 42

27:04you hear the discussion of a physician with junior doctors on different types of hernias

27:10you have 90 seconds to read questions 37 to 42.

28:47hello doctor could you please explain to us about different types of hernias well

28:53inguinal hernias are located in the lower abdomen just above the leg crease adjacent or near the pubic region

29:00at times they can also occur on both sides of the pubic area which is called bilateral inguinal hernias

29:07inguinal hernias along with femoral hernias make up the two types of groin

29:12hernias and can cause pain that extends into the upper thigh or scrotum

29:18inguinal hernias can be categorized as direct or indirect an indirect inguinal hernia occurs due

29:25to natural weakness in the internal inguinal ring while a direct inguinal hernia caused due to the weakness in the

29:31floor of the inguinal canal and is more likely to develop in men above 40.

29:37the floor of the inguinal canal is located just below the internal inguinal ring

29:42when inguinal hernias are repaired using the tension repair technique recurrence rates may be more than 15 percent

29:50however other techniques used for hernia repair such as tension free and

29:55laparoscopic tension free have much lower recurrence rates of just one percent

30:01a sportsman’s hernia is a condition of chronic exercise-related supra-inguinal

30:06groin pain generally it involves a direct inguinal hernia femoral hernias along with inguinal

30:13hernias are groin hernias which are very common in women but can occur in men as well

30:19a weakness in the lower groin makes the intestinal sac to drop into the femoral canal

30:24a space near the femoral vein that carries blood from the leg these hernias are highly prone to

30:30develop incarceration or strangulation as an early complication incisional hernias appears in the

30:36abdomen at the site of a previous surgery that can appear weeks months or even years after a surgery and can vary

30:44in size from small to very large and complex umbilical hernias appear near the belly

30:50button or navel due to a common weakness from the blood vessels of the umbilical cord this may occur in infants at or

30:57just after birth and may resolve by three or four years of age however in adults umbilical hernias will

31:04not resolve and may progressively worsen over time epigastric hernias are more common in

31:10men than women they occur due to a weakness or opening in the muscles or tendons of the upper

31:16abdominal wall on a line between the breastbone and the navel or umbilicus

31:22spaghelion hernias a protrusion of intestine or an empty sac through a weakness between the muscle fibers of

31:29the abdominal wall often on the right hand side of the abdomen it becomes impossible to detect because

31:36often there is no obvious swelling or lump it develops between the muscles of the

31:41abdominal wall rather than protruding through layers of fat it often develops in later life of men

31:47and women when the abdominal muscles become weaker hadal hernias are slightly different

31:53from other types of hernias because they are a weakness or opening in the diaphragm that separates the chest

31:59cavity from the abdominal cavity these hernias cause reflux of acid from the stomach and to the esophagus

32:06resulting in heartburn pain and erosion of the esophagus

32:22that is the end of part c you now have two minutes to check your answers

32:51me

33:04you