Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
FUTURE LAND
NOTES
7/2018
1
Table of content
1.OET Future Land Notes 3-15 7.2014 309
2.Speaking 8.2014 323
16 – 90 9.2014 339
Official book cards 16
Recalls 2014 cards 10.2014 355
22
Recalls 2015 cards 11.2014 367
53
Reading 2015 283-514
3.Writing 91-242 1.2015 283
2.2015 395
Writing grammar 91-140 3.2015 407
Samples of official book 141 4.2015 423
Recalls of 2014 153-203 5.2015 435
1.2014 153 6.2015 451
2.2014 163 7.2015 463
3.2014 167 8.2015 477
5.2014 170 9.2015 487
6.2014 176 10.2015 503
7.2014 179
8.2014 183
9.2014 5. Listening 515-893
189 Recalls of 2014
10.2014 515-678
194 1.2014
11.2014 515
198 2.2014 530
Recalls of 2015 3.2014 545
204-242 5.2014
1.2015 564
204 6.2014
2.2015 584
207 7.2014
3.2015 601
210 8.2014
4.2015 619
214 9.2014
5.2015 633
218 10.2014
6.2015 651
223 11.2014
7.2015 667
227
8.2015 231
9.2015 Recalls of 2015 679-927
235 1.2015
10.2015 679
240 2.2015 691
3.2015 707
4.Reading 243-514 4.2015 728
Recalls of 2014 247-382 5.2015 743
1.2014 247 6.2015 759
2.2014 263 7.2015 777
3.2014 271 8.2015 793
5.2014 283 9.2015 809
6.2014 295 Listening answers 828-893
2
OET Notes Future Land
الحمد هلل وحده والصالة والسالم على من ال نبي بعده أما بعد:
فهذه الطبعة الثانية من مذكرة OETبعد إعادة تنظيمها وتصحيح بعض األخطاء الموجودة في الطبعة األولى
مصدرها الرئيسي كورس أ .نسمة وكورس Mr. Jayعلى اليوتيوب بجانب مواد أخرى متفرقة يفضل
قراءتها وحل ثالثة اختبارات على األقل قبل أخذ قرار بأخذ أي كورس مع مراجعة اإلجابة مع نموذج اإلجابة
ويكون وظيفة الكورس بعد ذلك لمن مستواه متوسط لتصحيح النطق و grammarوقد تم ارفاق االختبارات
مع اجابتها في نفس الملف ومرفق بملف writingمذكرة عن األخطاء الشائعة في grammarخاصة في
writingقد أرفقتها ألهميتها كما مرفق بعد كل اختبار writingنماذج مصححه من .benchmarking
ويتميز اختبار OETبسهولته مقارنة باالختبارات األخرى ألنه انجليزي طبي وليس انجليزي عام ولكن
مشكلته هو أن تكلفته ضعف االختبارات األخرى تقريبا بجانب أنه ليس متاح في جميع الدول العربية بل
مصر واالمارات وسلطنة عمان فقط لالن وهناك مركز سيفتح في السعودية شهر سبتمبر 2018غالبا بجانب
أن نتيجته تتأخر ثالثة أسابيع مع العلم أنه يجرى مرة واحدة شهريا في نفس اليوم في جميع دول العالم.
واالختبار مدته ثالث ساعات تقريبا وتكلفته 587دوالر استرالي ( 1700لاير تقريبا) وهو يتكون من أربعة
أجزاء :السماع ( 30دقيقة 30 +دقيقة) والقراءة ( 15دقيقة 45+دقيقة) والكتابة ( 45دقيقة) ثم راحة لمدة
ساعة تقريبا يبدأ بعدها المحادثة ( 20دقيقة) 5 :دقائق مقدمة 8 +دقائق لكل حالة من الحالتين 3-2 :دقائق
قراءة الكارت & 4-5.5دقيقة لعمل .)role play
والدرجة المطلوبة لبريطانيا وإيرلندا هو Bاجمالي وفي كل bandأما استراليا كما هو مذكور بالموقع
الرسمي هي:
With a minimum score of B in each of the four components (listening, reading, writing and
speaking).
ii. a maximum of two test sittings in a six month period only if:
you are tested in all four components in each sitting, and
you achieve a minimum score of B in each component across the two sittings, and
no score in any component of the test is below C.
وال تنسوا متابعة قناتنا على اليوتيوب بنفس االسم وال تنسونا من صالح دعائكم
مع تحيات اخوانكم في جروب OET Future Land
oetfutureland@gmail.com
3
1. Listening
هو عبارة عن جزأين مدة كل جزء 30دقيقة
وهناك دقيقة قبل كل جزء لقراءة األسئلة كلها ودقيقتين في نهاية االختبار للمراجعة (خالف 20-10ثانية قبل
وبعد كل سؤال) ثم تسمع السؤال وتقرأه في ورقة االجابة ويتلوه المقطع (من المحادثة في Aأو المحاضرة
في (Bالذي فيه اإلجابة ومطلوب منك أن تكتب اإلجابة أثناء السماع بسرعة جدا مع العلم أن عدد األسئلة -8
13سؤال لكل جزء وكل جزء عليه %50من الدرجة.
أوالListening A :
هذا الجزء هو األسهل في السماع وعليه االعتماد في النجاح وهو عبارة عن محادثة بين طبيب ومريض وكل
سؤال يطلب منك كتابة عدد من short notesعن عنوان السؤال.
مالحظات هامة:
.1المطلوب منك كتابة short notesوليس جمل كاملة وهو يعطيك في المقطع notesأكثر من المطلوب
فلو مطلوب ان تكتب 5 notesستجده يعطيك 8 notesمثال وانت تحتار ما تتذكره منها .وأحيانا تسمع
بعض الجمل في منتصف الكالم يقوم المتحدث بالكالم بسرعة وممكن بشكل غير مفهوم وده عادي.
.2ال يتم محاسبتك على أخطاء grammarأو spellingأو punctuationومسموح باالختصارات
المشهورة مثل DM. HTN، IHD،URTI
.3ممكن تكتب بالمعنى :مثال في الحادثة المريض قال إنه يدخن 30سيجارة في اليوم أنت ممكن تكتب
heavy smoker
.4في اإلجابة تكتب عدد من notesالتي لها عالقة بالسؤال ( )much relevant informationولو ليست
هي اإلجابة من الناحية الطبية :فمثال إذا كان السؤال أن تكتب عن التاريخ المرضي اكتب أي شيء يقوله
المريض عن مرضه وقصته وأي أحداث رافقته ولو طبيا ال تعتبر history of present illness
.5حاول االختصار في العنصر الواحد وممكن تقسيم المعلومة الواحدة الى عنصرين مثال في المحادثة
hit/hurt his head and armفي اإلجابة ممكن تقسمهم notes 2فتكتب hit/hurt leg – hit/hurt
arm
.6يمكنك كتابة عدد من short notesزيادة عن المطلوب :لو المطلوب كتابة 4 notesيمكنك كتبة 6
وعمل /في نفس السطر لكتابة noteجديدة
.7اكتب بسرعة جدا وال تكتب الكلمات كاملة وفي فترة الراحة ( 10-20ثانية قبل وبعد كل سؤال) كمل باقي
الكلمات المختصرة
.8حاول االستماع كثيرا حتى تتعود على Australian accentوأول ثالثة اختبارات يفضل أن تقرأ
نموذج اإلجابة أو transcriptأثناء السماع حتى تتعود على accent
4
ثانياListening B: :
مقدمة:
هو عبارة عن محاضرة علمية عن موضوع طبي محدد وخالل المحاضرة هناك أنواع مختلفة من األسئلة
فمنها كتابة short notesمثل جزء Aومنها مأل الفراغات ومنها MCQوغيرها.
مالحظات هامة:
.1الكالم هنا يكتب بالنص وليس بالمعنى كالجزء األول
.2أسئلة MCQيجب عمل دائرة حول االختيار الصحيح واختيار نفس العدد المطلوب فلو مطلوب منك ان
تختار اثنين من اإلجابات لو اخترت إجابة واحدة أو ثالث إجابات تعتبر اإلجابة خطأ
.3ضع خط تحت key wordsفي السؤال لتركز عليه في السماع
.4أسئلة أمأل الفراغات يجب أن تكتب نفس العدد المطلوب فلو مطلوب مثال كتابة أشياء لو كتبت اثنين فقط
أو أربعة أشياء تحتسب خطأ ولو انت متذكر اثنين فقط اكتب الثالثة أي شيء حتى لو خطأ حتى يحتسب لك ما
كتبته من درجة السؤال
.5هناك ثالثة أسئلة تقريبا أمأل الفراغات صعبة ألنها تحتوي على إعادة صياغة وليس ما تسمعه بالنص بل
مختصر ما تسمعه وكذلك أنت تجيب بالمعنى أيضا
.6يتم الحساب على grammarولكن ال يتم الحساب على spellingمادامت الكلمة واضحة ومفهومة (هذا
كالم Mr. Jayأما أ .نسمة فتقول أنه يتم المحاسبة حتى على spellingفي .part B
5
2. Reading
ويتكون اختبار القراءة من جزأين :الجزء األول (أمأل الفراغات) مدته 15دقيقة وعليه 3/1الدرجة والجزء
الثاني( )MCQمدته 45دقيقة وعليه 3/2الدرجة ويعتبر االعتماد على الجزء الثاني في النجاح أما الجزء
األول فهو لتعويض أي خطأ في أسئلة الجزء الثاني
أوالReading A :
هو الجزء األصعب ألنه يتطلب سرعة كبيرة وكثيرا ما يحتاج إعادة صياغة وهو عبارة عن عنوان موضوع
طبي ما وتحته ( 3-4 textاجمالي 650كلمة) في صفحتين ثم بعد ذلك تأتي األسئلة ( ±30سؤال) في
صفحتين حيث أن صفحة األسئلة مقسمة لقسمين :النصف األيسر موجود فيه Summaryبه فراغات وكل
فراغ له رقم أما الجزء األيمن ففيه األرقام حيث تكتب الكلمات التي ينبغي أن تكتب في الفراغ.
مالحظات هامة:
.1الوقت لن يتسع لحل كافة األسئلة وهذا طبيعي وكل سؤال عليه %1فقط من مجموع الدرجة (حيث أن
مجموع كل األسئلة عليه %33فقط) فال داعي للقلق
.2عليك أن تعرف text typeفي 20ثانية :هل هو
(Question and answer, research/abstract, statistics, definition, FAQs, case study
).etc.
.2تبدأ بقراءة القطعة قراءة سريعة جدا ) )skim and scanفي 3-2دقيقة ومطلوب منك أثناء القراءة
معرفة heading, sub-heading & key words :مع وضع خط تحت key wordsوهذه مهارة تزداد
بالتدريب.
.3يفضل أن تبدأ الحل من أول مقطع في الصفحة الثانية (السؤال 13تقريبا) حيث يكون الترتيب موجود
واألسئلة سهلة تقريبا بنفس النص دون تغيير في 8دقائق ثم ارجع للصفحة األولى وحل البراجراف الثاني في
4دقائق أما البراجراف األول (سؤال 5-1تقريبا) فغالبا لن تجد الوقت الكافي لحله.
.4عند قراءتك للبرجراف تحاول سريعا معرفة رقم textوتعود إليه لمأل الفراغات
.2يمكن أن تكتب في كل فراغ 3-1كلمات
.4كثيرا ما تحتاج إعادة صياغة للكلمات حسب المعنى أو grammarمثال في textمكتوب:
pregnant with twins or tripleولكن في summaryمكتوب pregnant with more thanفأنت
تكتب one pregnancy
.5األرقام تكتب كما هي 12 weeksمثال
.6ال تضيع وقت في إجابة واحدة إذا لم تجدها بل تخطاها لما بعدها ثم عد إليها فيما بعد لو هناك وقت
6
ثانياReading B :
هو الجزء األسهل وعليه %66من الدرجة وهو عبارة عن جزأين B1&B2كال منهما عبارة عن عنوان
تحته عدد من paragraphsكال منهما حوالي 800-600كلمة وبعد كل جزء عدد 10-8سؤال MCQ
وفي كل سؤال يذكر رقم paragraphالذي فيه اإلجابة
مالحظات هامة:
.1اقرأ السؤال واالختيارات من أجل exclusion
.2التعميمات أو extremeغالبا خطأ مثلall, never, no, only :
.3هناك تغيير للصياغة:
Always 100%, most 90%, usually / normally/ generally 80%, often 60%,
)sometimes 50%, occasionally 20%, seldom/rarely 10% and never 0%
.4يجب أن تركز في صياغة السؤال فمثال لو في القطعة can cause/ may cause/ in part of cause
وفي اإلجابة causeفقط تكون خطأ
وكذلك مثال لو في السؤال no cure of HIV till nowوفي االختيارات cure of HIV unachievable
تكون خطأ ألنه نفي حاليا ومستقبال
أما لو في القطعة potential direct and directوفي االختيارات potential directفقط تكون صح
.5أحد األسئلة المعتادة السؤال عن معنى كلمة في الجملة لمعرفة مدى علمك بالمترادفات أو تأتي اإلجابة
بكلمات مختلفة ولكن مترادفة مع البراجراف وجرت العادة عند السؤال عن كلمة غير معروفة ابحث عن في
االختيارات عن كلمة أيضا غير معروفة.
7
3. Writing
وهو عبارة عن طلب خطاب تحويل (غالبا) أو خطاب خروج أو إرشادات لمقدمي الرعاية للمريض مثل دار
المسنين يتكون من 200-180كلمة 10 ±كلمات والزمن المتاح لقراءة notesهو 5دقائق ثم 40دقيقة
لكتابة الخطاب
مالحظات هامة:
.1يجب أن تختار templateللخطاب وتتدرب عليه كثيرا وسأذكر هنا ال templateالذي ذكرته أ .نسمة
وفي البداية يجب مذاكرة templateجيدا ووضعها أمامك قبل كتابة أي خطاب ثم التدريب على كتابة
الخطابات بقراءة notesأوال ثم قراءة بعض كتابات الزمالء الذين نجحوا في االختبار ثم تكتب أنت الخطاب
بنفسك وهناك مذكرة مرفقة بها نماذج اختبارات 2015 &2014مع أمثلة من إجابات الزمالء طبعا هي
ليست نموذجية ولكنها مفيدة للغاية.
.2يجب أن تختار من notesما يتعلق بتخصص الطبيب الذي تحول له المريض وتتجاهل باقي notes
.3كل paragraphيجب أن يشتمل على أكثر من جملة و sentence passiveأكثر من activeمثل
… blood tests were ordered, she was instructed to commence
.4لو الخطاب يحتوي على ثالثة أخطاء punctuationأو ثالثة أخطاء grammarأو أربعة أخطاء متنوعة
يرسب الممتحن قبل أن يتم قراءة الخطاب فيجب مالحظة أخطاء grammarالصغيرة مثل أوات التعريف
ومتى تكتب aومتى ال تكتبها فمثال familyتكتب قبلها aاذا كنت تريد العائلة الصغيرة وال تكتبها اذا كنت
تقصد العائلة الكبيرة وكذلك األزمنة ونفيها فال تنسى اضافة sللفعل في المضارع البسيط مع he, she, it
مثال وتذكر أن نفي I haveاذا كان في الماضي البسيط يكون did not haveأما اذا كانت الجملة الماضي
التام فتكون had not hadوكذلك اذا عطفت كلمتين فال بد أن تكون من نفس النوع فال يصح عطف noun
and adjectiveمثال وهكذا وهناك مذكرة مرفقة لجزء الكتابة بكورس OETممتازة خاصة في توضيح
األخطاء الشائعة وكيفية تجنبها.
.5يبدأ حساب الكلمات من بداية الخطاب نفسه مثل … Thank you for seeingوالعنوان ال يحسب
وكذلك Yours sincerelyالتي تكتب في النهاية أيضا ال تحسب وثالثة كلمات أو أكثر يمكن كتابتهم
كاختصار مثل URTIويحسب كلمة واحدة والتاريخ مثل 2017/12/15يحسب كلمة واحدة أيضا وحروف
التعريف مثل a, anيحسبون كلمة كذلك
.6ينبغي استخدام formal vocabularyمثل : informبدال من tellوكذلك commenceبال من start
.7في introduction & conclusionيفضل عدم ذكر أي تفاصيل.
.8ال تنسى أن تترك سطر فارغ من الكلمات بعد كل paragraphوقبل وبعد تاريخ اليوم وأول سطر في
الخطاب تترك فراغ يسير على يسار السطر
.9مهم جدا punctuationومتى تضع ( (; or , or .ومتى تكتب الحرف كبير Aأو صغير aفمثال أي كلمة
تبدأها بعد ( ).تكون بحرف كبير Aوكلمة butيأتي قبلها ,وبعدها جملة تامة بينما andال يكتب قبلها ,
8
: التدريب على أدوات الربط وأهمها التاليwriting من األشياء الهامة في10.
1. Fortunately, unfortunately, luckily, unluckily, regrettably, unexpectedly
),( بدونverb to be ) أو قبل الفعل الرئيسي وبعدcomma ,( وهذه الكلمات تأتي في بداية الكالم وبعدها
2. In addition to, beside, together with, along with
noun or gerund ) قبلها أو بعدها والذي يأتي بعدها إما,( وهذه الكلمات تأتي بدون
3. (Moreover, furthermore=and) (However, nevertheless=but) (Thus, therefore=so)
) بخالف بعض,( ) وبعدهاsemicolon ;( ) وفي وسط الكالم قبلها,( هذه الكلمات في بداية الكالم بعدها
:الكلمات التي تستخدم في الربط أيضا مثل
Please note,... It is important to… Please ensure that… It is worth mentioning that..
المذكور هناك خيارات عدة توضع بين قوسين ( ) كبديل للجملة األولى وذلك لتختارtemplate في11.
كلمة على األقل أما إذا كانت180 قليلة فتختار الجملة الطويلة لتصل الىnotes بينها في حالة إذا كانت
كلمة وهذان مثاالن200 كثيرة وهو األغلب فتختار الجمل الصغيرة لتختصر الكلمات وال تزيد عنnotes
:للجملة الصغيرة والكبيرة
Your further management is highly appreciated/ I would be grateful if you could
manage her condition as you think appropriate.
كلمة وكالهما يؤدي نفس المعني14 كلمات فقط أما الثانية بها6 فالجملة األولى بها
For any queries, please contact me. / please do not hesitate to contact me for any
assistance you require regarding this patient.
كلمة15 كلمات والجملة الثانية بها6 وهنا أيضا الجملة األولى بها
:وكذلك عند ذكر عالجات كثيرة لألمراض التي يعاني منها المريض ممكن تكتب بعد ذكر األمراض
Which have been managed accordingly/ for which she has been taking….
فالجملة األولى مختصرة والثانية تطويل ألنك ستذكر األدوية بالتفصيل
: طريقة حساب الدرجة كما هو مذكور بالموقع الرسمي.12
Your performance is scored against five criteria and receives a band score for each criterion:
9
OET writing template
Dr Lisa Smith Doctor’s name/Admitting officer
(if doctor’s name not given)
1. Address Endocrinologist specialty
City Hospital address
New town
10/02/2018 Today’s date
Dear Dr Smith Dear (doctor’s name)
Re: Mrs. Priya Sharma DOB Re:(patient’s name) DOB/age (if
08/05/1952 (or aged 35 years) DOB not present)
2. Introduction 1. Thank you for seeing Mrs. Sharma (family name) (I am writing this
Mainly 2 letter to refer you Mrs…), 2. a/an 42-year-old accountant,
sentences
(25-30 words)
3. whose features are consistent with (whose features are suggestive of)
(who has recently developed) (who is presenting with symptoms and signs
suggestive of).
4. Your further management would be highly appreciated (I would be
grateful if you could manage her condition as you think appropriate).
3. Body 1 1. Mrs Sharma is married (widowed) with two children, 2. Regarding
Social and her medical history she suffers from (she has medical history of) (whose
medical history medical records show that she has a long history of) (her past medical
(45-50 words) history reveal that) (her past medical is unremarkable apart from
Mainly present 3. for which she has been taking (Which has been managed accordingly)
. Please note, (It is worth mentioning that) the patient has an allergy to...
4. Body 2 1. On 15/01/2018, 2. the patient attended my surgery with (presented
In between with) (came complaining of) a two days history of… 3. ;thus (therefore),
visits …….one month later, he developed…. later on, ...
(45-50words)
Mainly past
5. Body 3 Today, Ms Sharma came complaining of ….. Her examination
Final visit revealed ….. Thus, ….
(today)
(45-50 words)
Mainly past
6. Conclusion 1. In view of the above, (My provisional diagnosis is)… ; therefore,
2. I am referring this patient for further management of her condition.
3. For any queries, please contact me. (please do not hesitate to contact
me for any assistance you require regarding this patient).
Yours sincerely,
Doctor …… .
10
4. Speaking
في البداية هناك تمهيد في خمسة دقائق وهو يعتبر تهيئة نفسية لك لالختبار وغير محسوب في الدرجة وهو
دردشة عادية مع الممتحن عن تخصصك واألشياء التي تحبها فيه ولماذا تدخل االختبار ...الخ أما االختبار
نفسه فهو حالتين role playكل حالة تقرأ notesفي ثالثة دقائق ومعك قلم رصاص تعلم به على األشياء
الهامة أو تكتب أي شيء تريد تذكره أثناء المحادثة وكذلك يمكنك سؤال الممتحن عن أي استفسار في الورقة
ثم االختبار نفسه ويفترض أن تنهي كل notesفي وقت ال يقل عن 4دقائق وال يزيد عن 5دقائق ونصف.
مالحظات هامة:
.1الممتحن ليس هو من يضع الدرجة بل يتم تسجيل االختبار وارساله ألستراليا ويتم وضع الدرجة من اثنين
مقيمين على حدة هناك فيمكنك أن تنظر في الورقة المكتوب فيها notesطوال االختبار وعدم االنشغال
بالممتحن والمهم هو انهاء notesخالل الوقت المتاح مع األخذ في الحذر أن الوقت غالبا يكون قليل وممكن
ينتهي قبل أن تنهي .task
.2المريض نوعان :مريض تلقاه للمرة األولى وهذا هو األغلب ونادرا ما يأتي مريض للمتابعة والفرق
الوحيد بينهما في طريقة تقديم نفسك له في مقدمة المحادثة وكذلك هناك مريض صعب وكثير االعتراض
reluctantوهذا هو األكثر ومريض عادي يستجيب لكالمك بسالسة وهذا األقل وفي حالة المريض الصعب
يجب أن تحتويه وتظهر تفهمك له وممكن تعيد صياغة الكالم بشكل مختلف وتبين مخاوفك لو لم يستجب
للعالج كما سيأتي في speaking templateوفي الغالب االعتراض سيستمر ألربعة أو خمسة مرات على
األكثر ثم يستجيب ألنه أيضا محكم بالوقت.
.3ابدأ بتقديم نفسك ثم أخذ historyبشكل مختصر ال يزيد عن ثالثة أسئلة ثم تتبع النقاط المذكورة في
الكارت وأهم شيء تنهي كامل النقاط الموجودة في الكارت خالل الوقت وفي جملة التشخيص الزم تشرح أي
مصطلح طبي وتظهر نفسك طبيعي ولست تحفظ بعض الجمل وتسمعها في االختبار ومن حين ال خر البد من
استخدام أحد جمل اختبار فهم المريض ومتابعته لك وطمأنته إذا أظهر التخوف من التشخيص.
.4الممارسة هي كلمة السر في النجاح فحاول أن تدريب كثيرا مع الزمالء على role playومرفق بالمذكرة
75 cardsللتدريب عليها هي عبارة عن .cards of recalls of 2014&2015 and official book
.5ال يهم accentبريطاني أو أمريكي أو استرالي المهم نطق الكلمة بشكل صحيح
.6نموذج المحادثة speaking templateسيكون مفيدا جدا في البداية لصياغة كل taskبشكل جيد.
.7تقييم المحادثة يكون على خمسة أشياء رئيسية لذا ال تحاول التوسع في الكالم والشرح خارج نطاق الكارت
ألنه ال يقيس معلوماتك بل هذه األشياء الخمسة وهذا النص التالي نقال من الموقع الرسمي لالختبار:
Your performance on each of the two role-plays is scored against five criteria and
receives a band score for each criterion:
11
Speaking introduction
1. Why are you taking the OET exam?
Actually, I am taking the OET exam to complete the Australian Medical Council registration process.
I am working as a physician for 12 years now. 6 years in Egypt and the other 6 years in Saudi Arabia.
Well, I am working for 8 hours every day from Sunday to Thursday every week.
A lot of reasons really. Medicine is a very respectful job and it gives you the chance to help
people. From the economic view, it earns good money.
Well, it was a big conflict for me. I like all parts of medicine. I was hesitated to choose one
specialty and leave the others. At last, I found my target on family medicine as on family
medicine you practice all.
Oooh, the most important advice is to choose their specialty carefully and to choose what they
actually like to do as they will spend the rest of their life doing it. To be always update
themselves with the recent guidelines, science and education will not stop with graduation.
It is an important question. From my point of view, I think this need a lot of efforts and much
contributing factors. For example, you need to do fewer mistakes in your practice, the fewer
mistake you do the better you will be. A well-established relationship with your patients is
mandatory also. And you need to understand your patient’s needs and concern and always pay
sympathy for their suffers. Last but not least, be always familiar with recent updates guidelines.
Let me see. On academic, I passed the Australian Medical Council exam part one on June 2017.
On practical side, I got the ACLS Advanced Cardiopulmonary Life Support Course on October
2017.
12
Speaking Role Play Template
1. Introduction ► 2. Sympathy &History ► 3. Diagnosis ► 4. Management► 5. Reassurance 6. Reluctant patient
► 7. Checking understanding Ending ►8. Sign posting ► 9. Ending & 10. Special cases
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5. Reassurance: Finally, after agreement: I’m pleased to
hear that. Now …
* Rest assured, this is quite a common It is
nothing to get alarmed about… 7. Checking understanding:
* Let me reassure you that eczema is self-
limited. 1. Is that clear // am I clear so far? // How
* Don’t worry, if you can follow my does that sound// Am I clear till now?
advice you will get much better soon. 2. Do you think you can do that // Do you
* Don’t worry it will go away by itself in a feel comfortable about my advice?
few days with some rest. 3. Do you have any question so far //
* I know it sounds difficult at first but would you like me to tell you more about
with practice, I am sure you will be able to that?
* I am sure you won’t have any more
trouble 8. Signposting:
* The staff here are very experienced and
will take good care of you. A. First of all …
* as I said before // as I told you earlier …
6. Reluctant Patient: B. I’m concerned about your smoking
habit. It is important to // necessary to stop
A. I really appreciate your concern smoking
* I can understand your worries * I have to highlight/ emphasize the
* I know how you feel but let me … importance of … it is very beneficial for
B. I completely understand your busy you.
time, but your health is my priority, what * I recommend that // I strongly advice
is more important your health or your job? that you should lose weight.
so I think you should find some time to… C. For this reason … therefore..., so…
What is more important the risk of …or… however…, in addition... also..., now…
C. Let me assure you, if you follow my D. that is a good question and let me
advice the risk of heart attack will be explain to you that …
greatly reduced; however, if you do not * It is a good idea to…
follow my advice and continue to smoke
then the risk of heart attack is much 9. Ending:
higher.
you don’t want that to happen, do you? A. Do you have any more question?
D. Let me explain to you why the insulin
therapy is necessary for you. * Hope you feel better soon.
E. Of course you will need to continue…
However, I don’t think …. will be helpful * Wish you a speed recovery.
in your situation. I would prefer
alternatives. B. I would like to see you in a week, don’t
*I understand … but let me explain to you hesitate to call me if you have any
why it is not a good choice for you to … concerns.
14
10. Special Cases
1. Breaking bad news: 4. Quit smoking:
Now in order to quit smoking, I
A. June, we have the test results back recommend that you attend our
and I’m sorry to tell you that the cause hospital’s quit smoking program. They
of your symptoms could be more run regular classes and I can tell you
serious than you think and that is a risk that it has helped many patients
that …. succeed in giving up smoking. Would
B. I realize that this come as a shock to you like to do that?
you (pause) 5. Alcohol addiction:
C. It is a very important that we do a Is quite a serious condition, and you
few further investigations including … really need some outside support to
D. Fortunately, we caught it early and help you overcome this. Therefore, I
there are some treatment options such recommend that you contact alcoholics
as chemotherapy. anonymous, or I can contact them on
E. We will keep a close on you and be your behalf, and arrange an
sure you are in very good hands. appointment. How does that sound?5.
F. It may be a good idea to talk to 6. Starting insulin:
someone about this. Do you have any I understand that self-injecting insulin
relative or close friend who can help can be challenging at first, but at our
you and provide support? clinic we run weekly training programs
which are run by our nurses. They can
2. Refer to a dietician: take you through the process step by
Now regarding your diet, I can refer step and help you gain confidence.
you to a dietician and they can provide Would you like me to make an
really good guidelines and healthy food appointment for you?
options.
3. refer to physiotherapy: 7. Exercise:
One way to speed up the recovery You need to start an exercise program,
process and to increase mobility is to and I recommend joining a local gym
visit a physiotherapist. They will be or sports Centre. They will be able to
able to design a rehabilitation program create a fitness program that can help
based on your needs and it can make a you lose weight and feel healthier. Do
big difference. Would you like to try you think you can do that?
that?
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Articles Usage with Countable & Uncountable Nouns
Whether an article is required or not depends on the noun that follows. For this purpose nouns can be classified into two types: countable &
uncountable nouns. The difference is based on whether the noun can be counted or not. For example complaint is a countable noun as it can be
counted. Therefore it is possible to say 1 complaint or 2 complaints. Advice on the other hand cannot be counted so it is not possible to say 1
advice or 2 advices , The correct expression is some/any advice or the expression a piece of advice.
Countable nouns
These nouns have a singular form and plural form.
Singular
In the singular form an article is usually used before the noun. Example: The doctor received a complaint from her patient.
NB. Exceptions: The article can be left out if it is replaced with another determiner such as his/her or this /that or any/each/every. E.g. The
doctor listened to each complaint. Her complaint was recorded.
Plural
In the plural form the article is usually not used before the noun. Example: The doctor received complaints from her patients.
Remember: Always use articles when referring a particular job such as: doctor/dentist/nurse/pharmacist/physiotherapist/teacher etc etc.
Note the use of an article before each noun Note the absence of the indefinite articles
in singular form, either as a/an/the a/an before each noun in singular form, but
the definite article
abscess The patient had an abscess on her gum. The patient had 3 abscesses on her gum.
ache The patient reported a dull ache in her The patient suffered from aches and pains.
abdomen.
accountant Mr. Hagen is an accountant. Mr. & Mrs. Hagen are both accountants.
appointment A follow-up appointment was scheduled. The patient did not attend her follow-up
appointments.
check up The patient attended for a check-up. Regular check-ups will keep you healthy.
complaint If you have a complaint, tell your doctor. If you have any complaints, tell your doctor.
condition You have a condition known as tuberculosis. There are 3 conditions which can indicate
the presence of cancer.
deposit A carious deposit was evident on tooth 32. Carious deposits were evident on teeth 32 &
33.
doctor The patient has not seen a doctor for several Three doctors were involved in the
years. treatment of the patient.
episode The patient had an episode of heart flutter. The patient reported 3 episodes of heart
flutter.
gum The gum surrounding tooth 23 was inflamed. The gums were infected.
increase There was an increase in the size of the The patient presented with numerous
swelling. swellings.
investigation An investigation is required to rule out bowel Investigations are required to rule out bowel
cancer. cancer.
91
limp The patient walked with a limp. All the patients had limps.
lip The patient had a swollen lip. (one lip) The patient had swollen lips. (both lips)
painkiller The patient requested a painkiller. Painkillers are not necessary with this
procedure.
result The patient hoped for a positive result. The results were positive.
review A review was scheduled after 2 weeks. The nurse received positive reviews from her
patients.
sensation The patient reported a tingling sensation in The patient experience tingling sensations in
his fingers. his fingers.
social worker A social worker has been arranged to offer Two social workers have been arranged to
ongoing care. offer ongoing care.
test A blood test was ordered. Blood and urine tests were ordered.
visit Please organise a visit by a social worker. Regular visits by a social worker are
required.
Uncountable nouns
These nouns cannot take a plural form such as: cancer, anaesthesia and information. For these words no article is required. However, the definite
article the as well as quantifiers such as some and any can be used before the noun.
92
discomfort If you experience discomfort, please consult your doctor.
Common mistakes
Incorrect Correct
Wound on her left knee has been stitched. A wound on her left hand has been stitched.
I am writing to refer Marvin, 7 year old boy who was admitted to I am writing to refer Marvin, a 7-year- old boy who was admitted to
hospital on 21/11/16. hospital on 21/11/16.
Mr Brown has been patient of mine for 7 years. Mr Brown has been a patient of mine for 7 years.
Please note, the patient has had prosthetic heart valve for year. Please note, the patient has had a prosthetic heart valve for a year.
Examination revealed abscess on her gum. Examination revealed an abscess on her gum.
Apart from bruises to her body, X-rays reveal that she has fracture of Apart from bruises to her body, X-rays reveal that she has a fracture
the right ankle. of the right ankle.
Mr Jones had a heart surgery in 2015. Mr Jones had heart surgery in 2015.
She had a healthy soft tissue. She had healthy soft tissue.
He had lacerated lip and swollen gum. He had a lacerated lip and swollen gums.
The patient has pollen allergy. The patient has a pollen allergy.
The patient has tender right elbow joint. The patient has a tender right elbow joint.
The patient presented for regular check-up on 12/2/16. The patient presented for a regular check-up on 12/2/16.
Indefinite Article: A or An
When you mention something for the first time the indefinite article a/an is required. This signifies to the reader that it
hasn’t been mentioned before.
93
Definite Article: The
When you mention something for the second and subsequent times that we mention it the definite article the is required
because we are referring a something which has been mentioned before.
Example: Initially, she came to me on 03/07/06 for a blood test. The results of the blood test were negative.
Correct application of this rule creates cohesion in your letter as you are able to connect ideas, as in the example above,
where the reader knows which blood test is being referred. Conversely, incorrect use can confuse the reader.
Example: Initially, she came to me on 03/07/06 for the blood test. The results of a blood test were negative.
In the example above the ideas are not connected and the reader will be confused.
Incorrect Correct
The patient has the family history of diabetes. The patient has a family history of diabetes.
Explanation: If it is the first time to give this information then the
indefinite article is required for countable nouns.
In addition, the pain in the right knee joint has appeared In addition, pain in the right knee joint has appeared over
over the last 2 days. the last 2 days.
Thank you for seeing, Mr and Mrs Conway, who have Thank you for seeing, Mr and Mrs Conway, who have
presented to me for the fertility advice. presented to me for fertility advice.
Explanation: If it is the first time to give this information and the
word is an uncountable noun, such as pain or advice, then no
article is required. Note, this error has a big effect on
meaning: the in this case implies that this subject has been
mentioned previously, which of course it hasn't.
For more details on countable & uncountable nouns click here
Thank you for seeing this patient, an eight year old girl who Thank you for seeing this patient ,an eight year old girl who
presented today with the broken left arm following the presented today with a broken left arm
accident at her school play ground.It has been forty minutes following an accident at her school play ground.It has been
since a accident. forty minutes since the accident.
The definite article is used when referring to something specific. It is very important to include this article to signify the
information is specific.
Note: These articles are usually omitted in the case notes. This is because the case notes are in short note form and
standard grammar rules do not apply. However for referral letters it is necessary to apply and adhere to standard
grammar rules.
Incorrect Correct
She was on Microgynon 30 for previous 5 years. She was on Microgynon 30 for the previous 5 years
He has been a smoker for last 12 years. He has been a smoker for the last 12 years.
Mr. Roberts has been a resident at our nursing home for Mr. Roberts has been a resident at our nursing home
past 2 years. for the past 2 years.
This medication needs to be taken twice a day for next 3 This medication needs to be taken twice a day forthe next 3
days. days.
Explanation: All the expressions above are referring to a specific
period of time so a definite article is required.
MrsSangean is currently on following medication: karvea MrsSangean is currently on the following medication:
150mg daily, oroxinen 0.1 daily. karvea 150mg daily, oroxinen 0.1 daily
Explanation:In this case, the writer is referring to specific
medication. i.e that which follows.
The patient reported pain in left ankle. The patient reported pain in the left ankle.
Explanation: Here the writer is referring to a specific side, i.e not
the right side but the left side.
94
Examination revealed a slightly swollen joint and a tender Examination revealed a slightly swollen joint and a tender
spot on medial aspect of it. spot on the medial aspect of it.
Explanation: Here the writer is referring to a specific region, i.e not
the anterior aspect but the medial aspect.
Based on above information, I believe the patient needs Based on the above information, I believe the patient needs
urgent admission to hospital. urgent admission to hospital.
Explanation: Here the writer is referring to a specific information,
i.e not the information on the medical chart but the information
written above.
Thank you for seeing this patient who presented at my Thank you for seeing this patient who presented at my
surgery regarding tooth 54 which has been temporary filled surgery regarding tooth 54 which has been temporary filled
by school dental service. by the school dental service.
Explanation: Here the writer is referring to a specific dental
service, i.e not the community dental service but the school dental
service.
Handy Hint!
Articles are usually omitted in the case notes. This is because the case notes are in short note form and standard grammar
rules do not apply. However for referral letters it is necessary to apply and adhere to standard grammar rules including
article usage.
Body Parts
The definite article "the" should be used when referring to parts of the body.
Incorrect Correct
Names of Diseases
Incorrect Correct
The patient is suffering from the high blood pressure. The patient is suffering from high blood pressure.
Recently, the patient has complained of the headache. Recently, the patient has complained of headache.
The patient was diagnosed with the arthritis. The patient was diagnosed with arthritis.
The patient has had the influenza for three days. The patient has had influenza for three days.
95
Same
Incorrect Correct
She has a family history of same disease that had She has a family history of the same disease that
been controlled by Risperidone. had been controlled by Risperidone.
The children were treated by same dentist. The children were treated by the same dentist.
The medication is same as last time. The medication is the same as last time.
A gerund is the …ing form of a verb which takes on the grammatical function of a noun. It can be the subject or object in
a sentence. Usually no article is required with gerunds.
Incorrect Correct
On review today, Mr Walker has reduced the On review today, Mr Walker has reduced smoking
smoking from 20 to 10 cigarettes per day. from 20 to 10 cigarettes per day.
The patient was advised to stop the drinking. The patient was advised to stop drinking.
Nominalisation is a process where verbs can be turned into a "noun phrase". For example:The patient sucked
his thumb until he was five becomes The patient had a habit of thumb sucking until the age of five.
Often in medical English, it is necessary to use nominalisation such as: The excessive drinking of alcohol will
adversely affect your health. The reduction of weight has led to improved health. It is common in these
cases to use an article before the nominalised expression.
The other benefit of using the style of writing is that it creates a formal tone and allows you to summarise
details from the case notes.
Incorrect Correct
96
Grammar & Vocabulary Clinic
Capitalisation
Correct use of capitals is an important area to master when writing referral letters. Study the rules of usage below to
ensure you meet the standard conventions.
Rules of Usage
Job titles
The Lactation Consultant, Mater Hospital
The Veterinary Eye Specialist, University of Queensland
Institutions
Mary Jones was admitted to Spirit Hospital.
Dr. Bloomfield works at Weller Point Medical Centre.
Places including addresses
168 Wickham Terrace, Spring Hill
12 Logan Road, Mt Gravatt
36 Barmore Street, Holland Park
Titles when they precede the name of a person
The patient was seen by Doctor Smith.
Nurse Jones is in charge of the patient's care.
3. Common Nouns: Common nouns do not name any specific institution, place, person or profession. These words
do not need to be capitalised.
97
Yours sincerely,
Common Errors
Incorrect Correct
His medical history shows that he is Epileptic. His medical history shows that he is epileptic.
Also, I have given Dycal base on 1.1 and dressed it with Also, I have given dycal base on 1.1 and dressed it
Glass Ionomer Cement. with glass ionomer cement.
The patient was diagnosed with Type 2 Diabetes. The patient was diagnosed with type 2 diabetes.
Mrs. Marsh has a history of Hyperthyroidism, Hypertension Mrs. Marsh has a history
and Glaucoma. of hyperthyroidism,hypertension and glaucoma.
The patient is allergic to Penicillin. The patient is allergic to penicillin.
The patient suffered from severe Abdominal pain. The patient suffered from severe abdominal pain.
Refer to rule 1 above.
Mr. duane thomson presented at my clinic today with the Mr. Duane Thomson presented at my clinic today with the
complaint of a broken posterior tooth. complaint of a broken posterior tooth.
The director of nursing The Director of Nursing
emergency department Emergency Department
Mater hospital Mater Hospital
84 Monash road 84 Monash Road
The patient was seen by doctor Jones. The patient was seen by Doctor Jones.
The above words are all proper nouns. Refer to rule 2 above.
As per the General Practitioner’s order, we are doing daily As per the general practitioner’s order, we are doing daily
home visits and wound dressing and also assisting him with home visits and wound dressing and also assisting him with
his showers. his showers.
Please see your Pharmacist for advice. Please see your pharmacist for advice.
Ms. Gatsby is a University student. Ms. Gatsby is a university student.
The above words are all common nouns. Refer to rule 3 above.
The patient first visited my surgery in march, 2008. The patient first visited my surgery in March, 2008.
Mrs. Green will be discharged from hospital on wednesday. Mrs. Green will be discharged from hospital onWednesday.
Symptoms of hay fever are worse in Spring. Symptoms of hay fever are worse in spring.
Refer to rule 4 above.
The patient requested that i prescribe antibiotics for the The patient requested that I prescribe antibiotics for the
virus. virus.
Refer to rule 5 above.
98
Present Perfect
Present perfect tense is used to describe an event which starts in the past and continues until the present.
Mastery of this pattern is an essential for writing successful referral letters. Three common ways to form present perfect
when writing referral letters are as follows:
Present perfect is often combined with for/since/over. Compare the usage below and note time markers used.
Handy Tip
When using time markers such as ...for the past 20 years, ...for the last 3months, ...for the next 3 months or ....
for the previous 3 months always use the definite article "the" as it its function is to specify a particular period of time.
Common Errors
Incorrect Correct
The patient was diagnosed hypothyroidism The patient has had hypothyroidism since
since 2012 2012. (present perfect)
Explanation: Past tense cannot be used with for or The patient was diagnosed with
since hypothyroidism in 2012. (simple past)
99
you can not use “been” with a noun. 2012.(present perfect simple)
She has been arthritic since 2012. (present perfect
You must use have or has + noun or been+ simple +adjective)
___ingverb. You can also use been + adjective
She has had arthritis since 2012. (present perfect
simple +noun)
He is smoking 2 packs of cigarettes a day for He has been smoking two packs of cigarettes a day for
the past 25 – 30 years. the past 25-30 years. (present perfect progressive)
Over the past week she remains free from Over the past week she has remained free from severe
severe pain and has been able to tolerate a pain and has been able to tolerate a fluid diet.
fluid diet. (present perfect simple)
Also, there is an ulcer on the right lower There is also an ulcer on the right lower lateral border
lateral border of the tongue which is present of the tongue, which has been present for more than
for more than one year. one year.(present perfect)
Mr. Diamond is a patient of mine since 2005 Mr Diamond has been a patient of mine since
Mr. Eddy is a known smoker for 25-30 years. 2005.(present perfect simple)
Explanation: The verbs in these sentences are in Mr. Eddy has been a smoker for 25 years. (present
simple present tense. Present perfect needs to be perfect simple)
used because you are
There is often confusion of whether to use simple past or present perfect tense. The basic rule to remember is if you are
referring a particular time in the past then you must use simple past tense. If you are referring to a period of time that
starts in the past and continues up to now use present perfect tense.
There are some common time markers used with simple past and present perfect. It is important to study, learn and use
these tenses correctly when writing referral letters as you must refer to both past events and periods of time leading to
the present.
Time Markers with Simple Past Time markers with Present Perfect
Common Errors
Incorrect Correct
She has underwent triple coronary bypass surgery She underwent triple coronary bypass surgery on
on 10/08/15 10/08/15
100
Active and Passive Verb Formation
When writing a referral letter, it is necessary to use a variety of verb forms including both active and
passive verbs. Using active verbs is good when you wish to create a personal tone or impart subjective
information. However, passive verbs and sentence structures enable the writer to be more objective and
focus attention on what is most important in a sentence such as the patient, procedures and treatment
rather than on health professional.
Compare
1. I advised her to do bed exercises to prevent further complications such as deep vein thrombosis.
2. Bed exercises were advised to prevent further complications such as deep vein thrombosis.(focus on
the treatment)
1. You need to take Flucloxacillin capsules twice a day for a duration of 2 weeks.
2. Flucloxacillin capsules need to be taken twice a day for a duration of 2 weeks.(focus on the
medication)
To form the passive, use the be verb (be, is/ are; was/were; has been/have been) + past participle as
described in the table below.
Active Passive
The patient was taking aspirin daily. Aspirin was being taken daily.
Present perfect
Present perfect
Aspirin has been taken daily for a period of one
The patient has taken aspirin daily for a period of year.
one year. Aspirin, noten and normison have been taken for
The patient has taken aspirin, noten and normison a period of one year.
for a period of one year.
The patient had taken aspirin daily for a period of Aspirin had been taken daily for a period of one
one year. year.
Aspirin, noten and normison had been taken for
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The patient had taken aspirin, noten and normison a period of one year.
for a period of one year.
Future Future
The patient will take aspirin in the evening Aspirin will be taken in the evening.
The patient should have taken aspirin in the evening. Aspirin should have been taken in the evening.
Incorrect Correct
She had done colonoscopy 3 years ago. A colonoscopy was done 3 years ago.
This sentence indicates the patient did the She had a colonoscopy done 3 years ago.
procedure! In these sentences it is unimportant who performed the colonoscopy
so passive voice is used.
Initially, she came to me on Initially, she came to me on 14/01/2006 for a general check
14/01/2012 for a general check up and up and her blood pressure was found to be 160/90.
was found her blood pressure 160/90. After the conjunction "and" a subject is required.
Noten 50mg 1/2 tablet daily prescribed Noten 50mg 1/2 tablet daily was prescribed while Zocor and
while Zocor and Calcium Caltrate Calcium Caltrate were continued.
Add the "be verb"
continued.
Today at my surgery attended Mr. Today, Mr. Attard attended my clinic complaining of pain in
Attard complaining of pain in his upper his upper left molar.
left molar. Use active form here as you need to focus on your patient, not your
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surgery
Past Perfect
Past Perfect is an important tense in referral letters. The main functions of this tense are:
When used with simple past it allows the writer to distinguish the order of events:
She had not been able to conceive over the previous four months and as a result she was
suffering from depression. This means: first she could not conceive, then she became
depressed.
When used in reported speech. The case notes may describe the patient's condition at a time in the
past, i.epatient found blood in toilet bowl 2 times. This can be written in the referral letter as
follows:
At today’s consultation, Ms. Leon reported that there had been blood in the toilet bowl on 2
occasions.
So the main benefit of using past perfect is that it allows the writer to express the order in which certain
health events occurred logically and clearly.
Handy Hint 1
Do not use past perfect when describing one past event as it is not necessary.
Compare
The patient had been feeling unwell last week.(incorrect if 1 past event described)
The patient was feeling unwell last week. (correct)
The patient had been feeling unwell last week and was admitted to hospital for observation. (correct
as 2 past events need to be distinguished)
Handy Hint 2
Past perfect is often used with the word previous instead of ago to demonstrate that you are referring to a
time before a particular date in the past, not the date you are writing the letter. See below for examples.
Incorrect Correct
She presented to me yesterday evening with abdominal She presented to me yesterday evening
pain, mostly on the left iliac fossa, and was since 24 with abdominal pain, mostly on the left
hours. iliac fossa, which had been occurring for
the previous 24 hours.
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Note that in the correct version 3 different times
need to be considered
Subject-Verb Agreement
Subject verb agreement is an area where accuracy is important. Below are some important rules which you
should remember.
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He needs to be assisted with
They need to be assisted with
activities of daily living.
activities of daily living.
Common Errors
Incorrect Correct
Alison’s school medical record reveals that her Alison’s school medical record reveals that her
attendance have been declining in recent past. attendance hasbeen declining in recent past.
I am writing to refer this patient who I suspect I am writing to refer this patient who I suspect is
is suffering from rheumatic fever and need suffering from rheumatic fever and needs urgent
urgent admission. admission.
I believe that the teeth 65 and 54 needs to be I believe that the teeth 65 and 54 need to be
extracted followed by space maintainer. extracted followed by space maintainer.
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Formal& Casual Expressions
The written language of English is different to the spoken language in that it is quite formal whereas the
spoken form is more casual.
If spoken language expressions are used in formal letters it affects the “tone and register” of the letter.
Therefore, it is important to
maintain a formal tone and use standard expressions. Below is a list of inappropriate casual expressions with
more formal appropriate expressions.
Example Words
Casual Formal Casual Formal Casual Formal Casual Formal Casual Formal Casual Formal
asks requests think believe get become so very but however kids children
for
say state get receive got became about regarding really greatly sad depressed
said stated got received So Therefore a bit slightly kid child till until
like include like such as don't do not Thanks Thank- kids children lots a lot of
you
Example Sentences
She refuses to eat solids and prefers fluids only She refuses to eat solids and prefers fluids such
like apple juice and lemonade. as apple juice and lemonade.
There are several measures which can be taken There are several measures which can be taken
to reduce the risk of infection like taking a to reduce the risk of infection including taking a
shower in morning, using separate towel for shower in morning, using separate towel for
everyone, changing underwear and bed sheets everyone, changing underwear and bed sheets
regularly, vacuuming carpets, keeping the nails regularly, vacuuming carpets, keeping the nails
short and washing hand thoroughly. short and washing hand thoroughly.
She was given general advise for softening her She was given her general advise for softening
stool, like changing her dietary habit but she her stool such as changing her dietary habit but
was non compliant. she was non compliant.
Thanks for seeing Mr. Brown. Thank you for seeing Mr. Brown.
Thanks for arranging a home visit for this Thank you for arranging a home visit for this
patient. If you have any further questions, patient. If you have any further questions,
please feel free to ask me. please be free to ask me.
In view of the above signs and symptoms I In view of the above signs and symptoms
think she is suffering from schizophrenia. I believeshe is suffering from schizophrenia
The patient's family is thinking about a The patient's family is considering a reduction
reduction in her medication. in her medication.
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I would really appreciate your attention I would very much appreciate your attention
regarding further management of this patient. regarding further management of this patient.
I would greatly appreciate your attention
Explanation: Really is spoken language and should be regarding further management of this patient.
avoided in formal writing.
About his dietary habits, he eats a large amount Regarding his dietary habits, he eats a large
of oily and sweet food. amount of oily and sweet food.
If you require any other information about her If you require any other
condition, please do not hesitate to contact me. information regarding her condition, please do
not hesitate to contact me.
Explanation: About is a casual expression, regarding is
more suitable. Lots of is also casual. “A large amount
of” is more formal.
There was nothing significant in his social There were no significant findings in his social
history. history.
Explanation: Nothing is more commonly a spoken
expression which is not suitable for writing.
Please do not hesitate to contact me if u need Please do not hesitate to contact me if you need
additional information. additional information.
She has got maternal postpartum haemorrhage She has had maternal postpartum haemorrhage
of 800mls. of 800ml.
Mr O’ Riley got an appointment for a follow up Mr O’ Riley has an appointment for a follow up
visit with his general practitioner, Dr. Avril visit with his general practitioner, Dr. Avril
Jensen. Jensen.
The mother got sick for a few days. The mother became sick for a few days
Should you have any concerns regarding them, Should you have any concerns regarding Mary
please do not hesitate to contact me. and her child, please do not hesitate to contact
Explanation: The pronoun them sounds casual here. It me.
is much better to use the patient’s name, especially in
the final sentence of the letter.
At the moment, she is weak and disorientated At the moment, she is weak and disorientated at
sometimes but severe pain has been alleviated. times but severe pain has been alleviated.
Explanation: Sometimes is a casual expression. More
formal expressions include: at times or on occasions At the moment, she is weak and
disorientated on occasions but severe pain has
been alleviated.
This pain was exaggerated to cold and hot This pain was exaggerated to hot and
things coldstimuli.
Explanation: Things is a casual expression and should
be avoided
A repeat vaginal examination revealed a very A repeat vaginal examination revealed a very
tender right vaginal fornix. But her blood tender right vaginal fornix. However, her blood
pressure pulse is within normal range. pressure pulse is within normal range.
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Explanation: It is not good English to begin a sentence
with the conjunction but In this case use However, as
it is more formal
Her temperature and blood pressure were Her temperature and blood pressure were
normal while pulse was elevated at 88. So I normal while pulse was elevated at
recommended that she return today for a blood 88. Therefore, I recommended that she return
test and reassessment. today for a blood test and reassessment.
Explanation: So is a casual word, you can use it
within a sentence, but not to start a sentence in
formal writing. Replace with: Therefore,
There was evidence of poor oral hygiene, There was evidence of poor oral hygiene,
carious lesions and active periodontal disease carious lesions and active periodontal disease as
too. well.
Explanation: too is informal, a more more formal
expression is as well.
Her husband was upset because, she was not Her husband was upset because, she was not
showing interest towards the kids. showing interest towards the children.
Mark's dad also suffers from this condition. Mark's father also suffers from this condition.
The teacher spoke to her mum regarding the The teacher spoke to her mother regarding the
regular absences from school. regular absences from school.
She had had termination of pregnancy 10 She had had termination of pregnancy 10
yearsback. yearsago.
He is a regular smoker and drinker with the only He is a regular smoker and drinker with the only
relevant past history of left inguinal hernia relevant past history of left inguinal hernia
operation 2 years back. operation 2 years previously.
He had a habit of thumb sucking till the age of He had a habit of thumb sucking until the age of
5. 5.
Explanation: Till is casual, until is formal
I am writing to request a follow-up for this I am writing to request a follow-up visit for this
patient. patient.
Examination revealed that his vitals were stable Examination revealed that his vital signs were
and left knee was swollen without effusion. stable and left knee was swollen without
Examination revealed normal vitals. effusion.
Examination revealed that his vital signs were
Explanation: Vitals and follow up are incomplete normal.
expressions, commonly used in spoken English, but
not suitable for formal writing.
Mrs. Jones is a widow who complained of Mrs. Jones is a widow who complained of
persistent chest pain at roughly 1.45pm. persistent chest pain at approximately 1.45pm.
Miss Roberts started smoking around 6 months Miss Roberts started smoking approximately 6
108
ago. months ago.
Roughly and around are casual or vague expressions.
I recommend some investigations to rule out I recommend further investigations to rule out
cancer. cancer.
I requested some blood tests. I requested additional blood tests.
Explanation: Some is vague and does not sound
professional.
Her BMI was 28 and all the rest of the Her BMI was 28 and the remainder of the
examinations were normal. examinations were normal.
Explanation: all the rest of sounds informal.
Abdominal examination revealed a small right Abdominal examination revealed a small right
groin swelling that’s consistent with inguinal groin swelling that is consistent with inguinal
hernia. hernia.
Thank you for your expert care and please don't Thank you for your expert care and please do
hesitate to contact us if you require further nothesitate to contact us if you require further
information. information.
In addition, she is just able to tolerate fluids. In addition, she is only able to tolerate fluids.
Medical Terminology
The medical case notes for the OET exam often contain abbreviations, medical acronyms and technical
language. The task for the writer is to expand these into full words and sentences. There are 3 reasons why
this is important.
1. As the OET is a test of English, you need to demonstrate your ability to transfer technical language in
the case notes into standard English.
2. For some letters you are may have to write to someone who is not a health professional such as a
social worker or family member.
3. A referral letter is not a report so the standard conventions of letter writing require a formal style
which includes using complete words and sentences.
Handy Hint: It is a test of English not Latin, so where possible avoid the use of Latin based acronyms
and words.
109
BW x-rays bite wing x-rays PMH past medical history
L left + positive
Exceptions to this rule include abbreviations of measurement. Therefore it is acceptable to use the
following in short form:
cm centimeter ml millilitre
g gram mg milligram
Common Errors
Incorrect Correct
Her current medications include sid Metformin Her current medications include a daily dose of
500 mg. mane and nocte, Glycosamine 5mg.mane Metformin 500 mg. in the morning and at night,
and Candesartan 10mg. nocte. Glycosamine 5mg.in the morning and Candesartan
10mg. at night.
After discharge from hospital, Mrs.Jones has been After discharge from hospital, Mrs.Jones has been
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told to take Aperients (PRN) and Aldomet (250 mg told to take Aperients when required and
bid). Aldomettwice a day.
I treated Claudia with prednisolone5mg 1t/sid for I treated Claudia with prednisolone 5mg tablet
seven days. once a day for seven days.
On examination, there was tenderness and rebound On examination, there was tenderness and rebound
tenderness over the R. iliac fossa. tenderness over the right
iliac fossa.
I am writing to refer Mrs. Wilson, a 45yr old I am writing to refer Mrs. Wilson, a 45-year-old
woman who is suffering from signs and symptoms woman who is suffering from signs and symptoms
suggestive of advanced English. suggestive of advanced English.
She presented to me yesterday evening with She presented to me yesterday evening with
abdominal pain mostly in the left iliac fossa which abdominal pain mostly in the left iliac fossa which
had been present for the last 24 hrs. had been present for the last 24 hours.
On examination she was found to have PR 88/min On examination she was found to have a pulse rate
of 88 beats per minute.
On examination she was found to have a pulse of
88.
Mr Duane Eddy 57/m is an a urgent referral Mr Duane Eddy, a 57 year old male is an a urgent
regarding an ulcer in R. lateral border of tongue. referral regarding an ulcer in the right lateral
border of tongue
I would appreciate if you could inform me about I would appreciate if you could inform me about
her treatment & progress over the next few days. her treatment and progress over the next few days.
The patient was discharged on Dec. 30 2009. The patient was discharged on December 30 2009.
The patient was discharged on 30/12/09.
Lab work and review was planned for the next Laboratory work and review was planned for the
morning. next morning.
Referring to a Patient
There are certain conventions which need to be followed when referring to a patient in a formal letter. This
worksheet will explain what you need to know so that you can conform to these conventions.
Handy Tip 1: Definitely do not use titles with first names only, i.eMr Thomas or Mrs. Carol as this is not
acceptable. See below for correct usage.
111
These titles can be used in the following ways
I am writing to refer Mr. Thomas Hacker (very formal, usually used above the address or after Re: but
not on the body of the letter.)
I am writing to refer this patient (commonly used in the opening sentence if patient's name has been
mentioned above as in Re: Mr. Thomas Hacker)
Question: When and how often should I use the patient's name in the letter?
Answer: The standard way is to write the patient's name in full below the opening saluation. Then, use the
patient's name once per paragraph as illustrated below ,after which you can use pronouns. It is also
important to be consistent with how you refer to the patient. Do not mix up your use of first names and
surnames in the letter as this will only confuse the reader.
Handy Tip 2: There is no need to write the patient's name out in full in the introduction if you have
stated it below the salutation i.e Re: Mrs. Carol Brady as it is very clear who you are writing about. In such
cases use "this patient" or title and surname "Mrs. Brady". If you do this you will be following standard
conventions.
Example Letter
31 July 2016
The Director
Redeemer Palliative Care Hospital
32 Nelson Drive
St Lucia
Queensland, 4050
Dear Sir/Madam,
I am writing to request palliative respite admission for this patient, a 42-year-old woman who has recently
been diagnosed with terminal cancer.
Mrs. Brady was admitted to Spirit Hospital on 20/10/16 due to severe stomach pain. During hospitalisation,
a laparoscopy was performed and she was diagnosed with stage 4 ovarian cancer on 22/10/16.
Unfortunately, the cancer has metastasized to her liver and left lung with a limited life expectancy. She has
also been experiencing increased pain for which she takes Oxycontin and Panadol as required. She is feeling
depressed and has not been eating well. Chemotherapy was offered but she refused the treatment and
wished to return home to her family.
Mrs. Brady lives with her husband and has two children aged 10 and 12. Mr. Brady has reduced his work
hours in order to care for his wife and the children who can be difficult to manage. Mr. Brady is finding it
difficult to cope emotionally and feels isolated with limited family support. Due to the difficulty of the
current situation, he has agreed to palliative respire admission for his wife.
It would be greatly appreciated if you could accept Mrs. Brady into your care and provide a complete
reassessment ofher pain medication to ensure maximum effectiveness.
Yours sincerely,
Community Nurse
112
Common Mistakes
Thank you for seeing my patient, Master Alfie Thank you for seeing my patient, Alfie, a 7-year-
Langer, a 7 year old boy. old boy.
Explanation: Master is somewhat old fashioned and
does not sound "familiar" if used in the body of the
letter.
Mr. Peter, a 23 year old young man, presented at Mr Holmes, a 23-year-old young man, presented at
my surgery today complaining of painful wisdom my surgery today complaining of painful wisdom
teeth. teeth.
Explanation: You can not use titles with first names
only.
I am writing to refer Miss. Green for surgical I am writing to refer Miss Green for surgical
assessment. assessment.
Explanation: Miss is not an abbreviation so no
punctuation required.
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Letter Format
One of the criteria used to assess your writing in the OET exam is Control of Presentation Features. This
criterion assesses the overall presentation of the letter and includes a lot of the features outside the body
of the letter including
Letter format
Punctuation
Capital letters
Spelling
This worksheet will describe the characteristics of formal medical correspondence. To do this, the letter has
been broken up into 6 parts.
1. Date: The date should be placed at either the top left or top right of the letter and can be either written
in full or as numbers as follows:
21/07/16
July 21, 2016
21st July, 2016
2. Address: The address gives the name and address of the person or facility to whom you are writing.
There are some basic conventions which need to be followed including:
Capital letters for job titles, names & street names
3.Salutation: If the name of the person is included in the case notes then it should be used. This can be
followed by either a comma or full colon.
If the name of person is not mentioned and they are a non-medical person, then you can begin
with Sir/Madam as used in business correspondence or if they are a medical professional you can use their
job title Doctor/Nurse/Dentist etc
Dear Sir/Madam,
Dear Doctor
Dear Nurse
4.Subject: The subject is a place where information such as the name & age of the patient can be included.
This can save you words in the body of the letter, but be careful not include too much information here,
and definitely no phrases or sentences. Both Re & RE are acceptable.
5.Body: The information in the body of the letter should be divided into paragraphs, with the standard
format for a referral letter being as follows:
Introduction which includes background information & purpose of writing or chief complaint in
summary form.
114
Note: OET requires the letters to be between 180~200 words approximately. The word length is based on
the body of the letter only.
6.Closer: The closer is the final part of the letter and should be written one space below the last line of the
body. Only the first word in the closer should be capitalised and a comma should following the last word.
Yours sincerely,(standard)
Sincerely yours,
Sincerely,
Yours truly, (American style, but gaining popularity in Australia)
Note: Yours faithfully, is often recommended as a closer when you don't know the name of the person to
whom you are writing. However, in formal medical correspondence it is not advised as it puts you in a
subservient position.
Thank you for taking over the care of Peter, a 16-year-old student who has a
history of cystic fibrosis (CF).
Peter was diagnosed with CF when he was born and he needs frequent admissions due
to recurrent lung infections. He lives with his parents and an elder brother.
Peter currently takes Pancrease, omeprazole and oral hypoglycaemics. His self-
management program includes active cycle breathing (ACB), positive expiratory
pressure (PEP), flutter and posture drainage (PD). Peter’s fitness is maintained
by biking to school.
Peter’s condition has improved and he started gym sessions today. I have arranged
for an appointment with Peter to check the effect of car fumes when he is biking.
I will consider a mask to keep his airway moisturised if the car fumes impact on
his breathing.
Peter will be discharged in 3 days from the medical ward and will require on
going care.
Yours sincerely,
Tania Robinson
Physiotherapist
115
Common Errors
Incorrect Correct
Explanation:
1. To not required.
Re: Julie Crosby, 25 yr receptionist, single Re: Julie Crosby, 25 years of age
Explanation: Too much information. Best practice is too Re: Julie Crosby, D.O.B 21/07/90
include name and age of patient only. Other information
such as gender, profession, marital status and so forth can
be included in the opening sentence.
116
The Comma
The comma is the most frequently used punctuation mark within sentences. Used correctly it allows the
writer to separate a group of words or phrase from other parts of a sentence. This is necessary in order to
add useful information in a sentence. The information can be added at the beginning, the middle or the
end. However if commas are not used or overused, the meaning can be affected and the flow of information
disrupted. By understanding the basic rules presented in this section you should be able to develop a good
understanding of how and when to use commas in referral letters.
Rules of Usage
1. The Adverbial Phrase: The adverbial phrase can be used in referral letters to provide information such
as a time, place, context, emphasis or mood in the sentence which is to follow and it is commonly separated
by a comma
Contrast: The patient's condition has improved. However, a follow up visit is required.
Sentence Structure
Comma preferred Regarding her she has been suffering asthma for which
medical history, from she uses a ventolin
inhaler.
117
Comma preferred Please note, the patient has an appointment
with his
physiotherapist at
10 o'clock on
Monday.
Handy Hint: Do not put a comma between a subject and a verb or a verb and an object.
2. Appositives: This is a noun or a noun phrase that is placed after another noun to explain or identify it. It
has a very important use in the introductory sentence of referral letters as follows.
Mr Smith, an 80 year old widow, was admitted to hospital with complaints of heart
palpitations.
Thank you for seeing Jordan, a 10 year old boy who presented at my clinic today with a main
concern of pain in tooth 54.
I am writing to refer Mrs. Bradley, a 42 year old married woman who is suffering from cancer.
3. Conditional Sentences: These sentences are frequently used in the conclusion of a referral letter and
the rules are as follows:
If you have any further questions regarding this patient, please don’t hesitate to call
me.
Don’t use a comma if the dependent clause is at the end of the sentence.
Please consult your doctor in case of irritation, redness or swelling.
I will forward the results to you when they become available.
The patient was admitted to hospital because of her deteriorating condition.
5. Comma Splices: A comma splice is two sentences joined together with a comma, but no conjunction.
This is an error as the information must be either joined with a coordinating conjunction such
as and/but/or or a new sentence must be started.
He does not have any dental experience, he is worried about the pain.(incorrect)
He does not have any dental experience and he is worried about the pain.(correct)
He does not have any dental experience. Therefore, he is worried about the pain.(correct)
6. Noun Clauses beginning with that should not be separated by a comma.
It is also important to know, that a re-check is organised for the 31.5.2009 at 10:30 in order to
remove the suture. (incorrect)
It is also important to know that a re-check is organised for the 31.5.2009 at 10:30 in order to
remove the suture.(correct)
7. Use commas to separate three or more words, phrases, or clauses written in a series.The final word
does not require a comma and it should be separated by a conjunction such as and or or
Mrs. Olsen has a history of hypertension, hypothyroidism, glaucoma for which she is on regular
medication. (incorrect)
Mrs. Olsen has a history of hypertension, hypothyroidism and glaucoma which is on regular
medication. (correct)
118
Common Errors
Incorrect Correct
1. On review today Mr Walker has reduced 1. On review today, Mr Walker has reduced
smoking from 20 to 10 cigarettes per day. smoking from 20 to 10 cigarettes per day.
2. On examination today there was a soft 2. On examination today, there was a soft
fluctuant swelling palpable on the left cheek fluctuant swelling palpable on the left cheek
3. Regrettably she has problems with breast 3. Regrettably, she has problems with breast
feeding and caring for the baby. feeding and caring for the baby.
4. Please note he has a prosthetic heart valve. 4. Please note, he has a prosthetic heart valve.
Comma preferred for adverbial phrases. Refer to
rule 1 above.
1. I am writing to refer Mr. Jones a 57 year old 1. I am writing to refer Mr. Jones, a 57 year old
man who was admitted to hospital on the man who was admitted to hospital on the
18th of July, diagnosed with myasthenia 18th of July, diagnosed with myasthenia
gravis. gravis.
2. Mr Jones, a 57 year old man was admitted to 2. Mr Jones, a 57 year old man, was admitted to
hospital on the 18th of July, diagnosed with hospital on the 18th of July, diagnosed with
myasthenia gravis. myasthenia gravis.
Comma required for appositives. Refer to rule 2
above.
Please note that, Daniel has an allergy to Please note that Daniel has an allergy to
peanuts. peanuts.
Apply the comma rule for comma splices. Refer to
rule 5 above.
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Capitalisation
Correct use of capitals is an important area to master when writing referral letters. Study the rules of usage below to
ensure you meet the standard conventions.
Rules of Usage
Job titles
The Lactation Consultant, Mater Hospital
The Veterinary Eye Specialist, University of Queensland
Institutions
Mary Jones was admitted to Spirit Hospital.
Dr. Bloomfield works at Weller Point Medical Centre.
Places including addresses
168 Wickham Terrace, Spring Hill
12 Logan Road, Mt Gravatt
36 Barmore Street, Holland Park
Titles when they precede the name of a person
The patient was seen by Doctor Smith.
Nurse Jones is in charge of the patient's care.
3. Common Nouns: Common nouns do not name any specific institution, place, person or profession. These words
do not need to be capitalised.
120
Common Errors
Incorrect Correct
His medical history shows that he is Epileptic. His medical history shows that he is epileptic.
Also, I have given Dycal base on 1.1 and dressed it with Also, I have given dycal base on 1.1 and dressed it
Glass Ionomer Cement. with glass ionomer cement.
The patient was diagnosed with Type 2 Diabetes. The patient was diagnosed with type 2 diabetes.
Mrs. Marsh has a history of Hyperthyroidism, Hypertension Mrs. Marsh has a history
and Glaucoma. of hyperthyroidism,hypertension and glaucoma.
The patient is allergic to Penicillin. The patient is allergic to penicillin.
The patient suffered from severe Abdominal pain. The patient suffered from severe abdominal pain.
Refer to rule 1 above.
Mr. duanethomson presented at my clinic today with the Mr. Duane Thomson presented at my clinic today with the
complaint of a broken posterior tooth. complaint of a broken posterior tooth.
The director of nursing The Director of Nursing
emergency department Emergency Department
Mater hospital Mater Hospital
84 Monash road 84 Monash Road
The patient was seen by doctor Jones. The patient was seen by Doctor Jones.
The above words are all proper nouns. Refer to rule 2 above.
As per the General Practitioner’s order, we are doing daily As per the general practitioner’s order, we are doing daily
home visits and wound dressing and also assisting him with home visits and wound dressing and also assisting him with
his showers. his showers.
Please see your Pharmacist for advice. Please see your pharmacist for advice.
Ms. Gatsby is a University student. Ms. Gatsby is a university student.
The above words are all common nouns. Refer to rule 3 above.
The patient first visited my surgery in march, 2008. The patient first visited my surgery in March, 2008.
Mrs. Green will be discharged from hospital on wednesday. Mrs. Green will be discharged from hospital onWednesday.
Symptoms of hay fever are worse in Spring. Symptoms of hay fever are worse in spring.
Refer to rule 4 above.
The patient requested that i prescribe antibiotics for the The patient requested that I prescribe antibiotics for the
virus. virus.
Refer to rule 5 above.
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Common Mistakes Regarding Physical Description
Incorrect Correct
Advice was given to reduce her weight. 1. Advice was given to reduce weight.
After the verb reduce it is not necessary to follow with a 2. The patient was advised to reduce weight.
pronoun. So you is not required. Simply say: 3. A reduction of weight was advised.
I advised him to reduce weight, or, you need to reduce
weight.
In addition, she had lost her weight. 1. In addition, she had lost weight.
After the verb lose it is not correct to follow with a 2. In addition, she has lost a further 11 kg of weight
pronoun. over the past 2 months.
3. In addition, the patient’s weight has significantly
reduced from 61 kg to 50 kg over the past 2 months.
He is now obese with a 99kilos weight and a 170cm height. 1. He is now obese with a weight of 99 kg and a height
The use of the correct verb & noun form and associated of 170cm. (noun form)
grammar is difficult. Refer opposite for correct usage. 2. He weighs 99 kg and is 170cm tall. (verb form)
3. He weighs 99kg and is 170cm in height. (verb form)
1. Today’s examination revealed multiple missing 1. Today’s examination revealed multiple missing
teeth, various carious lesions and a periodontal teeth, various carious lesions and a periodontal
pocket of depth 4-9mm. pocket depth of 4-9mm.
2. There are several periodental pockets with about 4- 2. There are several periodontal pockets which are
9 mm in depth. about 4’9 mm in depth or
Correct word order is: 3. There are several periodontal pockets with a depth
Depth of 4-9mm of about 4-9 mm.
Height of 173cm 4. His height is 173cm.
Length of 20 m
Weight of 78kg
3. His height was 173cm. Weight can change but height
can not so don’t use past tense.
1. He was overweight 85 Kg with respect to his 1. He was overweight at 85 kg with respect to his
height 173 cm. height of 173 cm.
This sentence is a shortened version similar to the
case notes. It is important to write in full sentences.
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Difficult Words
The English language is governed by rules. However, there are also many exceptions to these rules and words which do
not follow the normal or expected pattern are those which often cause problems. Study this list carefully so that you can
improve your grammatical accuracy and knowledge.
Complain Vs Complaint
Complain is a verb
The patient complained of severe abdominal pain.
Complaint is a noun
Mr. Cochrane presented with complaints of nausea, headache and fever. (plural)
Mr. Cochrane presented with a complaint of nausea. (singular with article)
Incorrect Correct
The patient complaints of chest pain and her blood pressure The patient complains of chest pain and her blood pressure
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is high. is high.(verb)
The patient presented with a complain of chest pain. The patient presented with a complaint of chest pain.(noun)
The patient presented with complaint of chest pain. The patient presented with a complaint of chest pain.
He presented to my office on 23/03/2008 complaining on (article required)
severe pain associated with the lower left first molar. He presented to my office on 23/03/2008
complaining of severe pain associated with the lower left
first molar.
I have suggested him to see you next week. I suggested (that) he see you next week.
I suggested her to return in morning as she required further I advised him to see you next week
blood test and assessment. I suggested (that) she return in morning as she required
I recommended him to rest for 3 days. further blood test and assessment.
Explanation:The words suggest & recommend cannot be followed I advised her to return in morning as she required further
by an object pronoun such as him/her whereas advise can. blood test and assessment.
I recommended (that) he rest for 3 days.
Explain Vs Tell
Explain and tell also have different rules which cause confusion
Incorrect Correct
I explained them that unsuccessful conception was not I explained to them that unsuccessful conception was not
unusual in their case. unusual in their case.
I have already explained the couple the basic advice I told them that unsuccessful conception was not unusual in
regarding conception. their case.
Explanation: The word explain cannot be followed by a pronoun or I have already explained to the couple basic advice
noun without the preposition to whereas tell can. regarding conception.
I have already told the couple basic advice regarding
conception.
Advise Vs Advice
Advise is a verb
It would be greatly appreciated if you could make It would be greatly appreciated if you could make a
a visit to this family and advice his parents visit to this family and advise his parents regarding
regarding the recommended vaccines for both the recommended vaccines for both children. (verb)
children. I am writing to refer this patient to you
I am writing to refer this patient to you for an advice for adviceregarding the management of his bilateral
regarding the management of his bilateral inguinal inguinal hernia(noun)
hernia. I gave some advice to the patient regarding her
I gave an advice to the patient regarding her medication. medication.(noun)
I gave advices to the patient regarding her medication. I gave advice to the patient regarding her medication.(noun)
Please advice the patient on how and when to take their Please advise the patient on how and when to take their
medication. medication. (verb)
Request
Request can be both a verb and noun.
Request as a verb
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Incorrect Correct
The patient requested for new dentures. The patient requested new dentures. (verb)
Ms. Green requested about IVF treatment. The patient made a request for new dentures. (noun)
Explanation: The common mistake is to use the verb form plus Ms. Green requested IVF treatment.(verb)
preposition which incorrect. Ms.Green made a request for IVF treatment. (noun)
Affect Vs Effect
Affect is a verb
Incorrect Correct
She has also been effected by glaucoma for the past 4 She has also been affected by glaucoma for the past 4 years.
years. (verb)
The side affects of this medication are unknown. The side effects of this medication are unknown. (noun)
Widow or Widower
Widow (noun) refers to a woman whose husband has died and who has not remarried.
Widower (noun) refers to a man whose wife has died and who has not remarried.
Widowed (adjective) refers either a man or woman whose spouse has died and has not remarried.
Incorrect Correct
I am writing to refer Mrs. Saunders, a 58-year-old widowed I am writing to refer Mrs. Saunders, a 58-year-
who admitted with pain, dehydration and nausea. oldwidow who admitted with pain, dehydration and
I am writing to refer Mr. Saunders, a 60-year-old widow nausea.(noun)
who complained of pain in his upper right second molar. I am writing to refer this patient a 58-year-oldwidowed
woman who admitted with pain, dehydration and
nausea.(adjective)
I am writing to refer Mr. Saunders, a 60-year-old widower
who complained of pain in his upper right second
molar.(noun)
History
History is always present, never past because you can’t erase it! Therefore you need to use simple present tense not past
tense when using this expression.
Incorrect Correct
Mrs. McGowan had a history of heart palpitation of 3 day Mrs. McGowan has a history of heart palpitation of 3 day
duration. duration.
Allergy Vs Allergic
Allergy is a countable noun
In addition, he is known allergic to nuts for which he was In addition, he has a known allergy to nuts for which he
admitted to hospital with anaphylaxis 2 years ago. was admitted to hospital with anaphylaxis 2 years
Regarding his medical history he is allergy to sulphur ago.(noun)
containing drugs. In addition, he is known to be allergic to nuts for which he
had been admitted in the hospital with anaphylaxis 2 years
ago.(adjective)
Regarding his medical history he has an allergy tosulphur
containing drugs.(noun)
Regarding his medical history he is allergic tosulphur
containing drugs.(adjective)
Confident Vs Confidence
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Confident is an adjective
The patient has not confident social situations. The patient has no confidence in social situations. (noun
The patient is not confidence in social situations. form)
The patient is not confident in social situations. (adjective
form)
Incorrect Correct
The patient has reduced speech output and a little eye The patient has reduced speech output and littleeye
contact. contact.(negative connotation required here)
There are few ways to help identify the possibility of There are a few ways to help identify the possibility of
threadworms such as checking the anus of your children at threadworms such as checking the anus of your children at
night and frequent scratching. night and frequent scratching.(positive connotation
required)
during/while
During is followed by a noun
He twisted his ankle during playing squash 3 months ago. He twisted his ankle during a game of squash 3 months ago.
He twisted his ankle while playing squash 3 months ago.
following/followed by
Incorrect Correct
She was admitted to our hospital followed by a collapse at She was admitted to our hospital following a collapse at
home with dehydration,nausea and severe pain. home with dehydration, nausea and severe pain.
Incorrect as it means the patient was admitted to hospital first, then Correct as it means the collapse occurred before being admitted to
collapsed. hospital.
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Years Vs Year
Incorrect Correct
I am writing to refer this patient,63 years old man who lives 1. I am writing to refer this patient, a 63- year- old
alone. man, who lives alone.
In this sentence there are two mistakes: 2. There are two 63-year-old men in the waiting room.
1. the expression is a phrase and therefore requires an
article “a “ to precede the phrase a 63-year-old
man. An article is required because the noun man is
singular. Compare with: There are two 63-year-old
men in the waiting room.
2. Years is an adjective in this sentence (it describes
the age of the man) and adjectives are uncountable.
This patient is 63 year old. This patient is 63 years old.
In this sentence the word years is a noun preceding an
adjective old. Nouns can be countable so in this case you
must make it plural.
Her father died at 50 year old of bowel cancer 1. Her father died at 50 years of age of bowel cancer
In this case at is a preposition and needs to be followed by 2. Her father died at the age of 50 of bowel cancer
a noun or noun phrase, rather than the adjective” old”. See 3. Her father died when he was 50 years old of bowel
column on the right for possible correct choices. Year is a cancer.
noun in this case so it should be written in plural form.
Other examples
1. In addition, he had a habit of thumb sucking until 1. In addition, he had a habit of thumb sucking until the
age of five years. age of five.
2. In addition he had a habit of thumb sucking until he 2. In addition, he had a habit of thumb sucking until he
was five years age. was five years of age.
3. Regarding the medical history, Alfie has a history of 3. In addition, he had a habit of thumb sucking until he
thumb sucking until the age of 5 years, was five years old.
1. In addition she has fillings, crowns, good dental 1. In addition she has fillings, crowns, good dental
hygiene and a 13 years old chrome /cobalt hygiene and a 13 year old chrome /cobalt removable
removable partial denture. partial denture.
Years is an adjective in this sentence (it describes the
age of the denture) and adjectives are uncountable.
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A to Z of Phrasal Verbs and Useful Vocabulary
Letter Expression Example sentence
1. admitted to The patient was admitted to our hospital in March 2008 for the first time.
associated with
advised to
Mr. Booth first came to see me on 12/08/08 complaining of shortness of
advice on
breath which was worse when he was lying down. It was associated with a
allergies
tightness in the chest and coughing.
allergic to
She was advised to return the next day for a blood test and follow up
arrived at
consultation. (verb)
arrived in For both children advice on recommended vaccines will be necessary. (noun)
confidence in
She lacks confidence in caring her baby in terms of breast feeding and
bathing.
4. discharge on He will be discharged on the 12th of August.
deteriorate Since 28th of July her condition has deteriorated with occasional
deny disorientation.
difficulty in She denied vomiting and she was vague reporting about laxatives.
diagnosed with Mr. MacIntosh presented to me with the complaint of difficulty inpassing
diagnosis of urine.
I am writing to refer my patient, Fletcher, a nine year old Labrador cross dog
who is diagnosed with high grade lymhoma. (verb)
Histological results confirmed the diagnosis of high grade lymphoma.(noun)
5. evidence of Examination findings revealed evidence of an enlarged prostate.
enclosed I have enclosed the radiograph for your convenience.
6. to follow The patient was advised to follow a low fat diet.
8. history The patient first attended me yesterday evening with a one day history
of lower abdominal pain
Mr. Abrahim has a positive family history of prostate cancer
9. indicate The family has indicated that they need an interpreter who speaks Farsi or
Arabic during follow-up visits with this family.
indicative of However, there was slight swelling in the right groin indicative ofinguinal
hernia
inconspicuous His family and social history is inconspicious.
11. known She is a known asthmatic since childhood and is on Budesonide inhaler for
the same.
13. to make an I have made an appointment for her through your receptionist.
appointment
14. on examination On examination, her blood pressure was 180/90 mm Hg with a regular
pulse of 70 beats per minute.
15. occasions Today she presented very anxious and depressed as she had noted some
blood in her motions on two separate occasions.
16. provisional Provisional diagnosis suggests prostate cancer.
present at Mr Gates presented at my clinic yesterday at 7pm with a complaint oflower
present to back pain.
Today, he presented to me complaining of a regular dull ache in the groin.
17. queries If you have any further queries, please do not hesitate to contact me.
18. reveal Examination today revealed a significantly increased right groin swelling.
risk factors His risk factors include: smoking 20 cigarettes per day, lack of exercise and a
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a routine recovery strong family history of hypertension.
reluctant to He has made a routine recovery and his wounds appear to be healing well.
rule out He is reluctant to seek treatment.
remarkable
findings I believe she needs an urgent assessment to rule out bipolar disorder
19. suggestive of Miss Jones is suffering from the signs and symptoms suggestive ofectopic
suspicious of pregnancy.
I am writing to refer this patient, a 60-year-old women,with
suffering from symptoms suspicious of bowel malignancy
signs and Ms.Tylor has been suffering from diabetes and she is administering insulin
symptoms injection by herself.
He is a 40-year-old man who is suffering from signs and symptomssuggestive
of peritonitis with perforated gastric ulcer.
20. treated with He also has been suffering from hypertension which has been treated
tentative with Atenolol 50 mg daily.
My tentative diagnosis is dental fluorosis.
21. underlying I would appreciate your assessment of this girl to find out whether he has
under control any underlying psychological problems.
uneventful Currently, her pain is under control with medication and she is tolerating
urgent fluids.
unremarkable Her second pregnancy and delivery were uneventful.
to undergo I would appreciate if you could give urgent attention to Mrs. Woods' problem.
treatment/surgery Cardiovascular examination was unremarkable and her electrocardiogram
/an operation was normal.
She underwent colonoscopy three years ago which was normal. (simple past)
During hospitalization, the patient has undergone an electromyogram and X-
ray. (present perfect)
22. vital signs Her vital signs were normal, but she was overweight (85 kg). Thereforeshe
was advised to reduce weight and do exercise.
23. with a complaint Mr Gates presented at my clinic yesterday at 7pm with a complaint oflower
of back pain.
Prepositions
Prepositions are a difficult area of language to fully master as their usage is not governed by strict rules. The best way to learn prepositions is by
regular reading so that you can slowly absorb and become comfortable with their correct use. However, it is possible to memorise the correct use
of a selection of prepositions in order to use them accurately in writing the referral letter.
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Prepositions of Time
In: In is used for longer On: On is used for days and At: At is used for the time of Some words require no
periods of time dates and some time day and for some expressions preposition
expressions
Prepositions of Place
In: In is used for inside of something On: is used for the surface area of At: At is used for a place of activity
something
Common Errors
Incorrect Correct
His father died of cancer during the age of 50. His father died of cancer at the age of 50.
In examination today, the patient was anxious and On examination today, the patient was anxious and
distressed. distressed.
Initial examination on today revealed inflammed gums. Initial examination today revealed inflammed gums.
On December 2006, the patient had his wisdom teeth In December 2006, the patient had his wisdom teeth
removed. removed.
The patient's family arrived at Australia in last year. The patient's family arrived in Australia last year.
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Useful signal markers
Letter Signal Marker Example Sentence
1. ______as well She suffers from oedema as well as bladder incontinence and only
as______ tolerates fluids.
as a result of This child was admitted with Acute Meningoencephalitis as a result of a
complication following Mumps.
as a result Let me inform you that that the patient has proven to be uncooperative
during his dental treatments. As a result, I would recommend the
treatments be carried out with a general anaesthetic.
along with On vaginal examination cervical excitation was noted along
withtenderness in the right fornix.
apart from this She looked very anxious and was having trouble sleeping. Apart from
at that time this, no abnormalities were found on rectal, cardiovascular and
respiratory examinations.
Initially, I saw the patient six months ago when she complained of
constipation. At that time, her physical examination was normal.
2. besides that The patient has smoked 40 cigarettes a day for 25-30 years. Besides
because of this that he has type 2 diabetes.
based on He smokes 20 cigarettes and drinks 2 beers every day. Because of this, he
has been told to cease smoking and to reduce alcohol.
Furthermore, a fine needle aspiration was taken and was
investigated. Based on that, I suggest the dog has developed lymphoma.
3. consequently The depth of periodontal pocket was 3.4mm.Consequently, he has
undergone extensive treatment for carious lesions and oral hygiene
maintenance.
4. during_________ During hospitalization, his vital signs have been monitored and he has
been assisted with his showers.
duration On 15/2/08, she presented complaining of lower abdominal pain of 1 day
duration.
despite
Despite various dental treatments and regular dental cleaning, his
general gum condition is only fair.
6. for this reason Mr. Fox's blood pressure was elevated and he was overweight. For this
reason the patient was advised to do exercise and follow a healthy diet.
8. hence The carious lesions on 65 are reasonably deep and hence the tooth has to
however be extracted.
The patient regularly visits the dentist and her oral hygiene status is
good. However, her gums are inflamed.
9. in terms of ___ In terms of her medical history, she has mild hypertension and a 12 year
history of diverticulitis.
I have prescribed agleam in order to reduced anxiety.
in order to
in addition Regarding the medical history, Alfie had a history of thumb sucking until
the age of 5. In addition, he is epileptic and uses dylantin to control the
in the meantime
attacks.
I have planned to review him in two months to monitor his blood pressure
in case of and smoking reduction. In the meantime, I believe he needs urological
assessment.
In case of any irritation, redness or swelling of the skin, discontinue the
treatment and consult your doctor immediately
13. may I remind you May I remind you that both the teeth will require root canal treatment
that…. and crown.
my main concern My main concern is that the patient is reluctant to breastfeed and
is that……. confident in caring for her baby.
14. It should be It should be noted that they may have a problem with communicating in
noted English as they understand limited English.
15. over…… Over the past week, she has remained free from severe pain and has
been tolerating a fluid diet.
She first presented to me on 3.7.06 with several episodes of heart
on review today, flutter over the previous few weeks.
On review today, the patient has reduced smoking to 10 cigarettes a day,
attended gym twice a week and lost 7kg so far.
16. please note Please note, he has an allergic reaction to nuts.
18. regarding Regarding his medical history, Jordan suffers from eczema and asthma
for which he receives treatment twice a year.
Regrettably, she complains of mild constipation and weakness.
regrettably
Recently, she has been prescribed Karvea 150mg and Oroxine 0.1mg per
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recently day, Timoptol Eye Drops 0.5% twice a day and Normison 10mg as
required.
19. since then His urinalysis and examination were normal except obesity and
borderline hypertension. Since then, he has been doing regular exercise
and has managed to lose 8kg of weight
20. therefore Her vital signs were normal, but she was overweight (85
the reason for kg). Therefore she was advised to reduce weight and do exercise.
The reason for the referral is to consider a possible prostate biopsy
regarding the patient’s condition.
21. up until now, Up until now, Mr. Hutton has leaded a very unhealthy life.
unfortunately Unfortunately, she is not expected to survive more than 3 months.
23. with regard to I am writing with regard to this patient, a 57 year-old married man who
is under our care with the diagnosis of myasthenia gravis
Dentists
Initial examination on 20/ 02/ 2008 revealed that 54 has a temporary filling with a cavity
extending through the furcation. Based on the bitewing radiological findings, I advised
both 54 and 65 be extracted along with the construction of a space maintainer. Moreover I
advised the filling of carious 55 and fissure sealant for all 6’s. In my view, general
anesthesia is the proper sedation as the patient is known to be uncooperative in a dentist
chair.
Nurses
When admitted to this hospital, Mr. Jagger complained of haemetemesis, anorexia,
dizziness associated with weight loss and anaemia. He also was suffering from severe
epigastric pain after meals. Therefore, his stool was examined and an endoscopy has been
performed.
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Compound Sentences and Coordinating Conjunctions
When writing referral letters it is necessary to take information from the case notes and write it in
complete sentences. The most basic way to do this is as a simple sentence. Simple sentences commonly
contain a subject, verb and object and are known as independent clauses.
This method is suitable for information which is not connected to other information in the case notes.
However, it is more common to group information which is related into compound sentences. In the
sentence below ,two ideas are joined by the conjunction and. Note that the subject for each clause is
different and each clause can function as a complete sentence
Example: I prescribed Panadol for his hand pain and he was advised to reduce weight and do exercise.
Compound sentences are joined by conjunctions and they show the relationship between the ideas. The
most common conjunctions are:
Example: She does not smoke but (she) is a heavy alcohol drinker.
Example: She does not smoke or drink alcohol so her health is good.
One important decision for the writer to make is whether to include a subject in the second clause.
Basically, the rule is you need to add a subject after a conjunction if the subject of the second clause is
different to that of the first clause.Or if the sentence is very long.
I prescribed Panadol for his hand pain and he was advised to reduce weight and do exercise. (In this
case you must add a subject after and as the subject is different in the second clause)
I prescribed Panadol for his hand pain and advised for weight reduction and exercise. (in this case you
can omit the subject I as it is the same as the subject for the first part of the sentence)
I prescribed Panadol for his hand pain and I advised for weight reduction and exercise. (this is
grammatically correct, but in terms of style not very good as it is clear the subject remains the same,
so need to repeat it)
Common Mistakes
Incorrect Correct
Nicole is a non-smoker and no drink alcohol or other Nicole is a non-smoker and (she) doesn’t drink
drugs. alcohol or take drugs.
The parents say that immunisations were given at The parents say that immunisations were given at
birth to both their children, but no record to prove birth to both their children, but they have no records
that. to prove that.
Explanation: No subject or verb after the conjunctionbut The parents say that immunisations were given at
birth to both their children, but there are no records
The wound has healed and free of infection to prove that.
Explanation: Omission of subject and verb The wound has healed and (it) is free of infection
Mr. Smith’s activities were restricted since last year Mr. Smith’s activities have been restricted since last
by grinding pain in the left hip and had difficulty in year by grinding pain in the left hip and he had
climbing and descending stairs. difficulty in climbing and descending stairs.
Explanation: No subject after the conjunction and, and note Her blood pressure was 175/95 and she took Normison
the subject for each clause is different. In the first clause the
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subject is Mr Smith’s activities and in the second clause the 1 tablet and 2 panadol at 10 pm
subject is Mr Smith (not his activities)
She is a widow and a resident at Golden Pond She is a widow and a resident at Golden Pond
Retirement Village, has a son in Warwick. Retirement Village and (she) has a son in Warwick.
Mr. Jones has been a patient of mine since 1999 and Mr. Jones has been a patient of mine since 1999 and
attending my clinic on a regular basis for scaling and (he) has been attending my clinic on a regular basis
cleaning. for scaling and cleaning.
The information in the case notes is usually written in note form, and therefore does not follow conventional grammatical
rules. However, when this information is organised into complete sentences in the referral letter it is necessary to follow
standard conventions of grammar and sentence structure. This worksheet explains how to group information using parallel
structures to ensure that the sentences you write are grammatically balanced. This can be achieved by making sure that
verbs, adjectives, nouns, prepositions, phrases and clauses are parallel. Parallel structures within a sentence are joined
with coordinating conjunctions such as and/or as well as with commas. Here are some examples:
With active verbs
He is now worried about his condition because he is overweight, lacks exercise and smokes regularly
With passive verbs
During hospitalization, IV fluids were commenced and a transdermal patch was used for her pain.
With nouns & noun phrases
He is now worried about his condition because of his increased weight, lack of exercise and his habit of smoking.
He will require information about how and when to take his medication, how to stop smoking and the necessity of
doing regular exercise.
With gerunds
In order to handle the above mentioned effects be cautious when driving a car, operating machinery
or performing any hazardous activities especially after taking your regular dose.
With prepositions
Threadworms resemble pieces of 1.5 cm cotton thread which is normally detectable at the surface of the feces
or around the anus at night.
With verbs in the conclusion
I am worried about Miss Jones and would appreciate your urgent assessment and treatment as you think
appropriate.
The important point to remember is that the structures must be balanced.
133
Common Mistakes
Incorrect Correct
Sally initially presented alone to my clinic on Sally initially presented alone to my clinic on 27/12/07 with
27/12/07 with a 3-month-history of constipation a 3-month-history of constipationand associated use of
and associated using laxatives laxatives
Explanation: The sentence is not balanced as noun phrases
He has a family history of stroke and diabetic. He has a family history of stroke and diabetes
Explanation: This sentence is not balanced as stroke is a noun and
diabetic is a adjective
Good hygiene should be maintained by taking a Good hygiene should be maintained by taking a
morning shower, using individual towels, washing morning shower, using individual
clothes daily and to vacuum regularly. towels, washing clothes daily
Explanation: the final verb is out of balance and vacuumming regularly.
I am writing to refer this patient, a 26 year old I am writing to refer this patient, a 26 year old
computer programmer, who is displaying sign and computer programmer, who is
symptoms consistent with subdural haematoma. displaying signs and symptoms consistent with
Explanation: Both nouns should be in plural form subdural haematoma.
His height is 170cm and weighing 99kg. His height is 170cm and weight is 99kg.
Explanation: unbalanced word form, height is a noun, weight is a
gerund
On subsequent visits, impressions for full upper and On subsequent visits, impressions for full upper and
lower dentures were made, bite registered and lower dentures were made, bite registration was
complete upper and lower dentures were delivered taken and complete upper and lower dentures were
. delivered
Explanation: Passive form required for all verbs
She diagnosed with hyperthyroidism in 1997, She was diagnosed with hyperthyroidism in 1997,
hypertension in 2003 and Glaucoma since 2004. hypertension in 2003 and Glaucoma in 2004.
Explanation: Time markers need to be balanced. She has had hyperthyroidism since 1997,
hypertension since 2003 and Glaucoma since 2004.
During hospitalization, IV fluids were commenced During hospitalization, IV fluids were commencedand a
and used a transdermal patch for her pain. transdermal patch was used for her pain.
Explanation: Passive form required for all verbs
Further examination revealed dry mouth, dentures Further examination revealed dry mouth. In addition,
were worn out on occlusal surfaces and a heavy her dentures were worn out on occlusal surfaces and a
calculus deposit was seen on the dentures. heavy calculus deposit was seen on the dentures.
Explanation: In example 1, by adding in addition, you can change Further examination revealed dry mouth, worn out
the structure and keep the sentence balanced. In example 2 the dentures on occlusal surfaces and heavy calculus
sentence is balanced as the verbs have been replaced with noun deposits on the dentures.
phrases.
She is feeling loneliness and isolated due to losing She is suffering from loneliness and isolation due to
her social contacts losing her social contacts. (nouns)
Explanation: Loneliness is a noun whereas isolated in an adjective She is feeling lonely and isolated due to losing her
so the word forms are not balanced. social contacts. (adjectives)
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Relative Clauses
In the introduction of a referral letter it is common practice to introduce the patient and provide some
relevant details relating to their situation or condition. The relative clause allows writers to do this in a
clear and concise manner.
Definition: A relative clause is the part of the sentence which provides information about the patient.They
can be divided into two types, defining and non-defining. Defining clauses provide details about the noun
being referred to. Commas are not required.
Non-defining clauses provide extra information about the noun being referred to but do not define
it.Commas are required.
Defining Non-defining
I am writing to refer this patient who is due I am writing to refer this patient,who is due
to be discharged today. to be discharged today, for ongoing
physiotherapy treatment.
Explanation: The relative clause defines the object
of the main clause i.e Which patient? The patient Explanation: The relative clause provides extra
who is being discharged. information (patient is due to be discharged) about
theobject of the main clause but does not define
it. It could be removed from the sentence and the
meaning would still be clear: I am writing to refer
this patient for ongoing physiotherapy treatment.
I am writing to refer Mrs. Patterson, a 36- Mrs. Patterson, who is a 36-year-old married
year-old married woman who is suffering woman, is suffering from mild depression.
from mild depression.
Explanation: The relative clause provides extra
Explanation: The relative clause defines the object information (Mrs. Patterson is a 36 year old
of the main clause i.e Who? Mrs. Patterson, a 36- woman) about the subject of the main clause but
year-old woman. does not define it. It could be removed from the
n.b. In this sentence, the first comma allows extra sentence and the meaning would still be clear: Mrs
information to be added about Mrs. Patterson. Patterson is suffering from mild depression.
Handy Tip
No name=no comma
In example 1 below, no comma is required as the relative clause is defining the person being referred to. In
example 2, the relative clause does not define the person being referred to because it is already known.
Therefore, If you include the patient's name, commas are required.
Mr. Holmes who lives with his wife in a Mr. Holmes, who lives with his wife in a
government flat, is an aged care pensioner. government flat, is an aged care pensioner.
Explanation: Commas required as it is a non- Mr. Holmes lives with his wife in a
defining relative clause. You can also express this government flatand is an aged care
information in a compound sentence. pensioner.
Mr. O'Riley, who lives alone in his own home, Mr. O'Riley, who lives alone in his own
and works as a fencing contractor and has home, worksas a fencing contractor and has
only one brother. only one brother.
Explanation: After the second comma a verb is
required. i.eMrO'Riley works..
Mrs. Peterson who recently moved to our Mrs. Peterson recently moved to our
135
retirement village following her husband's retirement village following her husband's
death. death.
Explanation: No relative pronoun needed here as it Mrs. Peterson, who recently moved to our
is a simple sentence. retirement village following her husband's
death, has a history of hypertension.
Mr. Brown presented at my clinic today with Mr. Brown presented at my clinic today with
a complaint of fractured front teeth in a a complaint of fractured front
traumatic car accident. teeth which occurred in a traumatic car
Explanation: A relative clause is required to define accident.
how the teeth were fractured. Alternatively it can Mr. Brown presented at my clinic today with
be written as two separate sentences. a complaint of fractured front teeth. This
occurred in a traumatic car accident.
I am writing regarding Mr. Jones, a 35-year- I am writing regarding Mr. Jones, a 35-year-
old male, who was recently diagnosed with old male who was recently diagnosed with
with tuberculosis. with tuberculosis.
Explanation: Second comma not required as it is a
defining relative clause, i.e it defines Mr. Jones
I am writing to refer Mrs. Margaret Green, a I am writing to refer Mrs. Margaret Green, a
66-year-old widow with three children, with 66-year-old widow with three children who is
complaints of chest pain. complaining of chest pain.
Explanation: Relative clause required here as two
prepositional phrases is confusing.
I am writing to refer, Ms. Abbot, a 58-year- I am writing to refer Ms. Abbot, a 58-year-old
old widow admitted with pain, dehydration widow who was admitted with pain,
and nausea. dehydration and nausea.
Explanation: Incorrect comma placement and
relative clause required.
Mr. Fisher was admitted to hospital with the Mr. Fisher was admitted to hospital with the
diagnosis of obstructive artery disease and diagnosis of obstructive artery disease which
end with quadruple artery bi-pass grafts. required quadruple artery bi-pass grafts.
Explanation: A relative clause is required to define
the treatment.
I am writing to refer this 14-year-old boy to I am writing to refer this 14-year-old boy who
you who came to me complaining of a came to me complaining of a sprained ankle.
sprained ankle.
Explanation: The relative pronoun must follow the
noun it is referring to.
I am writing to refer this patient, a 39-year- I am writing to refer this patient, a 39-year-
old widowed woman, who is under our care old widowed woman who is under our care
after being injured in a car accident. after being injured in a car accident.
Explanation: No comma required as it is a defining
relative clause.
Mr. Roberts who is a 72-year-old retired Mr. Roberts, who is a 72-year-old retired
gentleman was admitted to hospital for gentleman, was admitted to hospital for
acute cerebral infarction on 08/03/10. acute cerebral infarction on 08/03/10.
Explanation: Commas required as it is a non-
defining relative clause and provides extra
information about Mr. Roberts.
I am writing to explain Mr. Clarke's current I am writing to explain Mr. Clarke's current
situation, who has been a patient of mine for situation. He has been a patient of mine for a
a long time. long time.
Explanation: The relative pronoun must be added I am writing to refer Mr. Clarke, who has
136
directly after the person you are referring to. been a patient of mine for a long
time. Currently, he is suffering from........
Clauses of Contrast
Contrast can be expressed by joining two clauses with the following linking words: although/but/despite/despite the fact
that/even though/however/in spite of/on the other hand/whereas/while. A comma is used to separate the two clauses as
illustrated below.
Although her condition has improved, she is still very weak.
Her condition has improved, but she is still very weak.
Despite an improvement in her condition, she is still very weak.
Despite the fact that there has been an improvement in her condition, she is still very weak.
Even though her condition has improved, she is still very weak.
Her condition has improved. However, she is still very weak.
Inspite of an improvement in her condition, she is still very weak
While her condition has improved, she is still very weak.
Common Mistakes
Incorrect Correct
Inspite of providing with exercises and compensatory Inspite of our provision of exercises and compensatory
techniques she was unable to cope with training due techniques, she was unable to cope with training due to an
to an increase in pain. increase in pain.
Explanation: providing is incorrect, as it was the patient who was Inspite of being provided with exercises and compensatory
provided excercise, in such cases you have 2 choices techniques, she was unable to cope with training due to an
1. Use a noun phrase In spite of our provision of increase in pain.
exercises
2. Use passive voice In spite of being provided with
excercise
Although she has improved, but she is still very weak Although she has improved, she is still very weak.
Explanation: This sentence has two linking words so one must be She has improved, but she is still very weak.
omitted.
Despite of regular follow up, plaque and tartar were Despite regular follow up, plaque and tartar were
detected over cervical and bucal surfaces of the detected over cervical and bucal surfaces of the
denture teeth. denture teeth.
Explanation: There is no linking expression “despite of” Inspite of regular follow up, plaque and tartar were
detected over cervical and bucal surfaces of the
denture teeth.
Despite of this advice, he regularly drinks 2~4 glasses Despite this advice, he regularly drinks 2~4 glasses of
of wine every night as well as 1~2 glasses of scotch wine every night as well as 1~2 glasses of scotch at
at weekends. weekends.
Explanation: As above Inspite of this advice, he regularly drinks 2~4 glasses
of wine every night as well as 1~2 glasses of scotch at
weekends.
137
Clauses of Purpose
Purpose clauses allow the writer to express why a certain action was taken in the past or why a certain action needs to be
taken in the future. It can be expressed by joining two clauses with the following linking words: in order to; so that. A
comma is required when the subordinate clause comes before the independent clause.
In order to reduce weight, a low fat diet has been recommended.(quite formal and suitable for referral letters)
A low fat diet has been recommended in order to lose weight.
A low fat diet has been recommended so that the patient can lose weight. (casual expression and used more in
informal writing or spoken English)
Rules
in order to + infinitive: Further investigation is required in order to rule out bowel cancer.
so that + past reference: A general anaesthetic was given so that the patient would not feel pain.
so that+ future reference: A general anaesthetic needs to be given so that the patient will not feel any pain.
Handy Tip: in order to rule out + disease name is a useful phrase for introductions or conclusions.
In order to rule out ectopic pregnancy, I would appreciate your urgent assessment.
The patient wants to have a scan for nuchal translucency in order to rule out Down's Syndrome.
Incorrect Correct
In order for alleviation of pain, the patient was In order to alleviate of pain, the patient was
prescribed paracetamol. prescribed paracetamol.
Explanation: In order must be followed by to + infinitive
verb, not for + noun
Clauses of Reason
In referral letters it is often necessary to state why a certain action was taken and clauses of reason allow the writer to
do this in a clear manner. It can be expressed by joining two clauses with the following linking words: due to/due to the
fact that; for this reason; because/ because of.
Examples
Due to failure to progress and fetal stress, an emergency caesarean section was performed.
Due to the fact that there was failure to progress and fetal stress, an emergency caesarean section was performed.
(formal)
There was evidence of poor progress and fetal stress. For this reason, an emergency caesarean section was
performed.
Because there was evidence of poor progress and fetal stress, an emergency caesarean section was performed.
Because of failure to progress and fetal stress, an emergency caesarean section was performed.
Rules
due to/because of + noun (underlined below)
Example: Due to a low fat diet, the patient's health improved.
The patient's health improved due to a low fat diet.
Because of a low fat diet, the patient's health improved.
The patient's health improved because of a low fat diet.
because + clause
Example: Mrs Healy's health improved because she was on a low fat diet.
Because she was on a low fat diet, Mrs Healy's health improved .
138
Example: The patient's health improved due to the fact that she was on a low fat diet.
Due to the fact that Mrs Healy was on a low fat diet, her health improved.
Handy Tip: due to + ing form allows the writer to express meaning clearly and concisely so it is useful in referral
letters.
Comma placement
A comma is required when the subordinate clause comes before the independent clause. However, if the
independent clause comes first, no comma is required.
Incorrect Correct
The patient is feeling lonely and isolated due to lose her The patient is feeling lonely and isolated due to losing her
usual social contacts. social contacts. (clear and concise)
The patient is feeling lonely and isolated due to the fact
Explanation: Incorrect word form and sentence structure after due that she lost her social contacts. (formal and a bit wordy)
to
His mother had difficulty in caring for both her son's illness His mother had difficulty in caring for both her son's illness
and looking after two other small children due to sick. and looking after two other small children due to her
Explanation: Incorrect word form and sentence structure after due sickness.
to His mother had difficulty in caring for both her son's illness
and looking after two other small children due
to being sick.
Recently, the Mr Hutton stopped playing sport because Recently, Mr Hutton stopped playing sport because
muscle soreness. of muscle soreness.
Explanation: Incorrect word form and sentence structure after Recently, Mr Hutton stopped playing sport because he had
because of muscle soreness.
Clauses of Time
A very important part of referral letters is summarising the patient history and order of events in the case notes. The use
of time conjunctions help the writer express these relationships clearly. Commonly used conjunctions include: ago,
during, when, while, since,first, on the next visit, at that time,after, later, in .......... time etc. etc.
Example sentences
The patient first saw me three months ago complaining of painful wisdom teeth.
During hospitalisation, the patient had surgery to remove a suspicious lesion on his lip.
When Mr. Matthews is discharged, he will need assistance with showering and general household chores.
While you are on this medication, please do not drive or consume alcohol.
Since being admitted 3 weeks ago, the patient has steadily improved and is due to be discharged today.
The patient first attended me yesterday evening
On the next visit, Peter's condition had worsened and he was very anxious.
Mr. Hauritz initially presented at my clinic on 20/11/09. At that time, examination revealed carious lesions on
several teeth along with poor dental hygiene.
On review after three months, she had made good progress with her weight reduction.
The patient was advised to reduce alcohol consumption, avoid heavy lifting and review in three months time.
A review consultation was scheduled for one month later.
Example paragraph
Six months ago, Mr. Roberts twisted his right ankle while playing golf. During the following months, the patient
experience intermittent attacks of pain which hindered his ability to work effectively. On review after three months, the
right ankle joint was x-rayed and the result appeared to be satisfactory. However, when the swelling, pain and impaired
improvement persisted, an MRI was ordered which revealed a detached cartilage.Currently, Mr. Roberts does not have
full mobility, and is no longer capable of full-time employment on which, financially, his family depends.
Rules
139
Example: While waiting in reception, the patient fainted.
Comma Placement
A comma is required when the time clause comes before the independent clause.
Handy Tip
Correct verb tense is an important point to consider when writing time clauses. The important points to remember are as
follows:
When the verb of the time clause is in present form, the verb in the main clause must also be present or future
form.
Example: While you display symptoms of fever and rash, you are still infectious.
When the verb of the time clause is in past form, the verb in the main clause must also be in past form.
Example: When the patient received his results, he fainted.
When the verb in the main clause is in present perfect form,the verb of the time clause must be in present perfect
form.
Example: While the patient has been in hospital, his condition has steadily improved.
Incorrect Correct
Today, the couple presented at my clinic. Mrs. Conway When the couple presented at my clinic today, Mrs.
informed me that her home ovulation prediction test Conway informed me that her home ovulation prediction
showed positive. test showed positive.
Explanation: To demonstrate a higher level of English proficiency Today, when the couple presented at my clinic, Mrs.
this information should be expressed in a complex sentence rather Conway informed me that her home ovulation prediction
than two simple sentences. test showed positive.
The patient has had placement of a prosthetic heart valve 12 The patient had placement of a prosthetic heart valve 12
months ago. months ago.
Explanation: has had is present perfect, but simple past is required
with the time marker ago.
I first saw Mrs. Smythe at my clinic last week , she urgently When I first saw Mrs. Smythe at my clinic last week , she
needed a new partial denture. urgently needed a new partial denture. (best choice)
Explanation: An adverb of time such as when required to connect I first saw Mrs. Smythe at my clinic last week andshe
these two independent clauses urgently needed a new partial denture.
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827
January 2014 Listening A 5-A (4) not seen a physiotherapist
2- (5) Can walk, but not comfortable
a year ago was in San Francisco , Can't manage stairs, only hobbling up
then work in California Can't put pressure on knees, can't kneel on it
On weekend with a friend from Canada, No crutches, no gaiters to help walking
not see each other for a long time Can move around
3/ 4 days walking around San Francisco Back to work
about 6/8 hours a day,
very hilly places B-(5) teacher, a lot on foot
By end of 4th day had soreness in knee, Knee in morning gone down a little bit
thought it would go away, but didn't Stiff when firstly get up
Had pain for 6/8 months before seeing a Sleeping uncomfortable, sleep at back, can't
doctor move around easily
Went to GP who referred him to 1st surgeon Put ice packs on knee trying to reduce
3-A-(3)1st surgery was 3 months ago swelling
Frustrated to have 2nd surgery By end of day knee is tired and sore
1st surgery and communication with surgeon Go home and put feet up
frustrating
Not informed he had to bring somebody to 6-A (3) using some ice
drive him home Take anti-inflammatory / Voltarin
Not knowing about having general Taken 2/3 times a day for 3 weeks
anesthesia, No other medications / a bit healthy
only told few minutes before surgery Take vitamins only
Frustrated of lack of communication
B-(5) running for the last 10 years/ 2,3 times
B-(4)10 days after surgery was checked a week
Told everything was ok Not really athletic , but trying to keep fit
Had great deal of swelling Going to the gym on and off for the last 10
Not know what to expect, not know whether years
normal or not Like the gym , feel confident
Severe swelling for nearly 3 months, about Not wild about swimming
10 weeks Got a bike and cycle to work about half an
Coz of bad experience with first surgeon , hour
got referred to another surgeon Not cycling recently
Want to cycle, do aerobics to keep weight
C-(3) 1st surgeon took x-ray, down
MRI and various scans Now can't run, so not sure what to do
Told there was a small tear in the left med- Time frame of recovery not discussed
meniscus before with surgeons
4-(2) 2nd surgeon said it was bad luck as 1st 7-(5) coz he had two surgeries, he might
surgeon didn't take enough of the meniscus expect recovery to be a little bit slow
away Main aim of treatment is to decrease
Only partial, a difficult judgment swelling and increase knee movement
So had complete meniscectomy of the med- Coz of 3 months not exercising , have
meniscus wasting of quadriceps muscle, the main
3 weeks ago. muscle in front of the knee
So daily activity and walking upstairs,
riding and running must work on it to
strengthen …
828
… January 2014
Frame-time , need to get goals, Listening B
once get full range of movements,
knee can bend and straighten fully 1.
then build strength through that range Patient(3)
Then get back to exercise like running and a- skills
riding b-beliefs
Go 6/8 weeks to start lightly jogging again c- knowledge of physical impairment,
, reasonably soon learning difficulties or anxiety stress
It differs from one to another,
no rush, work gradually on strength and Mode of delivery(3)
movement 1-oral
Then long term goals of cycling and running 2-written
3-multimedia
8-(4) 2/3 weeks exercise ,
most can be done at home 2-(2)
Simple , do something while lying down 1- patient's education
Not put weight on knees 2-how the person perceives the doctors/ role
Strengthen stability of hips, knees and calf relations
muscles at the back of the chin 3-literacy skills and how it affects
Due to all these weeks he became weaker understanding
The more frequent he can do them, the Influence the healthcare interaction
better
Only ¾ times a day for movement and
strengthening exercised of knees 3- complete
Variety of positions, not putting weight 15 and 74
knees and some standing Poor or very poor
Prescriptions and Drug labels
9-(3) go through a set of exercises
Have a look at knee movement and strength 4-(3)
Look at MRI films Require more medical care
Teach some basic exercises Increase rate of hospitalization
Progression over 6 to 8 weeks will be step Problem communicating with healthcare
by step providers
Take a look about how comfortable he can Barrier to receive optimal care
do according to the strength of movement Reporting physicians not explaining
See him weekly for the next 2/3 weeks treatment in terms can be easily understood
Then progress to next stage and show some
exercises, 5-(3) instructions
stick to gym membership Appointment cards
Then transfer exercises without consultation Prescriptions
See him weekly then become independent. Pathology reports
6-(4)
1- a- poor reliability
b-illiterate people are ashamed to discuss
and hide it
2- a-poor indicator
b-not assume well-educated are health
literate.
829
11- 1- provision of visual, interactive
7-a- 66 words / columns, materials like computer modules,
according to numbers of syllables and level screen programs in clinical practice
of difficulty 2- education of health professionals
-read out loud the words 3- education of family and friends
-score the correct pronunciation and 4- creative use of internet as a tool of health
understand the meaning of words education
9-
1- NO
2-NO
3-NO
4-YES
830
May 2014 Listening (A) No shortness of breath/ only after
exertion
2-(8) tingling sensation, something She's fit/goes to the gym
filling her 6-(7) now she's non-smoker
-pretty in both hands -in the past, in her 20s smoking 2/3
-mainly in left hand and arm, numbness cigarettes a day for 3/4 years
-sometimes can't feel it on the bridge of -no history of high blood pressure
her nose -no disturbance in bladder and bowl
-can't pinpoint the starting date function
-a couple of months ago -cholesterol checked recently and
-gradual onset normal
-at night -alcohol: average drinker, 2/3 glasses/
-lying on bed position not binge drinking
3-(11) not constant/ come and go -no illicit drugs
-nothing make them worse 7-(6) preosteoprosis condition
-being anxious does not bring the (Osteopenia)
symptoms -not a serious condition
-nothing make them better -have bone density scan
Sometimes lying on different positions / -no operations
on back is better -no fractures
-not waken her from sleep -only taking calcium and vitamin D
-no headaches No regular medications/ no OTC
-stiff neck and stiff shoulders 8-(7) academic job in linguistics
No leg symptoms -full time job
No back pain -keep her too busy
In the past had some back injuries -work on computer a lot
Not get worse on the last 6 weeks/ -leave it only at lunch time or meetings
almost the same -not exacerbated to her symptoms
No visual disturbance -sometimes exercises
1st time to have something like this -go to the gym/ go running in the
4-a-(4) mother died because of heart morning
failure at age 56
she's now 63 9-(7) not specific serious condition
Diagnosed as scleroderma 2 weeks -worried because of her mother's
before death condition
Had lots of problems, difficulty No severe heart disease/ low risk
breathing, heart problems - gives attention to heart problem as well
b-(4) grandfather died due to heart -not cardiac problem
failure, heart disease -more likely neurological problem
at the age of 85 -may be hand nerves like carpal tunnel
grandmother had some strange arterial syndrome
conditions -There may be a neck problem/wear and
she lost speech, died at the age of 80 tear in neck desk
5-(8) no chest pain
Soft tingling sensation in nipples 10-(4) x-rays on neck and cervical spine
Not sure if have heart palpitations -ECG test/ exercise stress test using
-sometimes feels racy treadmill
When lying down/ at bed time -unreasonable to drop heart problems
No missing beats -appointment to discuss results
831
May 2014 Listening (B)
7-1- C
2-heal and repair 2-B
-regulate everything 3-C
Whole person
Healthy lifestyle 8-one and half hour
Herbal medicine -regularities
-treat the cause -pain
Do no harm Reproduction problems
-practitioners as teachers History of miscarriage
Use of contraceptives
3-what's wrong Hormonal imbalance
-why it's wrong Educate to look for signs
-emotional state LH kit
-occupation Prolactin
Outcome of life LH
-no artificial drugs
-no surgeries 9-1-Vitamin D
-stress management Iron
-meditation 2-egg quality
Vitamins and minerals Sperm quality
-herbals Sperm quantity
3-taking in antioxidants
4-1-educate people about their health Eating wholegrain everyday
2-regain responsibility about their health Daily intakes of fruit and vegetables
3-treatment plan
4-patient's compliance 10-emotional
-intervene and manage when recurrence How stress
Disappointment
5-mental/ spiritual Wellbeing
Generic prescription Calms
-specific needs of patients Depression
-a drug to fix us Side effects
-preventable
-primary 11-
-even not ill at that time 1-C
2-C
6-digestive disorder 3-B
-filling intolerance
-mal-absorption
-immune
-common cold
-eczema
-migrain
Anxiety
Depression
832
July 2014 Listening (A) C-(7) soya a good source of calcium but
tastes different
2-(1) sent to have bone mineral density test Need to look at recommended daily intakes
3-(2) Mom has osteoporosis Can take tablets / best absorbed at night
Family history put him in 80% of risk factor 5-(6) it helps the absorption of calcium
High risk of osteoporosis even still young If low affects amount of calcium absorbed
-reach peak bone mass at the age of 25 They keep slip-slop-slap / not exposed to
the sun
He is 31 so needs to have hope
Have low vitamin D level
Try to reduce the risk factor
Sunshine the best source of vitamin D
4- A-(4) the main building block of bone
You can get it in some oil or fish
Stored in bones
You can also get it in tablets
Strengthen bones
6-A-(4) not doing exercise
Regulates heart beats
Work in an office/ sit down most of the time
Muscle contract
Walk for 10 minutes a day to office/
B-(5) as a child not have enough calcium/ relaxing walking
mom anti-milk
No strength training only incidental walking
Now has reasonable intakes of milk yogurt
and cheese B-(5) not doing the right exercise
Had soya products as a child but not like it It needs to be more specific
either
Take the body out of its comfort zone
So not have anything only occasional
Do resistance training and strength training
cheese or yogurt
Something that has a ground –strike/ force
His intakes was not good
applied to it
833
Put pressure on bones B- (4) change the way fast then slow
Take muscles then bones out of comfort Reverse order( what you start with end
zone with)
What’s difficult today won’t be the same in Not expose in hot hours
6 months
Be in the sun before 10 and after 3
Still young so change a lot at the beginning
For half an hour without sunscreen
Make sure no sore back or neck
To get vitamin D expose forearms ,face and
Once get comfortable/ change above a kilo hands
for a couple of weeks
834
July 2014 Listening (B) 6-1- cognitive impairment
2-1- awareness
2-dementia
Sustain or shift -Memory -Language
3- being old by itself/ aging
The symptoms and signs throughout the day
4-multiple medical conditions
2- attention - Consciousness
5- be on different medications
-awareness/ cognition
6-sensory impairment
3- 56 - very sick
7- 1-chest infection
-close to death -80 to 85%
-and urinary tract infection
-older -late
-sedatives -opioids
-The doctors and nurses
-steroids -anesthesia
-the patient -relatives
2-1-drugs 2-when started
4- increase mortality
3-what dose
-need for residential care
8-1- B 2-C 3-B
-falls and fractures
9- conversation -attending to you
-pressure sores
-missing doses/ given medication
5-1- inattention
-vital signs -temperature
e.g. the patient is not listening and is not
-respiratory rate -blood sugar
giving the right answers is asked a question
-Bowel and bladders
2-agitatation -e.g. try to get out of bed
e.g. accuse family and nurses they are trying Metabolic disease -Pain
to hide things 2- so agitated
4-aggressive behavior 3-at a great risk of hurting themselves
e.g. if things are not explained to them 4- hydration -Bed sores
5-withdrawn Bladder care -vital signs
e.g. lay quietly and not show concern about
11- 1- b 2-a
staff
835
August 2014 Listening A 7-(6) it's very common no need to be
alarmed
2-(6) -inflammation at the strong ligament
no left heel pain underneath foot
-on insole of the heel -wearing thongs for a long day which
Couple of weeks is not supportive
-at the back - no time to rest so inflammation is
-getting progressively worse still there
-not see anyone about it -morning pain and after rest indicates
-only a friend's advice plantar fasciitis
-never seen a podiatrist before -linked to childhood problems
8-(8) couple of conservative things to
3-(3) first step in the morning is the be done
worst -reduce tightness in calf
-improves with movement but not -exercise done to show restrictness in
getting better calf muscles
-if sitting for a long time and then Loosen up calf muscle
stand up returns Teach him some stretches
Take stress of the heel
4-(3) a couple of weeks at the zoo Reduce inflammation
-it was hot wearing thongs Ice the area with a long freezed bottle
-walking around the whole day for 10 minutes
Massage
5-(5) when very young at 10 had a lot Look at shoes not wear thongs for
of feet problems long
-play a lot of sports Sandals instead
-problems in the same place Limit use of thongs for lifetime
-but in both heels
-feeling it was bruised at the top of 9-(4) review in a month time
the heels If not improving, put insole in shoes
Not complete resolution of pain
6-(6) tender when touch the insole of Only reduction or improvement of
the heel pain
-no pain underneath the ball of the
heel 10-A (3)-play a lot of sports
-no left foot pain Not organized sports, office sports
-left ankle very loose, perfect Basketball and soccer in winter
-right ankle is restricted at the back of Cricket in summer
the calf
Watch him walking for a couple of
meters, normal
836
B-(3) high ankle support shoes for August 2014 Listening B
basketball
Shoes are a couple of years old/ need 2-a natural attributes
renewal -can be taught or learned
For cricket and soccer has the b)medicine, law, helping vulnerable
standard supporting footwear people
C-(3) continue sports c)women with breast lump/or
Stretch calf as it adds pressure to the somebody in court charged with a
heel crime.
Keep both calves away from D) -professional expertise
participating -moral expertise
Give sometime to rest foot
3-profession itself
11-A (4) 3 and half year old son, -look at students' needs/ revere elders
while walking his knees are close for their expertise and guidance
together -patients
Mother thinks he's pigeon toed -confidentiality, not exploit them
Mom had corrective footwear at 12 sexually, and keeping patients'
for a couple of weeks secrets.
Had problems with knees and feet
Worried of genetic conditions 4-a-1989
Dad has not noticed any problem b-the mental health act
Not like walking much, likes to be c-another level of requirements for
picked up professionals to work in a certain
B-(4) close knees are not a problem way, not to hold patients against their
for his age will, conduct themselves in relation to
If excessive fatigue, worried of patients' belonging doctors well
genetic causes behave.
Some not prefer intervention at this d-as if you are a member at a tennis
age, but if scary they have to club, you have to adhere to the rules
Bring mom, his son and his footwear if you wish to remain a member at
12-(6) should all footwear be custom- this club.
fitted?
Off the shelf shoes are fine 5-a- what's morally a good behavior
Firm shoes to keep heals steady and what's immoral
walking b-where: America, when: 1970s
Something that bends at the ball of c-1992
foot
Something that can be fastened to
foot to keep it firm
Thongs not recommended for a life
time
837
6-1-respecting confidentiality of 9-a- degree of freedom to work out
patients and their families their own ethical behavior so that
3-not misusing their skills governments not to dictate how
4-respect humanity and dignity of doctors behave in their ethical life
patients b- use a code to deter an individual
from over strain into immoral
7-a- privacy behavior.
b-you can't always maintain secrets -self-regulation, and retribution, bad
because sometimes you can't keep it apple, punishment
confidential
c-if patients tells you they are 10-a- body of professional to punish
intending to kill someone like a people who break rules
relative or an ex-boyfriend b-worst: expulsion from college
d- you have to keep patients -least: reprimand , warning
information confidential c-codes shouldn't punish, but promote
-but you also need to go to police and good behavior.
warn the intended victim
11-a- code of ethics are good things
8- a- try to work out all existing and help professionals to work well.
problems in regard to applying the -protect the needs of the patients
principle of confidentiality b-refine codes and to let them work as
b- if a patient was charged with a readily as possible
crime, like a sexual abuse of a family
member , you have to go to the court
and offer testimony. However, you
need to keep information of patients
confidential
838
9.2014 Listening A -O2 rate is 99 so normal /
2-A-(5): -Her brother breathing is normal as well
-she’s well, but smaller than her brother -no respiration problem
-parents need to know why babies -35 week lungs still immature
delivered 4 weeks earlier -Babies are OK as steroids helped
-Olive is small not have a lot of reserve -blood test to check O2 level
-she’s at risk of potential problems -Put on blood gas machine
-so she is taken to nursery 5-(9):
- not kept warm unlike her brother -not huge nearly 1800grams
-not have enough brown fats so taken to -Not growth restricted
incubator -Follow up when 2 years with pediatric
B-(9): to check her muscles
-come out of incubator when 1800 to 2 -Catch up on her nutrition outside uterus
kilos -Fast intervention due to lack of food in
-It depends on her placenta need extra calories so breast
-when she is stable get out of incubator feed and formula feed
-Given some fluids IV -Not going to be a big child
-Given milk to feed her -Try to get enough nutrition and glucose
-When maintain temperature , she will for the brain
get out -She is neurologically normal
-Depends on how quickly she responses -Blood sugar level is also normal
-No set weight -no seizures
-No set time
3-(8): 6-(9):
- first baby -blood checks to make sure babies are
-Found quiet early they are twins not infected - cause wife was GBS+
-At week 5 start early scan to prepare Broad spectrum Antibiotic for 24 hours
-High risk pregnancy cause of twins -start penicillin and gentamicin
-Regular doctor appointments, -take vitamin K cause they are not able
everything is normal to produce it at birth
-Regular scans/ shows regular growing -it is not produced in stomach till it has
-Scan is stressful for them so missed a food
couple of scans -risk of hemorrhagic disease of new born
-35 week scan was normal - give antibiotics
-Olive’s placenta was smaller , had less -24 hours steroids for caution
fluids -waiting for colostrums to come
-So take out babies immediately 7-(5) - wife like to breast-feed
4-(9): -especially for Olive
- mother took 2 doses of antenatal -Cause she is growth-restricted,
steroids she might get a disease in the gut
-Were told to have caesarian - so breast-feed even a couple of drops
-babies hearts’ monitored a lot of times - important to give the children
-Olive not require oxygen colostrums
-Put shining light on foot - give them some sugary water till they
-Pulse oximetery measures o2 saturation settle down and temperature OK
level -no problem breathing
839
8-(5) - once temperature is maintained 5-1-c 2-b 3-a 4-b 5-c
will be taken out of incubator 6- cerebral palsy
-Not have enough fat to keep them -perforation
warm, might feel cold -large intestine
-even the babies have a tube in their nose -peritoneal cavity
they can be bathed -Nutrition
-Do the first bath as a demonstration -fevers
-Parents to give the first bath after two -fungal and yeast
days. -through the gut
9-(5)
-no set age 7-liver function test
-no set weight -resistant
-premature taken out of incubator within -can go to the eye
38 to 40 weeks -liver and spleen
- anticipated to get out in 2 weeks or a -14 days
couple of days longer
-depend on how Olive goes establish her 8-half
feeding -GP
10-(4) -skin infection
-recovery in 5 to 6 days after cesarean -beard line
-Keep her as long as possible as babies -Great toe
are still in nursery -IV antibiotics
-By day 6 she will be discharged -oral antibiotics
-Give him a parking pass 9-not too often, but occasional
-thromboses
9.2014 Listening B -in blood stream
-10% mortality
2- -37 -4 weeks
-females -repeat ultrasound
-6 weeks 10-
-Rash over 1- lost 10% of body weight
-mild inflammation 2- mutation
-steroids 3-intial decrease, but not fully
-pregnancy suppressed
3- 2- feed 4- one of the drugs not effective
3- move 5- get input with clinical nurses, social
4-limbs workers and progress follow-up
5-evaluation 6- difficult to treat HIV infection
4- 11-1- staphylococcus
-no evidence of an infection -hand hygiene and hand rub
-neurological exam 2- check cooling towers and make
-post infection sure water is pure.
-contrast 3- the flu and HIV
-lesion 4- condom usage and circumcision
840
10.2014 LISTENING (A) 8-(4) a-not vegetarian, but not eat a lot of
meat
2-A-(4) a- chest tightness b-had regular periods/ not excessive flow of
b-beating and sweating blood
c-tiredness and dizziness c-since mid 40s not as long as it used to be/
d- last for 10/15 seconds not 5 days
2-B-(4) a- sat down d-still regular /good amount of blood flow
b-took a deep breath
c-walked over to a water dispenser 9-(9) a-Animea/ no enough iron to make
d- quickly drank 2 glasses of water blood
e- sat down again and then just got back in b-problems with thyroid
line c-mother had a thyroid problem , but
3- A (5)a- when got home was still dizzy Roseanna did not test it
b-short of breath d-thyroid function test to be done
c-felt weak e-if thyroid is overactive , it sends signals to
d-rang her GP the body to speed up every thing.
e-told her to go to hospital emergency f-no feel agitated/ no tremors
3-B (2) g-lose of weight is negative
a- if still dizzy need to check blood h- put on weight not related to food habits,
pressure, worry of heart arrhythmia but put it down to metabolism
b-risk of heart attack due to its intense.
4-(5) a- she had just finished film making, 10-(6) a- nodules on her thyroid
had a stressful time b-had an operation to take the nodules off
b-worked crazy hours c-still had thyroid
c-smoking more than usual d-not overactive thyroid/ not cancerous
d-she wasn’t unwell, not have a cold e- something related to calcium/may be
e-not drinking more fluids, not get enough parathyroid gland
sleep, and not eat normally f-it organizes calcium level in the body
5-(6) a- it happened a week before g-quite dangerous if untreated
b- she had a sharp pain across chest h-had neck problems in her 60s
c- last for few seconds, she took her breath i-mother was thin , but getting older, she put
back , it was intense on weight
d- not burning pain , but sharp, she had to 11-A-(4) a-daibetes normal
sit down b-Tonsils removal
e- started above right breast the across down c-appendix removal
into arms d-no medications
f-not remember if had it before or not B-(2) a-dad not diabetic
6-(4) a-smoke once a day, then skip weeks b-3 brothers dad-side are diabetic
b-advised by doctors to quit
c-one cup of coffee a day 12- (6)-a-she’s still young 45
d-not a heavy drinker/ not every week b-it is normal to happen once more
7-(5) a-not sure whether it is arrhythmia or c-the older she gets, more normal to have
not heart problems
b-order ECG for heart d-check heart concerns
c- may not get again for weeks or months e-not want to over investigate her
d-better to do 24 hour Halter Monitor f-if recurrent it would be warning
c- cause ECG in her case is of limited utility g-after proceeding in examination, she can
go
841
10.2014 Listening (B) 8-a-leg elevation
3-present 4-explore
5-local 9-a-unsuitable
4-1-intermittent b-reactions
842
11.2014 Listening (A) 6-Tests discussed (4):
-circulation in legs
2- Details of the problem: (7) -ultrasound
-used to be a good runner as a little girl -Check varicose veins
-right foot perfectly right - She have 5 children
-left foot deteriorated considerably -cardiograph/ECG
-one toe shortened
-whole foot considerably 7- Current medications (4):
deformed/shorter -A lot of medications
-one toe has been cut at the back of the -5 pills for osteoporosis
first little joint -5 pills for thyroid
-have a painful corn on the left little - Ostelin is a Vitamin D
toe/can’t endure any pressure on it
-had various operations on it 8-Thyroid: A-Problems (1):
-30 years ago had toe cut-off/ had blood -underactive thyroid/ not have operation
poisoning and went back to hospital B-Thyroid tests (2):
- Cannot remember last test of thyroid
3-Current treatment (2): function
-had regular podiatry treatment/ordinary -blood tests to assess medication /
-cut nails-massage pathology
4-Other medical problems: A-(3) -screening tests/ thyroid function
not have -diabetes -Circulation
problems -diabetes in family members 9-Medications
B- problems with fingers (5): -Medication system (4):
-Mother had arthritis -not have a list of medications
-she had arthritis in her two left fingers -Put bottles in a basket.
-not sure osteoarthritis or not -No set box for each day
-not rheumatoid arthritis/ not gouty -Works perfectly for her
arthritis -Checking medications (2):
-probably wear and tear in fingers -Name of pharmacy/can’t remember/ a
-tender with movement Greek name? George
- may be tendon causing the problem -secretary to ring the pharmacy up to
-sometimes can’t catch/annoying for her know the exact medications taken
5-General health: A-Mobility (4):
-independent/wear sandals a lot 10-Immediate plans (6):
-walking perfectly well -run few blood tests
-walk long distance/ to trains , shops -circulation in legs
-can walk for an hour -call pharmacist to check medications
B-Level of independence (5): -bring the medications list
-do cooking -check thyroid
-do shopping -give her a slip for a scan and blood tests
-have a niece and her daughter live in the -review in a couple of weeks
same street
-one son lives ten minutes away
-available in emergencies
843
11.2014 Listening (B) 8- a- involves two yearly
mammograms
2- a. Survival B- able to reduce the risk of death by
b-improvement of duration of breast cancer by proximity 30%
survival c-because mammograms is less
c-quality of life sensitive in premenopausal due to the
density of their breasts
3- 1990s
changes 9- a- 1 in 10 women
treatment b- BRCA1 AND BRCA2 GENES
developed c- bilateral/ ovarian cancer
international effort d- cause they are not sex linked
844
1.2015 Listening (A) 7- A (2) anxious about laser options
Taking up a new high-contact sport
2-(3) -she was in England for 4 years Neither glasses nor lenses are good
Saw optometrist only once B (6) -lasik is a good option for many
One check up for 4 years patients
More than two years since her eyes checked From prescription her cornea is thick
3-(7) rigid contacts not soft Lasik will be perfect
Since she was 13 Use micro-keratome
Last year have a lot of troubles/ before was All done under anaesthia
normal Topical not general
Uncomfortable/ by the end of the day Alter structure of the eye
scratchy
Eyes get weepy 8-A (5) lasik surgery is elective
Not sure if taking good care of them or not Have to pay for it
Wearing for 15 years 3 to4 thousand for both eyes
Pain only recently Depends on physiology of eyes
4-A (3)-the same cleaner used for many Make sure cornea is thick if too thin not
years / nightly enough
Special cleaner to break protein down Given name of ophthalmologist
Store them in a stored solution Look at sources and success rate
Occasionally remember to use protein B (6) -discomfort
removal/ not regular Dryness
B (2) -lenses are 4/5 years old Take drops for infection postoperatively
Had new glasses and contacts before going drops for inflammation
to UK use lubricants for 24 hours
The actual product and the prescription for no stitching / cornea heals perfectly
them are pretty old
5- (7) -no injury or disease in eyes 9-A (3) implanted contacts
No allergies If cornea is too thin, it will be an option for
Got hay fever in UK but was not serious her
One uncles father-side had glaucoma Traditionally used for certain cases , but not
Father's vision is perfect hers
No glaucoma mother-side/ perfect B (4) -one day
No diabetes No need for hospitalization
No macular degeneration Twp separate occasions
No other eye diseases High risk of infection
Make sure eye respond correctly
6- A (3) people with rigid lenses have it/ so Antbiotic drops given
have contact lenses Give anti-inflammatory
Cornea is flatter in one meridian and steeper
along the other 10- (7) have a look at contacts
Difficult to use soft coz it needs stable ones Make sure nothing affect their comfort
B (4) -full time/ wet soft more suitable Stop rigid contacts for weeks before surgery
Disposable/ corrective of stigmatism Coz they alter the shape of the cornea
Wear them once in occasion and then throw Use soft instead today
them For about a week
Wear all day depending on how tolerant/ Try them/ perfect for her
dry Comfortable, but not replace Lasik
Examine her cornea / lubricant
845
1.2015 Listening B 7- 1- 20%
2-cook
2- 1-C/ E Clean
2-B/D Run out
Get to work
3- Drive
1- eligibility of social security and Seated
physical disability benefits Stand
2-whether with a disability can work 3- average intellect
and length of this disability Intellectual disability
3-assist patients to manage illness and Automatically accepted of having a
disability disability
95%psychological conditions
Ability to work
Family roles
846
3.2015 Listening A 7-(9) take certain supplements, specific
2-(8) 6 months ago saw an optometrist formula by a group of macular degeneration
-no new glasses then -prevent deterioration
-a year ago has recent glasses -eat leafy green vegetables
-reading glasses / not generally used -high level of antioxidants
Happy with distant sight Eggs include lutein mineral
-difficulty reading small printed books -increase amount of pigments in retina
-mainly phone books/ frustrating -prevent against free radicals that causes
-eye vision in good eye not as good as it damage
used to be 12 months ago -not wearing sunglasses/ start
3-(8) around 06/ notice slight waviness in -wear a hat cause of UV/ USE SUN
reading lines PROTECTION
-on right eye -CHANGE diet and some protection
Ophthalmologist referred him to retinal 8-(7) very good health
specialist -take blood pressure and cholesterol tablets
-scan by a specialist of retina by late 06/07 -last blood test, cholesterol checked:2.3
Notice accumulation of fluid in front of -consider removing cholesterol tablets
retina -no laser treatment for retina
-prescribed lucenits injection, monthly -no other operations of eyes
For 2 years -no cataract surgery
-costly so refer to eye and ear -smoker at 20 till 45 (long time ago)
4-(3) in the past saw a specialist every 3 9-(7) managing well
months/ now every 6 months -active gardener
-goes to public clinic -ride a bike everyday
-see one of three doctors at retinal clinic -like working in workshops
5-(4) doctors disappointed -like fixing things
-it wasn't that successful -not wear glasses
-had 25 lucenits injections -make sure to wear safety glasses to protect
-lost some vision on right eye (25%)/ not left eye
happy -still driving/ not using computer a lot
-last scan no fluids, good -can get safety glasses with a prescription
-now wait and watch 10-(4) spoke to family/ worried about
6-a-(4) using it for years/a lot use it every hereditary
day, but not properly -have 5 children/ eldest over 50
-check the very central visual field of both -tell them to keep an eye on eyes
eyes -make sure they've Amsler charts
-cover one eye when doing it -get eye checked every two years to predict
-not to look for small creepy things macular degeneration
-get any significant change from the day 11-(6) check for frames
before -update reading glasses
b-(4) covering one eye is very important/ -check for safety glasses
was overlooked when he started -give leaflet about supplements
-make sure not wearing glasses -schedule for review in 12 months
-if not covered the good eye takes over/ -be sure to check left eye
happen with him -keep going with amsler chart
-do it every day/second day/ brain adapt -in case of any concern , come and check in-
easily to changes in vision between
-take seconds: stick it on fridge, behind
toilet door
847
3.2015 Listening (B) 8- impaired(reduced)
2-transport -neglect(trauma)
-room temperature -multiple(recent)
-warm/comfortable -significant (various)
-meal -processes(conditions)
-disease/illness -primary(secondary)
-30 to 100%
9- immune
3- economical -infection
-fats and proteins -weaning
-glucose Number of ventilated
-healing -mortality
-Concentrated -costs
- some by-products
-larger amounts of 10- functioning gut
-1 to 2%, 30% -mechanically
-intestine
4- muscle or organ -less expensive
-anti-bodies -oral diet
-fluid -bacterial translocation
-body protein
-carbohydrates and fats 11- feeding intolerance
-electrolyte imbalance
5- metabolic reaction, growth and -metabolic
maintenance of tissue
-water 12- infection risks
Diet -non-protein calories
-permanent -lack of vitamins and minerals
-heart failure -production of excess carbon dioxide
-possible paralysis
-potential wide-spread 13-
1-A
6-21 2-B
-calcium
-iron
-patient's recovery
-oxygen
-intensive care
-muscle strength
7-1-B 2-A
3-C 4-A
848
April 2015 Listening (A) You get an excess of iron in the body
2-(9) He's 31 turning 32 Iron can accumulate in certain soft tissues
-teacher/ now being a father staying at home causing damage
-Has twins Accumulated tissues are mainly ( liver, lung
They are over two years old and some of the endocrinal organs
-from England
In Australia for 8 to 9 years/ back to 6-a-(5) test family members early / first
England for a year degree relatives (brothers, sisters)
-majority of family in England (parents and Even check uncles as they might get the
brothers) disease
-uncle in Australia Prevent organ damage
-this uncle has haemochromatosis. Prevent iron from building up
The best time to diagnose is between 18 and
3-(9) no known medical history 30
-not been in hospital before b-(7) blood tests for family members
-no operations test iron levels, few different iron tests
-no regular medications test stores of iron to know how much of iron
-no OTC on regular basis is there
-no vitamins/ no Chinese herbs/ no herbal then genes test to see if you get defective
medicine gene around the body
-no allergies people who get symptoms inherited two of
-not see a doctor often the abnormal genes
-never been a smoker some people have only one gene who have
-drinking a little alcohol no symptoms only carriers, but can pass it to
-feel quite well/ do organized physical children
exercises/ running around. collect these blood tests to know if you have
the disease or only a carrier or not have it at
4-a-(7) uncle is 62 now (2 years younger all.
than his mother)
-he was quite advanced/ not found out by 7-a-(5) Treatment:
regular check-up -donating blood if catch early/ blood out
-not think he only has symptoms/ not talk to -taken once a week
him directly -monitor iron levels on regular basis till iron
-firstly he had blood platelet once a week / stores are under control
found very high iron/ now it's under control -one unit of blood 30 m.
-suffers from arthritis -because of excessive iron he won't feel any
Active/ play tennis regularly- difference
But feel a little discomfort
b-(2) everyone else is clear (this uncle is b-(9) Problems:
mother-side -can get problems from blood accumulation
also, one aunt from mother-side -heart and liver problems
5-(7) it's an inherited condition -can cause diabetes
Passed by genes through families -joint pain , arthritis like his uncle
From a gene that doesn't work properly -get tired/ lethargic
It causes an excess of iron to be absorbed -thyroid glands
from the gut -can cause skin pigment change/ darker
-affect life expectancy
-not expected to cause complete organ
damage for someone his age
849
8-(2) if have the gene check his partner 6-1990s -For teens/ adolescents
-check children/ hypothetical only if he has -The benefits -Getting younger
the disease -6-month-old -Significant
9-(4) unlikely to have symptoms now/ only -GP -Audiologist
if have too much iron -A mild -Moderate
-organs affected only if untreated for long -Fitting -Updating
time -Severe -profound
Feel tired/ lethargic
-joint pain 7- older children with significant hearing
-may be knee problems/ however it can be loss
caused by other things other than -kids with genetic causes (mutation of
haemochromatosis connexin 26)
-premature babies
10-(2) if he get both genes and iron studies -meningitis
are abnormal then he has the disease -kids nausty syndrome
-other complications like heart or liver can
be prevented by taking out blood 8-TYPE 1:
-keeping blood testing -locomotive
11-(3) first get these blood tests today -pre audio- logy
-booking appointment in three weeks -increasing loudness
-bring his partner to explain her the -placing a ball, an egg, a puzzle
condition.
4.2015 Listening (B) TYPE2:
2-its microphone -speech -Cognitive -Disabilities
-a cable -externally on the scalp -Steady state -Loudness
-a magnet-bodily (on the body) -Frequency -Sedated
Their clothes- -22 - 20 -By electric activity
-Round window -The forehead -The ears
-Contour of the cochlear
(surgical procedures) 9-1-of deafness
-1.5 terms of their cochlear -good outcomes
-before going deaf
3-the sound -progressive
-Hair cell death -Electrodes 2-implant
-Auditory brainstem -The brain -the earlier, the better
-children under four
4-1-A 2-B 3-C Two implants
-perception
5-A-1-significant guidance of speech Localization
perception Coming from
2-gain awareness of environmental sounds
(safety issues) 10-1-being auditory verbal
3-better access to employment (social -Duration and device use
occasions) -cognitive delay
B- surgical risks(risk of infection) -home and school environment
Small risks of meningitis- / normal schools
-risk of anesthetic 2- homeland, normal schools rather than
Some develop tinnitus- signing schools
Minority not get benefit of perception 11-1-A 2-B
850
May 2015 Listening A 5-(6) also called a cap like a jacket that
2-a (4) accident in 2010, 4 years ago fits up over to reduce the seized tooth
Now she is 11/ she was 7 then Used for teeth that can't be restored by
She was piggy packing her younger any other means
sister If the tooth is dead, you can't put the
It's not a good thing teeth are not crown as it will get drier and fractured
designed to do that Put a post on the root canal and then
b-(8) her mouth was all sore build a crown
Had a lot of swelling Reluctant for young people to do crowns
She was very distressed, it was very Coz they are destructive, you need to
difficult remove a lot of healthy substances form
2 lower front teeth broken the tooth.
1 upper front tooth broken
The next day had an x-ray 6-(14) 2 lower incisors affected
The other front tooth hammered up into 1 upper incisor which was broken and
gums the one hammered up to gums
It was the same day , went to emergency The 2 lowers have fractures
dental clinic They are kept very well
The next day went to normal local dental Both stayed vital and alive
clinic and saw a pediatric dentist Long term prospect
A lot of appointments
7-(6) appearance is fine
3-(6) it settled itself down Remained alive
It took sometime for gums and teeth It's crowned at the bottom
More than on weekly basis to check Not coming off/ satisfactory
gums Tooth remain healthy
Her lips and everything was swollen Let it be and replace at a late stage
Only have soup for two weeks
They checked her immunization, 8-(7) the 3 teeth talked about are going
especially tetanus well/ satisfactory
The remaining tooth hammered up was
4-(5) in first days no complaint of cold x-rayed
things Do orthodontic treatment / took so long
Mom was more upset than her Months or a year
She said it was just a tooth not he whole Constructed on a brace to put pressure
body on tooth
Not give reaction to cold, but the dentist On monthly basis till it comes down
not put something protective over her Endodontist said it was doing fine, pulp
teeth was doing well
They tested with cold ice each time, the But subsequently it was not alive
top one was slow to react She had gingivitis
The doctor worried about it but Given mouth wash to keep it clean
eventually it wasn't slow There was infection beside the tooth
The other two bottoms were fine There was infection beside the tooth
851
9-(5) structure not connected directly to 4-1- 2005 -100 -50
bone 2- 17,000 -60,000 -20
They're in a sling of fibers which 3-9th
supplies blood to teeth 5-the breakthrough of the year
Fibers run between bone and teeth root 1-an adult, skin or hair
If tooth removed drastically, fibers erupt 3-a stem cell
Tooth will be dead The back of the eye
Coz of loss of fiber , tooth will be fixed Sample
to bones as there is no space
6-1- eye conditions
10-(7) tooth will definitely die Therapeutic
No long term prospects for that tooth Correct
solution must be transplant Reimplant
transplant from one tooth at the back
come to the front 2- enlarged animal
worry it would look different, but
informed it would look the same 7-clear window
they have two teeth as options Thickness
if one tooth not taken for transplant 469
the other tooth will be taken Mutations
Minor trauma
11-(2) look at her routinely , every 6 Soccer ball
months Rugby ball
It's been handled conservatively
8- 1- A 2-B
5.2015 Listening B 3-C 4-B
2- human genome
Different 9- 1- FIFTEEN- 12
Healthy eyes 2- medication- toxins
The technological 3-serious- severe
Glass-slide 4-investigation- diagnosis
60 5-tissues-arteies
Far-ends
Cohort size 10-elderly
Life expectancy
3-centeral Genetic
Reading The quality of DNA
People aged Same patients
Focused Large cohort
An electrical signal Their archived
Optic nerve
Processing 11-1-c 2-b
852
JUNE 2015-0208 Listening A cardiologist advice
2-(8) she was 6/ now she is 23 No allergies to any other medications
-parents tried to explain transposition of 6-(6) not replaced since 1991
great vessels It is a backup/ when tested not used a lot
-told she was out of breath/ would make Not used very often / batteries last longer
operations to keep up with other kids Under her ribs
-remember nurses and play room In abdomen/ not feel it/ not cause any
-difficult to walk after surgery problems
-not remember wasn't able to keep up with A wire goes from pacemaker to outside of
other kids the heart
-lips and finger nails turning blue
-basically when running so much 7-(8) echo once a year or every 6 months
To monitor a leaking valve/ make sure not
3-(9) no other surgeries getting worse, but seems consistent
-not start doing so much Not remember which valve is leaking
Then do ballet dancing Difficult to remember which valve coz both
Then some more dancing/ consistently by sides of the heart became back to front
getting older Keep on checking is very important in the
Fit in teenage long term
5 hours of dancing a week/ quite tiring Check pace maker coz batteries will run
Not as much when at school/ busy down
Now not as fit as she likes to be Batteries need replacement
Still takes classes/ walking regularly Very minor procedure/ done under general
No symptoms/ no shortness of breath anesthesia
Short of breath after walking up a hill, but Short operation, cutover , take it down and
not concerning replace it
The same fitness of girls her age
8- A-(8) not expecting heart problems/
4-a-(10) no other health problems stable
No coughs/ no symptoms Pacemaker not a problem
No wheezing / no asthma Electronic security gate recognize it at
No problem with urinary bladder airport as it is made of metal so alarm goes
Bowels are ok off
No nausea, no vomiting/ good appetite Carry pacemaker ID card
Headaches from now and then due to stress Tell them where to check it and they scan it
No smoking with a hand-help device
Alcoholic once a week/ 3 to 4 drinks Sometimes gates are not sensitive
No recreational drugs If forget and passed not worry
b-(6) No chest pain Security gates not affecting pacemaker
No palpations B-(3) oxygen on plane is pressurized, but
No blackouts/ no dizzy spells not to zero when 30,000 feet
No swollen up ankle people with severe heart or lung diseases
Notice bruising quite easily can have low o2 in blood
No family history of heart problems not worry/ she exercises, not blue so no
No congenital heart problems problems
5-(5) lisinopril once a day C-(9) not need to tell airlines about it , not
Aspirin once a week an issue
Not remember lisinopril dose Coz of complications as traveling overseas,
Not frequently aspirin/ got dizzy/ based on
853
will have a letter
Explaining you have a pacemaker, 4-3 times
medications and contacts -Women who haven't had a baby
Some people are funny if you carry -Gentle
medications thinking you take it for -The initial inflammatory responses settled
someone overseas -Sprained ankle or any other soft tissue --
A letter will be written with phone numbers injury
Tell travel insurance about pre-existing -Ice and some sort of strapping
medical conditions -Overused -Rest -Ice
Adjust it to cover you -Compression -Elevation -At rest
Need to carry signed prescriptions and -Gravity, sitting and standing
letters -Not to do too much in these early weeks
854
July 2015 Listening A 7-(5) returned a couple of years ago.
2-(5) Peter Baker -have it monitored and PET scan
-68 years old/ retired now -preferred to monitor every 4 months
-was an engineer / steel work -for 3 years now/ nothing flared up
-retired 10 years ago -so develop check up to every 6 months
-not much medical conditions at present -only these surgeries in life
-high blood pressure
8-(5) BP about 20 years
3-(7) had childhood problems, but can't -managed by Coversyl
remember -4/5 mg once a day
-was a normal child / not significant -under control now
-at 21 had a car accident/ broke a femur -check every 6 months
-put a metal nail in thigh -seen by GP
-very big accident
-2 operations at leg 9-(7) blood tests occasionally when required
-fractured skull for couples of days by a GP
-now normal nothing affected -cholestorel tested regularly/ low / doctor
happy
4-(5) at 35 had laparoscopy -no anemia
-remove gall bladder -urine tests/ no diabetes
-a bit messy using silicon tubes instead of Prostate blood tests/ PSA normal
rubber -get no symptoms
-got pretty sick for long/ not expected Gets up only once at night/ not serious
-was OK since then
-no long-term effects 10-(9) aspirin 100 mg a day
-no OTC
5-(9) at 60 melanoma removal No natural supplements
-from back -no vitamins
-8 years ago No recreational drugs/ no illicit drugs
-wife noticed small spot at the back -no allergies
-see local GP Non-smoker now/ only for a couple of years
-at first not think it's serious at 20s
Biopsy taken -drink alcohol socially
-discover melanoma then Couple of glasses on weekends
-hospital admission Red wine/ beer / 3 to 4 glasses at most
Radiotherapy was not needed -some days not drink at all
-regular monitoring
11-(9) no running diseases in family
6-(7) at 65 returned back -4 brothers and sisters / all alive and well
-lump at a scar tissue Mom and dad passed away
-remove it again/ took a large piece -dad died at 30 due to angina
-no radiotherapy for a couple of reasons -heart attack mainly
-keeping in reserve in case of recurrence - no other family members with the same
--very large area so had to radiate the arm problem
and lymph glands as well -dad was a smoker/ pipe
-so only the surgery and recurrence once -mom died at 73 of emphysema
only -she was a smoker too
855
12-(9) do a lot of baby-sitting 5- 1- reduced radiation exposure
-golf a couple of times a week 3D imaging
-regular swimming / twice a week
-lap swimming / good for cardio-vascular 2-less shaking
system Better cooling system
-baby-sitting for daughters' kids
-golf mainly couple of times a week , but 3-autoclaves are used
not regularly Personal protection gear is worn
- member at Rotary/ meetings once a week
-have good social network 6-revolutionary
-wife to look after him if things go wrong -1940s
Low-decay
13-(3) BP check-up Mottled
-listen to heart and lungs Naturally occurring
-make sure they're going well
-appointment to discuss findings 7-Australia
Mass medication
7.2015 Listening B Infringement of liberties
2- 1- smells and sights Hip fractures
2-standing up and sitting down Water-pipes / burst
3-communication
8-1- societal/ dietary
3-caries / decays 2-330ml /375ml
-periodontal disease /gum 3-profitable/ palatable
-3 or 4 years old 4-performance/ rehydration
-pain 5-attack/ dissolve
-distressed
-permanent teeth 9- 1-eneormous pressure
-drift Constant abrasion
--edentulous /have no teeth and wear Wet, warm environment
dentures
10-functionally
4- -bleeding gums -esthetically
Halitosis / bad breath -standard of living
Loose teeth Expectation by parents
Types of brush Simpler
Action of brushing -quicker
How often
Diet 11- 1- bone grafting
Dental floss 2-amount/health /bone
3-correction of jaw abnormalities
4-root filling of teeth/ success rate
Operating microscopes
856
August Listening A 6-(9) dull pain with heat
Muscle damage
2-a-(6) 33 years old Right shoulder painful
-in good health Wrist hurt when picking up coffee/ shower
-83-85 kilograms Right wrist and shoulder
-cholesterol low no cuts nor bruises
-blood pressure low/fine limited movement for wrist and shoulder
-no medications strength is impacted cause of pain and
-no allergies muscles are weaker
pins and needles in upper right shoulder
B-(3) regular biking/100-150km a day no other aches or pains/ head, neck and knee
-no smoking are fine
Not too much alcohol
/ New Zealand white 7-(6) a lot of pain more than a normal sprain
-3/4 a week( Friday- Sunday) Doing further investigations
x-ray for wrist
3-(5) no diabetes shoulder may have a damage to rotator calf
-not heart attacks not being able to raise it so need for
-mother heavy smoker ultrasound
-father had a pace maker for 30 years find out possibility of a tear
-no heart attack for father , lived till 83 need to see a specialist if tissue not repaired
quickly/ need for surgery
4-a-(6) several years of health crisis
-giardia 8-(7) firstly rest shoulder
-malaria Apply ice for 24-48 hours
Amebic dysentery Help swelling and pain
Infection caused weight lose to 65 kg Ice application by pressing against the skin/
Diarrhea constantly not direct to avoid skin burning
Sling helpful to support shoulders for 2 days
b-(3) go to local embassy for pain
500mg of anti-malaria/ chloroquine If managed OK, move it a little to avoid
Various shots of anti-viruses tightness
Pretty minimal medical care See a chemist to get support for wrist
-since then about 20 years in Australia Painful at 1st couple of days till becoming
seems fine better
5-(6) recently went over the top of a friend 9-a-(4) duration of healing depend on x-ray
biking with If fractured plaster is needed
Smashing himself on asphalt Take up to 6 weeks
Shoulder hurt If simple sprain recover in two weeks
No need to call ambulance or hospital
They laughed about it/ went to coffee shop B- (5)1st couple of days painful
When went home pain was more than After 2-3 days physiotherapy will be helpful
normal Teach about stretches and massage
Pain started immediately after having Regain ranger of movement
coffee/ adrenaline went down Alleviate symptoms of pain
Not able to use right hand
The finger and wrist weak
857
10-(7) analgesia is important 4-blood loss
Panadeine forte is a strong pain medication Intravenous access
Paracetamol and panadol are safer Third space
Codeine can affect thinking / cause Fasting
drowsiness Blood pressure
Start with panadeine or panadeine extra Obstructive shock
Anti-inflammatory medication is also
important/ Ibuprofine 5-disability
Safe as Panadol but different so can be used -medical record
in conjunction Confused
May cause reflux or stomach acidity In hospital
Taken with food three times a day Cause to problem
Treat it
11-(7) work in an office/ sedentary
A lot of computer work 6-1-orthopedic
Worry about taking notes or answering 2-pregnant
mails 3-chest issues
Better do dictating for the next couple of Lactate issues
weeks
Continue to work but not using right wrist 7-pain
or shoulder Asleep
Give him a medical certificate Fluid overload
Patient agreed Fluid balance
Drugs and doses and their indications
12-(4) take papers for x-rays, ultrasound and Good signal
medical certificate
-come back in a couple of days to see 8-try and isolate the problem
progress Manually bagging
Look at results of scans The machine
Follow-up with a specialist Sputum secretion
Metabolic disturbance
8.2015 Listening B
2- the electrical cord 9-accurate reading
-equipment On the floor
-adequate Tubing /Air-way device
ECG Out of battery/ Not plugged in anesthetic
Meaningful gas
Blood sugar
Wounds 10-time
Dressing -saturation
3-drowsy Manual ventilation with bag
-81 Mechanical ventilation
Dementia Reversal
Himself or staff Era-syringing
Eye opening High-spinal
Verbal response Respiratory effort
Motor response
90% 11-1-B 2-C
Oxygen till saturation come up to 99%
858
September 2015 Listening A 7-(7) going in November
2-(7) 24 years old -flying to Zambia
-lives in Colton -lives with two friends Go there in 2/3 weeks
-not married- no partner -no children – Then to South Africa
retailer -full-time job Volunteer work
Work in 2 places
3-(9) first got it 2004 HIV clinics and an orphanage
-since then had it on and off Visiting some friends in South Africa
-last year specially had it every couple of In Cape town for 5 weeks
months
-quite severe since 2004 8-(7) recurrent tonsillitis/ immune system
-bad fever -swollen neck -went to hospital and respiratory tract are prone
Generally feeling unwell Most episodes due to viruses
-in hospital for 2 days -needed IV antibiotic Mostly due to a bacteria called streptococci
-not told bacterial or viral infection Respond to antibiotic
A course given to eradicate/ reduce future
4-(4) pretty much recovered after that risks
-got it again 3 months later/ mild Recurrent episodes: surgery, tonsillectomy
-then have it after 6 months to reduce the risks
- a year ago had it every few months or But still can get infection
every couple of weeks Refer to ENT surgeon to discuss risks and
-no review to look for bacteria/ no swap benefits of surgery
done
9-(5) hepatitis B/A
5-(7) first time was the worst Typhoid fever
-old GP gave her permanent prescription of Update routine vaccines: measles , rubella
Amoxicillin Tetanus poster shot
-majority of symptoms got better but not all rabies
-get it whenever have symptoms
-clear up within couple of days 10-(3) can get them all here or referred to a
-see a surgeon for the side effects travel medical clinic
-make her sick, nauseous -can get them all at once
-stomach pain -got back only for hepatitis A as it needs a
poster after 6 months
6-a-(4) MEDICAL PROBLEMS:
-pretty good 11-(7+6) Zambia is a malaria-endemic area
-no significant medical history -need to take malaria prophylaxes
Thalassemia/ no transfusion -in tablet form
-no major infections -taken in few days before going
b-(7) Medications: -3 different drugs recommended
Only antibiotics -doxycyclin antibiotic/ the cheapest, may
No regular medications cause rash or photo-sensitivity
No allergies -if exposed to sun can get sunburned easily
OTC: multivitamins -try melfoquine
Not regular smoker only with drinking if previous problem with antibiotic, will
Drinking once on weekends cause stomach upset
2 cigarettes a week Abit more expensive
Rarely smoke marijuana, but no other illicit Smaller risk of causing psychosis
drugs
859
Malarone (combination of two anti-malaria 5-1- flow cytometry
drugs) -morphology tests
Very well-tolerated 2- renal function -hepatitis B -HIV test
Rare side effects, but the most expensive
12-(5) write a referral to ENT 6-type of leukaemia
-get an appointment by next month -age of the patient
Scheduled to see her before going to check -general health of the patient
everything is right -8 months/ sometimes years
Organize vaccines Chemotherapy
Can arrange appointment at travel health -immunotherapy
center to ask any questions. -radiotherapy
-bone marrow transplant
9.2015 Listening B -induction
-destroy leukaemic cells/ induce remission
2-the bone marrow -prevent from returning or relapsing
-accumulation of abnormal white cells -maintenance
-blood
-needs urgent treatment 7- 1- chemotherapy -radiotherapy
-chronic 2-for neutropenia to stimulate white cell
-may not need treatment for sometime production and monitoring of temperature
-3100/ 8 people per day 3-nausea or vomiting
-21% increase 4-infertility -lethargic and malaise
-childhood cancer 5-50% -67% -38%
-adults
Over 50 years of age 8-cells -nodes -tissues
-35 different -B or T cell
3-genetic -5500 -12 people -90%
-exposure to intense radiation -generally unknown
-chemicals: benzin -western lifestyle
-viruses : HTLV -viruses -HTLV -bacteria
-Severe immune deficiency -HIV
4-LOW HEMOGLOBINE
-pallor -lethargy -dyspenia 9-1-weight loss
-night sweats -anorexia
-fevers 2- painless and rubbery
-malaise 3-skin involvement
-recurrent infections -testicular swelling
-eye involvement
-low platelets -stomach involvement
-continuous bruises -central nervous system symptoms
-purpra
-bleeding gums 10-1- Histological examination of an
excised lymphnodes
-organ infiltration 2- bone marrow biobsy
-liver -CAT scan of neck, chest, abdomine..
Spleen -PET scanning
-lymph nodes -other blood tests
Brain/ skin 11-1- B, 2-B , 3-A , 4-A
860
January 2014 Listening A 5-A (4) not seen a physiotherapist
2- (5) Can walk, but not comfortable
a year ago was in San Francisco , Can't manage stairs, only hobbling up
then work in California Can't put pressure on knees, can't kneel on it
On weekend with a friend from Canada, No crutches, no gaiters to help walking
not see each other for a long time Can move around
3/ 4 days walking around San Francisco Back to work
about 6/8 hours a day,
very hilly places B-(5) teacher, a lot on foot
By end of 4th day had soreness in knee, Knee in morning gone down a little bit
thought it would go away, but didn't Stiff when firstly get up
Had pain for 6/8 months before seeing a Sleeping uncomfortable, sleep at back, can't
doctor move around easily
Went to GP who referred him to 1st surgeon Put ice packs on knee trying to reduce
3-A-(3)1st surgery was 3 months ago swelling
Frustrated to have 2nd surgery By end of day knee is tired and sore
1st surgery and communication with surgeon Go home and put feet up
frustrating
Not informed he had to bring somebody to 6-A (3) using some ice
drive him home Take anti-inflammatory / Voltarin
Not knowing about having general Taken 2/3 times a day for 3 weeks
anesthesia, No other medications / a bit healthy
only told few minutes before surgery Take vitamins only
Frustrated of lack of communication
B-(5) running for the last 10 years/ 2,3 times
B-(4)10 days after surgery was checked a week
Told everything was ok Not really athletic , but trying to keep fit
Had great deal of swelling Going to the gym on and off for the last 10
Not know what to expect, not know whether years
normal or not Like the gym , feel confident
Severe swelling for nearly 3 months, about Not wild about swimming
10 weeks Got a bike and cycle to work about half an
Coz of bad experience with first surgeon , hour
got referred to another surgeon Not cycling recently
Want to cycle, do aerobics to keep weight
C-(3) 1st surgeon took x-ray, down
MRI and various scans Now can't run, so not sure what to do
Told there was a small tear in the left med- Time frame of recovery not discussed
meniscus before with surgeons
4-(2) 2nd surgeon said it was bad luck as 1st 7-(5) coz he had two surgeries, he might
surgeon didn't take enough of the meniscus expect recovery to be a little bit slow
away Main aim of treatment is to decrease
Only partial, a difficult judgment swelling and increase knee movement
So had complete meniscectomy of the med- Coz of 3 months not exercising , have
meniscus wasting of quadriceps muscle, the main
3 weeks ago. muscle in front of the knee
So daily activity and walking upstairs,
riding and running must work on it to
strengthen …
861
… January 2014
Frame-time , need to get goals, Listening B
once get full range of movements,
knee can bend and straighten fully 1.
then build strength through that range Patient(3)
Then get back to exercise like running and a- skills
riding b-beliefs
Go 6/8 weeks to start lightly jogging again c- knowledge of physical impairment,
, reasonably soon learning difficulties or anxiety stress
It differs from one to another,
no rush, work gradually on strength and Mode of delivery(3)
movement 1-oral
Then long term goals of cycling and running 2-written
3-multimedia
8-(4) 2/3 weeks exercise ,
most can be done at home 2-(2)
Simple , do something while lying down 1- patient's education
Not put weight on knees 2-how the person perceives the doctors/ role
Strengthen stability of hips, knees and calf relations
muscles at the back of the chin 3-literacy skills and how it affects
Due to all these weeks he became weaker understanding
The more frequent he can do them, the Influence the healthcare interaction
better
Only ¾ times a day for movement and
strengthening exercised of knees 3- complete
Variety of positions, not putting weight 15 and 74
knees and some standing Poor or very poor
Prescriptions and Drug labels
9-(3) go through a set of exercises
Have a look at knee movement and strength 4-(3)
Look at MRI films Require more medical care
Teach some basic exercises Increase rate of hospitalization
Progression over 6 to 8 weeks will be step Problem communicating with healthcare
by step providers
Take a look about how comfortable he can Barrier to receive optimal care
do according to the strength of movement Reporting physicians not explaining
See him weekly for the next 2/3 weeks treatment in terms can be easily understood
Then progress to next stage and show some
exercises, 5-(3) instructions
stick to gym membership Appointment cards
Then transfer exercises without consultation Prescriptions
See him weekly then become independent. Pathology reports
6-(4)
1- a- poor reliability
b-illiterate people are ashamed to discuss
and hide it
2- a-poor indicator
b-not assume well-educated are health
literate.
862
11- 1- provision of visual, interactive
7-a- 66 words / columns, materials like computer modules,
according to numbers of syllables and level screen programs in clinical practice
of difficulty 2- education of health professionals
-read out loud the words 3- education of family and friends
-score the correct pronunciation and 4- creative use of internet as a tool of health
understand the meaning of words education
9-
1- NO
2-NO
3-NO
4-YES
863
May 2014 Listening (A) No shortness of breath/ only after
exertion
2-(8) tingling sensation, something She's fit/goes to the gym
filling her 6-(7) now she's non-smoker
-pretty in both hands -in the past, in her 20s smoking 2/3
-mainly in left hand and arm, numbness cigarettes a day for 3/4 years
-sometimes can't feel it on the bridge of -no history of high blood pressure
her nose -no disturbance in bladder and bowl
-can't pinpoint the starting date function
-a couple of months ago -cholesterol checked recently and
-gradual onset normal
-at night -alcohol: average drinker, 2/3 glasses/
-lying on bed position not binge drinking
3-(11) not constant/ come and go -no illicit drugs
-nothing make them worse 7-(6) preosteoprosis condition
-being anxious does not bring the (Osteopenia)
symptoms -not a serious condition
-nothing make them better -have bone density scan
Sometimes lying on different positions / -no operations
on back is better -no fractures
-not waken her from sleep -only taking calcium and vitamin D
-no headaches No regular medications/ no OTC
-stiff neck and stiff shoulders 8-(7) academic job in linguistics
No leg symptoms -full time job
No back pain -keep her too busy
In the past had some back injuries -work on computer a lot
Not get worse on the last 6 weeks/ -leave it only at lunch time or meetings
almost the same -not exacerbated to her symptoms
No visual disturbance -sometimes exercises
1st time to have something like this -go to the gym/ go running in the
4-a-(4) mother died because of heart morning
failure at age 56
she's now 63 9-(7) not specific serious condition
Diagnosed as scleroderma 2 weeks -worried because of her mother's
before death condition
Had lots of problems, difficulty No severe heart disease/ low risk
breathing, heart problems - gives attention to heart problem as well
b-(4) grandfather died due to heart -not cardiac problem
failure, heart disease -more likely neurological problem
at the age of 85 -may be hand nerves like carpal tunnel
grandmother had some strange arterial syndrome
conditions -There may be a neck problem/wear and
she lost speech, died at the age of 80 tear in neck desk
5-(8) no chest pain
Soft tingling sensation in nipples 10-(4) x-rays on neck and cervical spine
Not sure if have heart palpitations -ECG test/ exercise stress test using
-sometimes feels racy treadmill
When lying down/ at bed time -unreasonable to drop heart problems
No missing beats -appointment to discuss results
864
May 2014 Listening (B)
7-1- C
2-heal and repair 2-B
-regulate everything 3-C
Whole person
Healthy lifestyle 8-one and half hour
Herbal medicine -regularities
-treat the cause -pain
Do no harm Reproduction problems
-practitioners as teachers History of miscarriage
Use of contraceptives
3-what's wrong Hormonal imbalance
-why it's wrong Educate to look for signs
-emotional state LH kit
-occupation Prolactin
Outcome of life LH
-no artificial drugs
-no surgeries 9-1-Vitamin D
-stress management Iron
-meditation 2-egg quality
Vitamins and minerals Sperm quality
-herbals Sperm quantity
3-taking in antioxidants
4-1-educate people about their health Eating wholegrain everyday
2-regain responsibility about their health Daily intakes of fruit and vegetables
3-treatment plan
4-patient's compliance 10-emotional
-intervene and manage when recurrence How stress
Disappointment
5-mental/ spiritual Wellbeing
Generic prescription Calms
-specific needs of patients Depression
-a drug to fix us Side effects
-preventable
-primary 11-
-even not ill at that time 1-C
2-C
6-digestive disorder 3-B
-filling intolerance
-mal-absorption
-immune
-common cold
-eczema
-migrain
Anxiety
Depression
865
July 2014 Listening (A) C-(7) soya a good source of calcium but
tastes different
2-(1) sent to have bone mineral density test Need to look at recommended daily intakes
3-(2) Mom has osteoporosis Can take tablets / best absorbed at night
Family history put him in 80% of risk factor 5-(6) it helps the absorption of calcium
High risk of osteoporosis even still young If low affects amount of calcium absorbed
-reach peak bone mass at the age of 25 They keep slip-slop-slap / not exposed to
the sun
He is 31 so needs to have hope
Have low vitamin D level
Try to reduce the risk factor
Sunshine the best source of vitamin D
4- A-(4) the main building block of bone
You can get it in some oil or fish
Stored in bones
You can also get it in tablets
Strengthen bones
6-A-(4) not doing exercise
Regulates heart beats
Work in an office/ sit down most of the time
Muscle contract
Walk for 10 minutes a day to office/
B-(5) as a child not have enough calcium/ relaxing walking
mom anti-milk
No strength training only incidental walking
Now has reasonable intakes of milk yogurt
and cheese B-(5) not doing the right exercise
Had soya products as a child but not like it It needs to be more specific
either
Take the body out of its comfort zone
So not have anything only occasional
Do resistance training and strength training
cheese or yogurt
Something that has a ground –strike/ force
His intakes was not good
applied to it
866
Put pressure on bones B- (4) change the way fast then slow
Take muscles then bones out of comfort Reverse order( what you start with end
zone with)
What’s difficult today won’t be the same in Not expose in hot hours
6 months
Be in the sun before 10 and after 3
Still young so change a lot at the beginning
For half an hour without sunscreen
Make sure no sore back or neck
To get vitamin D expose forearms ,face and
Once get comfortable/ change above a kilo hands
for a couple of weeks
867
July 2014 Listening (B) 6-1- cognitive impairment
2-1- awareness
2-dementia
Sustain or shift -Memory -Language
3- being old by itself/ aging
The symptoms and signs throughout the day
4-multiple medical conditions
2- attention - Consciousness
5- be on different medications
-awareness/ cognition
6-sensory impairment
3- 56 - very sick
7- 1-chest infection
-close to death -80 to 85%
-and urinary tract infection
-older -late
-sedatives -opioids
-The doctors and nurses
-steroids -anesthesia
-the patient -relatives
2-1-drugs 2-when started
4- increase mortality
3-what dose
-need for residential care
8-1- B 2-C 3-B
-falls and fractures
9- conversation -attending to you
-pressure sores
-missing doses/ given medication
5-1- inattention
-vital signs -temperature
e.g. the patient is not listening and is not
-respiratory rate -blood sugar
giving the right answers is asked a question
-Bowel and bladders
2-agitatation -e.g. try to get out of bed
e.g. accuse family and nurses they are trying Metabolic disease -Pain
to hide things 2- so agitated
4-aggressive behavior 3-at a great risk of hurting themselves
e.g. if things are not explained to them 4- hydration -Bed sores
5-withdrawn Bladder care -vital signs
e.g. lay quietly and not show concern about
11- 1- b 2-a
staff
868
August 2014 Listening A 7-(6) it's very common no need to be
alarmed
2-(6) -inflammation at the strong ligament
no left heel pain underneath foot
-on insole of the heel -wearing thongs for a long day which
Couple of weeks is not supportive
-at the back - no time to rest so inflammation is
-getting progressively worse still there
-not see anyone about it -morning pain and after rest indicates
-only a friend's advice plantar fasciitis
-never seen a podiatrist before -linked to childhood problems
8-(8) couple of conservative things to
3-(3) first step in the morning is the be done
worst -reduce tightness in calf
-improves with movement but not -exercise done to show restrictness in
getting better calf muscles
-if sitting for a long time and then Loosen up calf muscle
stand up returns Teach him some stretches
Take stress of the heel
4-(3) a couple of weeks at the zoo Reduce inflammation
-it was hot wearing thongs Ice the area with a long freezed bottle
-walking around the whole day for 10 minutes
Massage
5-(5) when very young at 10 had a lot Look at shoes not wear thongs for
of feet problems long
-play a lot of sports Sandals instead
-problems in the same place Limit use of thongs for lifetime
-but in both heels
-feeling it was bruised at the top of 9-(4) review in a month time
the heels If not improving, put insole in shoes
Not complete resolution of pain
6-(6) tender when touch the insole of Only reduction or improvement of
the heel pain
-no pain underneath the ball of the
heel 10-A (3)-play a lot of sports
-no left foot pain Not organized sports, office sports
-left ankle very loose, perfect Basketball and soccer in winter
-right ankle is restricted at the back of Cricket in summer
the calf
Watch him walking for a couple of
meters, normal
869
B-(3) high ankle support shoes for August 2014 Listening B
basketball
Shoes are a couple of years old/ need 2-a natural attributes
renewal -can be taught or learned
For cricket and soccer has the b)medicine, law, helping vulnerable
standard supporting footwear people
C-(3) continue sports c)women with breast lump/or
Stretch calf as it adds pressure to the somebody in court charged with a
heel crime.
Keep both calves away from D) -professional expertise
participating -moral expertise
Give sometime to rest foot
3-profession itself
11-A (4) 3 and half year old son, -look at students' needs/ revere elders
while walking his knees are close for their expertise and guidance
together -patients
Mother thinks he's pigeon toed -confidentiality, not exploit them
Mom had corrective footwear at 12 sexually, and keeping patients'
for a couple of weeks secrets.
Had problems with knees and feet
Worried of genetic conditions 4-a-1989
Dad has not noticed any problem b-the mental health act
Not like walking much, likes to be c-another level of requirements for
picked up professionals to work in a certain
B-(4) close knees are not a problem way, not to hold patients against their
for his age will, conduct themselves in relation to
If excessive fatigue, worried of patients' belonging doctors well
genetic causes behave.
Some not prefer intervention at this d-as if you are a member at a tennis
age, but if scary they have to club, you have to adhere to the rules
Bring mom, his son and his footwear if you wish to remain a member at
12-(6) should all footwear be custom- this club.
fitted?
Off the shelf shoes are fine 5-a- what's morally a good behavior
Firm shoes to keep heals steady and what's immoral
walking b-where: America, when: 1970s
Something that bends at the ball of c-1992
foot
Something that can be fastened to
foot to keep it firm
Thongs not recommended for a life
time
870
6-1-respecting confidentiality of 9-a- degree of freedom to work out
patients and their families their own ethical behavior so that
3-not misusing their skills governments not to dictate how
4-respect humanity and dignity of doctors behave in their ethical life
patients b- use a code to deter an individual
from over strain into immoral
7-a- privacy behavior.
b-you can't always maintain secrets -self-regulation, and retribution, bad
because sometimes you can't keep it apple, punishment
confidential
c-if patients tells you they are 10-a- body of professional to punish
intending to kill someone like a people who break rules
relative or an ex-boyfriend b-worst: expulsion from college
d- you have to keep patients -least: reprimand , warning
information confidential c-codes shouldn't punish, but promote
-but you also need to go to police and good behavior.
warn the intended victim
11-a- code of ethics are good things
8- a- try to work out all existing and help professionals to work well.
problems in regard to applying the -protect the needs of the patients
principle of confidentiality b-refine codes and to let them work as
b- if a patient was charged with a readily as possible
crime, like a sexual abuse of a family
member , you have to go to the court
and offer testimony. However, you
need to keep information of patients
confidential
871
9.2014 Listening A -O2 rate is 99 so normal /
2-A-(5): -Her brother breathing is normal as well
-she’s well, but smaller than her brother -no respiration problem
-parents need to know why babies -35 week lungs still immature
delivered 4 weeks earlier -Babies are OK as steroids helped
-Olive is small not have a lot of reserve -blood test to check O2 level
-she’s at risk of potential problems -Put on blood gas machine
-so she is taken to nursery 5-(9):
- not kept warm unlike her brother -not huge nearly 1800grams
-not have enough brown fats so taken to -Not growth restricted
incubator -Follow up when 2 years with pediatric
B-(9): to check her muscles
-come out of incubator when 1800 to 2 -Catch up on her nutrition outside uterus
kilos -Fast intervention due to lack of food in
-It depends on her placenta need extra calories so breast
-when she is stable get out of incubator feed and formula feed
-Given some fluids IV -Not going to be a big child
-Given milk to feed her -Try to get enough nutrition and glucose
-When maintain temperature , she will for the brain
get out -She is neurologically normal
-Depends on how quickly she responses -Blood sugar level is also normal
-No set weight -no seizures
-No set time
3-(8): 6-(9):
- first baby -blood checks to make sure babies are
-Found quiet early they are twins not infected - cause wife was GBS+
-At week 5 start early scan to prepare Broad spectrum Antibiotic for 24 hours
-High risk pregnancy cause of twins -start penicillin and gentamicin
-Regular doctor appointments, -take vitamin K cause they are not able
everything is normal to produce it at birth
-Regular scans/ shows regular growing -it is not produced in stomach till it has
-Scan is stressful for them so missed a food
couple of scans -risk of hemorrhagic disease of new born
-35 week scan was normal - give antibiotics
-Olive’s placenta was smaller , had less -24 hours steroids for caution
fluids -waiting for colostrums to come
-So take out babies immediately 7-(5) - wife like to breast-feed
4-(9): -especially for Olive
- mother took 2 doses of antenatal -Cause she is growth-restricted,
steroids she might get a disease in the gut
-Were told to have caesarian - so breast-feed even a couple of drops
-babies hearts’ monitored a lot of times - important to give the children
-Olive not require oxygen colostrums
-Put shining light on foot - give them some sugary water till they
-Pulse oximetery measures o2 saturation settle down and temperature OK
level -no problem breathing
872
8-(5) - once temperature is maintained 5-1-c 2-b 3-a 4-b 5-c
will be taken out of incubator 6- cerebral palsy
-Not have enough fat to keep them -perforation
warm, might feel cold -large intestine
-even the babies have a tube in their nose -peritoneal cavity
they can be bathed -Nutrition
-Do the first bath as a demonstration -fevers
-Parents to give the first bath after two -fungal and yeast
days. -through the gut
9-(5)
-no set age 7-liver function test
-no set weight -resistant
-premature taken out of incubator within -can go to the eye
38 to 40 weeks -liver and spleen
- anticipated to get out in 2 weeks or a -14 days
couple of days longer
-depend on how Olive goes establish her 8-half
feeding -GP
10-(4) -skin infection
-recovery in 5 to 6 days after cesarean -beard line
-Keep her as long as possible as babies -Great toe
are still in nursery -IV antibiotics
-By day 6 she will be discharged -oral antibiotics
-Give him a parking pass 9-not too often, but occasional
-thromboses
9.2014 Listening B -in blood stream
-10% mortality
2- -37 -4 weeks
-females -repeat ultrasound
-6 weeks 10-
-Rash over 1- lost 10% of body weight
-mild inflammation 2- mutation
-steroids 3-intial decrease, but not fully
-pregnancy suppressed
3- 2- feed 4- one of the drugs not effective
3- move 5- get input with clinical nurses, social
4-limbs workers and progress follow-up
5-evaluation 6- difficult to treat HIV infection
4- 11-1- staphylococcus
-no evidence of an infection -hand hygiene and hand rub
-neurological exam 2- check cooling towers and make
-post infection sure water is pure.
-contrast 3- the flu and HIV
-lesion 4- condom usage and circumcision
873
10.2014 LISTENING (A) 8-(4) a-not vegetarian, but not eat a lot of
meat
2-A-(4) a- chest tightness b-had regular periods/ not excessive flow of
b-beating and sweating blood
c-tiredness and dizziness c-since mid 40s not as long as it used to be/
d- last for 10/15 seconds not 5 days
2-B-(4) a- sat down d-still regular /good amount of blood flow
b-took a deep breath
c-walked over to a water dispenser 9-(9) a-Animea/ no enough iron to make
d- quickly drank 2 glasses of water blood
e- sat down again and then just got back in b-problems with thyroid
line c-mother had a thyroid problem , but
3- A (5)a- when got home was still dizzy Roseanna did not test it
b-short of breath d-thyroid function test to be done
c-felt weak e-if thyroid is overactive , it sends signals to
d-rang her GP the body to speed up every thing.
e-told her to go to hospital emergency f-no feel agitated/ no tremors
3-B (2) g-lose of weight is negative
a- if still dizzy need to check blood h- put on weight not related to food habits,
pressure, worry of heart arrhythmia but put it down to metabolism
b-risk of heart attack due to its intense.
4-(5) a- she had just finished film making, 10-(6) a- nodules on her thyroid
had a stressful time b-had an operation to take the nodules off
b-worked crazy hours c-still had thyroid
c-smoking more than usual d-not overactive thyroid/ not cancerous
d-she wasn’t unwell, not have a cold e- something related to calcium/may be
e-not drinking more fluids, not get enough parathyroid gland
sleep, and not eat normally f-it organizes calcium level in the body
5-(6) a- it happened a week before g-quite dangerous if untreated
b- she had a sharp pain across chest h-had neck problems in her 60s
c- last for few seconds, she took her breath i-mother was thin , but getting older, she put
back , it was intense on weight
d- not burning pain , but sharp, she had to 11-A-(4) a-daibetes normal
sit down b-Tonsils removal
e- started above right breast the across down c-appendix removal
into arms d-no medications
f-not remember if had it before or not B-(2) a-dad not diabetic
6-(4) a-smoke once a day, then skip weeks b-3 brothers dad-side are diabetic
b-advised by doctors to quit
c-one cup of coffee a day 12- (6)-a-she’s still young 45
d-not a heavy drinker/ not every week b-it is normal to happen once more
7-(5) a-not sure whether it is arrhythmia or c-the older she gets, more normal to have
not heart problems
b-order ECG for heart d-check heart concerns
c- may not get again for weeks or months e-not want to over investigate her
d-better to do 24 hour Halter Monitor f-if recurrent it would be warning
c- cause ECG in her case is of limited utility g-after proceeding in examination, she can
go
874
10.2014 Listening (B) 8-a-leg elevation
3-present 4-explore
5-local 9-a-unsuitable
4-1-intermittent b-reactions
875
11.2014 Listening (A) 6-Tests discussed (4):
-circulation in legs
2- Details of the problem: (7) -ultrasound
-used to be a good runner as a little girl -Check varicose veins
-right foot perfectly right - She have 5 children
-left foot deteriorated considerably -cardiograph/ECG
-one toe shortened
-whole foot considerably 7- Current medications (4):
deformed/shorter -A lot of medications
-one toe has been cut at the back of the -5 pills for osteoporosis
first little joint -5 pills for thyroid
-have a painful corn on the left little - Ostelin is a Vitamin D
toe/can’t endure any pressure on it
-had various operations on it 8-Thyroid: A-Problems (1):
-30 years ago had toe cut-off/ had blood -underactive thyroid/ not have operation
poisoning and went back to hospital B-Thyroid tests (2):
- Cannot remember last test of thyroid
3-Current treatment (2): function
-had regular podiatry treatment/ordinary -blood tests to assess medication /
-cut nails-massage pathology
4-Other medical problems: A-(3) -screening tests/ thyroid function
not have -diabetes -Circulation
problems -diabetes in family members 9-Medications
B- problems with fingers (5): -Medication system (4):
-Mother had arthritis -not have a list of medications
-she had arthritis in her two left fingers -Put bottles in a basket.
-not sure osteoarthritis or not -No set box for each day
-not rheumatoid arthritis/ not gouty -Works perfectly for her
arthritis -Checking medications (2):
-probably wear and tear in fingers -Name of pharmacy/can’t remember/ a
-tender with movement Greek name? George
- may be tendon causing the problem -secretary to ring the pharmacy up to
-sometimes can’t catch/annoying for her know the exact medications taken
5-General health: A-Mobility (4):
-independent/wear sandals a lot 10-Immediate plans (6):
-walking perfectly well -run few blood tests
-walk long distance/ to trains , shops -circulation in legs
-can walk for an hour -call pharmacist to check medications
B-Level of independence (5): -bring the medications list
-do cooking -check thyroid
-do shopping -give her a slip for a scan and blood tests
-have a niece and her daughter live in the -review in a couple of weeks
same street
-one son lives ten minutes away
-available in emergencies
876
11.2014 Listening (B) 8- a- involves two yearly
mammograms
2- a. Survival B- able to reduce the risk of death by
b-improvement of duration of breast cancer by proximity 30%
survival c-because mammograms is less
c-quality of life sensitive in premenopausal due to the
density of their breasts
3- 1990s
changes 9- a- 1 in 10 women
treatment b- BRCA1 AND BRCA2 GENES
developed c- bilateral/ ovarian cancer
international effort d- cause they are not sex linked
877
1.2015 Listening (A) 7- A (2) anxious about laser options
Taking up a new high-contact sport
2-(3) -she was in England for 4 years Neither glasses nor lenses are good
Saw optometrist only once B (6) -lasik is a good option for many
One check up for 4 years patients
More than two years since her eyes checked From prescription her cornea is thick
3-(7) rigid contacts not soft Lasik will be perfect
Since she was 13 Use micro-keratome
Last year have a lot of troubles/ before was All done under anaesthia
normal Topical not general
Uncomfortable/ by the end of the day Alter structure of the eye
scratchy
Eyes get weepy 8-A (5) lasik surgery is elective
Not sure if taking good care of them or not Have to pay for it
Wearing for 15 years 3 to4 thousand for both eyes
Pain only recently Depends on physiology of eyes
4-A (3)-the same cleaner used for many Make sure cornea is thick if too thin not
years / nightly enough
Special cleaner to break protein down Given name of ophthalmologist
Store them in a stored solution Look at sources and success rate
Occasionally remember to use protein B (6) -discomfort
removal/ not regular Dryness
B (2) -lenses are 4/5 years old Take drops for infection postoperatively
Had new glasses and contacts before going drops for inflammation
to UK use lubricants for 24 hours
The actual product and the prescription for no stitching / cornea heals perfectly
them are pretty old
5- (7) -no injury or disease in eyes 9-A (3) implanted contacts
No allergies If cornea is too thin, it will be an option for
Got hay fever in UK but was not serious her
One uncles father-side had glaucoma Traditionally used for certain cases , but not
Father's vision is perfect hers
No glaucoma mother-side/ perfect B (4) -one day
No diabetes No need for hospitalization
No macular degeneration Twp separate occasions
No other eye diseases High risk of infection
Make sure eye respond correctly
6- A (3) people with rigid lenses have it/ so Antbiotic drops given
have contact lenses Give anti-inflammatory
Cornea is flatter in one meridian and steeper
along the other 10- (7) have a look at contacts
Difficult to use soft coz it needs stable ones Make sure nothing affect their comfort
B (4) -full time/ wet soft more suitable Stop rigid contacts for weeks before surgery
Disposable/ corrective of stigmatism Coz they alter the shape of the cornea
Wear them once in occasion and then throw Use soft instead today
them For about a week
Wear all day depending on how tolerant/ Try them/ perfect for her
dry Comfortable, but not replace Lasik
Examine her cornea / lubricant
878
1.2015 Listening B 7- 1- 20%
2-cook
2- 1-C/ E Clean
2-B/D Run out
Get to work
3- Drive
1- eligibility of social security and Seated
physical disability benefits Stand
2-whether with a disability can work 3- average intellect
and length of this disability Intellectual disability
3-assist patients to manage illness and Automatically accepted of having a
disability disability
95%psychological conditions
Ability to work
Family roles
879
3.2015 Listening A 7-(9) take certain supplements, specific
2-(8) 6 months ago saw an optometrist formula by a group of macular degeneration
-no new glasses then -prevent deterioration
-a year ago has recent glasses -eat leafy green vegetables
-reading glasses / not generally used -high level of antioxidants
Happy with distant sight Eggs include lutein mineral
-difficulty reading small printed books -increase amount of pigments in retina
-mainly phone books/ frustrating -prevent against free radicals that causes
-eye vision in good eye not as good as it damage
used to be 12 months ago -not wearing sunglasses/ start
3-(8) around 06/ notice slight waviness in -wear a hat cause of UV/ USE SUN
reading lines PROTECTION
-on right eye -CHANGE diet and some protection
Ophthalmologist referred him to retinal 8-(7) very good health
specialist -take blood pressure and cholesterol tablets
-scan by a specialist of retina by late 06/07 -last blood test, cholesterol checked:2.3
Notice accumulation of fluid in front of -consider removing cholesterol tablets
retina -no laser treatment for retina
-prescribed lucenits injection, monthly -no other operations of eyes
For 2 years -no cataract surgery
-costly so refer to eye and ear -smoker at 20 till 45 (long time ago)
4-(3) in the past saw a specialist every 3 9-(7) managing well
months/ now every 6 months -active gardener
-goes to public clinic -ride a bike everyday
-see one of three doctors at retinal clinic -like working in workshops
5-(4) doctors disappointed -like fixing things
-it wasn't that successful -not wear glasses
-had 25 lucenits injections -make sure to wear safety glasses to protect
-lost some vision on right eye (25%)/ not left eye
happy -still driving/ not using computer a lot
-last scan no fluids, good -can get safety glasses with a prescription
-now wait and watch 10-(4) spoke to family/ worried about
6-a-(4) using it for years/a lot use it every hereditary
day, but not properly -have 5 children/ eldest over 50
-check the very central visual field of both -tell them to keep an eye on eyes
eyes -make sure they've Amsler charts
-cover one eye when doing it -get eye checked every two years to predict
-not to look for small creepy things macular degeneration
-get any significant change from the day 11-(6) check for frames
before -update reading glasses
b-(4) covering one eye is very important/ -check for safety glasses
was overlooked when he started -give leaflet about supplements
-make sure not wearing glasses -schedule for review in 12 months
-if not covered the good eye takes over/ -be sure to check left eye
happen with him -keep going with amsler chart
-do it every day/second day/ brain adapt -in case of any concern , come and check in-
easily to changes in vision between
-take seconds: stick it on fridge, behind
toilet door
880
3.2015 Listening (B) 8- impaired(reduced)
2-transport -neglect(trauma)
-room temperature -multiple(recent)
-warm/comfortable -significant (various)
-meal -processes(conditions)
-disease/illness -primary(secondary)
-30 to 100%
9- immune
3- economical -infection
-fats and proteins -weaning
-glucose Number of ventilated
-healing -mortality
-Concentrated -costs
- some by-products
-larger amounts of 10- functioning gut
-1 to 2%, 30% -mechanically
-intestine
4- muscle or organ -less expensive
-anti-bodies -oral diet
-fluid -bacterial translocation
-body protein
-carbohydrates and fats 11- feeding intolerance
-electrolyte imbalance
5- metabolic reaction, growth and -metabolic
maintenance of tissue
-water 12- infection risks
Diet -non-protein calories
-permanent -lack of vitamins and minerals
-heart failure -production of excess carbon dioxide
-possible paralysis
-potential wide-spread 13-
1-A
6-21 2-B
-calcium
-iron
-patient's recovery
-oxygen
-intensive care
-muscle strength
7-1-B 2-A
3-C 4-A
881
April 2015 Listening (A) You get an excess of iron in the body
2-(9) He's 31 turning 32 Iron can accumulate in certain soft tissues
-teacher/ now being a father staying at home causing damage
-Has twins Accumulated tissues are mainly ( liver, lung
They are over two years old and some of the endocrinal organs
-from England
In Australia for 8 to 9 years/ back to 6-a-(5) test family members early / first
England for a year degree relatives (brothers, sisters)
-majority of family in England (parents and Even check uncles as they might get the
brothers) disease
-uncle in Australia Prevent organ damage
-this uncle has haemochromatosis. Prevent iron from building up
The best time to diagnose is between 18 and
3-(9) no known medical history 30
-not been in hospital before b-(7) blood tests for family members
-no operations test iron levels, few different iron tests
-no regular medications test stores of iron to know how much of iron
-no OTC on regular basis is there
-no vitamins/ no Chinese herbs/ no herbal then genes test to see if you get defective
medicine gene around the body
-no allergies people who get symptoms inherited two of
-not see a doctor often the abnormal genes
-never been a smoker some people have only one gene who have
-drinking a little alcohol no symptoms only carriers, but can pass it to
-feel quite well/ do organized physical children
exercises/ running around. collect these blood tests to know if you have
the disease or only a carrier or not have it at
4-a-(7) uncle is 62 now (2 years younger all.
than his mother)
-he was quite advanced/ not found out by 7-a-(5) Treatment:
regular check-up -donating blood if catch early/ blood out
-not think he only has symptoms/ not talk to -taken once a week
him directly -monitor iron levels on regular basis till iron
-firstly he had blood platelet once a week / stores are under control
found very high iron/ now it's under control -one unit of blood 30 m.
-suffers from arthritis -because of excessive iron he won't feel any
Active/ play tennis regularly- difference
But feel a little discomfort
b-(2) everyone else is clear (this uncle is b-(9) Problems:
mother-side -can get problems from blood accumulation
also, one aunt from mother-side -heart and liver problems
5-(7) it's an inherited condition -can cause diabetes
Passed by genes through families -joint pain , arthritis like his uncle
From a gene that doesn't work properly -get tired/ lethargic
It causes an excess of iron to be absorbed -thyroid glands
from the gut -can cause skin pigment change/ darker
-affect life expectancy
-not expected to cause complete organ
damage for someone his age
882
8-(2) if have the gene check his partner 6-1990s -For teens/ adolescents
-check children/ hypothetical only if he has -The benefits -Getting younger
the disease -6-month-old -Significant
9-(4) unlikely to have symptoms now/ only -GP -Audiologist
if have too much iron -A mild -Moderate
-organs affected only if untreated for long -Fitting -Updating
time -Severe -profound
Feel tired/ lethargic
-joint pain 7- older children with significant hearing
-may be knee problems/ however it can be loss
caused by other things other than -kids with genetic causes (mutation of
haemochromatosis connexin 26)
-premature babies
10-(2) if he get both genes and iron studies -meningitis
are abnormal then he has the disease -kids nausty syndrome
-other complications like heart or liver can
be prevented by taking out blood 8-TYPE 1:
-keeping blood testing -locomotive
11-(3) first get these blood tests today -pre audio- logy
-booking appointment in three weeks -increasing loudness
-bring his partner to explain her the -placing a ball, an egg, a puzzle
condition.
4.2015 Listening (B) TYPE2:
2-its microphone -speech -Cognitive -Disabilities
-a cable -externally on the scalp -Steady state -Loudness
-a magnet-bodily (on the body) -Frequency -Sedated
Their clothes- -22 - 20 -By electric activity
-Round window -The forehead -The ears
-Contour of the cochlear
(surgical procedures) 9-1-of deafness
-1.5 terms of their cochlear -good outcomes
-before going deaf
3-the sound -progressive
-Hair cell death -Electrodes 2-implant
-Auditory brainstem -The brain -the earlier, the better
-children under four
4-1-A 2-B 3-C Two implants
-perception
5-A-1-significant guidance of speech Localization
perception Coming from
2-gain awareness of environmental sounds
(safety issues) 10-1-being auditory verbal
3-better access to employment (social -Duration and device use
occasions) -cognitive delay
B- surgical risks(risk of infection) -home and school environment
Small risks of meningitis- / normal schools
-risk of anesthetic 2- homeland, normal schools rather than
Some develop tinnitus- signing schools
Minority not get benefit of perception 11-1-A 2-B
883
May 2015 Listening A 5-(6) also called a cap like a jacket that
2-a (4) accident in 2010, 4 years ago fits up over to reduce the seized tooth
Now she is 11/ she was 7 then Used for teeth that can't be restored by
She was piggy packing her younger any other means
sister If the tooth is dead, you can't put the
It's not a good thing teeth are not crown as it will get drier and fractured
designed to do that Put a post on the root canal and then
b-(8) her mouth was all sore build a crown
Had a lot of swelling Reluctant for young people to do crowns
She was very distressed, it was very Coz they are destructive, you need to
difficult remove a lot of healthy substances form
2 lower front teeth broken the tooth.
1 upper front tooth broken
The next day had an x-ray 6-(14) 2 lower incisors affected
The other front tooth hammered up into 1 upper incisor which was broken and
gums the one hammered up to gums
It was the same day , went to emergency The 2 lowers have fractures
dental clinic They are kept very well
The next day went to normal local dental Both stayed vital and alive
clinic and saw a pediatric dentist Long term prospect
A lot of appointments
7-(6) appearance is fine
3-(6) it settled itself down Remained alive
It took sometime for gums and teeth It's crowned at the bottom
More than on weekly basis to check Not coming off/ satisfactory
gums Tooth remain healthy
Her lips and everything was swollen Let it be and replace at a late stage
Only have soup for two weeks
They checked her immunization, 8-(7) the 3 teeth talked about are going
especially tetanus well/ satisfactory
The remaining tooth hammered up was
4-(5) in first days no complaint of cold x-rayed
things Do orthodontic treatment / took so long
Mom was more upset than her Months or a year
She said it was just a tooth not he whole Constructed on a brace to put pressure
body on tooth
Not give reaction to cold, but the dentist On monthly basis till it comes down
not put something protective over her Endodontist said it was doing fine, pulp
teeth was doing well
They tested with cold ice each time, the But subsequently it was not alive
top one was slow to react She had gingivitis
The doctor worried about it but Given mouth wash to keep it clean
eventually it wasn't slow There was infection beside the tooth
The other two bottoms were fine There was infection beside the tooth
884
9-(5) structure not connected directly to 4-1- 2005 -100 -50
bone 2- 17,000 -60,000 -20
They're in a sling of fibers which 3-9th
supplies blood to teeth 5-the breakthrough of the year
Fibers run between bone and teeth root 1-an adult, skin or hair
If tooth removed drastically, fibers erupt 3-a stem cell
Tooth will be dead The back of the eye
Coz of loss of fiber , tooth will be fixed Sample
to bones as there is no space
6-1- eye conditions
10-(7) tooth will definitely die Therapeutic
No long term prospects for that tooth Correct
solution must be transplant Reimplant
transplant from one tooth at the back
come to the front 2- enlarged animal
worry it would look different, but
informed it would look the same 7-clear window
they have two teeth as options Thickness
if one tooth not taken for transplant 469
the other tooth will be taken Mutations
Minor trauma
11-(2) look at her routinely , every 6 Soccer ball
months Rugby ball
It's been handled conservatively
8- 1- A 2-B
5.2015 Listening B 3-C 4-B
2- human genome
Different 9- 1- FIFTEEN- 12
Healthy eyes 2- medication- toxins
The technological 3-serious- severe
Glass-slide 4-investigation- diagnosis
60 5-tissues-arteies
Far-ends
Cohort size 10-elderly
Life expectancy
3-centeral Genetic
Reading The quality of DNA
People aged Same patients
Focused Large cohort
An electrical signal Their archived
Optic nerve
Processing 11-1-c 2-b
885
JUNE 2015-0208 Listening A cardiologist advice
2-(8) she was 6/ now she is 23 No allergies to any other medications
-parents tried to explain transposition of 6-(6) not replaced since 1991
great vessels It is a backup/ when tested not used a lot
-told she was out of breath/ would make Not used very often / batteries last longer
operations to keep up with other kids Under her ribs
-remember nurses and play room In abdomen/ not feel it/ not cause any
-difficult to walk after surgery problems
-not remember wasn't able to keep up with A wire goes from pacemaker to outside of
other kids the heart
-lips and finger nails turning blue
-basically when running so much 7-(8) echo once a year or every 6 months
To monitor a leaking valve/ make sure not
3-(9) no other surgeries getting worse, but seems consistent
-not start doing so much Not remember which valve is leaking
Then do ballet dancing Difficult to remember which valve coz both
Then some more dancing/ consistently by sides of the heart became back to front
getting older Keep on checking is very important in the
Fit in teenage long term
5 hours of dancing a week/ quite tiring Check pace maker coz batteries will run
Not as much when at school/ busy down
Now not as fit as she likes to be Batteries need replacement
Still takes classes/ walking regularly Very minor procedure/ done under general
No symptoms/ no shortness of breath anesthesia
Short of breath after walking up a hill, but Short operation, cutover , take it down and
not concerning replace it
The same fitness of girls her age
8- A-(8) not expecting heart problems/
4-a-(10) no other health problems stable
No coughs/ no symptoms Pacemaker not a problem
No wheezing / no asthma Electronic security gate recognize it at
No problem with urinary bladder airport as it is made of metal so alarm goes
Bowels are ok off
No nausea, no vomiting/ good appetite Carry pacemaker ID card
Headaches from now and then due to stress Tell them where to check it and they scan it
No smoking with a hand-help device
Alcoholic once a week/ 3 to 4 drinks Sometimes gates are not sensitive
No recreational drugs If forget and passed not worry
b-(6) No chest pain Security gates not affecting pacemaker
No palpations B-(3) oxygen on plane is pressurized, but
No blackouts/ no dizzy spells not to zero when 30,000 feet
No swollen up ankle people with severe heart or lung diseases
Notice bruising quite easily can have low o2 in blood
No family history of heart problems not worry/ she exercises, not blue so no
No congenital heart problems problems
5-(5) lisinopril once a day C-(9) not need to tell airlines about it , not
Aspirin once a week an issue
Not remember lisinopril dose Coz of complications as traveling overseas,
Not frequently aspirin/ got dizzy/ based on
886
will have a letter
Explaining you have a pacemaker, 4-3 times
medications and contacts -Women who haven't had a baby
Some people are funny if you carry -Gentle
medications thinking you take it for -The initial inflammatory responses settled
someone overseas -Sprained ankle or any other soft tissue --
A letter will be written with phone numbers injury
Tell travel insurance about pre-existing -Ice and some sort of strapping
medical conditions -Overused -Rest -Ice
Adjust it to cover you -Compression -Elevation -At rest
Need to carry signed prescriptions and -Gravity, sitting and standing
letters -Not to do too much in these early weeks
887
July 2015 Listening A 7-(5) returned a couple of years ago.
2-(5) Peter Baker -have it monitored and PET scan
-68 years old/ retired now -preferred to monitor every 4 months
-was an engineer / steel work -for 3 years now/ nothing flared up
-retired 10 years ago -so develop check up to every 6 months
-not much medical conditions at present -only these surgeries in life
-high blood pressure
8-(5) BP about 20 years
3-(7) had childhood problems, but can't -managed by Coversyl
remember -4/5 mg once a day
-was a normal child / not significant -under control now
-at 21 had a car accident/ broke a femur -check every 6 months
-put a metal nail in thigh -seen by GP
-very big accident
-2 operations at leg 9-(7) blood tests occasionally when required
-fractured skull for couples of days by a GP
-now normal nothing affected -cholestorel tested regularly/ low / doctor
happy
4-(5) at 35 had laparoscopy -no anemia
-remove gall bladder -urine tests/ no diabetes
-a bit messy using silicon tubes instead of Prostate blood tests/ PSA normal
rubber -get no symptoms
-got pretty sick for long/ not expected Gets up only once at night/ not serious
-was OK since then
-no long-term effects 10-(9) aspirin 100 mg a day
-no OTC
5-(9) at 60 melanoma removal No natural supplements
-from back -no vitamins
-8 years ago No recreational drugs/ no illicit drugs
-wife noticed small spot at the back -no allergies
-see local GP Non-smoker now/ only for a couple of years
-at first not think it's serious at 20s
Biopsy taken -drink alcohol socially
-discover melanoma then Couple of glasses on weekends
-hospital admission Red wine/ beer / 3 to 4 glasses at most
Radiotherapy was not needed -some days not drink at all
-regular monitoring
11-(9) no running diseases in family
6-(7) at 65 returned back -4 brothers and sisters / all alive and well
-lump at a scar tissue Mom and dad passed away
-remove it again/ took a large piece -dad died at 30 due to angina
-no radiotherapy for a couple of reasons -heart attack mainly
-keeping in reserve in case of recurrence - no other family members with the same
--very large area so had to radiate the arm problem
and lymph glands as well -dad was a smoker/ pipe
-so only the surgery and recurrence once -mom died at 73 of emphysema
only -she was a smoker too
888
12-(9) do a lot of baby-sitting 5- 1- reduced radiation exposure
-golf a couple of times a week 3D imaging
-regular swimming / twice a week
-lap swimming / good for cardio-vascular 2-less shaking
system Better cooling system
-baby-sitting for daughters' kids
-golf mainly couple of times a week , but 3-autoclaves are used
not regularly Personal protection gear is worn
- member at Rotary/ meetings once a week
-have good social network 6-revolutionary
-wife to look after him if things go wrong -1940s
Low-decay
13-(3) BP check-up Mottled
-listen to heart and lungs Naturally occurring
-make sure they're going well
-appointment to discuss findings 7-Australia
Mass medication
7.2015 Listening B Infringement of liberties
2- 1- smells and sights Hip fractures
2-standing up and sitting down Water-pipes / burst
3-communication
8-1- societal/ dietary
3-caries / decays 2-330ml /375ml
-periodontal disease /gum 3-profitable/ palatable
-3 or 4 years old 4-performance/ rehydration
-pain 5-attack/ dissolve
-distressed
-permanent teeth 9- 1-eneormous pressure
-drift Constant abrasion
--edentulous /have no teeth and wear Wet, warm environment
dentures
10-functionally
4- -bleeding gums -esthetically
Halitosis / bad breath -standard of living
Loose teeth Expectation by parents
Types of brush Simpler
Action of brushing -quicker
How often
Diet 11- 1- bone grafting
Dental floss 2-amount/health /bone
3-correction of jaw abnormalities
4-root filling of teeth/ success rate
Operating microscopes
889
August Listening A 6-(9) dull pain with heat
Muscle damage
2-a-(6) 33 years old Right shoulder painful
-in good health Wrist hurt when picking up coffee/ shower
-83-85 kilograms Right wrist and shoulder
-cholesterol low no cuts nor bruises
-blood pressure low/fine limited movement for wrist and shoulder
-no medications strength is impacted cause of pain and
-no allergies muscles are weaker
pins and needles in upper right shoulder
B-(3) regular biking/100-150km a day no other aches or pains/ head, neck and knee
-no smoking are fine
Not too much alcohol
/ New Zealand white 7-(6) a lot of pain more than a normal sprain
-3/4 a week( Friday- Sunday) Doing further investigations
x-ray for wrist
3-(5) no diabetes shoulder may have a damage to rotator calf
-not heart attacks not being able to raise it so need for
-mother heavy smoker ultrasound
-father had a pace maker for 30 years find out possibility of a tear
-no heart attack for father , lived till 83 need to see a specialist if tissue not repaired
quickly/ need for surgery
4-a-(6) several years of health crisis
-giardia 8-(7) firstly rest shoulder
-malaria Apply ice for 24-48 hours
Amebic dysentery Help swelling and pain
Infection caused weight lose to 65 kg Ice application by pressing against the skin/
Diarrhea constantly not direct to avoid skin burning
Sling helpful to support shoulders for 2 days
b-(3) go to local embassy for pain
500mg of anti-malaria/ chloroquine If managed OK, move it a little to avoid
Various shots of anti-viruses tightness
Pretty minimal medical care See a chemist to get support for wrist
-since then about 20 years in Australia Painful at 1st couple of days till becoming
seems fine better
5-(6) recently went over the top of a friend 9-a-(4) duration of healing depend on x-ray
biking with If fractured plaster is needed
Smashing himself on asphalt Take up to 6 weeks
Shoulder hurt If simple sprain recover in two weeks
No need to call ambulance or hospital
They laughed about it/ went to coffee shop B- (5)1st couple of days painful
When went home pain was more than After 2-3 days physiotherapy will be helpful
normal Teach about stretches and massage
Pain started immediately after having Regain ranger of movement
coffee/ adrenaline went down Alleviate symptoms of pain
Not able to use right hand
The finger and wrist weak
890
10-(7) analgesia is important 4-blood loss
Panadeine forte is a strong pain medication Intravenous access
Paracetamol and panadol are safer Third space
Codeine can affect thinking / cause Fasting
drowsiness Blood pressure
Start with panadeine or panadeine extra Obstructive shock
Anti-inflammatory medication is also
important/ Ibuprofine 5-disability
Safe as Panadol but different so can be used -medical record
in conjunction Confused
May cause reflux or stomach acidity In hospital
Taken with food three times a day Cause to problem
Treat it
11-(7) work in an office/ sedentary
A lot of computer work 6-1-orthopedic
Worry about taking notes or answering 2-pregnant
mails 3-chest issues
Better do dictating for the next couple of Lactate issues
weeks
Continue to work but not using right wrist 7-pain
or shoulder Asleep
Give him a medical certificate Fluid overload
Patient agreed Fluid balance
Drugs and doses and their indications
12-(4) take papers for x-rays, ultrasound and Good signal
medical certificate
-come back in a couple of days to see 8-try and isolate the problem
progress Manually bagging
Look at results of scans The machine
Follow-up with a specialist Sputum secretion
Metabolic disturbance
8.2015 Listening B
2- the electrical cord 9-accurate reading
-equipment On the floor
-adequate Tubing /Air-way device
ECG Out of battery/ Not plugged in anesthetic
Meaningful gas
Blood sugar
Wounds 10-time
Dressing -saturation
3-drowsy Manual ventilation with bag
-81 Mechanical ventilation
Dementia Reversal
Himself or staff Era-syringing
Eye opening High-spinal
Verbal response Respiratory effort
Motor response
90% 11-1-B 2-C
Oxygen till saturation come up to 99%
891
September 2015 Listening A 7-(7) going in November
2-(7) 24 years old -flying to Zambia
-lives in Colton -lives with two friends Go there in 2/3 weeks
-not married- no partner -no children – Then to South Africa
retailer -full-time job Volunteer work
Work in 2 places
3-(9) first got it 2004 HIV clinics and an orphanage
-since then had it on and off Visiting some friends in South Africa
-last year specially had it every couple of In Cape town for 5 weeks
months
-quite severe since 2004 8-(7) recurrent tonsillitis/ immune system
-bad fever -swollen neck -went to hospital and respiratory tract are prone
Generally feeling unwell Most episodes due to viruses
-in hospital for 2 days -needed IV antibiotic Mostly due to a bacteria called streptococci
-not told bacterial or viral infection Respond to antibiotic
A course given to eradicate/ reduce future
4-(4) pretty much recovered after that risks
-got it again 3 months later/ mild Recurrent episodes: surgery, tonsillectomy
-then have it after 6 months to reduce the risks
- a year ago had it every few months or But still can get infection
every couple of weeks Refer to ENT surgeon to discuss risks and
-no review to look for bacteria/ no swap benefits of surgery
done
9-(5) hepatitis B/A
5-(7) first time was the worst Typhoid fever
-old GP gave her permanent prescription of Update routine vaccines: measles , rubella
Amoxicillin Tetanus poster shot
-majority of symptoms got better but not all rabies
-get it whenever have symptoms
-clear up within couple of days 10-(3) can get them all here or referred to a
-see a surgeon for the side effects travel medical clinic
-make her sick, nauseous -can get them all at once
-stomach pain -got back only for hepatitis A as it needs a
poster after 6 months
6-a-(4) MEDICAL PROBLEMS:
-pretty good 11-(7+6) Zambia is a malaria-endemic area
-no significant medical history -need to take malaria prophylaxes
Thalassemia/ no transfusion -in tablet form
-no major infections -taken in few days before going
b-(7) Medications: -3 different drugs recommended
Only antibiotics -doxycyclin antibiotic/ the cheapest, may
No regular medications cause rash or photo-sensitivity
No allergies -if exposed to sun can get sunburned easily
OTC: multivitamins -try melfoquine
Not regular smoker only with drinking if previous problem with antibiotic, will
Drinking once on weekends cause stomach upset
2 cigarettes a week Abit more expensive
Rarely smoke marijuana, but no other illicit Smaller risk of causing psychosis
drugs
892
Malarone (combination of two anti-malaria 5-1- flow cytometry
drugs) -morphology tests
Very well-tolerated 2- renal function -hepatitis B -HIV test
Rare side effects, but the most expensive
12-(5) write a referral to ENT 6-type of leukaemia
-get an appointment by next month -age of the patient
Scheduled to see her before going to check -general health of the patient
everything is right -8 months/ sometimes years
Organize vaccines Chemotherapy
Can arrange appointment at travel health -immunotherapy
center to ask any questions. -radiotherapy
-bone marrow transplant
9.2015 Listening B -induction
-destroy leukaemic cells/ induce remission
2-the bone marrow -prevent from returning or relapsing
-accumulation of abnormal white cells -maintenance
-blood
-needs urgent treatment 7- 1- chemotherapy -radiotherapy
-chronic 2-for neutropenia to stimulate white cell
-may not need treatment for sometime production and monitoring of temperature
-3100/ 8 people per day 3-nausea or vomiting
-21% increase 4-infertility -lethargic and malaise
-childhood cancer 5-50% -67% -38%
-adults
Over 50 years of age 8-cells -nodes -tissues
-35 different -B or T cell
3-genetic -5500 -12 people -90%
-exposure to intense radiation -generally unknown
-chemicals: benzin -western lifestyle
-viruses : HTLV -viruses -HTLV -bacteria
-Severe immune deficiency -HIV
4-LOW HEMOGLOBINE
-pallor -lethargy -dyspenia 9-1-weight loss
-night sweats -anorexia
-fevers 2- painless and rubbery
-malaise 3-skin involvement
-recurrent infections -testicular swelling
-eye involvement
-low platelets -stomach involvement
-continuous bruises -central nervous system symptoms
-purpra
-bleeding gums 10-1- Histological examination of an
excised lymphnodes
-organ infiltration 2- bone marrow biobsy
-liver -CAT scan of neck, chest, abdomine..
Spleen -PET scanning
-lymph nodes -other blood tests
Brain/ skin 11-1- B, 2-B , 3-A , 4-A
893