OETリスニング練習模試 4

Practice Test

Dictation Practice

Part A Extract 1

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Patient:	Hello, Doctor.
Doctor:	Yes, Miss Elissa. What’s your problem?
Patient:	I’m getting acne from continually washing the area around my , and the condition is still worsening.
Doctor:	What’s your age?
Patient:	.
Doctor:	How old were you when ?
Patient:	Well, it was when I was .
Doctor:	And can you describe the ?
Patient:	, and it lasts for almost six days.
Doctor:	Would you describe the flow as light or thick?
Patient:	Mmm. It’s light.
Doctor:	Do you use any medication?
Patient:	Yeah, I take the .
Doctor:	Are you allergic to any drugs?
Patient:	Yes. . I feel difficulty in breathing.
Doctor:	What are the medicines you are taking?
Patient:	Alesse-28, 20 mcg, 0.10 milligram tablet.
Doctor:	Is anyone in your family ?
Patient:	Yeah, my mom has .
Doctor:	Do you smoke or drink?
Patient:	I don’t smoke, but I drink socially.
Doctor:	You drink caffeine?
Patient:	Yeah, four servings a day.
Doctor:	Mmm. Your diagnosis report shows you have symptoms of of face acne problems and allergies. In a diagnosis of apocrine and apocrine glands shows no evidence of hyperhidrosis, chromhidrosis, or bromhidrosis. But your face shows keratotic papules. I would suggest you go for antibiotic therapy. Take a tetracycline capsule. I would also suggest you take oral antibiotic therapy with doxycycline 100 milligrams a day.
Patient:	Doctor, why does the acne occur?
Doctor:	Acne is a skin condition that happens when your with oil in dead skin cells. It often results in blackheads or pimples, whiteheads, and often appears on the face, chest, forehead, chin, shoulders, and upper back and shoulders. (Most…) Acne is the most common among teenagers like you. The androgen hormones increase during puberty, causing the spacious glands to enlarge and secrete more sebum. Hormone changes during pregnancy and the use of also impact sebum secretion. Moreover, low amounts of androgens circulate in the blood can still worsen acne. Medications such as drugs containing corticosteroids, testosterone, or lithium worsens the disease.
Patient:	Which food should I avoid, Dr.?
Doctor:	Certain dietary factors, such as skim-milk in such as bagle, bread, and potato chips worsen acne.
Patient:	Can you recommend any effective foods for acne?
Doctor:	You must stop eating , and processed foods. And you should include foods that are rich of antioxidants, anti-inflammatory compounds, and other acne-fighting nutrients. Foods such as blueberry sweet potatoes, green tea, carrots, cilantro, spearmint, oats, apples, barley, and mustard greens.
Patient:	Okay. Thank you, Doctor.
Doctor:	Thank you.

Part A Extract 2

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Patient:	Good morning. I’ve got an appointment with Dr. Gonzalez at
Physician:	Okay, please be seated. Let me check with your record. In the meantime, please sign in and be seated. Margaret Nicholson?
Patient:	I’m here.
Physician:	, please. Here we are. What’s the reason for your visit today?
Patient:	Well, lately, I’ve been feeling really tired, and often I get frequent . Moreover, I’ve been getting a for like the last three weeks.
Physician:	When did these symptoms start?
Patient:	I started feeling tired all the time about two months ago. Then a few days after that, the headaches started. I got the upset stomach .
Physician:	Are you taking any medications?
Patient:	Only vitamins.
Physician:	What vitamins are you taking?
Patient:	I am taking vitamin C and a daily.
Physician:	Okay, let me examine your vital signs.
Patient:	How am I doing?
Physician:	. No high temperature and your blood pressure is also normal. Please wait for a moment here.
Patient:	Thank you, Doctor.
Physician:	I see here that you have started feeling tiredness two months ago and then frequent headaches. You’re also suffering with an upset stomach and a persistent cough. Did you ?
Patient:	No, doctor.
Physician:	Let me perform a quick physical checkup. Take a deep breath. for a moment and exhale. Repeat this again. Have there been any changes in your diet or your weight recently?
Patient:	My diet is the same as usual. However, I lost £5 very recently.
Physician:	Did you ever ?
Patient:	Well, it is pretty hard for me to fall asleep. I also wake up often during the night.
Physician:	Do you drink or smoke?
Patient:	No, Doctor. Well, recently the ownership has changed and I had to work a lot of , even during the weekends.
Physician:	I think you’re suffering from pneumonia. Other than that, I do not see any of the problem. The reason could be probably the stress that causes headaches, upset stomach, and sleeplessness. For now, try to relax yourself and start doing exercises. Meet me again after you receive all the medical diagnosis reports. I’m going to prescribe medicines for . Are you allergic to any medicine?
Patient:	Not to my knowledge.
Physician:	I want you to do a to identify the bacteria Streptococcus pneumoniae and Legionella pneumophila.
Patient:	Is it something serious, doctor?
Physician:	Not at all. I doubt that could be bacterial pneumonia. Take Levofloxacin milligrams orally every .
Patient:	I want to know my cholesterol level. When will I get the medical reports, Doctor?
Physician:	You’ll get the medical results . Don’t stress yourself. Everything will be okay.
Patient:	Can pneumonia be prevented, Doctor?
Physician:	In most of the cases, pneumonia can be prevented. You could have a vaccine to defend against pneumonia once you get all these medical investigation reports. I would suggest prevnar 13 pneumonia vaccine that is very effective against l pneumonia.
Patient:	What food should I include in my diet, Dr.?
Physician:	I have plenty of fruit juice and fresh fruits, yogurts, milkshakes, smoothies. Eat plenty of full cream, milk or yogurt, or even ice cream with , fish or eggs, and cooked vegetables.
Patient:	Thank you, Doctor.
Physician:	You are welcome.

Transcript

Part A Extract 1

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Patient	: Hello, Doctor.
Doctor	: Yes, Miss Elissa. What’s your problem?
Patient	: I’m getting acne from continually washing the area around my chin, right temple and left temple, and the condition is still worsening.
Doctor	: What’s your age?
Patient	: 19.
Doctor	: How old were you when you started your period?
Patient	: Well, it was when I was 13.
Doctor	: And can you describe the length of your cycle?
Patient	: Once in 24 days, and it lasts for almost six days.
Doctor	: Would you describe the flow as light or thick?
Patient	: Mmm. It’s light.
Doctor	: Do you use any medication?
Patient	: Yeah, I take the oral contraceptive pill.
Doctor	: Are you allergic to any drugs?
Patient	: Yes. Allergic to penicillin. I feel difficulty in breathing.
Doctor	: What are the medicines you are taking?
Patient	: Alesse-28, 20 mcg, 0.10 milligram tablet.
Doctor	: Is anyone in your family prone to any disease?
Patient	: Yeah, my mom has stress disorder and anxiety.
Doctor	: Do you smoke or drink?
Patient	: I don’t smoke, but I drink socially.
Doctor	: You drink caffeine?
Patient	: Yeah, four servings a day.
Doctor	: Mmm. Your diagnosis report shows you have symptoms of periodic reddening of face acne problems and allergies. In a diagnosis of apocrine and apocrine glands shows no evidence of hyperhidrosis, chromhidrosis or bromhidrosis. But your face shows keratotic papules. I would suggest you go for antibiotic therapy. Take a tetracycline 250 milligram capsule. I would also suggest you take oral antibiotic therapy with doxycycline 100 milligrams a day.
Patient	: Doctor, why does the acne occur?
Doctor	: Acne is a skin condition that happens when your hair follicles become clogged with oil in dead skin cells. It often results in black heads or pimples, whiteheads and often appears on the face, chest, forehead, chin, shoulders and upper back and shoulders. (Most…) Acne is the most common among teenagers like you. The androgen hormones increase during puberty, causing the spacious glands to enlarge and secrete more sebum. Hormone changes during pregnancy and the use of oral contraceptives also impact sebum secretion. Moreover, low amounts of androgens circulate in the blood can still worsen acne. Medications such as drugs containing corticosteroids, testosterone or lithium worsens the disease.
Patient	: Which food should I avoid, Dr.?
Doctor	: Certain dietary factors, such as skim-milk in carbohydrate rich foods such as bagle, bread, and potato chips worsen acne.
Patient	: Can you recommend any effective foods for acne?
Doctor	: You must stop eating processed sugar, caffeine, dairy products and processed foods. And you should include foods that are rich of antioxidants, anti-inflammatory compounds, and other acne fighting nutrients. Foods such as blueberry sweet potatoes, green tea, carrots, cilantro, spearmint, oats, apples, barley and mustard greens.
Patient	: Okay. Thank you, Doctor.
Doctor	: Thank you.

Part A Extract 2

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Patient	: Good morning. I’ve got an appointment with Dr. Gonzalez at 8:30
Physician	: Okay, please be seated. Let me check with your record. In the meantime, please sign in and be seated. Margaret Nicholson?
Patient	: I’m here.
Physician	: Follow me to room number three, please. Here we are. What’s the reason for your visit today?
Patient	: Well, lately, I’ve been feeling really tired and often I get frequent headaches and an upset stomach. Moreover, I’ve been getting a persistent cough for like the last three weeks.
Physician	: When did these symptoms start?
Patient	: I started feeling tired all the time about two months ago. Then a few days after that, the headaches started. I got the upset stomach long before feeling the tiredness.
Physician	: Are you taking any medications?
Patient	: Only vitamins.
Physician	: What vitamins are you taking?
Patient	: I am taking vitamin C and a multivitamin tablet daily.
Physician	: Okay, let me examine your vital signs.
Patient	: How am I doing?
Physician	: Everything is normal. No high temperature and your blood pressure is also normal. Please wait for a moment here.
Patient	: Thank you, Doctor.
Physician	: I see here that you have started feeling tiredness two months ago and then frequent headaches. You’re also suffering with an upset stomach and a persistent cough. Did you run a fever as well?
Patient	: No, doctor.
Physician	: Let me perform a quick physical checkup. Take a deep breath. Hold your breath for a moment and exhale. Repeat this again. Have there been any changes in your diet or your weight recently?
Patient	: My diet is the same as usual. However, I lost £5 very recently.
Physician	: Did you ever suffer from insomnia?
Patient	: Well, it is pretty hard for me to fall asleep. I also wake up often during the night.
Physician	: Do you drink or smoke?
Patient	: No, Doctor. Well, recently the ownership has changed and I had to work a lot of overtime at late hours, even during the weekends.
Physician	: I think you’re suffering from pneumonia. Other than that, I do not see any of the problem. The reason could be probably the stress at your workplace that causes headaches, upset stomach, and sleeplessness. For now, try to relax yourself and start doing exercises. Meet me again after you receive all the medical diagnosis reports. I’m going to prescribe medicines for bacterial pneumonia. Are you allergic to any medicine?
Patient	: Not to my knowledge.
Physician	: I want you to do a blood test and urine test to identify the bacteria Streptococcus pneumoniae and Legionella pneumophila.
Patient	: Is it something serious, doctor?
Physician	: Not at all. I doubt that could be bacterial pneumonia. Take Levofloxacin 750 milligrams orally every 24 hours for 7 to 14 days.
Patient	: I want to know my cholesterol level. When will I get the medical reports, Doctor?
Physician	: You’ll get the medical results in two weeks. Don’t stress yourself. Everything will be okay.
Patient	: Can pneumonia be prevented, Doctor?
Physician	: In most of the cases, pneumonia can be prevented. You could have a vaccine to defend against pneumonia once you get all these medical investigation reports. I would suggest prevnar 13 pneumonia vaccine that is very effective against 13 types of bacterial pneumonia.
Patient	: What food should I include in my diet, Dr.?
Physician	: I have plenty of fruit juice and fresh fruits, yogurts, milkshakes, smoothies. Eat plenty of full cream, milk or yogurt or even ice cream with light meals of lean meat, fish or eggs and cooked vegetables.
Patient	: Thank you, Doctor.
Physician	: You are welcome.

Part B Q25

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Dr	: Skin cancers are caused by the abnormal cells that are capable enough to invade and spread to other parts of the body. Generally, skin cancers are classified as melanoma or non-melanoma skin cancers, such as basal cell carcinoma and squamous cell carcinoma, in addition to less common types of tumors, such as merkel cell carcinoma, lymphomas, kaposi sarcoma, or hair and sweat gland tumors.
	Skin cancer symptoms include alterations in the appearance of a mole or spot on the skin or the development of a new spot or lump on the skin. It may also cause symptoms in signs such as itching, skin alterations, scaling, swelling or bleeding, etc.

Part B Q26

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Dr	Depression is a sickness involving the body, thoughts, and mood that severely impacts the way a person sleeps, eats, behaves and the way one feels about one’s self.
	Depressive disorders are categorized by pervasive mood swings that severely affect all aspects of an individual’s daily activities. A depressive disorder is not just a mood swing, but it is more of a case of persistent sadness.
	Certain symptoms of depression include feelings of worthlessness, helplessness, hopelessness, guilty feeling, lack of interest, irritability, loss of appetite, loss of energy, self loathing, sleep disorders, etc.

Part B Q27

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Nurse	: Doctor, should frailty be considered before any operation in an older person?
Dr	: Frailty is not just a phrase, but a health metric that should be performed before the surgery to any older person. I think the frailty scores a very good concept. It may dictate the objective of the surgery.
	The frailty score concept relates to the inexorable decline of physiological reserves that is a normal consequence of the aging process. We must consider that a healthy 60-year-old will not be as fit as a healthy 40-year-old individual. When faced with the necessity to have surgery, the frailty concept really is more objective.
	Frailty can be simply evaluated with a walking test, such as a very slow walk speed or an inability to walk very far giving a good approximation. Both patients and loved ones should consider the consequences of surgery before the procedure begins, especially in the frail.

Part B Q28

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Nurse	: Doctor, would you please explain to me the severity of epidermolysis bullosa in children?
Dr	: Well, epidermolysis bullosa is a rare genetic condition in children. The genes that cause epidermolysis bullosa may be presented in other family members as well. There are four major categories of epidermolysis bullosa.
	In the case of epidermis bullosa simplex, there will be blistering, mainly on the hands and feet with little scarring or without scarring it all. When it becomes severe, the patient will have more widespread blistering and other severe medical conditions like blistering in the mouth and digestive track.
	In the patients with milder junctional epidermolysis bullosa, there will be limited blistering that often improves with age. Patients may also have hair loss and abnormal fingernails and toenails. Children are prone to have growth and malnutrition issues. In the scarring type of dystrophic epidermolysis bullosa, especially mild cases, the blistering is primarily found on elbows, feet, and hands.
	When the disease becomes severe, there is a higher risk of developing skin cancer as the patient gets older. In the case of kindler syndrome, the patients have an increased sensitivity to sunlight, in addition to blistering.

Part B Q29

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Dr	: Clonus is a neurological condition that has suffered when the controlling nerves of the muscles are damaged, causing involuntary muscle contractions. Often clonus spasms occur in a rhythmic pattern.
	Symptoms are very common in a few muscles such as knees, ankles, wrists, calves, jaw, biceps. Damaged nerves result in misfire leading to muscle tightness involuntary contractions in pain. Clonus causes a muscle pulse for an extended period that can result in muscle fatigue.

Part B Q30

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Nurse	: Doctor, I feel that a solution should be devised to cope with delirium in patients in ICU. What do you think?
Dr:	: Haloperidol has been used for a long time in patients in ICU in an attempt to prevent delirium; A very severe and sometimes persistent acute confusion. According to a recent study, Haloperidol is ineffective.
	Delirium is extremely prominent since it’s strongly associated with cognitive impairments for a long term. Significantly, medications are the means that patients approach often.
	However, unfortunately, it’s demonstrated that medications aren’t the right approach always, or at least the haloperidol. Nevertheless, for delirium, there’s not going to be a miracle in terms of medications.

Part C Extra 1

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Doctor	: The presence of Microalbuminuria is the early clinical evidence of diabetic neuropathy, defined as the appearance of low but abnormal levels of albumin in the urine. The characteristics of diabetic neuropathy are a decline in glomerular filtration ratio, progressive increase in proteinuria, hypertension, and a high risk of cardiovascular morbidity. Therefore, the evidence of microalbuminuria should trigger diagnosis for possible vascular diseases in aggressive intervention to cope with all cardiovascular risk factors in diabetics Type1 and 2.
	The natural history of diabetic neuropathy progresses slowly over the years. In Type1 diabetes, microalbuminuria occurs after five years and the end stage renal disease develops in 50% of Type1 diabetics. Whereas type2 diabetics has a more variable course, very few patients with microalbuminuria progress to advance renal disease without intervention. Approximately 20% of patients of Type2 diabetes develop an end stage renal disease. However, due to the increased number of Type2 diabetes patients compared to Type1 diabetes, the maximum number of patients on dialysis are type2 diabetics.
	There are many factors which account for the pathophysiology of diabetic neuropathy, primarily anatomical and structure changes in the kidney result in increased glomerular capillary pressure in diabetes, which is associated with hyper filtration at the glomerulus.
	The next factor is the glucose that can increase the formation of advanced glucose elation, end products by inverseably binding to proteins in kidneys and circulation. Over the years, these formed advanced glycosylation in products which stimulate the growth in fibrotic factors contributing to overall renal damage.
	Thirdly, angiotensin2 contributes to the advancement of diabetic neuropathy by narrowing the efferent arterioles in the glomerulus, subsequently resulting in higher glomerular capillary pressure while diagnosing diabetic neuropathy.
	Early investigation of glucose intolerance and diabetes to distinguish patients who are at risk for developing microalbuminuria is suggested, especially if they have other risks for Type2 diabetes, such as lipid central obesity, abnormalities or hypertension.
	Therefore, the investigation of microalbuminuria presence should be performed at diagnosis in patients with Type2 diabetes, whereas in patients with Type1 diabetes. Since microalbuminuria rarely occurs with short term Type1 diabetes. The diagnosis should begin after five years of disease. According to the findings, the microvascular complications develop during the pre puberty period of diabetes. Therefore, clinical judgment should be demonstrated when individualizing these suggestions.
	The object of diabetic neuropathy therapy involves multi clinical approaches. Tight glycemic control is the keystone in the prevention and management of diabetic neuropathy. The United Kingdom prospective diabetes study and diabetes control and complications trial have established that an intensive diabetes therapy (can consider…) can considerably decrease the risk of microalbuminuria in neuropathy development. Nonetheless, blood pressure control is another keystone, and prevention and treatment in addition to glycemic control. The significance of blood pressure control, irrespective of what agent is used, cannot be emphasised enough in diabetes, both for slow progression of neuropathy and for preventing cardiovascular morbidity.
	According to the recent Joint National Committee guidelines, blood pressure and diabetics is reduced to less than 130 over 80 mmHG. It is very crucial for doctors and patients to understand early on the three or more agents. Angiotensin receptor blockers, or angiotensin converting inside inhibitors are considered first line agents in patients with co committing hypertension and diabetes. Diuretics might be added as a second line agent in many cases after angiotensin blockade in diabetes. Dihydropyridines, a class of calcium channel blockers, may be considered as the third or fourth line agents and diabetics only after initiation of angiotensin blockade and diuretics. There are also other non-pharmaceutical suggestions, such as dietary restriction of protein intake, restrictions of protein, 0.8 grams per kilogram weight per day in patients with over neuropathy or even 0.6 grams per kilogram weight per day recommended in the case of declining glomerular filtration ratio.
	Moreover, it is very essential to stick to a low sodium diet in diabetic neuropathy since many diabetics with renal disease are salt sensitive. Therefore, restricting salt intake will certainly help in reaching blood pressure goals. With secondary benefits of regression of left ventricle hypertrophy decreased stroke risk and reduction in proteinuria. It recommended a low sodium diet of 2.3 grams daily in patients with diabetes in either hypertension or proteinuria. Moreover, avoiding nephrotoxic agents such as radiocontrast media, non-steroidal anti inflammatory drugs is highly recommended. Last but not least, annual diagnosis of microalbuminuria in diabetics will allow the detection of neuropathy at an early stage, improve glycemic control and intensive anti hypertensive treatment will ultimately slow down the progression of diabetic neuropathy.

Part C Extra 2

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Doctor	: Thalassemia is a hereditary disease of the red blood cells called the erythrocytes. The disease is classified as hemoglobinopathy. The genetic disorder results in the composition of an abnormal hemoglobin molecule. The blood cells are prone to mechanical injury and die easily. Many patients with thalassemia require periodic blood transfusions for their survival.
	The thalassemias are classified based on the infection chain of the globin and molecule. The production of Alpha Globin is deficient in Alpha Globin Thalassemia, while Beta Globin is defective in Beta Thalassemia. Alpha thalassemias lead to excess gamma chains in newborns and excess beta chain production in adults. The excess beta chains produce unstable tetramers with abnormal oxygen dissociation curves.
	Alpha Globin has four genetic loci. The more of these loci are defective or affected by the mutation, the more serious the manifestation of disease will be. Missing one loci or abnormal gene makes your child a silent Alpha thalassemia carrier. Silent Alpha thalassemia carriers develop no symptoms or signs of the disease, however, are able to pass thalassemia onto their children.
	Missing two loci or mutated genes is a condition called Alpha thalassemia minor or having Alpha thalassemia trait. In this condition, the red blood cells may be smaller than normal, called microcytosis, and at times may have very mild anemia.
	The condition of missing three loci or mutated genes is called hemoglobin H disease. Symptoms and signs will be moderate to severe. In the case that all four loci are affected, the fetus cannot survive once outside the uterus, resulting in stillbirth with high dropped fatalities. Even if it is born alive, it will die shortly after birth.
	Beta thalassemia occurs when the gene that controls the secretion of beta globin is defective. Beta thalassemia can result in anemia ranging from mild to severe and it’s very common in people of African, South Asian and Mediterranean descent.
	Alpha globin along with Beta globin is one of the proteins that composes hemoglobin. Beta globin is made on chromosome 11. Beta thalassemia is classified into three major categories, depending on the number of mutated Beta globin genes in the intensity of the mutations. Beta thalassemia trait, or Beta thalassemia minor occurs when one of the Beta globin genes are mutated. Typically, patients with this condition have very mild signs and symptoms that don’t require any treatment. However, they can pass on thalassemia to their children. Usually the patients are mildly anemic, and their red blood cells are smaller than normal conditions called microcytosis.
	Beta thalassemia major occurs when both of the beta globin genes are altered and the mutations are severe. This is the most severe condition of beta thalassemia. Children with beta thalassemia major often appear healthy immediately after birth, but start developing symptoms within the subsequent two years of their life. This condition results in severe symptoms with life threatening anemia requiring periodic blood transfusions.
	Mutations of both the beta globin in genes may also result in beta thalassemia intermedia. However, the mutations are less severe than beta thalassemia major. Patients with this condition usually have moderately severe anemia and at times require periodic blood transfusions.