OETリスニング練習模試 10
| Doctor: | Come in. It’s Mrs. Jackson isn’t it? |
| Mrs Jackson: | That’s right. Alice Jackson. |
| Doctor: | To my understanding you have been referred to me because you are suffering from tennis elbow, is that correct? |
| Mrs Jackson: | Yes, the pain has just got to be too much to bear. |
| Doctor: | So tell me, when did you first start feeling pain in your elbow, did you suffer some sort of injury? |
| Mrs Jackson: | Oh no, nothing that I can remember the pain started about five months ago. At first it was just a mild aching in my right elbow. I just thought I was getting older or I bumped it taking care of the kids. I get bumped around quite a lot, taking care of three young children. |
| Doctor: | Yes, I’m sure it’s quite tiring to run around after three children. Now, you said it started out as a mild pain. What happened next? |
| Mrs Jackson: | We were painting one of the kids bedrooms about a month ago, and the pain became much more severe. I started having difficulties doing even simple everyday tasks like brushing my hair or picking up light objects or pouring water into a glass. Beside, I decided to see my GP after I almost dropped a saucepan of boiling water after a bout of sudden pain in my elbow. |
| Doctor: | What was the recommendation of your GP? |
| Mrs Jackson: | He diagnosed my problem straight away whis tennis elbow, which is a curious name considering I’ve never even stepped foot on a tennis court. Anyway, he recommended physiotherapy and suggested steroid injection to help with the pain. He also recommended taking anti-inflammatory medications. I declined the steroids injection, and for no real improvement from taking the anti-inflammatory medications. And this is what brings me here today. |
| Doctor: | I see. Well, just to clear up the matter of the name. Most cases of tennis elbow are not related at all to playing tennis. It is simply the common name for a problem with extensor tendon at the elbow. This tendon is vulnerable to injury because all of the muscles on the back of the forum that help to lift up the wrist and fingers narrowed to one single tendon. And the reason you did not experience any relief from the anti-inflammatory medications is because we have come to find that this condition does not usually involve inflammatory cells. |
| Mrs Jackson: | How interesting. Do you think I should have taken the steroids injection? |
| Doctor: | No, I don’t think it would have helped. Studies have shown that for this type of injury steroid injections are only effective in the first six weeks. For an injury such as yours that has been causing you pain for six months, the best type of treatment is physiotherapy. |
| Mrs Jackson: | Okay. Is there anything that can be done in the short term for my pain? Since the incident is the boiling water I’m in a significant amount of pain on a regular basis. |
| Doctor: | Yes, there is one option we can try for short term relief of pain, acupuncture. The risk and side effects are minimal, especially compared to a steroid injection, and it has been shown to settle the pain whilst waiting for physiotherapy to have its effect. Another reason it is important to get your pain under control is because it will allow you to increase the intensity of your physiotherapy exercises. |
| Mrs Jackson: | Sounds like a plan. How many sessions of acupuncture will I need to undergo? I have a slight fear of needles so the fewer the better. |
| Doctor: | Yes. This is a common worry. Acupuncture is most effective when carried out regularly so I recommend that the sessions be scheduled twice a week. After you’ve undergone four to five sessions where we can save your pain has been reduced. Then perhaps we make adjustments to your physiotherapy exercises as well. |
| Mrs Jackson: | Can you tell me a bit more about the physiotherapy exercises. How long will it take before I know if they’re making a difference. |
| Doctor: | The physiotherapy exercises I’m prescribing focus on strengthening the problematic tendon. I mentioned earlier, it is important to build up the intensity gradually as the tendon won’t respond well to sudden changes in intensity. If you overdo it, you will experience pain, and we’ll have to take the exercises back again for a few days. It typically takes about six weeks before there is a significant difference, and 12 weeks before there is full resolution of the problem. |
| Mrs Jackson: | Very Well. Will I need to come into the office for sessions? That can be quite difficult to do since it requires me finding someone to look after my children. |
| Doctor: | Oh no, for the most part you will carry out the exercises at home. I will check in with you regularly to see if there has been a reduction in your pain as a result of the acupuncture sessions, and then monitor your progress with the exercises. |
| Mrs Jackson: | I have just one more question. Is that okay? |
| Doctor: | Yes, of course. The more you understand about your treatment plan the more you’ll likely follow through and it will work. |
| Mrs Jackson: | How likely is it that I will have a recurrence? I mean, is this a problem I may deal with often for the rest of my life. |
| Doctor: | The recurrence rate is quite low. Within two years of treatment, the recurrence rate is eight and a half percent for patients who have undergone physiotherapy. Some of this also depends on you. If you carry out the exercises diligently every day and increase the intensity gradually, you’re less likely to have any major flare ups in the short term, and to experience recurrence in the long run. We also work on making sure your shoulder girdle posture is correct during lifting activities to reduce the likelihood of recurrence. |
| Mrs Jackson: | That sounds fantastic. |
| Doctor: | Hello. Come on in. It’s nice to finally meet you Luke though not under the circumstances. |
| Luke: | Yes, of course. Nice to meet you as well. The other night in the emergency department was quite an ordeal but hopefully you can help me get to the bottom of this. |
| Doctor: | So let’s take a minute to go through the incident in the emergency room the other night, to make sure we’re on the same page. So when you went to the emergency room, you had been experiencing diarrhea for about one month, is that correct? |
| Luke: | Yes, that is correct, and in the 16 days prior to that night I had experienced an intensification of symptoms. I mean I lost about 14 kilograms in those 16 days. My stool was watery but I didn’t see any mucus. Neither was there any blood. So at first I was not worried, just diarrhea right? But after I noticed the weight coming off. And as I was having diarrhea about 10 times a day. I knew I needed to do something. |
| Doctor: | I am glad that you did decide to do something. Your record showed that you were dehydrated on admission and your respiratory rate was increased. Speaking of your weight loss your body mass index was 17 kilograms per meter squared, which is below the health range. |
| Luke: | Once they got me started on intravenous fluids, and that special diet I felt much better. |
| Doctor: | Yes, they started you on a gluten and lactose free diet, and gave you an extra boost of thiamine and complex B vitamin. So trying to get to the cause of your problems, none of your labs indicated an infectious etiology, and you indicated that you have not traveled out of the country recently. |
| Luke: | That’s true. No traveling or anything like that recently, |
| Doctor: | Based on your labs and description of the symptoms, I’m going to recommend testing for celiac disease. I want to stress that celiac disease is quite rare. Approximately one out of every hundred people have it though most people with the disease may be unaware that they have this disease. |
| Luke: | I have heard of that, doesn’t it have a genetic link? |
| Doctor: | It does. If you have a relative with celiac disease, you are at the greater risk of developing the disease. It’s also more common in individuals with Type One Diabetes and thyroid disorders. |
| Luke: | And it has to do with diet, correct? I know, I have heard a lot about gluten free diets lately. Is it related to that? |
| Doctor: | Celiac disease is a chronic degenerative disease, involving inflammation in the small intestine. This inflammation occurs when a person with the disease eats a food containing gluten and causes difficulty absorbing nutrients. Gluten is found in foods containing wheat, barley, rye and other grains. |
| Luke: | So everything,basically? |
| Doctor: | Yes it is found in many of the packaged foods you find in supermarkets and restaurants, such as pastas, processed meats, broth sauces and marinades. |
| Luke: | You said you wanted to do testing, what, what does that involve exactly? Is it painful? |
| Doctor: | The initial screening is not painful. I’m going to proceed with caution and start with blood tests. |
| Luke: | In the meantime, should I try to stop using foods with gluten? Just in case I do have celiac disease. |
| Doctor: | No, absolutely not. You should carry on with your normal diet. If you restrict your diet prior to the blood test, it may cause a false negative test result. Specific antibody blood tests are used in the diagnosis of celiac disease, sometimes along with genetic tests when blood test results are unclear. Genetic tests can be used to rule out the possibility of celiac disease. Since, if you don’t have the gene, you cannot have the disease. However, it is possible to have the genes that enable a disease, without having the disease. |
| Luke: | Well, sounds complicated. |
| Doctor: | Yes, it’s definitely not a straightforward positive or negative result. Depending on the results of the blood tests we may also decide to do an endoscopy to take biopsy samples of the wall of the small intestine. We will then look at the samples under a microscope for changes of CD. As I said before, celiac disease is quite rare. So in the end, we may find that you don’t have it. And something else is the cause of your symptoms. Unfortunately, celiac disease can mimic the symptoms of more common problems, and as a result be misdiagnosed. |
| Luke: | Okay. It sounds like I need to prepare myself for multiple procedures and tests. |
| Doctor: | Yes, it will definitely take some patience on your part. But, luckily we can get started on the blood test quite quickly. I’m going to set you up with an appointment to have your blood drawn in the next couple of days. How does that sound? |
| Luke: | Painful, but necessary. |
| Doctor: | Mr. Haskell was admitted last night for chest pain. The initial diagnosis in the AMD was acute coronary syndrome. The patient was given a liter of fluid because his pressure was low. |
| At this point, I started to think the case was peculiar. ordered a CAT scan off his chest. looking for a thoracic dissection. | |
| I thought he had had a heart attack but he appeared to be a healthy 60-year-old. I realized he was mildly hypoxic and his mediastinum looked enlarged. So I | |
| This was confirmed when I got a call from the radiologist informing me that the patient had a type one dissection. |
| Nurse: | Hello, Dr. Jones. Do you have a minute while I run a situation by you? |
| Dr. Jones: | Yes, of course, what do you have going on? |
| Nurse: | I have this patient Mr. Davis, who is a 91 year old resident who has been here for several months. So he tells me that he has an ache in his right foot. He thinks he might have stepped on something or twisted his ankle or he might have got bitten by a bug. I noticed that his ankle is reddened slightly swollen and warm to the touch. Mr. Davis temperatures within normal limits and he has a strong pedal pulse bilaterally. Right now he seems to be resting comfortably, but he’s still experiencing some pain. |
| Dr. Jones: | I see it sounds like the first step would be to get an X ray to rule out fracture. We also need to do a Doppler ultrasound to rule out deep vein thrombosis that will be even more serious than a fracture. And it also means that we need to act fast. |
| Physician: | Good morning everyone. We will now go through overnight admission. Jason, could you get us started, please. |
| Jason: | Of course, We have Mrs Perry, who was admitted with complaints of nausea, vomiting, and abdominal pain. Her vital signs on admission were temperature 37.6 degrees Celsius, blood pressure, 113 over 82 pulse 84, and a respiratory rate 20. Initial physical examination revealed distended abdomen, tender on palpation. Lab results are still pending. |
| Physician: | Okay. While we’re waiting for lab results, we continue to administer pre admission medication, and her pain will be managed with IV morphine four milligrams every four hours. Next we have… |
| Nurse: | Jeanie, I have this patient that I need some help with. |
| Janie: | I’m happy to help. Are you referring to Mr. Menendez? I met his wife. She’s so nice. |
| Nurse: | Yes, that’s the patient. Mr Mendez was recently diagnosed with diabetes, after presenting in the A&E about a month ago with nausea and vomiting and general confusion. He is overweight and says he does not regularly exercise is also not following a special diet, and says he eats whatever his wife puts in front of him, because it is all so good. Mrs Menendez reports that her husband has been very thirsty lately, and makes very frequent trips to the bathroom. She also said her husband seems to have got worse since his diagnosis. |
| Janie: | It sounds like both need to work with the diabetes educator to learn about blood glucose monitoring, medication administration, as well as proper diet and exercise. Diabetes is an overwhelming diagnosis and requires long term follow up and support. |
| Podiatrist: | Charles presented with a painful ingrown toenail on the big toe of the right foot that had been going on for about four months. As a result of this, he has not been able to wear clothes in shoes. He had two courses of antibiotics before coming to my office. |
| Upon examination, I could see that the nail was clearly deep within the side of the toe and causing quite a lot of pain. I considered simply cutting back the nail but found it was necessary to remove the knowledge under the local anesthetic and apply a chemical to prevent regrowth of this section. | |
| Then, normal daily wound care commenced. The patient reported no discomfort at this point, and the area healed within four weeks. |
| Patient: | So as you already know, I have been experiencing shin pain since I started to increase my training regimen to prepare for a triathlon. |
| PT: | Yes, you’ve been working with the exercises I gave you for the last three months. Have you seen any improvement? |
| Patient: | No, in fact now I’m experiencing pain in my shins when they walk, which didn’t happen before. |
| PT: | Oh, I see. Since the exercises do not seem to be having any effects you are experiencing intensified pain. This is something more serious than I originally thought. I’m going to recommend an X-ray to see if there’s any bone injury. In the meantime, no exercise at all, we need to keep you off the foot while we figure out what’s causing this. |
| Interviewer: | I have with me Dr. Terry, an expert in Angelman syndrome, a rare genetic disorder. Hello, Dr. Terry. Thank you very much for taking the time to sit down with us today. |
| Dr. Terry: | Thank you very much for the opportunity to talk about my journey with Angelman syndrome. |
| Interviewer: | I understand you started the argument with a completely different area of healthcare. Can you tell us a bit about your journey as an expert in public health to an expert in Angelman? |
| Dr. Terry: | Yes, it has been quite a journey. I started out my career in health care earning a master’s degree in Public Health. I worked primarily on pregnancy related deaths and participated, and making documentary films about women’s health projects in several countries in Africa. It was fulfilling work. |
| My life was changed when my son Samuel was diagnosed with Angelman syndrome. That was over 17 years ago. And back then so little was known about the disease. So I decided to go back to college, and I had one and only one goal in mind – find a cure for Angelman syndrome. | |
| Interviewer: | And go back to college you did. You enrolled in the neuroscience graduate program at a prominent University in the US, and then went on to earn your PhD. Tell us a bit about what you’re doing nowadays. |
| Dr. Terry: | I’m currently the director and Scientific Officer of a prestigious research organization dedicated solely to Angelman syndrome. Our organization brings together patient advocacy groups, doctors scientists and the pharmaceutical companies. |
| Interviewer: | So before we get into the current work of your organization. Let’s give those listening an introduction to Angelman syndrome. |
| Dr. Terry: | Of course, it wasn’t until 1995 that scientists managed to isolate the gene that causes Angelman. So, a proper diagnosis was not even available until the late 1990s. Now we know that Angelman is about as common as Huntington’s – a disease that the public is much more aware of. This means that there’s a one in 10,000 chance of a child being born with the syndrome. |
| These days, most medium to large school districts have one or two kids with this disorder, and most GP’s will encounter at least one patient with Angelman, during their professional career. It was previously thought that geography or ethnic origin played a role in Angelman syndrome. But as we learn more about the disease, we are finding out that is not the case. For example, as recently as five years ago, there were no reported cases in China. But it turns out that was because of a lack of diagnosis. Now, there are cases in China and research is being actively conducted by scientists there. | |
| Getting back to my personal journey. When my son was born, I immediately knew something wasn’t right. He was very cheerful all the time, but seemed to be a barrier when it came to communication. He also didn’t hit development milestones, such as sitting up.After a visit with our pediatrician, we were referred to a neurologist, who diagnosed our son with cerebral palsy. But something didn’t feel right about that diagnosis with me and my husband who’s also a doctor. So our next step was to visit a geneticist. | |
| When the diagnosis of Angelman came down, I was initially stumped searching all over the internet for more information. It turned out that the first international conference in the world on the disease was taking place next month in Finland. | |
| Interviewer: | So, what did you do there? |
| Dr. Terry: | I went to that conference, of course. I met the scientist who discovered the Angelman gene. With the knowledge I gained there and through my graduate work, I started to develop ideas for treatment. The idea that I came up with was turning on a silenced gene. You see, Angelman syndrome is a result of both copies of a particular gene, being turned off, which results in proteins needed for normal Nervous System functioning, not being produced. I’ve been through a lot of ups and downs as my work, but we’re still forging ahead. |
| Interviewer: | Tell me a bit more about your son. He is a young adult now. What is his life like? |
| Dr. Terry: | My son is doing well, as are we. We are lucky in that most kids with Angelman experience terrible seizures, but my son has not had one in over 14 years. |
| Pathologist: | First of all, Thank you for having me here today. I’m going to be talking about a topic that those of you who choose to go into pediatrics, will encounter regularly, and it is important to know how to help parents as well as to know when to refer children to a specialist. |
| The topic is late language emergence or LLE. LLE refers to a delay in language onset, with no other diagnosed disabilities or developmental delays, and is diagnosed when the trajectories of language development are below age expectations. | |
| Children who present with LLE or late talkers may present with expressive language delays or mixed expressive and receptive delays Expressive language delays refer to delayed vocabulary acquisition, and typically involves slow development of sentence structure and articulation. Late talkers with mixed expressive and receptive language delays exhibit delays comprehending language, and in oral language production. | |
| Some children with LLE are often referred to as late bloomers indicating that they will catch up with their peers by three to five years of age. And in fact, approximately 50 to 70% of late talkers are reported to catch up to peers and demonstrate normal language development by late preschool and school age, with only one in five late talkers still demonstrating language impairment at the age of seven. | |
| However, it can be difficult to differentiate between late bloomers and late talkers as it will only become apparent later If the child will continue to have delays or catch up with peers. And as we will discuss in a moment, early intervention can be key. | |
| Risk factors for LLE can be divided into a number of categories, including child factors, family factors and protective factors. Child factors include gender and motor development. For example, boys are at a higher risk for LLE than girls. Family factors include family history, as well as the presence of siblings. Children who have parents with a history of LLE are more likely to experience this problem, as well as children who have more siblings. This may be due to the fact that single children typically receive more attention from their parents. | |
| Protective Factors refer to areas such as pre-, peri-, and postnatal care, as well as learning opportunities available to the child. Learning opportunities that are beneficial to all children, but particularly those with LLE include exposure to rich and varied vocabulary, syntax and discourse patterns, access to printed materials involvement in structured and unstructured play interactions and conversations and engagement in gross and fine motor activities, among others. Protective factors are particularly important as early identification and intervention can mitigate the impact of other risk factors. LLE can also be an early or secondary sign of other disorders, such as specific language impairment, social communication disorder, autism spectrum disorder, among others. | |
| Making a differential diagnosis requires close monitoring of the global development of the child in other domains, such as cognitive communication, sensory and motor skills. | |
| Initial treatment for toddlers and preschoolers with LLE, typically involves a speech language pathologist monitoring the progress of the child and introducing indirect language stimulation, which can help remediate problems and prevent future difficulties and the need for subsequent school based services. | |
| When language delays persist over time, or are present with other identified or suspected delays or disabilities, such as those previously mentioned, direct speech and language services are necessary. The speech language pathologists will take into consideration a number of factors when developing an intervention plan, such as language or languages spoken at home, cultural background and family history. | |
| A key component of success of intervention with children with LLE is working closely with the families. Families must be given the opportunity to share concerns and priorities that may influence the intervention plan. This will help to ensure a supportive, informed and collaborative relationship with the family, which is most definitely in the child’s best interest. | |
| Most intervention plans will take a multidisciplinary approach in which the speech language pathologist will work with a family, and a variety of other professionals such as audiologists, special education teachers, interpreters, neuro developmental pediatricians, occupational therapists, school psychologists, among other health professionals. |