OET

FUTURE LAND

NOTES

The rapid way to pass OET exam

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

Link of Listening Audios to download:

https://drive.google.com/drive/folders/1CSxC8i6F7KLLjjXNex_ssgpvpckYKO
6z?usp=sharing

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).‬‬

‫‪NOTE: We will only accept test results:‬‬

‫‪i. from one test sitting, or‬‬

‫‪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:

• Overall Task Fulfillment

• Appropriateness of Language
• Comprehension of Stimulus
• Linguistic Features (grammar and cohesion)
• Presentation Features (spelling, punctuation, layout).

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:‬‬

‫& ‪(1. Overall Communicative Effectiveness, 2.Intelligibility, 3.Fluency, 4.Appropriateness‬‬

‫)‪5.Resources of Grammar and Expression.‬‬

‫‪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.

2. How long have you been working as a physician?

I am working as a physician for 12 years now. 6 years in Egypt and the other 6 years in Saudi Arabia.

3. What about your working hours?

Well, I am working for 8 hours every day from Sunday to Thursday every week.

4. Why did you choose medicine as a career?

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.

5. What about your specialty? And why?

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.

6. What is your advice for fresh graduates?

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.

7. How to be a successful physician?

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.

8. What was the last training you had?

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.

9. What is the recent medical advance you heard about?

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
1. Introduction:
Good afternoon, my name is doctor …. , I am
the treating doctor for today. How can I help
you?
FU visit: Good afternoon, nice to meet you
again. How are you so far? //How can I help
you?
2. Sympathy & History:
A. Starting:
Oh, I am really sorry to hear that, it must
have been very painful/ it must be
stressful for you but can I ask you some
questions first if you don’t mind?
all right Mr. … I appreciate your (fears,
worries, concern, etc.)
would you mind if I ask you a few further
questions regarding this situation?
B. Clarify:
* What about appetite? Are you eating
well?
* Do you have // Have you had any
symptoms like …?
Could you describe the pain? Does it
occur all the time or just now and again?
* Does anything special make it worse or
relieve it?
Does anything seem to bring it on or
aggravate it?
C. Site:
* Which part of your body is affected?
* Could you tell me where the pain is?
* Can you tell me where it hurts?
D. Duration: When did it start?
How long have you had it// been suffering
from this problem// been feeling like that?
13
E. End of history:
* Have you tried/taken any medication for it?
* Is there anything else that is bothering you?
3. Diagnosis:
A. Well, based on your symptoms and
after examination, I believe that you have
what is called …. , and let me explain ….
* You are suffering from a condition
known as… have you ever heared of that?
* The X ray indicates that you have ….. //
the tests show that it is probably a
condition known as ….. and let me
explain….
B. It is a condition caused by …. The
symptoms include ….. the best treatment
is...
4. Management:
A. I think we would start with …
I will give you a prescription for ...
I’ll write a referral letter to …
We will run some tests to see …
B. First of all …… it is also important to
…. do you think you can do it?
C. There are some very effective
strategies to cope with …… I would like
to explain them for you Is that okay?
D. I see that must be a very difficult
situation for you but the good news is that
there are several options available which
will help you. Would you like to hear
more about that?
D. It is a good time to start …. , in terms
of ……. , it will be necessary for you to…
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?

15
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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.

Countable nouns Singular form Plural form

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.

cavity The cavity was exposed. The cavities were exposed.

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.

examination An examination is necessary to rule out Blood urine examinations revealed no

cancer. abnormalities.

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.

interpreter An interpreter is required. Interpreters will be required.

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.

parasite The threadworm is a parasite. Threadworms are parasites.

lip The patient had a swollen lip. (one lip) The patient had swollen lips. (both lips)

smoker She is a smoker. They are smokers.

operation An operation is necessary. Two operations are necessary.

painkiller The patient requested a painkiller. Painkillers are not necessary with this
procedure.

physiotherapist An appointment needs to be a arranged with Two physiotherapists work at this

a physiotherapist. rehabilitation centre.

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.

teacher Steve is a teacher. Steve and Chris are teachers.

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.

Uncountable nouns Indefinite articles cannot be used with uncountable nouns.

However definite article “the” as well as quantifiers such as some
and any can be used.

accommodation The patient lives in rental accommodation.

advice Advice on diet is requested.

assistance The patient will require assistance upon discharge.

attention The patient requires urgent attention.

behaviour On examination, the patient's behaviour was abnormal.

cancer The patient has cancer.

caries Deep caries were present on several teeth.

concentration The patient has poor concentration.

damage The scan confirmed damage to the medial cartilage.

92
 discomfort If you experience discomfort, please consult your doctor.

information Should you require further information, please do not hesitate to

contact me.

pain The patient experienced pain on palpation.

progress The patient has made good progress.

tissue She has healthy, soft tissue.

treatment The condition did not respond to treatment.

research Further research is required.

surgery The patient chose not to have surgery.

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.

The patient has a cancer. The patient has cancer.

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.

New Information Vs Previously Mentioned Information

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.

Referring to Something Specific

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.
 He has been a smoker for last 12 years.
 Mr. Roberts has been a resident at our nursing home for
past 2 years.
 This medication needs to be taken twice a day for next 3
days.
Explanation: All the expressions above are referring to a specific
period of time so a definite article is required.
 She was on Microgynon 30 for the previous 5 years
 He has been a smoker for the last 12 years.
 Mr. Roberts has been a resident at our nursing home
for the past 2 years.
 This medication needs to be taken twice a day forthe next 3
days.

 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.

 Patient complained of chest pain.  The patient complained of chest pain.

Explanation: Patient requires an article to indicate which patient
the writer is referring to.

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.

Special Usage of Articles

There are some situations where you should always use the definite article and there are some situations where the
indefinite article is required. Understanding these rules can greatly reduce the number of "minor" errors in your writing so
please study these rules carefully.

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

 Pain in left groin.  Pain in the left groin.

 Pain in stomach.  Pain in the stomach.
 I suspect it to be adenoma of parotid gland.  I suspect it to be adenoma of the parotid gland.
 Mr. Smith had an operation on a left knee.  Mr. Smith had an operation on the left knee.

Names of Diseases

Do not use an article for names of diseases or conditions.

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

Always use the definite article with this word.

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.

Articles with Gerunds

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.

Articles and Nominalisation

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

 The patient is complaining of discomfort  The patient is complaining of discomfort

during passing of urine. during the passing of urine.

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

1. Medications and Diseases

 Capitals are required for proper nouns. Proper nouns include the brand name of a drug or registered
trademark of the manufacturer.
 Ritalin
 Voltaren
 Zocor
 The chemical constituent should be written in lower case.
 penicillin
 amoxicillin
 Names of diseases should always be lower case.
 bowel cancer
 high blood pressure
 diabetes
 epilepsy
 Eponyms: Some medical conditions are named after the person who discovered it. In this case the first word
should be capitalised.
 Parkinson’s disease
 Bell’s palsy
 Names of medical procedures do not require capitals.
 orthopantomogram
 x-ray
 caesarian section
 Body parts should always be lower case
 heart
 adrenal gland
 knee
2. Proper Nouns: Proper nouns name something specific as in the examples below. These words must always be
capitalised.

 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.

 The patient was admitted to hospital.

 The patient does not have a family doctor.
 Steve is a teacher.
 Yoshiro is a doctor.
 Reza is a dentist.
4. Holidays, months, days of the week all need to be capitalised. However seasons do not.

 The baby was born on Christmas Day.

 The patient was admitted to hospital on January 12.
 Please come and see me on Wednesday.
 The vaccination will be available in spring.
5. The pronoun "I" must always be capitalised.

 It was I who treated the patient.

6. Capitalise the first word of a salutation and the first word of a complimentary close.

 Dear Dr. Jameson:

97
  Yours sincerely,
Common Errors
Incorrect
 His medical history shows that he is Epileptic.
 Also, I have given Dycal base on 1.1 and dressed it with
Glass Ionomer Cement.
 The patient was diagnosed with Type 2 Diabetes.
 Mrs. Marsh has a history of Hyperthyroidism, Hypertension
and Glaucoma.
 The patient is allergic to Penicillin.
 The patient suffered from severe Abdominal pain.
Refer to rule 1 above.
 Mr. duane thomson presented at my clinic today with the
complaint of a broken posterior tooth.
 The director of nursing
 emergency department
 Mater hospital
 84 Monash road
 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
home visits and wound dressing and also assisting him with
his showers.
 Please see your Pharmacist for advice.
 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.
 Mrs. Green will be discharged from hospital on wednesday.
 Symptoms of hay fever are worse in Spring.
Refer to rule 4 above.
 The patient requested that i prescribe antibiotics for the
virus.
Refer to rule 5 above.
 dear Dr. Roberts:
 yours sincerely,
Refer to rule 6 above.
98
Correct
 His medical history shows that he is epileptic.
 Also, I have given dycal base on 1.1 and dressed it
with glass ionomer cement.
 The patient was diagnosed with type 2 diabetes.
 Mrs. Marsh has a history
of hyperthyroidism,hypertension and glaucoma.
 The patient is allergic to penicillin.
 The patient suffered from severe abdominal pain.
 Mr. Duane Thomson presented at my clinic today with the
complaint of a broken posterior tooth.
 The Director of Nursing
 Emergency Department
 Mater Hospital
 84 Monash Road
 The patient was seen by Doctor Jones.
 As per the general practitioner’s order, we are doing daily
home visits and wound dressing and also assisting him with
his showers.
 Please see your pharmacist for advice.
 Ms. Gatsby is a university student.
 The patient first visited my surgery in March, 2008.
 Mrs. Green will be discharged from hospital onWednesday.
 Symptoms of hay fever are worse in spring.
 The patient requested that I prescribe antibiotics for the
virus.
 Dear Dr. Roberts:
 Yours sincerely,
 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 Simple Present Perfect Progressive Present Perfect Passive

Form: have/has+ past participle Form: have/has +been+ past

Form: have/has+been+____ing (present
participle
participle)
 I have treated Mr. Smith at
this hospital for 3 years.  Mr. Smith has been treated at
 I have been treating Mr. Smith at
 Dr X has treated Mr. Smith this hospital for 3 years(..byDr
this hospital for 3 years.
at this hospital for 3 years. X).
 Dr X has been treating Mr. Smith
 They have been treated at this
at this hospital for 3 years.
hospital for 3 years(..byDr X).

Present perfect is often combined with for/since/over. Compare the usage below and note time markers used.

For Since Over

For is used to describe a period Since is used to refer to the

of time
 I have been treating the
patient for 3 years.
 The patient has been on
this medication for 6
months.
 I haven’t seen the patient
for 1 year.
 The patient has been in
pain for 5 hours.
 The patient has been
waiting for 15 minutes.
 He has been complaining
of back pain for a week.
 He has not had bowel
motions for 3 days.
 He has been a smoker for
a period of 25 years.
start of period of time
Over uses similar time markers to for but is
used to express a change in condition,
 I have been treating the
patient since 2012. or to describe a repeated event.
 The patient has been on
 The patient's condition has deteriorated
this medication since
over the past 3 months.(change in
January.
condition)
 I haven’t seen this patient
since December 2014.
 The patient has presented several times
 The patient has been in
over the last year. (repeated event)
pain since 10am.
 The patient has been
 The patient's back pain has worsened
waiting since 11.45am.
over the last week.(change in condition)
 He has tried to quit smoking several
 He has been complaining
times over the past 25 years.(repeated
of back pain since last
event)
week.
 The patient has experienced seizures on
 He has not had bowel
3 occasions over the past year.(repeated
motions since Saturday.
event)
 He has been a smoker
since 1990.

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)

 She has been having problems with arthritis in her

 She has been problems with arthritis in her
hands since 2012. (present perfect progressive)
hands.
Explanation: Problems in this sentence is a noun so
 She has had problems with arthritis in her hands since

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
the past 25 – 30 years.
 Over the past week she remains free from
severe pain and has been able to tolerate a
fluid diet.
 Also, there is an ulcer on the right lower
lateral border of the tongue which is present
for more than one year.
 Mr. Diamond is a patient of mine since 2005
 Mr. Eddy is a known smoker for 25-30 years.
Explanation: The verbs in these sentences are in
simple present tense. Present perfect needs to be
used because you are
 He has been smoking two packs of cigarettes a day for
the past 25-30 years. (present perfect progressive)
 Over the past week she has remained free from severe
pain and has been able to tolerate a fluid diet.
 (present perfect simple)
 There is also an ulcer on the right lower lateral border
of the tongue, which has been present for more than
one year.(present perfect)
 Mr Diamond has been a patient of mine since
2005.(present perfect simple)
 Mr. Eddy has been a smoker for 25 years. (present
perfect simple)

referring to a time period which started in the past

and has continued to the present.

 Mrs. Brown has been presenting to me on

several occasions over the past few months.  Mrs. Brown has presented to me on several occasions
Explanation: Progressive form not required. over the past few months.

Simple Past or Present Perfect

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

 He has been sucking his thumb for five years.

 Mrs. Kelly has had diverticulitis for the last 12
 He sucked his thumb until he was 5.
years.
 Mrs. Kelly had diverticulitis when she was a teenager.
 He has been seeing me since 2012.
 He first came to see me in 2012.The patient didn’t
 The patient hasn’t responded to
respond to treatment.
treatment yet.
 The patient was diagnosed with cancer 3 months ago.
 The patient has shown no signs of
 The patient stopped taking medication yesterday.
improvement up to now.
 The patient has stopped taking
medication recently.

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 the patient to stop smoking.

2. The patient was advised to stop smoking (focus on the patient)

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

Present simple Present simple

 The patient takes aspirin daily.  Aspirin is taken daily.

Present simple continuous

Present simple continuous
 Aspirin is being taken daily.
 The patient is taking aspirin daily.

Past simple Past simple

 The patient took aspirin daily.  Aspirin was taken daily.

 The patient took 3 tablets daily.  3 tablets were taken daily.

Past simple continuous Past simple continuous

 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.

Present perfect continuous

Present perfect continuous
 Nil: This form is rarely used in the passive.
 The patient has been taking aspirin daily.

Past perfect Past perfect

 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

101
  The patient had taken aspirin, noten and normison
for a period of one year.
Past perfect continuous
 The patient had been taking aspirin daily.
Future
 The patient will take aspirin in the evening
Modal form
 The patient should have taken aspirin in the evening.
Please review the list of common mistakes below.
Incorrect
 She was performed a colostomy
accompanied with a partial bowel
resection.
 As per the doctor’s order, we were
organized daily home visits.
 On 9/7/15 he was presented to me for
his regular check up.
 On the subsequent visit the treatment
options was discussed.
 She had done colonoscopy 3 years ago.
This sentence indicates the patient did the
procedure!
 Initially, she came to me on
14/01/2012 for a general check up and
was found her blood pressure 160/90.
 In addition, her baby will need to
monitor his growth and general health
condition.
This sentence indicates the baby will monitor
their own growth!
 Noten 50mg 1/2 tablet daily prescribed
while Zocor and Calcium Caltrate
continued.
 Today at my surgery attended Mr.
Attard complaining of pain in his upper
left molar.
a period of one year.
Past perfect continuous
 Nil: This form is rarely used in the passive.
Future
 Aspirin will be taken in the evening.
Modal form
 Aspirin should have been taken in the evening.
Correct
 A colostomy was performed with a partial bowel resection.
 A colostomy was performed on the patient by the doctor with
a partial bowel resection.
The first example is better as it more concise and also it is obvious
the roles of patient and doctor so it is unnecessary to state them.
 As per the doctor’s order, daily home visits were organised.
(passive)
 As per the doctor’s order, we organised daily home visits.
(active)
Both sentences are grammatically correct but the first example is
preferred because it focuses attention on the procedure rather than
the health professional.
 On 9/7/15 he presented to me for his regular check up.
(active)
Active voice is preferred here as the patient is the subject and most
likely presented himself.
 On the subsequent visit the treatment options were discussed.
Because the noun is plural the plural verb “were” is required.
 A colonoscopy was done 3 years ago.
 She had a colonoscopy done 3 years ago.
In these sentences it is unimportant who performed the colonoscopy
so passive voice is used.
 Initially, she came to me on 14/01/2006 for a general check
up and her blood pressure was found to be 160/90.
After the conjunction "and" a subject is required.
 In addition, the baby’s growth and general health
condition will need to be monitored.
Future form of the passive.
 Noten 50mg 1/2 tablet daily was prescribed while Zocor and
Calcium Caltrate were continued.
Add the "be verb"
 Today, Mr. Attard attended my clinic complaining of pain in
his upper left molar.
Use active form here as you need to focus on your patient, not your
102
 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 on 03/07/2015 for a regular check up

because she experienced several episode of heart flutter
over the past few weeks.
 She presented to me on 03/07/2015 for a
 Past perfect tense is necessary here (had
regular check up because she had
experienced) to differentiate what happened prior
experienced several episodes of heart
to the check up, which is also in the past.
flutter over the previous few weeks.
 As your meaning is prior to 03/07/105and not the
day of writing the letter, you should use the
word previous instead of past.

 On review two weeks later, the frequency of headache

decreased.  On review two weeks later, the frequency
of headachehad decreased.
 Use past perfect to indicate that frequency of headache
had decreased prior to the consultation.

 A review on 25/04/15 showed the patient’s general health

improved and her blood pressure dropped to 140/85 and
she lost 4 kg.
 Past perfect is used when describing a condition
that was true at a certain time in the past.
 A review on 25/04/15 showed the patient’s
general health had improved and her blood
pressure had droppedto 140/85 and
she had lost 4kg.

 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.

103
  Note that in the correct version 3 different times
need to be considered

2. The present i. e today: time of writing

3. Yesterday evenings consultation

4. Symptoms which occurred before yesterday's

consultation.

 She was admitted to Royal Brisbane and Women’s Hospital

on 24/07/15 because she collapsed at home.
 She was admitted to Royal Brisbane and
Women’s Hospital on 24/07/15 because
 Use past perfect tense to create a time line, so
she had collapsed at home.
past perfect indicates the collapse occurred before
the admission.

 Initially she presented to me in July 2015

 Initially she presented to me in July 2015 with a complaint
with a complaint of chest discomfort
of chest discomfort for three weeks.
which had been presentfor three weeks.
 If you use this time expression: for a few
weeks then you must either use a relative clause
 Initially she presented to me in July 2006
and past perfect verb tense, or the very concise
with a complaint of chest discomfort of 3
and useful expression: of______duration.
week duration.

 Mrs. Jones had taken Microgynon 30 for the previous 5

years but had stopped in May 2015.  Mrs. Jones had taken Microgynon 30 for the
 There is no need to use past perfect twice. previous 5 years but stopped in May 2015.

 On rechecking at 10.45pm, her condition has further

deteriorated and an ambulance was arranged for transfer
 On rechecking at 10.45pm, her
to hospital.
condition had further deteriorated and an
 Use past perfect and simple past together to
ambulance was arranged for transfer to
distinguish the order of events i.e her condition
hospital.
deteriorated then an ambulance was called.

Subject-Verb Agreement

Subject verb agreement is an area where accuracy is important. Below are some important rules which you
should remember.

Singular subject & verb Plural subject & verb Explanation

 The suture has been removed.

 The sutures have been removed.

The verb agrees with the subject

 One of the medications is  All of the medications are
which is this case is either singular
unavailable. unavailable. in one or plural in all.

The verb agrees with the subject

 One of the
 All of the medications have side which is this case is either singular
medications has side effects.
effects in one or plural in all.

 Mrs. Pratt lives in rental

 Mr. & Mrs. Pratt live in rental
accommodation.
accommodation.

104
  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.

 All these findings has been confirmed with bite-

 All these findings have been confirmed with bite-wing
wing radiographs.
radiographs.

 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.

 Threadworms look like fine pieces of cotton thread

 Threadworms looks like fine pieces of cotton that can grow up to 1.5 cm long.
thread that can grow up to 1.5 cm long.  A threadworm looks like fine pieces of cotton thread
that can grow up to 1.5 cm long.

For more details follow these links:

 The Writing Centre

 The Owl

105
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

Inappropriate Casual or Spoken Expression Appropriate Formal Expression

 She refuses to eat solids and prefers fluids only
like apple juice and lemonade.
 There are several measures which can be taken
to reduce the risk of infection like taking a
shower in morning, using separate towel for
everyone, changing underwear and bed sheets
regularly, vacuuming carpets, keeping the nails
short and washing hand thoroughly.
 She was given general advise for softening her
stool, like changing her dietary habit but she
was non compliant.
 She refuses to eat solids and prefers fluids such
as apple juice and lemonade.
 There are several measures which can be taken
to reduce the risk of infection including taking a
shower in morning, using separate towel for
everyone, changing underwear and bed sheets
regularly, vacuuming carpets, keeping the nails
short and washing hand thoroughly.
 She was given her general advise for softening
her stool such as changing her dietary habit but
she was non compliant.

Explanation: Like is a casual expression, and the two

commonly used formal expressions with the same
meaning are such as & including.

 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.

Explanation: Thanks is a casual expression and should

be written in full.

 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.

Explanation: think is informal and preferable

expression is either believe or consider, depending on
the context.

106
  I would really appreciate your attention
regarding further management of this patient.
Explanation: Really is spoken language and should be
avoided in formal writing.
 About his dietary habits, he eats a large amount
of oily and sweet food.
 If you require any other information about 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.
 She had lots of pain.
 He eats lots of oily food.
Explanation:Lots is a spoken expression
 There was nothing significant in his social
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
additional information.
Explanation: Definitely no text or SMS language in
formal letters. Replace with: you
 She has got maternal postpartum haemorrhage
of 800mls.
 Mr O’ Riley got an appointment for a follow up
visit with his general practitioner, Dr. Avril
Jensen.
 The mother got sick for a few days.
Explanation: Got/Get are casual expressions and
should generally be avoided in formal letters.
 Should you have any concerns regarding them,
please do not hesitate to contact me.
Explanation: The pronoun them sounds casual here. It
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
sometimes but severe pain has been alleviated.
Explanation: Sometimes is a casual expression. More
formal expressions include: at times or on occasions
 This pain was exaggerated to cold and hot
things
Explanation: Things is a casual expression and should
be avoided
 A repeat vaginal examination revealed a very
tender right vaginal fornix. But her blood
pressure pulse is within normal range.
 I would very much appreciate your attention
regarding further management of this patient.
 I would greatly appreciate your attention
regarding further management of this patient.
 Regarding his dietary habits, he eats a large
amount of oily and sweet food.
 If you require any other
information regarding her condition, please do
not hesitate to contact me.
 She had a lot of pain.
 He eats large amounts of oily food.
 There were no significant findings in his social
history.
 Please do not hesitate to contact me if you need
additional information.
 She has had maternal postpartum haemorrhage
of 800ml.
 Mr O’ Riley has an appointment for a follow up
visit with his general practitioner, Dr. Avril
Jensen.
 The mother became sick for a few days
 Should you have any concerns regarding Mary
and her child, please do not hesitate to contact
me.
 At the moment, she is weak and disorientated at
times but severe pain has been alleviated.
 At the moment, she is weak and
disorientated on occasions but severe pain has
been alleviated.
 This pain was exaggerated to hot and
coldstimuli.
 A repeat vaginal examination revealed a very
tender right vaginal fornix. However, her blood
pressure pulse is within normal range.
107
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
normal while pulse was elevated at 88. So I
recommended that she return 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,
carious lesions and active periodontal disease
too.
Explanation: too is informal, a more more formal
expression is as well.
 Her husband was upset because, she was not
showing interest towards the kids.
 Mark's dad also suffers from this condition.
 The teacher spoke to her mum regarding the
regular absences from school.
Explanation: kids, dad, mum are all spoken
expressions which are inappropriate in formal letters.
 She had had termination of pregnancy 10
yearsback.
 He is a regular smoker and drinker with the only
relevant past history of left inguinal hernia
operation 2 years back.
Explanation: Back is used as a spoken expression not a
written expression.
 He had a habit of thumb sucking till the age of
5.
Explanation: Till is casual, until is formal
 She was so anxious.
Explanation: So is informal and subjective,
whereasvery is more formal and objective.
 Owen has big tonsils.
Explanation: big is informal and does not sound
professional.
 I am writing to request a follow-up for this
patient.
 Examination revealed that his vitals were stable
and left knee was swollen without effusion.
 Examination revealed normal vitals.
Explanation: Vitals and follow up are incomplete
expressions, commonly used in spoken English, but
not suitable for formal writing.
 Mrs. Jones is a widow who complained of
persistent chest pain at roughly 1.45pm.
 Miss Roberts started smoking around 6 months
 Her temperature and blood pressure were
normal while pulse was elevated at
88. Therefore, I recommended that she return
today for a blood test and reassessment.
 There was evidence of poor oral hygiene,
carious lesions and active periodontal disease as
well.
 Her husband was upset because, she was not
showing interest towards the children.
 Mark's father also suffers from this condition.
 The teacher spoke to her mother regarding the
regular absences from school.
 She had had termination of pregnancy 10
yearsago.
 He is a regular smoker and drinker with the only
relevant past history of left inguinal hernia
operation 2 years previously.
 He had a habit of thumb sucking until the age of
5.
 She was very anxious.
 Owen has enlarged tonsils
 I am writing to request a follow-up visit for this
patient.
 Examination revealed that his vital signs were
stable and left knee was swollen without
effusion.
 Examination revealed that his vital signs were
normal.
 Mrs. Jones is a widow who complained of
persistent chest pain at approximately 1.45pm.
 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
cancer.
 I requested some blood tests.
Explanation: Some is vague and does not sound
professional.
 I recommend further investigations to rule out
cancer.
 I requested additional blood tests.

 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
groin swelling that’s consistent with inguinal
hernia.
 Thank you for your expert care and please don't
hesitate to contact us if you require further
information.
 Abdominal examination revealed a small right
groin swelling that is consistent with inguinal
hernia.
 Thank you for your expert care and please do
nothesitate to contact us if you require further
information.

Explanation: It is best to avoid contractions in formal

letters as these are used more in spoken English.

 In addition, she is just able to tolerate fluids.  In addition, she is only able to tolerate fluids.

Explanation:Just can sound informal at times.

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.

Here is a list of common abbreviations used in Australia.

Acronym/Short Form Full Expression Acronym/Short Form Full Expression

Abdo Abdomen mane in the morning

AC before meals min minute

ADL activities of daily living NAD no abnormality detected

& and nocte in the evening

BD/bid 2 times a day OPG orthopantomogram

BP blood pressure P/PR Pulse/Pulse Rate

109
BW x-rays bite wing x-rays PMH past medical history

C/O complains of PRN as required

cap capsule QID 4 times a day

DOB Date of Birth R right

ECG electrocardiograph tab tablet

F/- fluoride application sid once a day

FBC full Blood Count TDS/tid 3 times a day

FTA failed to Attend w/o without

IV intravenous y/yrs year

h hour ? rheumatic fever possibility of something

hx history 6/h 6 hourly

L left + positive

lab laboratory 3/12 3 months

Exceptions to this rule include abbreviations of measurement. Therefore it is acceptable to use the
following in short form:

Acronym/Short Form Full Expression Acronym/Short Form Full Expression

cm centimeter ml millilitre

g gram mg milligram

kg kilogram mm hg milligram of mercury

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

110
 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.

 Her mother died of MI  Her mother died of myocardial infarction

 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.

The basic rules regarding titles are as follows:

 Mr. is used for adult men, married or single

 Mrs. is used for married women including widows
 Ms. is used to refer to both married or unmarried women
 Miss is used for young girls or unmarried women
 Master is used for young boys, but is rare nowadays as it has become old fashioned. It is still commonly
used on an envelope, but not in the body of the letter.
nb Both miss & master are not abbreviations so no punctuation is required.

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. Hacker (standard)

 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 Thomas (informal and commonly used for children)

 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,

Re: Mrs. Carol Brady

DOB 4 February 1974

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

Mr. Langer is an only child. Alfie is an only child.

Explanation: Mr. is only used for adult men, so if
the patient is a child you should use their first
name.

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
my surgery today complaining of painful wisdom
teeth.
Explanation: You can not use titles with first names
only.
Mr Holmes, a 23-year-old young man, presented at
my surgery today complaining of painful wisdom
teeth.

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.

Dear Dr., Dear Doctor,

I am writing this letter.... I am writing this letter....
Explanation: Do not use short forms without the
surname of the person.

113
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

 Commas not required when the address in separated by lines

Dr. John Howard Dr Ian Hanson Lactation Consultant
1 Wickham Tce Consultant Orthopaedic Surgeon Breast Feeding Support Centre
Spring Hill Riverlea Public Hospital 68 Main Street
QLD, 4010 Graham Street Romaville
Riverlea N.S.W, 2068

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.

 Dear Dr. Wilson,

 Dear Dr. Wilson:

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.

 Re: Dylan Charles D.O.B.04/12/2010

 RE: Dylan Charles D.O.B.04/12/2010

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.

 Past medical/social history

 Current condition in detail or discharge plan
 Conclusion, which if time permits, should be specific to the scenario in then case notes.

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)

 With best regards,

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.

Sample Letter Format from a Physiotherapist

05/02/2016

Mr. Alex Hinges

Southside Physiotherapy Centre
15 Kings Street
New Hampshire
N.S.W 2240

Dear Mr. Hinges,

Re: Master Peter MacLean
D.O.B. 17/10/1999

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.

He was admitted with an exacerbation of his CF on 02/02/2016 with frequent small

and non-productive coughs. Examination revealed a thin and moderate dehydrated
young man with hyperinflated chest. His temperature was spiking. He had
moderately decreased lung function with blood oxygen saturation (SaO2) of 95%.
There were widespread crackles on auscultation. Peter was treated with
antibiotics intravenously.

Initial physiotherapy consisted of PD, percussion and vibration. Effective cough

techniques were demonstrated.

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

30 Dec. 15 30 December 2015

Explanation: The date should be written in full. 30/12/15

To Dr. Blair Howell

Dr. Blair Howell, Admitting Doctor
Admitting doctor 28 George Street
28, George street, Spring Hill
Spring hill, Queensland 4000
Queensland 4000

Explanation:

1. To not required.

2. Commas not required when the address is written

top at the letter because the information is
separated lines.

3. Capitals required for job titles

4. Capitals required for street names & suburbs.

Dear Dr Jones Dear Dr. Jones,

Explanation: Comma or full colon required Dear Dr. Jones:

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.

Your's sincerely, Yours sincerely,

Explanation: The possessive form is used before nouns,
not adverbs

Regards, With best regards,

Mary Smith Mary Smith
Charge Nurse Charge Nurse
Explanation: Informal, email style closer

Thanks, Thank you for your assistance regarding this patient.

Mary Smith
Charge Nurse Yours sincerely,
Explanation: Too casual Mary Smith
Charge Nurse

Hello Dr. Jones, Dear Dr. Jones

Hi Dr. Jones
Explanation: Too casual

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

 Context: On examination, there was slight tenderness in the right fornix.

 Date: On today’s visit, the patient was pale and sweaty.
 Emphasis: Please note, the patient is allergic to penicillin.
 Mood: Unfortunately, the patient’s condition has worsened. Note, mood or comment adverbs,
such as unfortunately or regrettably convey the health professionals concern toward the
patient’s condition and are therefore effective ways of displaying emphathy.

 Contrast: The patient's condition has improved. However, a follow up visit is required.
Sentence Structure

Adverbial Phrase Subject Verb Object/Compliment

blank I suspect the patient has

developed ectopic
pregnancy.

Comma preferred Unfortunately, I suspect the patient has

developed ectopic
pregnancy.

blank Abdominal revealed slight right iliac

examination fossa tenderness.

Comma preferred On examination, slight right iliac was revealed. blank

fossa tenderness

blank Clinical revealed a large mesioincisal

examination of fracture.
hard tissues

Comma preferred On examination, a large was revealed. blank

mesioincisal
fracture

Comma preferred Regarding her she has been suffering asthma for which
medical history, from she uses a ventolin
inhaler.

Comma preferred On review today, there was no improvement in

her condition.

Comma preferred In terms of his he is a heavy smoker and

medical history, a heavy to
moderate drinker.

117
Comma preferred Please note, the patient has an appointment
with his
physiotherapist at
10 o'clock on
Monday.

Comma preferred In addition, there are composite and

amalgam
restorations on
several teeth.

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:

 Use a comma if the if clause is at the beginning of the sentence.

 If you could take over her antenatal care,it would be much appreciated.

 If you have any further questions regarding this patient, please don’t hesitate to call
me.

 Don’t use a comma if the if clause is at the end of the sentence.

 It would be greatly appreciated if you could take over her antenatal care.
 Please don’t hesitate to call me if you have any further questions regarding this patient.
4. Complex sentences:
 Use a comma if the dependent clause is at the beginning of the sentence.
 In case of irritation, redness or swelling, please consult your doctor.
 When the results become available, I will forward them to you.
 Because of her deteriorating condition, the patient was admitted to hospital.

 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
1. On review today Mr Walker has reduced
smoking from 20 to 10 cigarettes per day.
2. On examination today there was a soft
fluctuant swelling palpable on the left cheek
3. Regrettably she has problems with breast
feeding and caring for the baby.
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
man who was admitted to hospital on the
18th of July, diagnosed with myasthenia
gravis.
2. Mr Jones, a 57 year old man was admitted to
hospital on the 18th of July, diagnosed with
myasthenia gravis.
Comma required for appositives. Refer to rule 2
above.
Apply the comma rule for conditional sentences.
Refer to rule 3 above.
Apply the comma rule for complex sentences.
Refer to rule 4 above.
 He has an allergy to nuts, once he was
hospitalised for severe anaphylactic
reaction.
Refer to rule 6 above.
 Please note that, Daniel has an allergy to
peanuts.
Apply the comma rule for comma splices. Refer to
rule 5 above.
 Mr.Farrah, presented at my surgery today
complaining of pain radiating from his left
ear to his front teeth.
Do place a comma between the subject and verb of
a sentence.
 Initial examination revealed, complete
edentulous upper and lower jaws with
healthy soft tissue.
 I am writing to request, visits for this family.
Do place a comma between the verb and object of
a sentence.
119
Correct
1. On review today, Mr Walker has reduced
smoking from 20 to 10 cigarettes per day.
2. On examination today, there was a soft
fluctuant swelling palpable on the left cheek
3. Regrettably, she has problems with breast
feeding and caring for the baby.
4. Please note, he has a prosthetic heart valve.
1. I am writing to refer Mr. Jones, a 57 year old
man who was admitted to hospital on the
18th of July, diagnosed with myasthenia
gravis.
2. Mr Jones, a 57 year old man, was admitted to
hospital on the 18th of July, diagnosed with
myasthenia gravis.
 He has an allergy to
nuts and was once hospitalised for severe
anaphylactic reaction.
 Please note that Daniel has an allergy to
peanuts.
 Mr.Farrah presented at my surgery today
complaining of pain radiating from his left
ear to his front teeth.
 Initial examination revealed complete
edentulous upper and lower jaws with
healthy soft tissue.
 I am writing to request visits for this family.
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

1. Medications and Diseases

 Capitals are required for proper nouns. Proper nouns include the brand name of a drug or registered
trademark of the manufacturer.
 Ritalin
 Voltaren
 Zocor
 The chemical constituent should be written in lower case.
 penicillin
 amoxicillin
 Names of diseases should always be lower case.
 bowel cancer
 high blood pressure
 diabetes
 epilepsy
 Eponyms: Some medical conditions are named after the person who discovered it. In this case the first word
should be capitalised.
 Parkinson’s disease
 Bell’s palsy
 Names of medical procedures do not require capitals.
 orthopantomogram
 x-ray
 caesarian section
 Body parts should always be lower case
 heart
 adrenal gland
 knee
2. Proper Nouns: Proper nouns name something specific as in the examples below. These words must always be
capitalised.

 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.

 The patient was admitted to hospital.

 The patient does not have a family doctor.
 Steve is a teacher.
 Yoshiro is a doctor.
 Reza is a dentist.
4. Holidays, months, days of the week all need to be capitalised. However seasons do not.

 The baby was born on Christmas Day.

 The patient was admitted to hospital on January 12.
 Please come and see me on Wednesday.
 The vaccination will be available in spring.
5. The pronoun "I" must always be capitalised.

 It was I who treated the patient.

6. Capitalise the first word of a salutation and the first word of a complimentary close.

 Dear Dr. Jameson:

 Yours sincerely,

120
 Common Errors
Incorrect
 His medical history shows that he is Epileptic.
 Also, I have given Dycal base on 1.1 and dressed it with
Glass Ionomer Cement.
 The patient was diagnosed with Type 2 Diabetes.
 Mrs. Marsh has a history of Hyperthyroidism, Hypertension
and Glaucoma.
 The patient is allergic to Penicillin.
 The patient suffered from severe Abdominal pain.
Refer to rule 1 above.
 Mr. duanethomson presented at my clinic today with the
complaint of a broken posterior tooth.
 The director of nursing
 emergency department
 Mater hospital
 84 Monash road
 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
home visits and wound dressing and also assisting him with
his showers.
 Please see your Pharmacist for advice.
 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.
 Mrs. Green will be discharged from hospital on wednesday.
 Symptoms of hay fever are worse in Spring.
Refer to rule 4 above.
 The patient requested that i prescribe antibiotics for the
virus.
Refer to rule 5 above.
 dear Dr. Roberts:
 yours sincerely,
Refer to rule 6 above.
121
Correct
 His medical history shows that he is epileptic.
 Also, I have given dycal base on 1.1 and dressed it
with glass ionomer cement.
 The patient was diagnosed with type 2 diabetes.
 Mrs. Marsh has a history
of hyperthyroidism,hypertension and glaucoma.
 The patient is allergic to penicillin.
 The patient suffered from severe abdominal pain.
 Mr. Duane Thomson presented at my clinic today with the
complaint of a broken posterior tooth.
 The Director of Nursing
 Emergency Department
 Mater Hospital
 84 Monash Road
 The patient was seen by Doctor Jones.
 As per the general practitioner’s order, we are doing daily
home visits and wound dressing and also assisting him with
his showers.
 Please see your pharmacist for advice.
 Ms. Gatsby is a university student.
 The patient first visited my surgery in March, 2008.
 Mrs. Green will be discharged from hospital onWednesday.
 Symptoms of hay fever are worse in spring.
 The patient requested that I prescribe antibiotics for the
virus.
 Dear Dr. Roberts:
 Yours sincerely,
 Common Mistakes Regarding Physical Description
Incorrect
Advice was given to reduce her weight.
After the verb reduce it is not necessary to follow with a
pronoun. So you is not required. Simply say:
I advised him to reduce weight, or, you need to reduce
weight.
In addition, she had lost her weight.
After the verb lose it is not correct to follow with a
pronoun.
He is now obese with a 99kilos weight and a 170cm height.
The use of the correct verb & noun form and associated
grammar is difficult. Refer opposite for correct usage.
Correct
1. Advice was given to reduce weight.
2. The patient was advised to reduce weight.
3. A reduction of weight was advised.
1. In addition, she had lost weight.
2. In addition, she has lost a further 11 kg of weight
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.
1. He is now obese with a weight of 99 kg and a height
of 170cm. (noun form)
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

 The patient presented with a complaint of severe abdominal pain.

Note 1: Complaint is a countable noun. so it can be used in the plural form or singular with an article.
Note 2: The two main prepositions used with complain are: complain of & complain about.

 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

122
 is high.
 The patient presented with a complain of chest pain.
 The patient presented with complaint of chest pain.
 He presented to my office on 23/03/2008 complaining on
severe pain associated with the lower left first molar.
is high.(verb)
 The patient presented with a complaint of chest pain.(noun)
 The patient presented with a complaint of chest pain.
(article required)
 He presented to my office on 23/03/2008
complaining of severe pain associated with the lower left
first molar.

Suggest & Recommend Vs Advise

Suggest, recommend and advise are all words commonly used in referral letters to report information were given to the
patient. However their rules of use differ and result in errors. Here are some examples of their correct and incorrect
usage.
Incorrect Correct

 I have suggested him to see you next week.
 I suggested her to return in morning as she required further
blood test and assessment.
 I recommended him to rest for 3 days.
Explanation:The words suggest & recommend cannot be followed
by an object pronoun such as him/her whereas advise can.
 I suggested (that) he see you next week.
 I advised him to see you next week
 I suggested (that) she return in morning as she required
further blood test and assessment.
 I advised her to return in morning as she required further
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
unusual in their case.
 I have already explained the couple the basic advice
regarding conception.
Explanation: The word explain cannot be followed by a pronoun or
noun without the preposition to whereas tell can.
 I explained to them that unsuccessful conception was not
unusual in their case.
 I told them that unsuccessful conception was not unusual in
their case.
 I have already explained to the couple basic advice
regarding conception.
 I have already told the couple basic advice regarding
conception.

Advise Vs Advice
Advise is a verb

 We advise patients on how to take their medication.

Advice is a noun

 We give advice or provide advice to patients on how to take their medication.

Note 1: The noun advice is uncountable so it can not be used in plural form. i.e. advices is incorrect as is an advice.

 I gave some advice to the patient regarding her medication.

Note 2: The pronunciation is different: advise advice
Incorrect Correct

 It would be greatly appreciated if you could make
a visit to this family and advice his parents
regarding the recommended vaccines for both
children.
 I am writing to refer this patient to you for an advice
regarding the management of his bilateral inguinal
hernia.
 I gave an advice to the patient regarding her medication.
 I gave advices to the patient regarding her medication.
 Please advice the patient on how and when to take their
medication.
 It would be greatly appreciated if you could make a
visit to this family and advise his parents regarding
the recommended vaccines for both children. (verb)
 I am writing to refer this patient to you
for adviceregarding the management of his bilateral
inguinal hernia(noun)
 I gave some advice to the patient regarding her
medication.(noun)
 I gave advice to the patient regarding her medication.(noun)
 Please advise the patient on how and when to take their
medication. (verb)

Request
Request can be both a verb and noun.
Request as a verb

 The patient requested painkillers. (verb form)

Request as a noun

 The patient made a request for painkillers. (noun form: request+for)

123
 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

 The patient has not been affected by the treatment.

Effect is a noun

 The treatment has had no effect.

Note: The pronunciation is the same.

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
who admitted with pain, dehydration and nausea.
 I am writing to refer Mr. Saunders, a 60-year-old widow
who complained of pain in his upper right second molar.
 I am writing to refer Mrs. Saunders, a 58-year-
oldwidow who admitted with pain, dehydration and
nausea.(noun)
 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

 Michael has no known allergies.(plural)

 Michael has a peanut allergy. (singular)
Allergic is an adjective

 Michael is allergic to peanuts.

Incorrect Correct

 In addition, he is known allergic to nuts for which he was
admitted to hospital with anaphylaxis 2 years ago.
 Regarding his medical history he is allergy to sulphur
containing drugs.
 In addition, he has a known allergy to nuts for which he
was admitted to hospital with anaphylaxis 2 years
ago.(noun)
 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

124
Confident is an adjective

 The patient is not confident in her ability as a mother.

Confidence is a noun

 The patient lacks confidence in her ability as a mother.

Incorrect Correct

 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)

a few/few & a little/little

Few and a few is used with plural nouns, and little and a little is used with uncountable nouns. Little and few
havenegative connotations and are similar in many to not much/ not many. A little and a few have positive
connotationsand are similar in meaning to some. Mixing up these words therefore will completely change the meaning of
the sentence.

Incorrect Correct

 The patient has reduced speech output and a little eye
contact.
 There are few ways to help identify the possibility of
threadworms such as checking the anus of your children at
night and frequent scratching.
 The patient has reduced speech output and littleeye
contact.(negative connotation required here)
 There are a few ways to help identify the possibility of
threadworms such as checking the anus of your children at
night and frequent scratching.(positive connotation
required)

during/while
During is followed by a noun

 During hospitalisation the patient made a full recovery.

 The patient had many visitors during his stay in hospital.
While is followed by a phrase or gerund: ____ing

 While in hospital, the patient made a full recovery.

 The patient had many visitors while recovering in hospital.
Incorrect Correct

 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.

125
 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.

126
 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)

 She is not on any medication and has no known allergies.

 Please note, the patient is allergic to penicillin.

 The patient arrived at my surgery in a depressed state.
 The family arrived in Australia in 2007
2.  believe  I believe the patient needs urgent assessment and hospital admission
 borderline  She was noted to be overweight and has borderline hypertension.
3.  consistent with  I am writing to refer Mr. Walker a 40 year old married patient, presenting
 commence with signs and symptoms consistent with prostatic enlargement.
 commence on  IV fluids were commenced in order to improve hydration.
 Therefore I commenced him on omeprazol 20 mg daily and strongly advised
him to stop smoking cigarettes and stop drinking alcohol. (active)
 She was commenced on 15gram alepam 1 tablet nightly for her current
anxiety and sleeplessness. (passive)

 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

127
  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

 There were no other remarkable findings.

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

 In November  On Monday  At 6 o'clock  Yesterday

 In Spring  On 20 November  At night  Today
 In 2006  On Christmas day  At lunchtime  Tomorrow
 In the past  On his birthday  At that time  Last week
 In the future  On review  At the moment  This week
 In the morning  On examination  At the age of 45  Next week
 In the afternoon  On investigation  At birth
 In her childhood  On presentation
 In his twenties  On two occasions

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

 In Australia  On the skin  At home

 In hospital  On the ground floor  At work
 In surgery  At the wound site
 In the stomach  At the clinic

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.

129
 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

130
  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

Example Cohesive Paragraphs

Doctors
Initially, I saw Mr. Jones last month when he came for check-up. At this time his blood
pressure showed a mild elevation (165/90).Also his weight was above the normal limit (85
kg while his height is 173 cm). However, the cardiovascular examination and the urinalysis
were normal. Therefore I advised him to lose weight, to stop smoking cigarettes and to
come for a review visit within one month. A prostate specific antigen test was requested to
be done before the next visit.

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.

131
 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.

Example: The patient is allergic to penicillin.

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:

and = the second clause contains a similar idea as the first

Example: She does not smoke and (she)drinks alcohol rarely.

but = the second clause contains an contrasting idea

Example: She does not smoke but (she) is a heavy alcohol drinker.

so=the second clause expresses a result or outcome

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.

Explanation: The sentence is not balanced and there is no

verb after the conjunction and

 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

132
 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)

 Her blood pressure was 175/95 and took Normison 1

tablet and 2 panadol at 10 pm.

Explanation: You must add a new subject here as it is

different to the subject of the first clause Her BP Vs She

 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.

Explanation: This error is called a comma splice. A comma

splice is incorrect because two sentences cannot be joined
with a comma alone. In this case you can join the sentences
with and.

 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.

Explanation: incomplete verb formation after and

Parallel Structures & Balanced Sentences

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
 Sally initially presented alone to my clinic on
27/12/07 with a 3-month-history of constipation
and associated using laxatives
Explanation: The sentence is not balanced as noun phrases
 He has a family history of stroke and diabetic.
Explanation: This sentence is not balanced as stroke is a noun and
diabetic is a adjective
 Good hygiene should be maintained by taking a
morning shower, using individual towels, washing
clothes daily and to vacuum regularly.
Explanation: the final verb is out of balance
 I am writing to refer this patient, a 26 year old
computer programmer, who is displaying sign and
symptoms consistent with subdural haematoma.
Explanation: Both nouns should be in plural form
 His height is 170cm and weighing 99kg.
Explanation: unbalanced word form, height is a noun, weight is a
gerund
 On subsequent visits, impressions for full upper and
lower dentures were made, bite registered and
complete upper and lower dentures were delivered
. delivered
Explanation: Passive form required for all verbs
 She diagnosed with hyperthyroidism in 1997,
hypertension in 2003 and Glaucoma since 2004.
Explanation: Time markers need to be balanced.
 During hospitalization, IV fluids were commenced
and used a transdermal patch for her pain.
Explanation: Passive form required for all verbs
 Further examination revealed dry mouth, dentures
were worn out on occlusal surfaces and a heavy
calculus deposit was seen on the dentures.
Explanation: In example 1, by adding in addition, you can change
the structure and keep the sentence balanced. In example 2 the
sentence is balanced as the verbs have been replaced with noun
phrases.
 She is feeling loneliness and isolated due to losing
her social contacts
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.
134
Correct
 Sally initially presented alone to my clinic on 27/12/07 with
a 3-month-history of constipationand associated use of
laxatives
 He has a family history of stroke and diabetes
 Good hygiene should be maintained by taking a
morning shower, using individual
towels, washing clothes daily
and vacuumming regularly.
 I am writing to refer this patient, a 26 year old
computer programmer, who is
displaying signs and symptoms consistent with
subdural haematoma.
 His height is 170cm and weight is 99kg.
 On subsequent visits, impressions for full upper and
lower dentures were made, bite registration was
taken and complete upper and lower dentures were
 She was diagnosed with hyperthyroidism in 1997,
hypertension in 2003 and Glaucoma in 2004.
 She has had hyperthyroidism since 1997,
hypertension since 2003 and Glaucoma since 2004.
 During hospitalization, IV fluids were commencedand a
transdermal patch was used for her pain.
 Further examination revealed dry mouth. In addition,
her dentures were worn out on occlusal surfaces and a
heavy calculus deposit was seen on the dentures.
 Further examination revealed dry mouth, worn out
dentures on occlusal surfaces and heavy calculus
deposits on the dentures.
 She is suffering from loneliness and isolation due to
losing her social contacts. (nouns)
social contacts. (adjectives)
 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
to be discharged today.
Explanation: The relative clause defines the object
of the main clause i.e Which patient? The patient
who is being discharged.
 I am writing to refer this patient,who is due
to be discharged today, for ongoing
physiotherapy treatment.
Explanation: The relative clause provides extra
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-
year-old married woman who is suffering
from mild depression.
Explanation: The relative clause defines the object
of the main clause i.e Who? Mrs. Patterson, a 36-
year-old woman.
n.b. In this sentence, the first comma allows extra
information to be added about Mrs. Patterson.
 Mrs. Patterson, who is a 36-year-old married
woman, is suffering from mild depression.
Explanation: The relative clause provides extra
information (Mrs. Patterson is a 36 year old
woman) about the subject of the main clause but
does not define it. It could be removed from the
sentence and the meaning would still be clear: Mrs
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.

1. The doctor who performed the operation is from Iraq.

2. Doctor Yousif, who is from Iraq, performed the operation.
Incorrect Correct

 Mr. Holmes who lives with his wife in a
government flat, is an aged care pensioner.
Explanation: Commas required as it is a non-
defining relative clause. You can also express this
information in a compound sentence.
 Mr. Holmes, who lives with his wife in a
government flat, is an aged care pensioner.
 Mr. Holmes lives with his wife in a
government flatand is an aged care
pensioner.

 Mr. O'Riley, who lives alone in his own home,
and works as a fencing contractor and has
only one brother.
Explanation: After the second comma a verb is
required. i.eMrO'Riley works..
 Mr. O'Riley, who lives alone in his own
home, worksas a fencing contractor and has
only one brother.

 Mrs. Peterson who recently moved to our  Mrs. Peterson recently moved to our

135
 retirement village following her husband's
death.
Explanation: No relative pronoun needed here as it
is a simple sentence.
 Mr. Brown presented at my clinic today with
a complaint of fractured front teeth in a
traumatic car accident.
Explanation: A relative clause is required to define
how the teeth were fractured. Alternatively it can
be written as two separate sentences.
 I am writing regarding Mr. Jones, a 35-year-
old male, who was recently diagnosed with
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
66-year-old widow with three children, with
complaints of chest pain.
Explanation: Relative clause required here as two
prepositional phrases is confusing.
 I am writing to refer, Ms. Abbot, a 58-year-
old widow admitted with pain, dehydration
and nausea.
Explanation: Incorrect comma placement and
relative clause required.
 Mr. Fisher was admitted to hospital with the
diagnosis of obstructive artery disease and
end with 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
you who came to me complaining of a
sprained ankle.
Explanation: The relative pronoun must follow the
noun it is referring to.
 I am writing to refer this patient, a 39-year-
old widowed woman, who is under our care
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
gentleman was admitted to hospital for
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
situation, who has been a patient of mine for
a long time.
Explanation: The relative pronoun must be added
136
retirement village following her husband's
death.
 Mrs. Peterson, who recently moved to our
retirement village following her husband's
death, has a history of hypertension.
 Mr. Brown presented at my clinic today with
a complaint of fractured front
teeth which occurred in a traumatic car
accident.
 Mr. Brown presented at my clinic today with
a complaint of fractured front teeth. This
occurred in a traumatic car accident.
 I am writing regarding Mr. Jones, a 35-year-
old male who was recently diagnosed with
with tuberculosis.
 I am writing to refer Mrs. Margaret Green, a
66-year-old widow with three children who is
complaining of chest pain.
 I am writing to refer Ms. Abbot, a 58-year-old
widow who was admitted with pain,
dehydration and nausea.
 Mr. Fisher was admitted to hospital with the
diagnosis of obstructive artery disease which
required quadruple artery bi-pass grafts.
 I am writing to refer this 14-year-old boy who
came to me complaining of a sprained ankle.
 I am writing to refer this patient, a 39-year-
old widowed woman who is under our care
after being injured in a car accident.
 Mr. Roberts, who is a 72-year-old retired
gentleman, was admitted to hospital for
acute cerebral infarction on 08/03/10.
 I am writing to explain Mr. Clarke's current
situation. He has been a patient of mine for a
long time.
 I am writing to refer Mr. Clarke, who has
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.

Rules for linking words

 Although/Even Though + clause (underlined below)

e.g. Although + her condition has improved, she is still very weak.
 Despite/Inspite of + noun or gerund (underlined below)
e.g. Despite an improvement in her condition, she is still very weak.
Despite overcoming her illness, she is still very weak
 Despite the fact that/Inspite of the fact that + clause (underlined below)
e.g. Despite the fact that there has been an improvement in her condition, she is still very weak.
Despite the fact that her condition has improved, she is still very weak.
 However : A comma is required after however
e.g. Her condition has improved. However, she is still very weak

Common Mistakes
Incorrect
 Inspite of providing with exercises and compensatory
techniques she was unable to cope with training due
to an increase in pain.
Explanation: providing is incorrect, as it was the patient who was
provided excercise, in such cases you have 2 choices
1. Use a noun phrase In spite of our provision of
exercises
2. Use passive voice In spite of being provided with
excercise
 Although she has improved, but she is still very weak
Explanation: This sentence has two linking words so one must be
omitted.
Correct
 Inspite of our provision of exercises and compensatory
techniques, she was unable to cope with training due to an
increase in pain.
 Inspite of being provided with exercises and compensatory
techniques, she was unable to cope with training due to an
increase in pain.
 Although she has improved, she is still very weak.
 She has improved, but she is still very weak.

 Despite of regular follow up, plaque and tartar were
detected over cervical and bucal surfaces of the
denture teeth.
Explanation: There is no linking expression “despite of”
 Despite of this advice, he regularly drinks 2~4 glasses
of wine every night as well as 1~2 glasses of scotch
at weekends.
Explanation: As above
 Despite regular follow up, plaque and tartar were
detected over cervical and bucal surfaces of the
denture teeth.
 Inspite of regular follow up, plaque and tartar were
detected over cervical and bucal surfaces of the
denture teeth.
 Despite this advice, he regularly drinks 2~4 glasses of
wine every night as well as 1~2 glasses of scotch at
weekends.
 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.

 due to + gerund (-----ing form)

Example: Due to losing weight, the patient's health improved.

 for this reason+ clause (underlined below)

Example: The patient was placed on a low fat diet. For this reason,her health improved.

 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 .

 due to the fact that + clause

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
usual social contacts.
Explanation: Incorrect word form and sentence structure after due
to
 The patient is feeling lonely and isolated due to losing her
social contacts. (clear and concise)
 The patient is feeling lonely and isolated due to the fact
that she lost her social contacts. (formal and a bit wordy)

 His mother had difficulty in caring for both her son's illness
and looking after two other small children due to sick.
Explanation: Incorrect word form and sentence structure after due
to
 His mother had difficulty in caring for both her son's illness
and looking after two other small children due to her
sickness.
 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

 During + noun (underlined below)

Example: During his stay in hospital, Mr Mason's condition has improved.

 When + time clause (underlined below)

Example: When Ms. Song returned today, she was pale and distressed.

 While + clause (underlined below)

139
Example: While waiting in reception, the patient fainted.

 Ago + past tense (underlined below)

The patient had a liver transplant 12 months ago.

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
informed me that her home ovulation prediction test
showed positive.
Explanation: To demonstrate a higher level of English proficiency
this information should be expressed in a complex sentence rather
than two simple sentences.
 When the couple presented at my clinic today, Mrs.
Conway informed me that her home ovulation prediction
test showed positive.
 Today, when the couple presented at my clinic, Mrs.
Conway informed me that her home ovulation prediction
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
2- (5)
a year ago was in San Francisco ,
then work in California
On weekend with a friend from Canada,
not see each other for a long time
3/ 4 days walking around San Francisco
about 6/8 hours a day,
very hilly places
By end of 4th day had soreness in knee,
thought it would go away, but didn't
Had pain for 6/8 months before seeing a
doctor
Went to GP who referred him to 1st surgeon
3-A-(3)1st surgery was 3 months ago
Frustrated to have 2nd surgery
1st surgery and communication with surgeon
frustrating
Not informed he had to bring somebody to
drive him home
Not knowing about having general
anesthesia,
only told few minutes before surgery
Frustrated of lack of communication
B-(4)10 days after surgery was checked
Told everything was ok
Had great deal of swelling
Not know what to expect, not know whether
normal or not
Severe swelling for nearly 3 months, about
10 weeks
Coz of bad experience with first surgeon ,
got referred to another surgeon
C-(3) 1st surgeon took x-ray,
MRI and various scans
Told there was a small tear in the left med-
meniscus
4-(2) 2nd surgeon said it was bad luck as 1st
surgeon didn't take enough of the meniscus
away
Only partial, a difficult judgment
So had complete meniscectomy of the med-
meniscus
3 weeks ago.
828
5-A (4) not seen a physiotherapist
Can walk, but not comfortable
Can't manage stairs, only hobbling up
Can't put pressure on knees, can't kneel on it
No crutches, no gaiters to help walking
Can move around
Back to work
B-(5) teacher, a lot on foot
Knee in morning gone down a little bit
Stiff when firstly get up
Sleeping uncomfortable, sleep at back, can't
move around easily
Put ice packs on knee trying to reduce
swelling
By end of day knee is tired and sore
Go home and put feet up
6-A (3) using some ice
Take anti-inflammatory / Voltarin
Taken 2/3 times a day for 3 weeks
No other medications / a bit healthy
Take vitamins only
B-(5) running for the last 10 years/ 2,3 times
a week
Not really athletic , but trying to keep fit
Going to the gym on and off for the last 10
years
Like the gym , feel confident
Not wild about swimming
Got a bike and cycle to work about half an
hour
Not cycling recently
Want to cycle, do aerobics to keep weight
down
Now can't run, so not sure what to do
Time frame of recovery not discussed
before with surgeons
7-(5) coz he had two surgeries, he might
expect recovery to be a little bit slow
Main aim of treatment is to decrease
swelling and increase knee movement
Coz of 3 months not exercising , have
wasting of quadriceps muscle, the main
muscle in front of the knee
So daily activity and walking upstairs,
riding and running must work on it to
strengthen …
… 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

7-a- 66 words / columns,
according to numbers of syllables and level
of difficulty
-read out loud the words
-score the correct pronunciation and
understand the meaning of words
11- 1- provision of visual, interactive
materials like computer modules,
screen programs in clinical practice
2- education of health professionals
3- education of family and friends
4- creative use of internet as a tool of health
education

- both reading comprehensive tests, and 12- sensitive and responsive

numeracy tests
-based on hospital materials and multi-
choice questions
-assess illiteracy in students in schools
-increase exposure to the health system
13. A. 1/10 patient have limited functional
health literacy

8- B. probably underestimate the size of

1- 8 people / 10%of sample have difficulty problem
reading and interpreting health tips
2- rate at 7 or below 7 year age C. the clinician need to be more aware of a
health literacy
3-7 patients/ 9% scores inadequate
functional health literacy
4- 20% unable to complete the test
5- 8 patients / 12% low or below average
literacy compared to students completing
year 9

9-
1- NO
2-NO
3-NO
4-YES

10- 1- 127 patients with rheumatoid arthritis

were functionally illiterate
2- 15% poor literacy based at a school room
3-100 patients with vary rheumatologically
condition over 50% rate below the 10th
grade level
4- third rate 7th grade level
5-88 patients, 12.5% had poor health
literacy
6-lower room schools have poor health
status
-more hospital outpatients visits

830
 May 2014 Listening (A)
2-(8) tingling sensation, something
filling her
-pretty in both hands
-mainly in left hand and arm, numbness
-sometimes can't feel it on the bridge of
her nose
-can't pinpoint the starting date
-a couple of months ago
-gradual onset
-at night
-lying on bed position
3-(11) not constant/ come and go
-nothing make them worse
-being anxious does not bring the
symptoms
-nothing make them better
Sometimes lying on different positions /
on back is better
-not waken her from sleep
-no headaches
-stiff neck and stiff shoulders
No leg symptoms
No back pain
In the past had some back injuries
Not get worse on the last 6 weeks/
almost the same
No visual disturbance
1st time to have something like this
4-a-(4) mother died because of heart
failure at age 56
she's now 63
Diagnosed as scleroderma 2 weeks
before death
Had lots of problems, difficulty
breathing, heart problems
b-(4) grandfather died due to heart
failure, heart disease
at the age of 85
grandmother had some strange arterial
conditions
she lost speech, died at the age of 80
5-(8) no chest pain
Soft tingling sensation in nipples
Not sure if have heart palpitations
-sometimes feels racy
When lying down/ at bed time
No missing beats
831
No shortness of breath/ only after
exertion
She's fit/goes to the gym
6-(7) now she's non-smoker
-in the past, in her 20s smoking 2/3
cigarettes a day for 3/4 years
-no history of high blood pressure
-no disturbance in bladder and bowl
function
-cholesterol checked recently and
normal
-alcohol: average drinker, 2/3 glasses/
not binge drinking
-no illicit drugs
7-(6) preosteoprosis condition
(Osteopenia)
-not a serious condition
-have bone density scan
-no operations
-no fractures
-only taking calcium and vitamin D
No regular medications/ no OTC
8-(7) academic job in linguistics
-full time job
-keep her too busy
-work on computer a lot
-leave it only at lunch time or meetings
-not exacerbated to her symptoms
-sometimes exercises
-go to the gym/ go running in the
morning
9-(7) not specific serious condition
-worried because of her mother's
condition
No severe heart disease/ low risk
- gives attention to heart problem as well
-not cardiac problem
-more likely neurological problem
-may be hand nerves like carpal tunnel
syndrome
-There may be a neck problem/wear and
tear in neck desk
10-(4) x-rays on neck and cervical spine
-ECG test/ exercise stress test using
treadmill
-unreasonable to drop heart problems
-appointment to discuss results
 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

- he is not normal/ not osteoporosis Supposedly 800 to 1000mg daily

- he is osteopenic 3 serves /one serve through incidental food

like broccoli
-the BMD test measures the amount of bone
in the bone 2 other serves like yellow cheese a cup of
yogurt
-it tests how strong the bones are/ not felt by
the person himself/ no feeling of weakness 250mg of calcium enriched milk

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
Take muscles then bones out of comfort
zone
7-A-(5) exercise needs to be weight-
bearing
Walking for 31-year-old is not enough
Do specific strength-training
The maximum weight you can lift
Lift weights/ when start it would be heavy
at the beginning
Find the hardest you can do
B-(5) exercise to work your arms and
muscles
Stabilize your shoulders and upper back
Exercise for the legs/ hips and lower back
Hips and lower back are the most likely
suffering that’s why tested at the BMD test
8-A-(6) all exercises need to be changed to
keep their benefits
He will start with the exercise program
given
What’s difficult today won’t be the same in
6 months
Still young so change a lot at the beginning
Make sure no sore back or neck
Once get comfortable/ change above a kilo
for a couple of weeks
Then 6,7,8 kilos (dumbbells)
Stay like this for a while, then change again
834
B- (4) change the way fast then slow
Reverse order( what you start with end
with)
Change the kind of exercise
Forget weights after a while and do
endurance exercises
It’s a bit complicated so checking frequently
is needed
9- A-(5) address calcium intake
Anti-milk mother so took recommended
intake by soya
Premenopausal women need higher intakes
(1300 mg daily)
4 serves a day
She is not anti-dairy , she takes some cheese
incidentally
Should eat sardine, tuna, salmon or calcium
enriched milk, juice or bread
B- (4) she is at home and has a garden
Once broke a hip
Not put sunscreen in the morning
Not expose in hot hours
Be in the sun before 10 and after 3
For half an hour without sunscreen
To get vitamin D expose forearms ,face and
hands
 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

3-paranoid thoughts 10-1-dehydration -Infection

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
2-(6)
no left heel pain
-on insole of the heel
Couple of weeks
-at the back
-getting progressively worse
-not see anyone about it
-only a friend's advice
-never seen a podiatrist before
3-(3) first step in the morning is the
worst
-improves with movement but not
getting better
-if sitting for a long time and then
stand up returns
4-(3) a couple of weeks at the zoo
-it was hot wearing thongs
-walking around the whole day
5-(5) when very young at 10 had a lot
of feet problems
-play a lot of sports
-problems in the same place
-but in both heels
-feeling it was bruised at the top of
the heels
6-(6) tender when touch the insole of
the heel
-no pain underneath the ball of the
heel
-no left foot pain
-left ankle very loose, perfect
-right ankle is restricted at the back of
the calf
Watch him walking for a couple of
meters, normal
836
7-(6) it's very common no need to be
alarmed
-inflammation at the strong ligament
underneath foot
-wearing thongs for a long day which
is not supportive
- no time to rest so inflammation is
still there
-morning pain and after rest indicates
plantar fasciitis
-linked to childhood problems
8-(8) couple of conservative things to
be done
-reduce tightness in calf
-exercise done to show restrictness in
calf muscles
Loosen up calf muscle
Teach him some stretches
Take stress of the heel
Reduce inflammation
Ice the area with a long freezed bottle
for 10 minutes
Massage
Look at shoes not wear thongs for
long
Sandals instead
Limit use of thongs for lifetime
9-(4) review in a month time
If not improving, put insole in shoes
Not complete resolution of pain
Only reduction or improvement of
pain
10-A (3)-play a lot of sports
Not organized sports, office sports
Basketball and soccer in winter
Cricket in summer
B-(3) high ankle support shoes for
basketball
Shoes are a couple of years old/ need
renewal
For cricket and soccer has the
standard supporting footwear
C-(3) continue sports
Stretch calf as it adds pressure to the
heel
Keep both calves away from
participating
Give sometime to rest foot
11-A (4) 3 and half year old son,
while walking his knees are close
together
Mother thinks he's pigeon toed
Mom had corrective footwear at 12
for a couple of weeks
Had problems with knees and feet
Worried of genetic conditions
Dad has not noticed any problem
Not like walking much, likes to be
picked up
B-(4) close knees are not a problem
for his age
If excessive fatigue, worried of
genetic causes
Some not prefer intervention at this
age, but if scary they have to
Bring mom, his son and his footwear
12-(6) should all footwear be custom-
fitted?
Off the shelf shoes are fine
Firm shoes to keep heals steady
walking
Something that bends at the ball of
foot
Something that can be fastened to
foot to keep it firm
Thongs not recommended for a life
time
837
August 2014 Listening B
2-a natural attributes
-can be taught or learned
b)medicine, law, helping vulnerable
people
c)women with breast lump/or
somebody in court charged with a
crime.
D) -professional expertise
-moral expertise
3-profession itself
-look at students' needs/ revere elders
for their expertise and guidance
-patients
-confidentiality, not exploit them
sexually, and keeping patients'
secrets.
4-a-1989
b-the mental health act
c-another level of requirements for
professionals to work in a certain
way, not to hold patients against their
will, conduct themselves in relation to
patients' belonging doctors well
behave.
d-as if you are a member at a tennis
club, you have to adhere to the rules
if you wish to remain a member at
this club.
5-a- what's morally a good behavior
and what's immoral
b-where: America, when: 1970s
c-1992
6-1-respecting confidentiality of
patients and their families
3-not misusing their skills
4-respect humanity and dignity of
patients
7-a- privacy
b-you can't always maintain secrets
because sometimes you can't keep it
confidential
c-if patients tells you they are
intending to kill someone like a
relative or an ex-boyfriend
d- you have to keep patients
information confidential
-but you also need to go to police and
warn the intended victim
8- a- try to work out all existing
problems in regard to applying the
principle of confidentiality
b- if a patient was charged with a
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-a- degree of freedom to work out
their own ethical behavior so that
governments not to dictate how
doctors behave in their ethical life
b- use a code to deter an individual
from over strain into immoral
behavior.
-self-regulation, and retribution, bad
apple, punishment
10-a- body of professional to punish
people who break rules
b-worst: expulsion from college
-least: reprimand , warning
c-codes shouldn't punish, but promote
good behavior.
11-a- code of ethics are good things
and help professionals to work well.
-protect the needs of the patients
b-refine codes and to let them work as
readily as possible
 9.2014 Listening A
2-A-(5):
-she’s well, but smaller than her brother
-parents need to know why babies
delivered 4 weeks earlier
-Olive is small not have a lot of reserve
-she’s at risk of potential problems
-so she is taken to nursery
- not kept warm unlike her brother
-not have enough brown fats so taken to
incubator
B-(9):
-come out of incubator when 1800 to 2
kilos
-It depends on her
-when she is stable get out of incubator
-Given some fluids IV
-Given milk to feed her
-When maintain temperature , she will
get out
-Depends on how quickly she responses
-No set weight
-No set time
3-(8):
- first baby
-Found quiet early they are twins
-At week 5 start early scan to prepare
-High risk pregnancy cause of twins
-Regular doctor appointments,
everything is normal
-Regular scans/ shows regular growing
-Scan is stressful for them so missed a
couple of scans
-35 week scan was normal
-Olive’s placenta was smaller , had less
fluids
-So take out babies immediately
4-(9):
- mother took 2 doses of antenatal
steroids
-Were told to have caesarian
-babies hearts’ monitored a lot of times
-Olive not require oxygen
-Put shining light on foot
-Pulse oximetery measures o2 saturation
level
839
-O2 rate is 99 so normal /
-Her brother breathing is normal as well
-no respiration problem
-35 week lungs still immature
-Babies are OK as steroids helped
-blood test to check O2 level
-Put on blood gas machine
5-(9):
-not huge nearly 1800grams
-Not growth restricted
-Follow up when 2 years with pediatric
to check her muscles
-Catch up on her nutrition outside uterus
-Fast intervention due to lack of food in
placenta need extra calories so breast
feed and formula feed
-Not going to be a big child
-Try to get enough nutrition and glucose
for the brain
-She is neurologically normal
-Blood sugar level is also normal
-no seizures
6-(9):
-blood checks to make sure babies are
not infected - cause wife was GBS+
Broad spectrum Antibiotic for 24 hours
-start penicillin and gentamicin
-take vitamin K cause they are not able
to produce it at birth
-it is not produced in stomach till it has
food
-risk of hemorrhagic disease of new born
- give antibiotics
-24 hours steroids for caution
-waiting for colostrums to come
7-(5) - wife like to breast-feed
-especially for Olive
-Cause she is growth-restricted,
she might get a disease in the gut
- so breast-feed even a couple of drops
- important to give the children
colostrums
- give them some sugary water till they
settle down and temperature OK
-no problem breathing
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)
2-A-(4) a- chest tightness
b-beating and sweating
c-tiredness and dizziness
d- last for 10/15 seconds
2-B-(4) a- sat down
b-took a deep breath
c-walked over to a water dispenser
d- quickly drank 2 glasses of water
e- sat down again and then just got back in
line
3- A (5)a- when got home was still dizzy
b-short of breath
c-felt weak
d-rang her GP
e-told her to go to hospital emergency
3-B (2)
a- if still dizzy need to check blood
pressure, worry of heart arrhythmia
b-risk of heart attack due to its intense.
4-(5) a- she had just finished film making,
had a stressful time
b-worked crazy hours
c-smoking more than usual
d-she wasn’t unwell, not have a cold
e-not drinking more fluids, not get enough
sleep, and not eat normally
5-(6) a- it happened a week before
b- she had a sharp pain across chest
c- last for few seconds, she took her breath
back , it was intense
d- not burning pain , but sharp, she had to
sit down
e- started above right breast the across down
into arms
f-not remember if had it before or not
6-(4) a-smoke once a day, then skip weeks
b-advised by doctors to quit
c-one cup of coffee a day
d-not a heavy drinker/ not every week
7-(5) a-not sure whether it is arrhythmia or
not
b-order ECG for heart
c- may not get again for weeks or months
d-better to do 24 hour Halter Monitor
c- cause ECG in her case is of limited utility
841
8-(4) a-not vegetarian, but not eat a lot of
meat
b-had regular periods/ not excessive flow of
blood
c-since mid 40s not as long as it used to be/
not 5 days
d-still regular /good amount of blood flow
9-(9) a-Animea/ no enough iron to make
blood
b-problems with thyroid
c-mother had a thyroid problem , but
Roseanna did not test it
d-thyroid function test to be done
e-if thyroid is overactive , it sends signals to
the body to speed up every thing.
f-no feel agitated/ no tremors
g-lose of weight is negative
h- put on weight not related to food habits,
but put it down to metabolism
10-(6) a- nodules on her thyroid
b-had an operation to take the nodules off
c-still had thyroid
d-not overactive thyroid/ not cancerous
e- something related to calcium/may be
parathyroid gland
f-it organizes calcium level in the body
g-quite dangerous if untreated
h-had neck problems in her 60s
i-mother was thin , but getting older, she put
on weight
11-A-(4) a-daibetes normal
b-Tonsils removal
c-appendix removal
d-no medications
B-(2) a-dad not diabetic
b-3 brothers dad-side are diabetic
12- (6)-a-she’s still young 45
b-it is normal to happen once more
c-the older she gets, more normal to have
heart problems
d-check heart concerns
e-not want to over investigate her
f-if recurrent it would be warning
g-after proceeding in examination, she can
go
 10.2014 Listening (B) 8-a-leg elevation

2-a-2008 b- assessed b- further investigations

c-managed d-2 weeks c-redistributing

e-venous leg f-diabetic foot d-skin care

g-surgical wounds e- glycemic control

3-1- 80% 2-diagnosis f-specific therapies

3-present 4-explore

5-local 9-a-unsuitable

4-1-intermittent b-reactions

2-a-duration b-severity c-adherence

3-a-own words b-regularly d-if incorrectly applied

4-a-makes it better b-sleep e-condition

c-affect mood d-appetite

5- a-procedure b-cleansing 10-1- The patient in a comfortable

position.
c-anxiety d-subjective
2-minimise interruptions
e-products f-standardized
3-deep breathing
g-educational
-distraction by engaging in
6-1- 0 to 10/ low vision conversation
2-point on the line 3-dementia 4- looking at facial expressions
4-the word 5-they can feel in control
5-observational/ severe brain injury 11- 1-A
7-a- aching or throbbing 2-B
b-dressing changes c-tingling 3-C
d-electric shock e-altered

f-light touch g-increase severity

842
 11.2014 Listening (A)
2- Details of the problem: (7)
-used to be a good runner as a little girl
-right foot perfectly right
-left foot deteriorated considerably
-one toe shortened
-whole foot considerably
deformed/shorter
-one toe has been cut at the back of the
first little joint
-have a painful corn on the left little
toe/can’t endure any pressure on it
-had various operations on it
-30 years ago had toe cut-off/ had blood
poisoning and went back to hospital
3-Current treatment (2):
-had regular podiatry treatment/ordinary
-cut nails-massage
4-Other medical problems: A-(3)
not have -diabetes -Circulation
problems -diabetes in family members
B- problems with fingers (5):
-Mother had arthritis
-she had arthritis in her two left fingers
-not sure osteoarthritis or not
-not rheumatoid arthritis/ not gouty
arthritis
-probably wear and tear in fingers
-tender with movement
- may be tendon causing the problem
-sometimes can’t catch/annoying for her
5-General health: A-Mobility (4):
-independent/wear sandals a lot
-walking perfectly well
-walk long distance/ to trains , shops
-can walk for an hour
B-Level of independence (5):
-do cooking
-do shopping
-have a niece and her daughter live in the
same street
-one son lives ten minutes away
-available in emergencies
843
6-Tests discussed (4):
-circulation in legs
-ultrasound
-Check varicose veins
- She have 5 children
-cardiograph/ECG
7- Current medications (4):
-A lot of medications
-5 pills for osteoporosis
-5 pills for thyroid
- Ostelin is a Vitamin D
8-Thyroid: A-Problems (1):
-underactive thyroid/ not have operation
B-Thyroid tests (2):
- Cannot remember last test of thyroid
function
-blood tests to assess medication /
pathology
-screening tests/ thyroid function
9-Medications
-Medication system (4):
-not have a list of medications
-Put bottles in a basket.
-No set box for each day
-Works perfectly for her
-Checking medications (2):
-Name of pharmacy/can’t remember/ a
Greek name? George
-secretary to ring the pharmacy up to
know the exact medications taken
10-Immediate plans (6):
-run few blood tests
-circulation in legs
-call pharmacist to check medications
-bring the medications list
-check thyroid
-give her a slip for a scan and blood tests
-review in a couple of weeks
 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

4- bones 10- a- the risk as rest of the

liver population
lungs b- high risk for breast cancer and
small risk cancer of ovary and gall
5- chemotherapy: bladder
a- 30% , 11- Anxiety and depression
b- 40% -screen women with breast cancer to
-Tamoxifen: a- 20%, b- 60% depression
-women given adequate information
6- a- the surface - the sources of the unreliable
b- more malignant information
c-is unable 12- a- false b-false c- not given d-
d- 45 to 50 true
7- purpose: diagnose at an early stage
- Introduction: in 1990s

844
 1.2015 Listening (A)
2-(3) -she was in England for 4 years
Saw optometrist only once
One check up for 4 years
More than two years since her eyes checked
3-(7) rigid contacts not soft
Since she was 13
Last year have a lot of troubles/ before was
normal
Uncomfortable/ by the end of the day
scratchy
Eyes get weepy
Not sure if taking good care of them or not
Wearing for 15 years
Pain only recently
4-A (3)-the same cleaner used for many
years / nightly
Special cleaner to break protein down
Store them in a stored solution
Occasionally remember to use protein
removal/ not regular
B (2) -lenses are 4/5 years old
Had new glasses and contacts before going
to UK
The actual product and the prescription for
them are pretty old
5- (7) -no injury or disease in eyes
No allergies
Got hay fever in UK but was not serious
One uncles father-side had glaucoma
Father's vision is perfect
No glaucoma mother-side/ perfect
No diabetes
No macular degeneration
No other eye diseases
6- A (3) people with rigid lenses have it/ so
have contact lenses
Cornea is flatter in one meridian and steeper
along the other
Difficult to use soft coz it needs stable ones
B (4) -full time/ wet soft more suitable
Disposable/ corrective of stigmatism
Wear them once in occasion and then throw
them
Wear all day depending on how tolerant/
dry
Examine her cornea / lubricant
845
7- A (2) anxious about laser options
Taking up a new high-contact sport
Neither glasses nor lenses are good
B (6) -lasik is a good option for many
patients
From prescription her cornea is thick
Lasik will be perfect
Use micro-keratome
All done under anaesthia
Topical not general
Alter structure of the eye
8-A (5) lasik surgery is elective
Have to pay for it
3 to4 thousand for both eyes
Depends on physiology of eyes
Make sure cornea is thick if too thin not
enough
Given name of ophthalmologist
Look at sources and success rate
B (6) -discomfort
Dryness
Take drops for infection postoperatively
drops for inflammation
use lubricants for 24 hours
no stitching / cornea heals perfectly
9-A (3) implanted contacts
If cornea is too thin, it will be an option for
her
Traditionally used for certain cases , but not
hers
B (4) -one day
No need for hospitalization
Twp separate occasions
High risk of infection
Make sure eye respond correctly
Antbiotic drops given
Give anti-inflammatory
10- (7) have a look at contacts
Make sure nothing affect their comfort
Stop rigid contacts for weeks before surgery
Coz they alter the shape of the cornea
Use soft instead today
For about a week
Try them/ perfect for her
Comfortable, but not replace Lasik
 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

4- 8- some form of sickness or illness

1-fill them out benefit
2- job capacity assessor 3/ 6
3- length of time anticipated to be Made any significant difference
affected by disability Job seeking benefits
-level of disability caused by the 9- appropriate agency
injury Ability to work
Any training to be made
5- Any transmition from one work to
1- back another
Neck Less physically demanding
Knee 10-1-B/C
Arthritic 2-d
2-reduce working hours
Seek disability pension

6- the main reason of referral to the

service
70% primary causes, back, neck,
physical
Psychiatric
Compulsive disorder
Anxiety

95%psychological conditions
Ability to work
Family roles

846
 3.2015 Listening A
2-(8) 6 months ago saw an optometrist
-no new glasses then
-a year ago has recent glasses
-reading glasses / not generally used
Happy with distant sight
-difficulty reading small printed books
-mainly phone books/ frustrating
-eye vision in good eye not as good as it
used to be 12 months ago
3-(8) around 06/ notice slight waviness in
reading lines
-on right eye
Ophthalmologist referred him to retinal
specialist
-scan by a specialist of retina by late 06/07
Notice accumulation of fluid in front of
retina
-prescribed lucenits injection, monthly
For 2 years
-costly so refer to eye and ear
4-(3) in the past saw a specialist every 3
months/ now every 6 months
-goes to public clinic
-see one of three doctors at retinal clinic
5-(4) doctors disappointed
-it wasn't that successful
-had 25 lucenits injections
-lost some vision on right eye (25%)/ not
happy
-last scan no fluids, good
-now wait and watch
6-a-(4) using it for years/a lot use it every
day, but not properly
-check the very central visual field of both
eyes
-cover one eye when doing it
-not to look for small creepy things
-get any significant change from the day
before
b-(4) covering one eye is very important/
was overlooked when he started
-make sure not wearing glasses
-if not covered the good eye takes over/
happen with him
-do it every day/second day/ brain adapt
easily to changes in vision
-take seconds: stick it on fridge, behind
toilet door
847
7-(9) take certain supplements, specific
formula by a group of macular degeneration
-prevent deterioration
-eat leafy green vegetables
-high level of antioxidants
Eggs include lutein mineral
-increase amount of pigments in retina
-prevent against free radicals that causes
damage
-not wearing sunglasses/ start
-wear a hat cause of UV/ USE SUN
PROTECTION
-CHANGE diet and some protection
8-(7) very good health
-take blood pressure and cholesterol tablets
-last blood test, cholesterol checked:2.3
-consider removing cholesterol tablets
-no laser treatment for retina
-no other operations of eyes
-no cataract surgery
-smoker at 20 till 45 (long time ago)
9-(7) managing well
-active gardener
-ride a bike everyday
-like working in workshops
-like fixing things
-not wear glasses
-make sure to wear safety glasses to protect
left eye
-still driving/ not using computer a lot
-can get safety glasses with a prescription
10-(4) spoke to family/ worried about
hereditary
-have 5 children/ eldest over 50
-tell them to keep an eye on eyes
-make sure they've Amsler charts
-get eye checked every two years to predict
macular degeneration
11-(6) check for frames
-update reading glasses
-check for safety glasses
-give leaflet about supplements
-schedule for review in 12 months
-be sure to check left eye
-keep going with amsler chart
-in case of any concern , come and check in-
between
 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
2-a (4) accident in 2010, 4 years ago
Now she is 11/ she was 7 then
She was piggy packing her younger
sister
It's not a good thing teeth are not
designed to do that
b-(8) her mouth was all sore
Had a lot of swelling
She was very distressed, it was very
difficult
2 lower front teeth broken
1 upper front tooth broken
The next day had an x-ray
The other front tooth hammered up into
gums
It was the same day , went to emergency
dental clinic
The next day went to normal local dental
clinic and saw a pediatric dentist
A lot of appointments
3-(6) it settled itself down
It took sometime for gums and teeth
More than on weekly basis to check
gums
Her lips and everything was swollen
Only have soup for two weeks
They checked her immunization,
especially tetanus
4-(5) in first days no complaint of cold
things
Mom was more upset than her
She said it was just a tooth not he whole
body
Not give reaction to cold, but the dentist
not put something protective over her
teeth
They tested with cold ice each time, the
top one was slow to react
The doctor worried about it but
eventually it wasn't slow
The other two bottoms were fine
851
5-(6) also called a cap like a jacket that
fits up over to reduce the seized tooth
Used for teeth that can't be restored by
any other means
If the tooth is dead, you can't put the
crown as it will get drier and fractured
Put a post on the root canal and then
build a crown
Reluctant for young people to do crowns
Coz they are destructive, you need to
remove a lot of healthy substances form
the tooth.
6-(14) 2 lower incisors affected
1 upper incisor which was broken and
the one hammered up to gums
The 2 lowers have fractures
They are kept very well
Both stayed vital and alive
Long term prospect
7-(6) appearance is fine
Remained alive
It's crowned at the bottom
Not coming off/ satisfactory
Tooth remain healthy
Let it be and replace at a late stage
8-(7) the 3 teeth talked about are going
well/ satisfactory
The remaining tooth hammered up was
x-rayed
Do orthodontic treatment / took so long
Months or a year
Constructed on a brace to put pressure
on tooth
On monthly basis till it comes down
Endodontist said it was doing fine, pulp
was doing well
But subsequently it was not alive
She had gingivitis
Given mouth wash to keep it clean
There was infection beside the tooth
There was infection beside the tooth
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
2-(8) she was 6/ now she is 23
-parents tried to explain transposition of
great vessels
-told she was out of breath/ would make
operations to keep up with other kids
-remember nurses and play room
-difficult to walk after surgery
-not remember wasn't able to keep up with
other kids
-lips and finger nails turning blue
-basically when running so much
3-(9) no other surgeries
-not start doing so much
Then do ballet dancing
Then some more dancing/ consistently by
getting older
Fit in teenage
5 hours of dancing a week/ quite tiring
Not as much when at school/ busy
Now not as fit as she likes to be
Still takes classes/ walking regularly
No symptoms/ no shortness of breath
Short of breath after walking up a hill, but
not concerning
The same fitness of girls her age
4-a-(10) no other health problems
No coughs/ no symptoms
No wheezing / no asthma
No problem with urinary bladder
Bowels are ok
No nausea, no vomiting/ good appetite
Headaches from now and then due to stress
No smoking
Alcoholic once a week/ 3 to 4 drinks
No recreational drugs
b-(6) No chest pain
No palpations
No blackouts/ no dizzy spells
No swollen up ankle
Notice bruising quite easily
No family history of heart problems
No congenital heart problems
5-(5) lisinopril once a day
Aspirin once a week
Not remember lisinopril dose
Not frequently aspirin/ got dizzy/ based on
853
cardiologist advice
No allergies to any other medications
6-(6) not replaced since 1991
It is a backup/ when tested not used a lot
Not used very often / batteries last longer
Under her ribs
In abdomen/ not feel it/ not cause any
problems
A wire goes from pacemaker to outside of
the heart
7-(8) echo once a year or every 6 months
To monitor a leaking valve/ make sure not
getting worse, but seems consistent
Not remember which valve is leaking
Difficult to remember which valve coz both
sides of the heart became back to front
Keep on checking is very important in the
long term
Check pace maker coz batteries will run
down
Batteries need replacement
Very minor procedure/ done under general
anesthesia
Short operation, cutover , take it down and
replace it
8- A-(8) not expecting heart problems/
stable
Pacemaker not a problem
Electronic security gate recognize it at
airport as it is made of metal so alarm goes
off
Carry pacemaker ID card
Tell them where to check it and they scan it
with a hand-help device
Sometimes gates are not sensitive
If forget and passed not worry
Security gates not affecting pacemaker
B-(3) oxygen on plane is pressurized, but
not to zero when 30,000 feet
people with severe heart or lung diseases
can have low o2 in blood
not worry/ she exercises, not blue so no
problems
C-(9) not need to tell airlines about it , not
an issue
Coz of complications as traveling overseas,
will have a letter
Explaining you have a pacemaker,
medications and contacts
Some people are funny if you carry
medications thinking you take it for
someone overseas
A letter will be written with phone numbers
Tell travel insurance about pre-existing
medical conditions
Adjust it to cover you
Need to carry signed prescriptions and
letters
4-3 times
-Women who haven't had a baby
-Gentle
-The initial inflammatory responses settled
-Sprained ankle or any other soft tissue --
injury
-Ice and some sort of strapping
-Overused -Rest -Ice
-Compression -Elevation -At rest
-Gravity, sitting and standing
-Not to do too much in these early weeks

9-A-(3) organize e-cardio-gram every year 5-2- release? Hold

Check pace maker every 6 months Significant? small-3
Seen once every 12 months 4-Up? in
B-(2) if things are fine before traveling it is Months? weeks
Ok to check when returned back
Set up with nother cardiologist if spending 6- 1- A 2-C 3-C 4-A
long-time overseas
C-(2) can call whenever/ call ambulance 7-OVERSTRETCHING
Come to emergency or call office to ASAP AWARNESS
MODES OF CONTROL
10-(6) write a letter to GP MUSCLES CONTRACT WITH THE
Sending ECG and pacemaker PELVIC FLOOR
Keep in touch with him GRAVITY-MUTUAL
Prescriptions got from cardiologist REPITITIONS
She has a GP so better to get prescriptions ENDURANCE
To avoid interactions CONTROL OF
Can give her a prescription of 6 months DOING ANYTHING WITH
Arrange appointment for echo and ECG SUPERFICIAL ABDOMINALS
6.2015 Listening B 8-backs -Height
2- 1- theromoregularities concerns -The change table
Energy demands -Where going to bath their babies
2- the first 48 hours -Pram handles
3-vascular tone -Weight -Pram net
Cardiac output -Prolonged standing
Blood pressure -Trying to feed a toddler
3- group of muscles -Cook dinner -Lifting
Stretch muscles and ligaments -Contract pelvic floor -Their knees
Pass through these structures to be born
Connective tissues 9-make moms very sore
-Less enthusiastic about breast feeding
Tendons or ligaments -Thoracic pain -Rib pain -Neck pain
Swollen -Headaches -Sitting up straight
Muscles are overstretched -Holding the weight of the baby
Motor patterns -The baby is supportive by a pillow
Very difficult Comfortable
10- 1-A 2-A

854
 July 2015 Listening A
2-(5) Peter Baker
-68 years old/ retired now
-was an engineer / steel work
-retired 10 years ago
-not much medical conditions at present
-high blood pressure
3-(7) had childhood problems, but can't
remember
-was a normal child / not significant
-at 21 had a car accident/ broke a femur
-put a metal nail in thigh
-very big accident
-2 operations at leg
-fractured skull for couples of days
-now normal nothing affected
4-(5) at 35 had laparoscopy
-remove gall bladder
-a bit messy using silicon tubes instead of
rubber
-got pretty sick for long/ not expected
-was OK since then
-no long-term effects
5-(9) at 60 melanoma removal
-from back
-8 years ago
-wife noticed small spot at the back
-see local GP
-at first not think it's serious
Biopsy taken
-discover melanoma then
-hospital admission
Radiotherapy was not needed
-regular monitoring
6-(7) at 65 returned back
-lump at a scar tissue
-remove it again/ took a large piece
-no radiotherapy for a couple of reasons
-keeping in reserve in case of recurrence
--very large area so had to radiate the arm
and lymph glands as well
-so only the surgery and recurrence once
only
855
7-(5) returned a couple of years ago.
-have it monitored and PET scan
-preferred to monitor every 4 months
-for 3 years now/ nothing flared up
-so develop check up to every 6 months
-only these surgeries in life
8-(5) BP about 20 years
-managed by Coversyl
-4/5 mg once a day
-under control now
-check every 6 months
-seen by GP
9-(7) blood tests occasionally when required
by a GP
-cholestorel tested regularly/ low / doctor
happy
-no anemia
-urine tests/ no diabetes
Prostate blood tests/ PSA normal
-get no symptoms
Gets up only once at night/ not serious
10-(9) aspirin 100 mg a day
-no OTC
No natural supplements
-no vitamins
No recreational drugs/ no illicit drugs
-no allergies
Non-smoker now/ only for a couple of years
at 20s
-drink alcohol socially
Couple of glasses on weekends
Red wine/ beer / 3 to 4 glasses at most
-some days not drink at all
11-(9) no running diseases in family
-4 brothers and sisters / all alive and well
Mom and dad passed away
-dad died at 30 due to angina
-heart attack mainly
- no other family members with the same
problem
-dad was a smoker/ pipe
-mom died at 73 of emphysema
-she was a smoker too
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

12- 1- c 2-c 3-a

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
biking with
Smashing himself on asphalt
Shoulder hurt
No need to call ambulance or hospital
They laughed about it/ went to coffee shop
When went home pain was more than
normal
Pain started immediately after having
coffee/ adrenaline went down
Not able to use right hand
The finger and wrist weak
9-a-(4) duration of healing depend on x-ray
If fractured plaster is needed
Take up to 6 weeks
If simple sprain recover in two weeks
B- (5)1st couple of days painful
After 2-3 days physiotherapy will be helpful
Teach about stretches and massage
Regain ranger of movement
Alleviate symptoms of pain

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
2-(7) 24 years old
-lives in Colton -lives with two friends
-not married- no partner -no children –
retailer -full-time job
3-(9) first got it 2004
-since then had it on and off
-last year specially had it every couple of
months
-quite severe since 2004
-bad fever -swollen neck -went to hospital
Generally feeling unwell
-in hospital for 2 days -needed IV antibiotic
-not told bacterial or viral infection
4-(4) pretty much recovered after that
-got it again 3 months later/ mild
-then have it after 6 months
- a year ago had it every few months or
every couple of weeks
-no review to look for bacteria/ no swap
done
5-(7) first time was the worst
-old GP gave her permanent prescription of
Amoxicillin
-majority of symptoms got better but not all
-get it whenever have symptoms
-clear up within couple of days
-see a surgeon for the side effects
-make her sick, nauseous
-stomach pain
6-a-(4) MEDICAL PROBLEMS:
-pretty good
-no significant medical history
Thalassemia/ no transfusion
-no major infections
b-(7) Medications:
Only antibiotics
No regular medications
No allergies
OTC: multivitamins
Not regular smoker only with drinking
Drinking once on weekends
2 cigarettes a week
Rarely smoke marijuana, but no other illicit
drugs
859
7-(7) going in November
-flying to Zambia
Go there in 2/3 weeks
Then to South Africa
Volunteer work
Work in 2 places
HIV clinics and an orphanage
Visiting some friends in South Africa
In Cape town for 5 weeks
8-(7) recurrent tonsillitis/ immune system
and respiratory tract are prone
Most episodes due to viruses
Mostly due to a bacteria called streptococci
Respond to antibiotic
A course given to eradicate/ reduce future
risks
Recurrent episodes: surgery, tonsillectomy
to reduce the risks
But still can get infection
Refer to ENT surgeon to discuss risks and
benefits of surgery
9-(5) hepatitis B/A
Typhoid fever
Update routine vaccines: measles , rubella
Tetanus poster shot
rabies
10-(3) can get them all here or referred to a
travel medical clinic
-can get them all at once
-got back only for hepatitis A as it needs a
poster after 6 months
11-(7+6) Zambia is a malaria-endemic area
-need to take malaria prophylaxes
-in tablet form
-taken in few days before going
-3 different drugs recommended
-doxycyclin antibiotic/ the cheapest, may
cause rash or photo-sensitivity
-if exposed to sun can get sunburned easily
-try melfoquine
if previous problem with antibiotic, will
cause stomach upset
Abit more expensive
Smaller risk of causing psychosis
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
2- (5)
a year ago was in San Francisco ,
then work in California
On weekend with a friend from Canada,
not see each other for a long time
3/ 4 days walking around San Francisco
about 6/8 hours a day,
very hilly places
By end of 4th day had soreness in knee,
thought it would go away, but didn't
Had pain for 6/8 months before seeing a
doctor
Went to GP who referred him to 1st surgeon
3-A-(3)1st surgery was 3 months ago
Frustrated to have 2nd surgery
1st surgery and communication with surgeon
frustrating
Not informed he had to bring somebody to
drive him home
Not knowing about having general
anesthesia,
only told few minutes before surgery
Frustrated of lack of communication
B-(4)10 days after surgery was checked
Told everything was ok
Had great deal of swelling
Not know what to expect, not know whether
normal or not
Severe swelling for nearly 3 months, about
10 weeks
Coz of bad experience with first surgeon ,
got referred to another surgeon
C-(3) 1st surgeon took x-ray,
MRI and various scans
Told there was a small tear in the left med-
meniscus
4-(2) 2nd surgeon said it was bad luck as 1st
surgeon didn't take enough of the meniscus
away
Only partial, a difficult judgment
So had complete meniscectomy of the med-
meniscus
3 weeks ago.
861
5-A (4) not seen a physiotherapist
Can walk, but not comfortable
Can't manage stairs, only hobbling up
Can't put pressure on knees, can't kneel on it
No crutches, no gaiters to help walking
Can move around
Back to work
B-(5) teacher, a lot on foot
Knee in morning gone down a little bit
Stiff when firstly get up
Sleeping uncomfortable, sleep at back, can't
move around easily
Put ice packs on knee trying to reduce
swelling
By end of day knee is tired and sore
Go home and put feet up
6-A (3) using some ice
Take anti-inflammatory / Voltarin
Taken 2/3 times a day for 3 weeks
No other medications / a bit healthy
Take vitamins only
B-(5) running for the last 10 years/ 2,3 times
a week
Not really athletic , but trying to keep fit
Going to the gym on and off for the last 10
years
Like the gym , feel confident
Not wild about swimming
Got a bike and cycle to work about half an
hour
Not cycling recently
Want to cycle, do aerobics to keep weight
down
Now can't run, so not sure what to do
Time frame of recovery not discussed
before with surgeons
7-(5) coz he had two surgeries, he might
expect recovery to be a little bit slow
Main aim of treatment is to decrease
swelling and increase knee movement
Coz of 3 months not exercising , have
wasting of quadriceps muscle, the main
muscle in front of the knee
So daily activity and walking upstairs,
riding and running must work on it to
strengthen …
… 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

7-a- 66 words / columns,
according to numbers of syllables and level
of difficulty
-read out loud the words
-score the correct pronunciation and
understand the meaning of words
11- 1- provision of visual, interactive
materials like computer modules,
screen programs in clinical practice
2- education of health professionals
3- education of family and friends
4- creative use of internet as a tool of health
education

- both reading comprehensive tests, and 12- sensitive and responsive

numeracy tests
-based on hospital materials and multi-
choice questions
-assess illiteracy in students in schools
-increase exposure to the health system
13. A. 1/10 patient have limited functional
health literacy

8- B. probably underestimate the size of

1- 8 people / 10%of sample have difficulty problem
reading and interpreting health tips
2- rate at 7 or below 7 year age C. the clinician need to be more aware of a
health literacy
3-7 patients/ 9% scores inadequate
functional health literacy
4- 20% unable to complete the test
5- 8 patients / 12% low or below average
literacy compared to students completing
year 9

9-
1- NO
2-NO
3-NO
4-YES

10- 1- 127 patients with rheumatoid arthritis

were functionally illiterate
2- 15% poor literacy based at a school room
3-100 patients with vary rheumatologically
condition over 50% rate below the 10th
grade level
4- third rate 7th grade level
5-88 patients, 12.5% had poor health
literacy
6-lower room schools have poor health
status
-more hospital outpatients visits

863
 May 2014 Listening (A)
2-(8) tingling sensation, something
filling her
-pretty in both hands
-mainly in left hand and arm, numbness
-sometimes can't feel it on the bridge of
her nose
-can't pinpoint the starting date
-a couple of months ago
-gradual onset
-at night
-lying on bed position
3-(11) not constant/ come and go
-nothing make them worse
-being anxious does not bring the
symptoms
-nothing make them better
Sometimes lying on different positions /
on back is better
-not waken her from sleep
-no headaches
-stiff neck and stiff shoulders
No leg symptoms
No back pain
In the past had some back injuries
Not get worse on the last 6 weeks/
almost the same
No visual disturbance
1st time to have something like this
4-a-(4) mother died because of heart
failure at age 56
she's now 63
Diagnosed as scleroderma 2 weeks
before death
Had lots of problems, difficulty
breathing, heart problems
b-(4) grandfather died due to heart
failure, heart disease
at the age of 85
grandmother had some strange arterial
conditions
she lost speech, died at the age of 80
5-(8) no chest pain
Soft tingling sensation in nipples
Not sure if have heart palpitations
-sometimes feels racy
When lying down/ at bed time
No missing beats
864
No shortness of breath/ only after
exertion
She's fit/goes to the gym
6-(7) now she's non-smoker
-in the past, in her 20s smoking 2/3
cigarettes a day for 3/4 years
-no history of high blood pressure
-no disturbance in bladder and bowl
function
-cholesterol checked recently and
normal
-alcohol: average drinker, 2/3 glasses/
not binge drinking
-no illicit drugs
7-(6) preosteoprosis condition
(Osteopenia)
-not a serious condition
-have bone density scan
-no operations
-no fractures
-only taking calcium and vitamin D
No regular medications/ no OTC
8-(7) academic job in linguistics
-full time job
-keep her too busy
-work on computer a lot
-leave it only at lunch time or meetings
-not exacerbated to her symptoms
-sometimes exercises
-go to the gym/ go running in the
morning
9-(7) not specific serious condition
-worried because of her mother's
condition
No severe heart disease/ low risk
- gives attention to heart problem as well
-not cardiac problem
-more likely neurological problem
-may be hand nerves like carpal tunnel
syndrome
-There may be a neck problem/wear and
tear in neck desk
10-(4) x-rays on neck and cervical spine
-ECG test/ exercise stress test using
treadmill
-unreasonable to drop heart problems
-appointment to discuss results
 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

- he is not normal/ not osteoporosis Supposedly 800 to 1000mg daily

- he is osteopenic 3 serves /one serve through incidental food

like broccoli
-the BMD test measures the amount of bone
in the bone 2 other serves like yellow cheese a cup of
yogurt
-it tests how strong the bones are/ not felt by
the person himself/ no feeling of weakness 250mg of calcium enriched milk

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
Take muscles then bones out of comfort
zone
7-A-(5) exercise needs to be weight-
bearing
Walking for 31-year-old is not enough
Do specific strength-training
The maximum weight you can lift
Lift weights/ when start it would be heavy
at the beginning
Find the hardest you can do
B-(5) exercise to work your arms and
muscles
Stabilize your shoulders and upper back
Exercise for the legs/ hips and lower back
Hips and lower back are the most likely
suffering that’s why tested at the BMD test
8-A-(6) all exercises need to be changed to
keep their benefits
He will start with the exercise program
given
What’s difficult today won’t be the same in
6 months
Still young so change a lot at the beginning
Make sure no sore back or neck
Once get comfortable/ change above a kilo
for a couple of weeks
Then 6,7,8 kilos (dumbbells)
Stay like this for a while, then change again
867
B- (4) change the way fast then slow
Reverse order( what you start with end
with)
Change the kind of exercise
Forget weights after a while and do
endurance exercises
It’s a bit complicated so checking frequently
is needed
9- A-(5) address calcium intake
Anti-milk mother so took recommended
intake by soya
Premenopausal women need higher intakes
(1300 mg daily)
4 serves a day
She is not anti-dairy , she takes some cheese
incidentally
Should eat sardine, tuna, salmon or calcium
enriched milk, juice or bread
B- (4) she is at home and has a garden
Once broke a hip
Not put sunscreen in the morning
Not expose in hot hours
Be in the sun before 10 and after 3
For half an hour without sunscreen
To get vitamin D expose forearms ,face and
hands
 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

3-paranoid thoughts 10-1-dehydration -Infection

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
2-(6)
no left heel pain
-on insole of the heel
Couple of weeks
-at the back
-getting progressively worse
-not see anyone about it
-only a friend's advice
-never seen a podiatrist before
3-(3) first step in the morning is the
worst
-improves with movement but not
getting better
-if sitting for a long time and then
stand up returns
4-(3) a couple of weeks at the zoo
-it was hot wearing thongs
-walking around the whole day
5-(5) when very young at 10 had a lot
of feet problems
-play a lot of sports
-problems in the same place
-but in both heels
-feeling it was bruised at the top of
the heels
6-(6) tender when touch the insole of
the heel
-no pain underneath the ball of the
heel
-no left foot pain
-left ankle very loose, perfect
-right ankle is restricted at the back of
the calf
Watch him walking for a couple of
meters, normal
869
7-(6) it's very common no need to be
alarmed
-inflammation at the strong ligament
underneath foot
-wearing thongs for a long day which
is not supportive
- no time to rest so inflammation is
still there
-morning pain and after rest indicates
plantar fasciitis
-linked to childhood problems
8-(8) couple of conservative things to
be done
-reduce tightness in calf
-exercise done to show restrictness in
calf muscles
Loosen up calf muscle
Teach him some stretches
Take stress of the heel
Reduce inflammation
Ice the area with a long freezed bottle
for 10 minutes
Massage
Look at shoes not wear thongs for
long
Sandals instead
Limit use of thongs for lifetime
9-(4) review in a month time
If not improving, put insole in shoes
Not complete resolution of pain
Only reduction or improvement of
pain
10-A (3)-play a lot of sports
Not organized sports, office sports
Basketball and soccer in winter
Cricket in summer
B-(3) high ankle support shoes for
basketball
Shoes are a couple of years old/ need
renewal
For cricket and soccer has the
standard supporting footwear
C-(3) continue sports
Stretch calf as it adds pressure to the
heel
Keep both calves away from
participating
Give sometime to rest foot
11-A (4) 3 and half year old son,
while walking his knees are close
together
Mother thinks he's pigeon toed
Mom had corrective footwear at 12
for a couple of weeks
Had problems with knees and feet
Worried of genetic conditions
Dad has not noticed any problem
Not like walking much, likes to be
picked up
B-(4) close knees are not a problem
for his age
If excessive fatigue, worried of
genetic causes
Some not prefer intervention at this
age, but if scary they have to
Bring mom, his son and his footwear
12-(6) should all footwear be custom-
fitted?
Off the shelf shoes are fine
Firm shoes to keep heals steady
walking
Something that bends at the ball of
foot
Something that can be fastened to
foot to keep it firm
Thongs not recommended for a life
time
870
August 2014 Listening B
2-a natural attributes
-can be taught or learned
b)medicine, law, helping vulnerable
people
c)women with breast lump/or
somebody in court charged with a
crime.
D) -professional expertise
-moral expertise
3-profession itself
-look at students' needs/ revere elders
for their expertise and guidance
-patients
-confidentiality, not exploit them
sexually, and keeping patients'
secrets.
4-a-1989
b-the mental health act
c-another level of requirements for
professionals to work in a certain
way, not to hold patients against their
will, conduct themselves in relation to
patients' belonging doctors well
behave.
d-as if you are a member at a tennis
club, you have to adhere to the rules
if you wish to remain a member at
this club.
5-a- what's morally a good behavior
and what's immoral
b-where: America, when: 1970s
c-1992
6-1-respecting confidentiality of
patients and their families
3-not misusing their skills
4-respect humanity and dignity of
patients
7-a- privacy
b-you can't always maintain secrets
because sometimes you can't keep it
confidential
c-if patients tells you they are
intending to kill someone like a
relative or an ex-boyfriend
d- you have to keep patients
information confidential
-but you also need to go to police and
warn the intended victim
8- a- try to work out all existing
problems in regard to applying the
principle of confidentiality
b- if a patient was charged with a
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-a- degree of freedom to work out
their own ethical behavior so that
governments not to dictate how
doctors behave in their ethical life
b- use a code to deter an individual
from over strain into immoral
behavior.
-self-regulation, and retribution, bad
apple, punishment
10-a- body of professional to punish
people who break rules
b-worst: expulsion from college
-least: reprimand , warning
c-codes shouldn't punish, but promote
good behavior.
11-a- code of ethics are good things
and help professionals to work well.
-protect the needs of the patients
b-refine codes and to let them work as
readily as possible
 9.2014 Listening A
2-A-(5):
-she’s well, but smaller than her brother
-parents need to know why babies
delivered 4 weeks earlier
-Olive is small not have a lot of reserve
-she’s at risk of potential problems
-so she is taken to nursery
- not kept warm unlike her brother
-not have enough brown fats so taken to
incubator
B-(9):
-come out of incubator when 1800 to 2
kilos
-It depends on her
-when she is stable get out of incubator
-Given some fluids IV
-Given milk to feed her
-When maintain temperature , she will
get out
-Depends on how quickly she responses
-No set weight
-No set time
3-(8):
- first baby
-Found quiet early they are twins
-At week 5 start early scan to prepare
-High risk pregnancy cause of twins
-Regular doctor appointments,
everything is normal
-Regular scans/ shows regular growing
-Scan is stressful for them so missed a
couple of scans
-35 week scan was normal
-Olive’s placenta was smaller , had less
fluids
-So take out babies immediately
4-(9):
- mother took 2 doses of antenatal
steroids
-Were told to have caesarian
-babies hearts’ monitored a lot of times
-Olive not require oxygen
-Put shining light on foot
-Pulse oximetery measures o2 saturation
level
872
-O2 rate is 99 so normal /
-Her brother breathing is normal as well
-no respiration problem
-35 week lungs still immature
-Babies are OK as steroids helped
-blood test to check O2 level
-Put on blood gas machine
5-(9):
-not huge nearly 1800grams
-Not growth restricted
-Follow up when 2 years with pediatric
to check her muscles
-Catch up on her nutrition outside uterus
-Fast intervention due to lack of food in
placenta need extra calories so breast
feed and formula feed
-Not going to be a big child
-Try to get enough nutrition and glucose
for the brain
-She is neurologically normal
-Blood sugar level is also normal
-no seizures
6-(9):
-blood checks to make sure babies are
not infected - cause wife was GBS+
Broad spectrum Antibiotic for 24 hours
-start penicillin and gentamicin
-take vitamin K cause they are not able
to produce it at birth
-it is not produced in stomach till it has
food
-risk of hemorrhagic disease of new born
- give antibiotics
-24 hours steroids for caution
-waiting for colostrums to come
7-(5) - wife like to breast-feed
-especially for Olive
-Cause she is growth-restricted,
she might get a disease in the gut
- so breast-feed even a couple of drops
- important to give the children
colostrums
- give them some sugary water till they
settle down and temperature OK
-no problem breathing
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)
2-A-(4) a- chest tightness
b-beating and sweating
c-tiredness and dizziness
d- last for 10/15 seconds
2-B-(4) a- sat down
b-took a deep breath
c-walked over to a water dispenser
d- quickly drank 2 glasses of water
e- sat down again and then just got back in
line
3- A (5)a- when got home was still dizzy
b-short of breath
c-felt weak
d-rang her GP
e-told her to go to hospital emergency
3-B (2)
a- if still dizzy need to check blood
pressure, worry of heart arrhythmia
b-risk of heart attack due to its intense.
4-(5) a- she had just finished film making,
had a stressful time
b-worked crazy hours
c-smoking more than usual
d-she wasn’t unwell, not have a cold
e-not drinking more fluids, not get enough
sleep, and not eat normally
5-(6) a- it happened a week before
b- she had a sharp pain across chest
c- last for few seconds, she took her breath
back , it was intense
d- not burning pain , but sharp, she had to
sit down
e- started above right breast the across down
into arms
f-not remember if had it before or not
6-(4) a-smoke once a day, then skip weeks
b-advised by doctors to quit
c-one cup of coffee a day
d-not a heavy drinker/ not every week
7-(5) a-not sure whether it is arrhythmia or
not
b-order ECG for heart
c- may not get again for weeks or months
d-better to do 24 hour Halter Monitor
c- cause ECG in her case is of limited utility
874
8-(4) a-not vegetarian, but not eat a lot of
meat
b-had regular periods/ not excessive flow of
blood
c-since mid 40s not as long as it used to be/
not 5 days
d-still regular /good amount of blood flow
9-(9) a-Animea/ no enough iron to make
blood
b-problems with thyroid
c-mother had a thyroid problem , but
Roseanna did not test it
d-thyroid function test to be done
e-if thyroid is overactive , it sends signals to
the body to speed up every thing.
f-no feel agitated/ no tremors
g-lose of weight is negative
h- put on weight not related to food habits,
but put it down to metabolism
10-(6) a- nodules on her thyroid
b-had an operation to take the nodules off
c-still had thyroid
d-not overactive thyroid/ not cancerous
e- something related to calcium/may be
parathyroid gland
f-it organizes calcium level in the body
g-quite dangerous if untreated
h-had neck problems in her 60s
i-mother was thin , but getting older, she put
on weight
11-A-(4) a-daibetes normal
b-Tonsils removal
c-appendix removal
d-no medications
B-(2) a-dad not diabetic
b-3 brothers dad-side are diabetic
12- (6)-a-she’s still young 45
b-it is normal to happen once more
c-the older she gets, more normal to have
heart problems
d-check heart concerns
e-not want to over investigate her
f-if recurrent it would be warning
g-after proceeding in examination, she can
go
 10.2014 Listening (B) 8-a-leg elevation

2-a-2008 b- assessed b- further investigations

c-managed d-2 weeks c-redistributing

e-venous leg f-diabetic foot d-skin care

g-surgical wounds e- glycemic control

3-1- 80% 2-diagnosis f-specific therapies

3-present 4-explore

5-local 9-a-unsuitable

4-1-intermittent b-reactions

2-a-duration b-severity c-adherence

3-a-own words b-regularly d-if incorrectly applied

4-a-makes it better b-sleep e-condition

c-affect mood d-appetite

5- a-procedure b-cleansing 10-1- The patient in a comfortable

position.
c-anxiety d-subjective
2-minimise interruptions
e-products f-standardized
3-deep breathing
g-educational
-distraction by engaging in
6-1- 0 to 10/ low vision conversation
2-point on the line 3-dementia 4- looking at facial expressions
4-the word 5-they can feel in control
5-observational/ severe brain injury 11- 1-A
7-a- aching or throbbing 2-B
b-dressing changes c-tingling 3-C
d-electric shock e-altered

f-light touch g-increase severity

875
 11.2014 Listening (A)
2- Details of the problem: (7)
-used to be a good runner as a little girl
-right foot perfectly right
-left foot deteriorated considerably
-one toe shortened
-whole foot considerably
deformed/shorter
-one toe has been cut at the back of the
first little joint
-have a painful corn on the left little
toe/can’t endure any pressure on it
-had various operations on it
-30 years ago had toe cut-off/ had blood
poisoning and went back to hospital
3-Current treatment (2):
-had regular podiatry treatment/ordinary
-cut nails-massage
4-Other medical problems: A-(3)
not have -diabetes -Circulation
problems -diabetes in family members
B- problems with fingers (5):
-Mother had arthritis
-she had arthritis in her two left fingers
-not sure osteoarthritis or not
-not rheumatoid arthritis/ not gouty
arthritis
-probably wear and tear in fingers
-tender with movement
- may be tendon causing the problem
-sometimes can’t catch/annoying for her
5-General health: A-Mobility (4):
-independent/wear sandals a lot
-walking perfectly well
-walk long distance/ to trains , shops
-can walk for an hour
B-Level of independence (5):
-do cooking
-do shopping
-have a niece and her daughter live in the
same street
-one son lives ten minutes away
-available in emergencies
876
6-Tests discussed (4):
-circulation in legs
-ultrasound
-Check varicose veins
- She have 5 children
-cardiograph/ECG
7- Current medications (4):
-A lot of medications
-5 pills for osteoporosis
-5 pills for thyroid
- Ostelin is a Vitamin D
8-Thyroid: A-Problems (1):
-underactive thyroid/ not have operation
B-Thyroid tests (2):
- Cannot remember last test of thyroid
function
-blood tests to assess medication /
pathology
-screening tests/ thyroid function
9-Medications
-Medication system (4):
-not have a list of medications
-Put bottles in a basket.
-No set box for each day
-Works perfectly for her
-Checking medications (2):
-Name of pharmacy/can’t remember/ a
Greek name? George
-secretary to ring the pharmacy up to
know the exact medications taken
10-Immediate plans (6):
-run few blood tests
-circulation in legs
-call pharmacist to check medications
-bring the medications list
-check thyroid
-give her a slip for a scan and blood tests
-review in a couple of weeks
 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

4- bones 10- a- the risk as rest of the

liver population
lungs b- high risk for breast cancer and
small risk cancer of ovary and gall
5- chemotherapy: bladder
a- 30% , 11- Anxiety and depression
b- 40% -screen women with breast cancer to
-Tamoxifen: a- 20%, b- 60% depression
-women given adequate information
6- a- the surface - the sources of the unreliable
b- more malignant information
c-is unable 12- a- false b-false c- not given d-
d- 45 to 50 true
7- purpose: diagnose at an early stage
- Introduction: in 1990s

877
 1.2015 Listening (A)
2-(3) -she was in England for 4 years
Saw optometrist only once
One check up for 4 years
More than two years since her eyes checked
3-(7) rigid contacts not soft
Since she was 13
Last year have a lot of troubles/ before was
normal
Uncomfortable/ by the end of the day
scratchy
Eyes get weepy
Not sure if taking good care of them or not
Wearing for 15 years
Pain only recently
4-A (3)-the same cleaner used for many
years / nightly
Special cleaner to break protein down
Store them in a stored solution
Occasionally remember to use protein
removal/ not regular
B (2) -lenses are 4/5 years old
Had new glasses and contacts before going
to UK
The actual product and the prescription for
them are pretty old
5- (7) -no injury or disease in eyes
No allergies
Got hay fever in UK but was not serious
One uncles father-side had glaucoma
Father's vision is perfect
No glaucoma mother-side/ perfect
No diabetes
No macular degeneration
No other eye diseases
6- A (3) people with rigid lenses have it/ so
have contact lenses
Cornea is flatter in one meridian and steeper
along the other
Difficult to use soft coz it needs stable ones
B (4) -full time/ wet soft more suitable
Disposable/ corrective of stigmatism
Wear them once in occasion and then throw
them
Wear all day depending on how tolerant/
dry
Examine her cornea / lubricant
878
7- A (2) anxious about laser options
Taking up a new high-contact sport
Neither glasses nor lenses are good
B (6) -lasik is a good option for many
patients
From prescription her cornea is thick
Lasik will be perfect
Use micro-keratome
All done under anaesthia
Topical not general
Alter structure of the eye
8-A (5) lasik surgery is elective
Have to pay for it
3 to4 thousand for both eyes
Depends on physiology of eyes
Make sure cornea is thick if too thin not
enough
Given name of ophthalmologist
Look at sources and success rate
B (6) -discomfort
Dryness
Take drops for infection postoperatively
drops for inflammation
use lubricants for 24 hours
no stitching / cornea heals perfectly
9-A (3) implanted contacts
If cornea is too thin, it will be an option for
her
Traditionally used for certain cases , but not
hers
B (4) -one day
No need for hospitalization
Twp separate occasions
High risk of infection
Make sure eye respond correctly
Antbiotic drops given
Give anti-inflammatory
10- (7) have a look at contacts
Make sure nothing affect their comfort
Stop rigid contacts for weeks before surgery
Coz they alter the shape of the cornea
Use soft instead today
For about a week
Try them/ perfect for her
Comfortable, but not replace Lasik
 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

4- 8- some form of sickness or illness

1-fill them out benefit
2- job capacity assessor 3/ 6
3- length of time anticipated to be Made any significant difference
affected by disability Job seeking benefits
-level of disability caused by the 9- appropriate agency
injury Ability to work
Any training to be made
5- Any transmition from one work to
1- back another
Neck Less physically demanding
Knee 10-1-B/C
Arthritic 2-d
2-reduce working hours
Seek disability pension

6- the main reason of referral to the

service
70% primary causes, back, neck,
physical
Psychiatric
Compulsive disorder
Anxiety

95%psychological conditions
Ability to work
Family roles

879
 3.2015 Listening A
2-(8) 6 months ago saw an optometrist
-no new glasses then
-a year ago has recent glasses
-reading glasses / not generally used
Happy with distant sight
-difficulty reading small printed books
-mainly phone books/ frustrating
-eye vision in good eye not as good as it
used to be 12 months ago
3-(8) around 06/ notice slight waviness in
reading lines
-on right eye
Ophthalmologist referred him to retinal
specialist
-scan by a specialist of retina by late 06/07
Notice accumulation of fluid in front of
retina
-prescribed lucenits injection, monthly
For 2 years
-costly so refer to eye and ear
4-(3) in the past saw a specialist every 3
months/ now every 6 months
-goes to public clinic
-see one of three doctors at retinal clinic
5-(4) doctors disappointed
-it wasn't that successful
-had 25 lucenits injections
-lost some vision on right eye (25%)/ not
happy
-last scan no fluids, good
-now wait and watch
6-a-(4) using it for years/a lot use it every
day, but not properly
-check the very central visual field of both
eyes
-cover one eye when doing it
-not to look for small creepy things
-get any significant change from the day
before
b-(4) covering one eye is very important/
was overlooked when he started
-make sure not wearing glasses
-if not covered the good eye takes over/
happen with him
-do it every day/second day/ brain adapt
easily to changes in vision
-take seconds: stick it on fridge, behind
toilet door
880
7-(9) take certain supplements, specific
formula by a group of macular degeneration
-prevent deterioration
-eat leafy green vegetables
-high level of antioxidants
Eggs include lutein mineral
-increase amount of pigments in retina
-prevent against free radicals that causes
damage
-not wearing sunglasses/ start
-wear a hat cause of UV/ USE SUN
PROTECTION
-CHANGE diet and some protection
8-(7) very good health
-take blood pressure and cholesterol tablets
-last blood test, cholesterol checked:2.3
-consider removing cholesterol tablets
-no laser treatment for retina
-no other operations of eyes
-no cataract surgery
-smoker at 20 till 45 (long time ago)
9-(7) managing well
-active gardener
-ride a bike everyday
-like working in workshops
-like fixing things
-not wear glasses
-make sure to wear safety glasses to protect
left eye
-still driving/ not using computer a lot
-can get safety glasses with a prescription
10-(4) spoke to family/ worried about
hereditary
-have 5 children/ eldest over 50
-tell them to keep an eye on eyes
-make sure they've Amsler charts
-get eye checked every two years to predict
macular degeneration
11-(6) check for frames
-update reading glasses
-check for safety glasses
-give leaflet about supplements
-schedule for review in 12 months
-be sure to check left eye
-keep going with amsler chart
-in case of any concern , come and check in-
between
 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
2-a (4) accident in 2010, 4 years ago
Now she is 11/ she was 7 then
She was piggy packing her younger
sister
It's not a good thing teeth are not
designed to do that
b-(8) her mouth was all sore
Had a lot of swelling
She was very distressed, it was very
difficult
2 lower front teeth broken
1 upper front tooth broken
The next day had an x-ray
The other front tooth hammered up into
gums
It was the same day , went to emergency
dental clinic
The next day went to normal local dental
clinic and saw a pediatric dentist
A lot of appointments
3-(6) it settled itself down
It took sometime for gums and teeth
More than on weekly basis to check
gums
Her lips and everything was swollen
Only have soup for two weeks
They checked her immunization,
especially tetanus
4-(5) in first days no complaint of cold
things
Mom was more upset than her
She said it was just a tooth not he whole
body
Not give reaction to cold, but the dentist
not put something protective over her
teeth
They tested with cold ice each time, the
top one was slow to react
The doctor worried about it but
eventually it wasn't slow
The other two bottoms were fine
884
5-(6) also called a cap like a jacket that
fits up over to reduce the seized tooth
Used for teeth that can't be restored by
any other means
If the tooth is dead, you can't put the
crown as it will get drier and fractured
Put a post on the root canal and then
build a crown
Reluctant for young people to do crowns
Coz they are destructive, you need to
remove a lot of healthy substances form
the tooth.
6-(14) 2 lower incisors affected
1 upper incisor which was broken and
the one hammered up to gums
The 2 lowers have fractures
They are kept very well
Both stayed vital and alive
Long term prospect
7-(6) appearance is fine
Remained alive
It's crowned at the bottom
Not coming off/ satisfactory
Tooth remain healthy
Let it be and replace at a late stage
8-(7) the 3 teeth talked about are going
well/ satisfactory
The remaining tooth hammered up was
x-rayed
Do orthodontic treatment / took so long
Months or a year
Constructed on a brace to put pressure
on tooth
On monthly basis till it comes down
Endodontist said it was doing fine, pulp
was doing well
But subsequently it was not alive
She had gingivitis
Given mouth wash to keep it clean
There was infection beside the tooth
There was infection beside the tooth
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
2-(8) she was 6/ now she is 23
-parents tried to explain transposition of
great vessels
-told she was out of breath/ would make
operations to keep up with other kids
-remember nurses and play room
-difficult to walk after surgery
-not remember wasn't able to keep up with
other kids
-lips and finger nails turning blue
-basically when running so much
3-(9) no other surgeries
-not start doing so much
Then do ballet dancing
Then some more dancing/ consistently by
getting older
Fit in teenage
5 hours of dancing a week/ quite tiring
Not as much when at school/ busy
Now not as fit as she likes to be
Still takes classes/ walking regularly
No symptoms/ no shortness of breath
Short of breath after walking up a hill, but
not concerning
The same fitness of girls her age
4-a-(10) no other health problems
No coughs/ no symptoms
No wheezing / no asthma
No problem with urinary bladder
Bowels are ok
No nausea, no vomiting/ good appetite
Headaches from now and then due to stress
No smoking
Alcoholic once a week/ 3 to 4 drinks
No recreational drugs
b-(6) No chest pain
No palpations
No blackouts/ no dizzy spells
No swollen up ankle
Notice bruising quite easily
No family history of heart problems
No congenital heart problems
5-(5) lisinopril once a day
Aspirin once a week
Not remember lisinopril dose
Not frequently aspirin/ got dizzy/ based on
886
cardiologist advice
No allergies to any other medications
6-(6) not replaced since 1991
It is a backup/ when tested not used a lot
Not used very often / batteries last longer
Under her ribs
In abdomen/ not feel it/ not cause any
problems
A wire goes from pacemaker to outside of
the heart
7-(8) echo once a year or every 6 months
To monitor a leaking valve/ make sure not
getting worse, but seems consistent
Not remember which valve is leaking
Difficult to remember which valve coz both
sides of the heart became back to front
Keep on checking is very important in the
long term
Check pace maker coz batteries will run
down
Batteries need replacement
Very minor procedure/ done under general
anesthesia
Short operation, cutover , take it down and
replace it
8- A-(8) not expecting heart problems/
stable
Pacemaker not a problem
Electronic security gate recognize it at
airport as it is made of metal so alarm goes
off
Carry pacemaker ID card
Tell them where to check it and they scan it
with a hand-help device
Sometimes gates are not sensitive
If forget and passed not worry
Security gates not affecting pacemaker
B-(3) oxygen on plane is pressurized, but
not to zero when 30,000 feet
people with severe heart or lung diseases
can have low o2 in blood
not worry/ she exercises, not blue so no
problems
C-(9) not need to tell airlines about it , not
an issue
Coz of complications as traveling overseas,
will have a letter
Explaining you have a pacemaker,
medications and contacts
Some people are funny if you carry
medications thinking you take it for
someone overseas
A letter will be written with phone numbers
Tell travel insurance about pre-existing
medical conditions
Adjust it to cover you
Need to carry signed prescriptions and
letters
4-3 times
-Women who haven't had a baby
-Gentle
-The initial inflammatory responses settled
-Sprained ankle or any other soft tissue --
injury
-Ice and some sort of strapping
-Overused -Rest -Ice
-Compression -Elevation -At rest
-Gravity, sitting and standing
-Not to do too much in these early weeks

9-A-(3) organize e-cardio-gram every year 5-2- release? Hold

Check pace maker every 6 months Significant? small-3
Seen once every 12 months 4-Up? in
B-(2) if things are fine before traveling it is Months? weeks
Ok to check when returned back
Set up with nother cardiologist if spending 6- 1- A 2-C 3-C 4-A
long-time overseas
C-(2) can call whenever/ call ambulance 7-OVERSTRETCHING
Come to emergency or call office to ASAP AWARNESS
MODES OF CONTROL
10-(6) write a letter to GP MUSCLES CONTRACT WITH THE
Sending ECG and pacemaker PELVIC FLOOR
Keep in touch with him GRAVITY-MUTUAL
Prescriptions got from cardiologist REPITITIONS
She has a GP so better to get prescriptions ENDURANCE
To avoid interactions CONTROL OF
Can give her a prescription of 6 months DOING ANYTHING WITH
Arrange appointment for echo and ECG SUPERFICIAL ABDOMINALS
6.2015 Listening B 8-backs -Height
2- 1- theromoregularities concerns -The change table
Energy demands -Where going to bath their babies
2- the first 48 hours -Pram handles
3-vascular tone -Weight -Pram net
Cardiac output -Prolonged standing
Blood pressure -Trying to feed a toddler
3- group of muscles -Cook dinner -Lifting
Stretch muscles and ligaments -Contract pelvic floor -Their knees
Pass through these structures to be born
Connective tissues 9-make moms very sore
-Less enthusiastic about breast feeding
Tendons or ligaments -Thoracic pain -Rib pain -Neck pain
Swollen -Headaches -Sitting up straight
Muscles are overstretched -Holding the weight of the baby
Motor patterns -The baby is supportive by a pillow
Very difficult Comfortable
10- 1-A 2-A

887
 July 2015 Listening A
2-(5) Peter Baker
-68 years old/ retired now
-was an engineer / steel work
-retired 10 years ago
-not much medical conditions at present
-high blood pressure
3-(7) had childhood problems, but can't
remember
-was a normal child / not significant
-at 21 had a car accident/ broke a femur
-put a metal nail in thigh
-very big accident
-2 operations at leg
-fractured skull for couples of days
-now normal nothing affected
4-(5) at 35 had laparoscopy
-remove gall bladder
-a bit messy using silicon tubes instead of
rubber
-got pretty sick for long/ not expected
-was OK since then
-no long-term effects
5-(9) at 60 melanoma removal
-from back
-8 years ago
-wife noticed small spot at the back
-see local GP
-at first not think it's serious
Biopsy taken
-discover melanoma then
-hospital admission
Radiotherapy was not needed
-regular monitoring
6-(7) at 65 returned back
-lump at a scar tissue
-remove it again/ took a large piece
-no radiotherapy for a couple of reasons
-keeping in reserve in case of recurrence
--very large area so had to radiate the arm
and lymph glands as well
-so only the surgery and recurrence once
only
888
7-(5) returned a couple of years ago.
-have it monitored and PET scan
-preferred to monitor every 4 months
-for 3 years now/ nothing flared up
-so develop check up to every 6 months
-only these surgeries in life
8-(5) BP about 20 years
-managed by Coversyl
-4/5 mg once a day
-under control now
-check every 6 months
-seen by GP
9-(7) blood tests occasionally when required
by a GP
-cholestorel tested regularly/ low / doctor
happy
-no anemia
-urine tests/ no diabetes
Prostate blood tests/ PSA normal
-get no symptoms
Gets up only once at night/ not serious
10-(9) aspirin 100 mg a day
-no OTC
No natural supplements
-no vitamins
No recreational drugs/ no illicit drugs
-no allergies
Non-smoker now/ only for a couple of years
at 20s
-drink alcohol socially
Couple of glasses on weekends
Red wine/ beer / 3 to 4 glasses at most
-some days not drink at all
11-(9) no running diseases in family
-4 brothers and sisters / all alive and well
Mom and dad passed away
-dad died at 30 due to angina
-heart attack mainly
- no other family members with the same
problem
-dad was a smoker/ pipe
-mom died at 73 of emphysema
-she was a smoker too
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

12- 1- c 2-c 3-a

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
biking with
Smashing himself on asphalt
Shoulder hurt
No need to call ambulance or hospital
They laughed about it/ went to coffee shop
When went home pain was more than
normal
Pain started immediately after having
coffee/ adrenaline went down
Not able to use right hand
The finger and wrist weak
9-a-(4) duration of healing depend on x-ray
If fractured plaster is needed
Take up to 6 weeks
If simple sprain recover in two weeks
B- (5)1st couple of days painful
After 2-3 days physiotherapy will be helpful
Teach about stretches and massage
Regain ranger of movement
Alleviate symptoms of pain

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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
2-(7) 24 years old
-lives in Colton -lives with two friends
-not married- no partner -no children –
retailer -full-time job
3-(9) first got it 2004
-since then had it on and off
-last year specially had it every couple of
months
-quite severe since 2004
-bad fever -swollen neck -went to hospital
Generally feeling unwell
-in hospital for 2 days -needed IV antibiotic
-not told bacterial or viral infection
4-(4) pretty much recovered after that
-got it again 3 months later/ mild
-then have it after 6 months
- a year ago had it every few months or
every couple of weeks
-no review to look for bacteria/ no swap
done
5-(7) first time was the worst
-old GP gave her permanent prescription of
Amoxicillin
-majority of symptoms got better but not all
-get it whenever have symptoms
-clear up within couple of days
-see a surgeon for the side effects
-make her sick, nauseous
-stomach pain
6-a-(4) MEDICAL PROBLEMS:
-pretty good
-no significant medical history
Thalassemia/ no transfusion
-no major infections
b-(7) Medications:
Only antibiotics
No regular medications
No allergies
OTC: multivitamins
Not regular smoker only with drinking
Drinking once on weekends
2 cigarettes a week
Rarely smoke marijuana, but no other illicit
drugs
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7-(7) going in November
-flying to Zambia
Go there in 2/3 weeks
Then to South Africa
Volunteer work
Work in 2 places
HIV clinics and an orphanage
Visiting some friends in South Africa
In Cape town for 5 weeks
8-(7) recurrent tonsillitis/ immune system
and respiratory tract are prone
Most episodes due to viruses
Mostly due to a bacteria called streptococci
Respond to antibiotic
A course given to eradicate/ reduce future
risks
Recurrent episodes: surgery, tonsillectomy
to reduce the risks
But still can get infection
Refer to ENT surgeon to discuss risks and
benefits of surgery
9-(5) hepatitis B/A
Typhoid fever
Update routine vaccines: measles , rubella
Tetanus poster shot
rabies
10-(3) can get them all here or referred to a
travel medical clinic
-can get them all at once
-got back only for hepatitis A as it needs a
poster after 6 months
11-(7+6) Zambia is a malaria-endemic area
-need to take malaria prophylaxes
-in tablet form
-taken in few days before going
-3 different drugs recommended
-doxycyclin antibiotic/ the cheapest, may
cause rash or photo-sensitivity
-if exposed to sun can get sunburned easily
-try melfoquine
if previous problem with antibiotic, will
cause stomach upset
Abit more expensive
Smaller risk of causing psychosis
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