Occupational English Test
Listening
Test
This test has three parts. In each part you’ll hear a number of different extracts. At the start of each extract, you’ll hear this sound: --beep—
You’ll have time to read the questions before you hear each extract and you’ll hear each extract ONCE ONLY. Complete your answers as you listen.
At the end of the test you’ll have two minutes to check your answers.
Part A
In this part of the test, you’ll hear two different extracts. In each extract, a health professional is talking to a patient.
For questions 1-24, complete the notes with information that you hear.
Now, look at the notes for extract one.
Extract
1: Questions 1-12
You hear a rheumatologist talking to a patient called Harry Davies, who suffers from gout and is attending for a medication review. For questions 1-12, complete the notes with a word or short phrase that you hear.
You now have thirty seconds to look at the notes.
Patient Harry Davies
Medical History • suffers from gout
• had his first serious attack while on holiday – pain in his
(1)____________________________ accompanied by swelling
• initially thought it was either:
- (2) ____________________________
- possibly related to medication taken for (3) ____________________________
control
• describes the pain as (4) ____________________________
• was unable to (5) ____________________________
• says the clinic initially suspected (6) ____________________________ before diagnosing gout
• reports previously feeling similar pain after (7) __________________________ – but less intense, self-resolving
Treatment received • (8) ____________________________ – not effective
• Colchicine – caused (9) ____________________________
• (10) ____________________________ – caused nausea (may have overdosed)
• (11) ____________________________ – quite effective
• Allopurinol – caused (12) ____________________________
Extract
2: Questions 13-24
You hear a doctor in an emergency department talking to a patient called Gail Kennedy. For questions 13-24, complete the notes with a word or short phrase that you hear.
You now have thirty seconds to look at the notes.
Patient History Gail Kennedy
Two weeks ago • returned from South America
• at first assumed she had extreme (13) ____________________________
• symptoms intensified over time
• suspected (14) ____________________________ and so contacted GP
• GP suspected malaria (despite commencement of
(15) ____________________________ two weeks prior to holiday)
• GP prescribed Artesunate plus Mefloquine (three-day course)
Following days •
(16) ____________________________ heavily.
Yesterday • persistent vomiting and (17) ____________________________
Observations
• no evidence of (18) ____________________________ from examination
• no SOB or wheezing
• patient describes heart as (19) ____________________________
• reports irritation and dryness in her (20) ____________________________
• reports no (21) ____________________________
• loss of appetite
Additional
information
• prior to holiday had vaccinations for both typhoid and
(22) ____________________________
• had (23) ____________________________ during holiday – self medicated
• underwent (24) ____________________________ in 2011
That
is the end of Part A. Now look at Part B.
Part
B
In this part of the test, you’ll hear six different extracts. In each extract, you’ll hear people talking in a different healthcare setting.
For questions 25-30, choose the answer (A, B or C) which fits best according to what you hear. You’ll have time to read each question before you listen. Complete your answers as you listen.
Now look at question 25.
Fill the circle in completely. Example:
25. You hear a patient talking to a dental receptionist.
How does he feel?
A. worried that he may have damaged a filling
B. disappointed that he can’t be seen immediately
C. nervous about being treated by a different dentist
26. You hear part of a presentation to nursing staff about an extension to visiting hours.
What is the speaker doing?
A. detailing the benefits of the planned change
B. reassuring them that their workload won’t increase
C. explaining steps they should take to avoid problems
27. You hear a surgeon discussing a patient with a nurse in the recovery ward.
What is the surgeon concerned about?
A. incomplete results from lab tests
B. possible post-operative side effects
C. the patient’s level of consciousness
28. You hear a chiropractor briefing a colleague about a patient called Ryan.
What is the overall aim of the treatment plan?
A. improving pain relief
B. restoring feelings in his arm
C. treating the side-effects of an operation
29. You hear a surgeon talking to a group of medical students about patient risk in emergency surgery.
The surgeon is emphasising the fact that
A. prompt preparation is the most effective way to minimise patient risk.
B. certain types of surgery carry more risk for patients than others.
C. patients at high risk require extra recovery time after surgery.
30. You hear a surgeon talking to a patient who’s just had a knee operation.
The man’s comments reveal that he’s
A. determined to start doing sport as quickly as possible.
B. impressed by how little time he spent in the hospital.
C. surprised that he’ll be relatively pain-free so soon.
That
is the end of Part B. Now look at Part C.
Part
C
In this part of the test, you’ll hear two different extracts. In each extract, you’ll hear health professionals talking about aspects of their work.
For questions 31-42, choose the answer (A, B or C) which fits best according to what you hear. Complete your answers as you listen.
Now look at extract one.
Fill the circle in completely.
Extract
1: Questions 31-36
You hear an interview with Dr Helen Sands, about her work with patients who are learning to cope with amputation. You now have 90 seconds to read questions 31-36.
31. How did the young patient called David react to the amputation of his leg?
A. He felt he was now excluded from normal life.
B. He compared it to the experience of a relative dying.
C. He resented his inability to take part in physical activities.
32. What does Dr Sands suggest about pain in a missing or ‘phantom’ limb?
A. Under-reporting by patients makes it hard to know how frequent it is.
B. The discomfort can generally be traced to a physical cause.
C. The problem affects far fewer patients than in the past.
33. Some patients feel that their missing limb is still attached but
A. would cause pain if they used it.
B. is fixed in a strange position.
C. has increased in size.
34. Dr Sands’ current treatment trial includes people who have
A. reacted badly to previous treatments.
B. failed to respond to any form of medication.
C. reported pain levels that impact on their daily lives.
35. In Dr Sands’ current trial, patients are
A. helped to come to terms with the loss of a limb emotionally.
B. shown how to manage a computer-operated prosthetic limb.
C. made to move a simulation of the missing limb in their minds.
36. Dr Sands feels one advantage of the trial group’s treatment is that
A. its effects are long-lasting.
B. it can be used by patients after discharge.
C. it helps certain patients to become almost pain-free.
Now
look at extract two.
Extract
2: Questions 37-42
You hear a dermatologist called Dr Jake
Cooper talking about a skin condition called Hidradenitis Suppurativa (HS). You
now have 90 seconds to read questions
37-42.
37. When describing the condition known as HS, Dr Cooper suggests that it
A. is fairly common so should be more accurately diagnosed.
B. would be better understood if it presented more uniformly.
C. may be incorrectly treated due to misinformation from patients.
38. Dr Cooper explains that one cause of HS may be blocked hair follicles resulting from
A. shaving of the affected area.
B. the overuse of deodorants.
C. the effects of smoking.
39. When describing the case of a patient called Sophie, Dr Cooper suggests that
A. HS has a tendency to get progressively worse.
B. diagnosis of HS may require a full patient history.
C. a multiple treatment approach is often required for HS.
40. Dr Cooper says that those treating patients with HS should be aware that the condition
A. may recur after disappearing for many years.
B. may be triggered by an episode of depression.
C. may become increasingly difficult to treat over time.
41. When discussing a patient called Emily, Dr Cooper suggests that her mother’s attitude
A. reflected a lack of sympathy and understanding.
B. led to a delay in confirming the correct diagnosis.
C. may have contributed to the severity of the symptoms.
42. When discussing the treatment of HS sufferers, Dr Cooper recommends they should
A. eat healthy foods such as brown bread.
B. restrict their intake of dairy products.
C. avoid all types of alcoholic drinks.
That
is the end of Part C.
You now have two minutes to check your answers.
THAT
IS THE END OF THE LISTENING TEST
LISTENING
SUB-TEST – ANSWER KEY
PARTS
A, B & C
LISTENING
SUB-TEST – ANSWER KEY
PART
A: QUESTIONS 1-12
1 left knee
2 (an) insect bite
3 cholesterol
4 excruciating
5 drive
6 septicaemia septicemia
7 (playing) rugby
8 anti(-)inflammatories
9 (awful) diarrhoea diarrhea
10 liquid morphine
11 (an) ice pack
12 (a) skin rash
13 jet lag
14 meningitis
15 Malarone
16 sweating
17 splitting headache
18 jaundice
19 (really) racing
20 eyes
21 abdominal discomfort
abdominal pain
22 hepatitis A
hep A
23 cold sores (all over her upper lip) cold sores (all over upper lip) cold sores (all over her lip)
cold sores (all over lip)
24 (a) lumpectomy
LISTENING
SUB-TEST – ANSWER KEY
PART
B: QUESTIONS 25-30
25 A worried that he may have damaged a filling
26 B reassuring them that their workload won’t increase
27 B possible post-operative side effects
28 C treating the side-effects of an operation
29 A prompt preparation is the most effective way to minimise patient risk.
30 B impressed by how little time he spent in the hospital.
PART
C: QUESTIONS 31-36
31 B He compared it to the experience of a relative dying.
32 A Under-reporting by patients makes it hard to know how frequent it is.
33 B is fixed in a strange position.
34 C reported pain levels that impact on their daily lives.
35 C made to move a simulation of the missing limb in their minds.
36 B it can be used by patients after discharge.
PART
C: QUESTIONS 37-42
37 A is fairly common so should be more accurately diagnosed.
38 C the effects of smoking.
39 B diagnosis of HS may require a full patient history.
40 A may recur after disappearing for many years.
41 A reflected a lack of sympathy and understanding.
42 B restrict their intake of dairy products.
---
END
OF KEY
Script
This test has three parts. In each part you’ll hear a number of different extracts. At the start of each extract, you’ll hear this sound: ---***---.
You’ll have time to read the questions before you hear each extract and you’ll hear each extract ONCE ONLY. Complete your answers as you listen.
At the end of the test, you’ll have two minutes to check your answers.
Part A. In this part of the test, you’ll hear two different extracts. In each extract, a health professional is talking to a patient. For questions 1 to 24, complete the notes with information you hear. Now, look at the notes for extract one.
PAUSE:
5 SECONDS
Extract
one. Questions 1 to 12.
You hear a rheumatologist talking to a patient called Harry Davies, who suffers from gout and is attending for a medication review. For questions 1 to 12, complete the notes with a word or short phrase. You now have thirty seconds to look at the notes.
PAUSE:
30 SECONDS
---***---
F: Now Mr Davies, I understand your GP has referred you to me so that we can review the medications you’re taking for your gout.
M: That’s right.
F: So tell me a bit about this gout. When did it start?
M: Well, my first serious attack was last year. My wife and I were on holiday, and I woke up one morning with a really bad pain in my left knee. Well, I never thought of gout, ‘cause I always assumed that just happens somewhere like your big toe. And anyway, I’m only 40, I thought it was something only old people get. So anyway, it was all red and swollen, and I decided it must be an insect bite. But I couldn’t think how that might‘ve happened, you know, without me feeling something at the time. Or my wife suggested it might be something to do with the pills I take for my cholesterol.
F: Unlikely I think.
M: But anyway, the pain didn’t get any better; in fact quite the opposite. I started to get frightened because I thought it might be a sign of something really serious – it was excruciating. So my wife thought I needed to get some help. So, she phoned the local clinic and told them about my symptoms. They told her to bring me in. It was a good thing she was there – I was in too much pain to drive. I mean, I could only just manage to walk from the house to the car.
Anyway, when we got there, the doctor took a look and said he wanted to take a blood sample. He said it might be an emergency, because it looked as if it could be septicaemia. So then we got really frightened, but about an hour later they came back and said no it wasn’t, thankfully, but they thought I had gout. So actually, at that stage, we were quite relieved.
F: I can imagine.
M: And the doctor asked if I’d ever felt anything like it before. Well, actually, then I remembered that in the winter I play quite a bit of rugby, and sometimes I’d get some soreness in the same place the day after, but I’d just thought I’d sprained it or something. And it would go away after a couple of days. But this pain’s much worse, and it comes even when I’ve been resting – I’ve had it quite a few times since my first attack.
F: Right. So what have you been taking to deal with the pain?
M: Well at first the doctor at the clinic suggested I took some anti-inflammatories, but I can’t say they made much difference. So when I got the next attack I was at home and I went to my GP. She suggested I took… I can’t remember the name, Col something
F: Colchicine?
M: That’s the one. So that dealt with the pain better, but it gave me awful diarrhoea.
F: Yeah.
M: I‘d never take it again. And then I had a really bad attack. I think the doctor had got to the stage where, you know, she was already giving me really powerful medicines to no effect - so, she gave me liquid morphine to take. It made me feel quite sick actually, and I was a little bit ‘away with the fairies’, you know, walking around not quite knowing where I was?
F: Right. Did you try any other sort of treatment apart from the medications?
M: Yes, my GP said I could try using an ice pack and that did make a bit of difference, but you can’t have it on all the time. So anyway, after that she said let’s try Allopurinol, see how you get on with that. So I started taking that, but I didn’t get on with it. It gave me a skin rash, so I rang her up and she told me to stop taking it – that I’d better see a specialist. So, I here I am. Is there’s anything more you can do?
F: Well, I’m sure we can find…[fade]
PAUSE:
10 SECONDS
Extract
two. Questions 13 to 24.
You hear a doctor in an emergency department talking to a patient called Gail Kennedy. For questions 13 to 24, complete the notes with a word or short phrase. You now have thirty seconds to look at the notes.
PAUSE:
30 SECONDS
---***---
Mrs Kennedy?
Yes.
I’m Doctor Jarvis. Sorry to keep you waiting. Now, can you tell me what’s brought you here today?
Well, I got back from holiday two weeks ago, and I’ve been feeling awful ever since. It was a long haul flight because we’d been to South America, and when I got back I felt awful. I thought it must be jet lag, but brutal, much worse than I remember having before. Anyway, I thought I’d get over it, but it actually got worse. After a few days, I was getting bad chills, non-stop shivering and achy muscles. I just felt lousy. I mean normally I’m pretty healthy, I don’t get a lot of illnesses, so I started to worry. I thought maybe I’d got meningitis. So I rang the doctor. When I told him where I’d been, he said I should come in and see him because it might be malaria. So I said, well it can’t be because I’ve been taking Malarone – I’d started on that two weeks before going away. I tried Larium a few years ago, but it gave me really odd dreams, so I didn’t want to take that again. Anyway the doctor said some sorts of malaria are resistant to these drugs, and I know I did get a few bites when we were there. He gave me some pills to take for three days just in case it was malaria.
Right. Can you tell me what they were?
Art something …
Artesunate?
That’s right. And something else. Hang on, I’ve got the box here… mefloquine. OK.
So I went home and I took the pills, but I didn’t feel any better, in fact I got worse. I felt really weak and I was sweating buckets, just dripping with it. I finished the pills yesterday morning. Since then, I’ve been really bad. I haven’t been able to keep anything down. I was throwing up all day yesterday and had the most splitting headache, I’ve never had anything like it. So I rang the doctor again and he said the blood test had come back negative, but if I wasn’t feeling better today I should come in to the emergency department, and get some more tests done.
Right. Well I’ll just do a brief examination… (pause)
OK, so your skin’s a good colour, I can’t see any sign of jaundice, and your breathing’s sounding pretty good – you haven’t had any episodes of breathlessness, have you?
No. But yesterday my heart was really racing. Yes, there’s some evidence of that, now.
And something else, all this week I’ve felt as if there was something scratchy in my eyes, like sand or something, and they feel really dry.
I see. And have you had any abdominal discomfort?
Well there’s no pain, but I don’t have any appetite – I can’t really keep anything down, like I said.
Right. Now, apart from taking the anti-malarials, did you have any vaccinations before you went away?
Yes, I had all the injections – typhoid, and what else?… not yellow fever because I’d already had that before,.. but I did have one for hepatitis A. And they were fine, I don’t usually have any problems with things like that. Then, while we were away, I did get cold sores all over my upper lip. I’ve had them before and I’d got some over-the- counter stuff for them so I just used that. Apart from that, I was fine during the holiday. I’m normally very healthy. I did have breast cancer a few years ago - that was in 2011. I had a lumpectomy, so I was taking tamoxifen for five years, but I don’t have to take it now.
OK. So it’s possible that this might be a reaction to certain drugs, but we’ll need to
…………….
[fade]
PAUSE:
10 SECONDS
That is the end of Part A. Now look at Part B. PAUSE: 5 SECONDS
Part B. In this part of the test, you’ll hear six different extracts. In each extract, you’ll hear people talking in a different healthcare setting.
For questions 25 to 30, choose the answer A, B or C which fits best according to what you hear. You’ll have time to read each question before you listen. Complete your answers as you listen.
Now look at Question 25. You hear a patient talking to a dental receptionist. Now read the question.
PAUSE:
15 SECONDS
---***---
M Hi, I’d like an urgent appointment, please.
F Let’s see. Who’s your usual dentist?
M Mr GarcÃa.
F You say it’s urgent – are you in pain?
M Yeah – it’s the tooth Mr GarcÃa filled last week.
F Well, he’s away today I’m afraid, but there’s a free slot this afternoon with his colleague Mrs Brown.
M That would be OK. But are you saying Mr GarcÃa could fit me in tomorrow?
F That’s right – we’d get you in first thing. Can you wait?
M Well, I’m not chewing on that side and I’m taking paracetamol, which is helping. The pain started when I was eating a steak so I’m frightened I might’ve upset Mr Garcia’s work. It makes sense for him to check it out.
F
OK. We’ll book you in for tomorrow morning at….. [fade]
PAUSE:
5 SECONDS
Question 26. You hear part of a presentation to nursing staff about an extension to visiting hours. Now read the question.
PAUSE:
15 SECONDS
---***---
F Now, you’ll have received the survey asking your opinion about extending visiting hours and doubtless you’ve got your own ideas about the possible impact on your work. You’re probably aware of the evidence pointing to the positive effects on patient recovery rates of increased contact with loved ones. This isn’t in question, but of course things must be managed properly. I’ve heard concerns about how busy everyone is; that you’ve got enough on your plates without having to worry about extra demands from visitors. Well, we’ve carefully planned things to prevent you being overrun with queries, interruptions and so on. Visitors will be given a list of ‘do’s’ and ‘don’ts’ outlining what’s expected of them. Meanwhile, managers will be monitoring things carefully to make sure routines
aren’t disrupted at all.
PAUSE: 5 SECONDS
Question 27. You hear a surgeon discussing a patient with a nurse in the recovery ward. Now read the question.
PAUSE:
15 SECONDS
---***---
M: It looks like Mrs Jones is still a bit groggy after her thyroidectomy. Will she
be going up to the ward soon?
F: Yes, I’m going to call a porter. She should be going up in fifteen minutes.
M: OK. I’ve added some extra post-op pathology orders. She may have problems with a drop in her calcium. Her thyroid was just huge. We didn’t see all four parathyroid glands and we need to check that they haven’t been affected by the procedure. She seems OK, but I want her calcium level checked twice a day. She needs to be monitored for any breathing problems, muscle cramping and numbness, and for tingling in her fingers.
F: OK, I’ll make sure a report to watch out for hypocalcaemia is passed on.
M: OK. If you need me, call me.
PAUSE:
5 SECONDS
Question 28. You hear a chiropractor briefing a colleague about a patient called Ryan. Now read the question.
PAUSE:
15 SECONDS
---***---
M Today, we’re going to start with Ryan. He’s two weeks post-surgery for a torn rotator cuff. He also had a spur on his acromion process removed. This is his first time in rehab, post- surgery I believe?
F That’s correct.
M OK, so today, we’re going to begin utilising high-frequency vibration to break up the scar tissue forming in his left shoulder joint following the surgery. We're going to do each of his treatments that way, so you'll see a progression over time – how we get him back to a point where he's able to live his normal life. Movement’s the key to rehabilitation, and this treatment resonates with the nerves too, so it should eventually help them heal quicker and reduce his discomfort.
PAUSE:
5 SECONDS
Question 29. You hear a surgeon talking to a group of medical students about patient risk in emergency surgery. Now read the question.
PAUSE:
15 SECONDS
---***---
M If you look at the risks of elective surgery, they’re really very low compared to emergencies. Clearly then, we can make the biggest difference in reducing risk and improving outcomes in emergency surgery. Our mortality outcomes here are actually below average. We’re at 8% compared to around 13% nationally. The emergency patients I handle tend to be older, so they’re at higher risk. And when they come in, we haven’t got long to prepare them in order to reduce any risks. Maybe an hour or two. In terms of patient safety, every minute, every half-hour we can use to get them ready counts. That’s because the patients we’re thinking about are prone to developing post- operative complications given that they have a range of associated heart, kidney and
lung problems.
PAUSE:
5 SECONDS
Question 30. You hear a surgeon talking to a patient who’s just had a knee operation. Now read the question.
PAUSE:
15 SECONDS
---***---
F How are you feeling Mr Shaw?
M Exhausted. But the pain-killers must be working – I can’t feel my knee, as you predicted.
F You’re bound to feel weary after an operation. It went well, though. We cleaned out loose cartilage from the joint. You can go home now.
M Oh, thanks. I had an arthroscopy on the other knee several years ago, so I know what it’s like. The idea that it gets done in less than a day is still pretty mind-boggling, though.
F You’ll need crutches for two weeks, but you should be walking OK within a month. Give it four months before you put any serious impact on it though.
M Four months? After my last op, I started running again within a month. Thinking about it though, I guess I paid for it. That knee had a lot of niggles for months afterwards.
F If your body’s hurting, it’s telling you something.
PAUSE:
10 SECONDS
That is the end of Part B. Now, look at Part C. PAUSE: 5 SECONDS
Part C. In this part of the test, you’ll hear two different extracts. In each extract, you’ll hear health professionals talking about aspects of their work.
For questions 31 to 42, choose the answer A, B or C which fits best according to what you hear. Complete your answers as you listen.
Now
look at extract one.
Extract one. Questions 31 to 36. You hear an interview with Dr Helen Sands, about her work with patients who are learning to cope with amputation.
You now have 90 seconds to read questions 31 to 36.
PAUSE:
90 SECONDS
---***---
M I’m joined today by Dr Helen Sands, who works with patients who’ve had limbs amputated. Now, amputation is an extremely traumatic experience for patients. Helen, in your experience, how do younger patients tend to react to it?
F Well, in a range of ways, depending on whether the loss was expected, if it was due to chronic illness, or to something sudden, like an accident. One of my young patients in that situation – let’s call him David – said losing his leg suddenly was like the pain of an unexpected death in the family. And although this didn’t really apply to him, for many young people, even watching a football game can make them feel shut out of activities they once took for granted. But then others come to terms with the fact that for them, normality will be something different from what it was before the operation.
M And patients can still suffer pain from a missing limb, can’t they, even after the limb’s been amputated – what’s called phantom limb syndrome. How common is this?
F Well, the phenomenon was first observed many years ago in soldiers who’d lost a limb in combat. The majority reported pain coming from the missing limb. Obviously surgical techniques have improved, but a large number of amputees still report suffering from a degree of pain from the missing limb. In a few instances, this might be due to a poorly-fitting prosthetic for example, or residual limb pain, but the majority of cases are harder to explain. And patients are reluctant to talk about it, in case medical professionals doubt their mental state, so it’s not very easy to say just how often it occurs. However, I still tend to think it’s large numbers.
M And you must have come across examples of this phantom limb syndrome in your own patients who have missing limbs.
F Yes, of course. Many patients report feeling as if the missing limb is still attached to their body, even years after the amputation. Some patients have reported actually trying to use it just as they did before. And in the case of other patients they feel as though the missing limb is permanently at an abnormal angle, and they have to make allowances for it when moving around. I’ve come across a number of instances of that. And other patients experience what we call telescoping – the sensation that the limb is still there as normal, but it’s become smaller… shrunk, somehow.
M And I understand that you have a treatment trial going on in the hospital at the moment.
F Well, yes. I mean, in the normal course of treatment, we administer analgesia, and we also make use of local injection therapy, using pain-blocking agents.
Unfortunately, though, these don’t always work as well as we might like. So we’re working with a group of patients who have reached the point where the pain’s badly affecting normal activities such as sleeping and going to work. All patients in the group have suffered from phantom-limb pain for ten years on average – so they’re the most extreme cases we could find.
M So how did you set about treating the patients in the trial group?
F Well, when a limb is lost, that affects a number of brain functions, and we wanted to try to restore those functions. So we attached electrodes to the remaining muscles of the stump and then asked patients to try to move the phantom limb. And patients could view their virtual limb moving on a computer. But they couldn’t just imagine moving the limb – they actually had to force their brain, if you like, to perform the action, because only then would these circuits, these pathways, be restored in their brains. So the patient controlled the virtual limb just as they would have with their own limb. And slowly, they got better at doing this, in a way that was productive to the brain. And patients invariably reported that as a result, their pain diminished.
M So the treatment was useful. Does it have any other advantages?
F Well, we followed up patients after different periods of time, and the improvements were still there, but not to the same degree – but the decrease in pain levels was still statistically significant. But this kind of treatment is very easy for patients to do at home once they’ve left the hospital. They only need a computer with a webcam, and the programme.
M And this research is ongoing, of course, so we [fade] ………….
PAUSE:
10 SECONDS
Now look at extract two.
Extract two. Questions 37 to 42. You hear a dermatologist called Dr Jake Cooper talking about a skin condition called Hidradenitis Suppurativa (HS).
You now have 90 seconds to read questions 37 to 42.
PAUSE:
90 SECONDS
---***---
Hello, my name's Jake Cooper. I'm a dermatologist and I'm going to talk about a skin condition called Hidradenitis Suppurativa, commonly abbreviated to HS.
Let me tell you a bit about this condition. HS is a chronic inflammatory disorder characterised by painful swollen lumps on the skin, which may break open, releasing fluid or pus. It's also called acne inversa, and in fact sufferers often think they’ve got acne or pimples. But unlike acne, HS affects apocrine gland-bearing sites, in particular the armpits and the pubic regions. It’s not a very well-known disease in the medical community, which is surprising as it affects about one per cent of the population, and early occurrences are commonly misdiagnosed as simple nodules or abscesses. This is unfortunate as the condition can be very distressing for the patient.
We don’t know exactly what causes HS, though it seems to be linked to blocking of the hair follicles in the affected area. It tends to occur most often in younger females, and it’s often found in patients who are overweight. Studies carried out into a possible link between deodorant use and HS have so far been inconclusive, but the condition is more prevalent amongst smokers and there’s some evidence that nicotine may affect the follicles. Patients sometimes worry that they’ve caused the condition by shaving or possibly by using depilatory creams, but there’s no evidence that either is a contributing factor.
Let me tell you about one case I encountered recently. This was a 22-year-old woman called Sophie who came to see me because she had a number of painful boils in her groin. These had been occurring, with fluctuating severity, for the previous three years. When I questioned her further, I learnt that she’d previously undergone incision and drainage of various lesions on multiple occasions, at various medical centres. She also told me she’d taken a course of an unknown oral antibiotic to treat an abscess about two months earlier. So I was able to put two and two together and make a connection with HS. Then we could start to think about the right sort of long-term treatment for her.
When treating patients with HS, it’s important to be aware of the impact it can have on them. Many studies have confirmed that patients with HS commonly experience depression as a result of their condition. Additionally, HS has a significant psycho-social impact. Patients reported feeling 'unworthy' and 'unlovable' and described their lesions as 'ugly, smelly, and embarrassing'. In some cases, symptoms may spontaneously resolve themselves for long periods of time. But both doctor and patient need to remember that there could be a flare up years or even decades later - and that currently, treatment is limited to finding a way to manage the condition.
HS may present itself in younger patients too. In another case, I saw a 14-year-old girl called Emily, who came to see me with her mother following a diagnosis of HS by her GP.
We needed to confirm the diagnosis and decide on the most appropriate treatment. Her mother expressed concerns about what she referred to as ‘Emily's unappealing hygiene'. This was said in front of the girl. Now, we know that HS is notably not due to poor hygiene. While HS is a skin disease, it’s happening lower in the dermis than just the surface level. In this case, Emily had a lesion on the mons pubis, which required surgical intervention.
Following incision and drainage, her condition improved, but this does illustrate the need to consider not just the patient, but also the attitude of family members.
In general, when it comes to treatment, once we make a diagnosis, there are multiple therapies indicated, depending on the severity of the disease and patient presentation. One thing patients often ask me is whether they need to make changes to their diet. One small- scale study followed twelve HS sufferers who cut out beer from their diet, together with other foods containing yeast, such as bread and some types of cake. And this did appear to have an effect on their symptoms. It’s also known that over-production of one group of hormones called androgens may contribute to the symptoms of HS. These hormones are linked to insulin, and foods such as milk and cheese can raise insulin levels, so reducing these types of foods might be helpful. However, a controlled diet which leads to weight loss, is certainly recommended for patients who are overweight or obese.
PAUSE: 10 SECONDS
That
is the end of Part C.
You now have two minutes to check your answers.
PAUSE:
120 SECONDS
That is the end of the Listening test.
