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READING SUB-TEST – QUESTION PAPER: PART A
TIME: 15 MINUTES
INSTRUCTIONS TO CANDIDATES
DO NOT open this Question Paper or the Text Booklet until you are told to do so.
Write your answers in the spaces provided in this Question Paper.
You must answer the questions within the 15-minute time limit.
One mark will be granted for each correct answer.
Answer ALL questions. Marks are NOT deducted for incorrect answers.
At the end of the 15 minutes, hand in this Question Paper and the Text Booklet.
DO NOT remove OET material from the test room.
www.occupationalenglishtest.org
© Cambridge Boxhill Language Assessment – ABN 51 988 559 414 (2019)
Part A
TIME: 15 minutes
• Look at the four texts, A-D, in the separate Text Booklet.
• For each question, 1-20, look through the texts, A-D, to find the relevant information.
• Write your answers in the spaces provided in this Question Paper.
• Answer all the questions within the 15-minute time limit.
• Your answers should be correctly spelt.
Hypothyroidism: Questions
Questions 1-7
For each question, 1-7, decide which text (A, B, C or D) the information comes from. You may use any
letter more than once.
In which text can you find information about
1 reassurance for patients regarding the impact of their condition?
2 how younger patients can be treated for hypothyroidism?
3 possible negative responses to treatment for hypothyroidism?
4 instances when the initial amount of a drug given should be reduced?
5 who is more likely to suffer from hypothyroidism?
6 avoiding a particular form of a drug?
7 what patients with hypothyroidism should eat?
Questions 8-15
Answer each of the questions, 8-15, with a word or short phrase from one of the texts. Each answer may include
words, numbers or both.
8 From what age are women considered to be more likely to develop thyroid problems?
9 In suspected cases of hypothyroidism, what can be checked instead of the free hormone level?
10 Which thyroid hormone needn’t normally be measured?
11 What characteristic of thyroid hormones means that over-treatment or under-treatment can be harmful?
12 What is sometimes reduced in post-menopausal women if they are prescribed too high a dose of
thyroid hormone?
13 What type of drinks should hypothyroid patients avoid?
14 What minimum daily dose of levothyroxine sodium should be given to a four-month old patient with
hypothyroidism?
15 What dose of levothyroxine sodium should be given to a three-year old with hypothyroidism?
Questions 16-20
Complete each of the sentences, 16-20, with a word or short phrase from one of the texts. Each answer may
include words, numbers or both.
16 The recommended diet for patients with hypothyroidism helps them maintain a healthy
17 Egg yolks contain , which is good for patients.
18 Diabetic patients treated with thyroid hormone may experience
19 Too much thyroid hormone can provoke heart problems for older people and patients already suffering
from
20 A TSH level of 7.5 mIU/L combined with free T4 that is normal is regarded
as hypothyroidism.
END OF PART A
THIS QUESTION PAPER WILL BE COLLECTED
Any answers recorded here will not be marked.
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R000007
READING SUB-TEST – TEXT BOOKLET: PART A
INSTRUCTIONS TO CANDIDATES
You must NOT remove OET material from the test room.
www.occupationalenglishtest.org
© Cambridge Boxhill Language Assessment – ABN 51 988 559 414 (2019)
Hypothyroidism: Texts
Text A
Third-generation thyroid-stimulating hormone (TSH) assays are generally the most sensitive screening tool
for primary hypothyroidism. If TSH levels are above the reference range, the next step is to measure free
thyroxine (T4) or the free thyroxine index (FTI), which serves as a surrogate of the free hormone level.
Routine measurement of triiodothyronine (T3) is not recommended.
Results in patients with hypothyroidism are as follows:
• Elevated TSH with decreased T4 or FTI
• Elevated TSH (usually 4.5-10.0 mIU/L) with normal free T4 or FTI is considered subclinical
hypothyroidism
Abnormalities in the complete blood count and metabolic profile that may be found in patients with
hypothyroidism include the following:
• Anaemia
• Dilutional hyponatremia
• Hyperlipidemia
• Reversible increases in creatinine
• Elevations in transaminases and creatinine kinase
No universal screening recommendations exist for thyroid disease for adults. The American Thyroid
Association recommends screening at age 35 years and every 5 years thereafter, with closer attention to
patients who are at high risk, such as the following:
• Pregnant women
• Women older than 60 years
• Patients with type 1 diabetes or other autoimmune disease
• Patients with a history of neck irradiation
Text B
Pediatric Dosage - Congenital or Acquired Hypothyroidism
Start Levothyroxine sodium tablets at the full daily dose in most pediatric patients. Use a lower starting
dose in newborns (0-3 months) at risk for cardiac failure and in children at risk for hyperactivity. Monitor for
clinical and laboratory response.
Levothyroxine Sodium Tablets Dosing Guidelines for Pediatric Hypothyroidism
AGE Daily Dose Per Kg Body Weight*
0-3 months 10-15 mcg/kg/day
3-6 months 8-10 mcg/kg/day
6-12 months 6-8 mcg/kg/day
1-5 years 5-6 mcg/kg/day
6-12 years 4-5 mcg/kg/day
Greater than 12 years but growth and puberty incomplete 2-3 mcg/kg/day
Growth and puberty complete 1.6 mcg/kg/day
Text C
Important Safety Issues with Consideration to Related Drugs
Over-or Under-Replacement with Thyroid Hormone
Because of their narrow therapeutic index, over-or under-treatment with thyroid hormones such as
levothyroxine may have a number of adverse effects.
Cardiac Adverse Reactions
Overtreatment with thyroid hormone may cause increase in heart rate, cardiac wall thickness and cardiac
contractility, and may precipitate angina or arrhythmias, particularly in elderly patients and those with underlying
cardiovascular disease.
Worsening of Diabetic Control
Initiation of thyroid hormone therapy may worsen diabetic control and cause hyperglycemia in patients with
diabetes mellitus.
Decreased Bone Mineral Density Associated with Thyroid Hormone Over-Replacement
Over-replacement with thyroid hormones may cause increased bone resorption and decreased bone mineral
density, particularly in post-menopausal women.
Myxedema Coma
Myxedema coma may result in unpredictable absorption of levothyroxine from the gastrointestinal tract.
Use of oral thyroid hormone drug products is not recommended in patients with myxedema coma. Health
care practitioners should use thyroid hormone products formulated for intravenous administration to treat
myxedema coma.
Adverse Reactions in Children
Pseudotumor cerebri and slipped capital femora epiphysis are associated with initiation of levothyroxine therapy
in children. Over-replacement in children may result in craniosynostosis in infants and premature closure of the
epiphyses in children with resultant compromised adult height.
Hypersensitivity Reactions
Patients treated with thyroid hormone products have experienced hypersensitivity reactions to inactive
ingredients, including urticaria, pruritus, skin rash, flushing, angioedema, gastrointestinal symptoms, fever,
arthralgia, serum sickness and wheezing.
Text D
Nutritional advice for patients with hypothyroidism
People with hypothyroidism should base their diet around vegetables, fruit and lean meats. They are low
in calories and very filling, which may help prevent weight gain. It should be emphasised to patients that
this is not a restrictive diet, and that there are plenty of food options available to them, including:
• eggs - whole eggs are best, as much of the iodine and selenium beneficial for patients is found in
the yolk, while the whites are full of protein
• meat
• fish
• vegetables - all vegetables are fine to eat, though cruciferous vegetables (e.g. broccoli, kale,
spinach, cabbage) should be eaten cooked, in moderate amounts
• fruits - apart from peaches, pears and strawberries
• gluten-free grains and seeds - e.g. rice, buckwheat, quinoa, chia seeds and flaxseed
• dairy - all dairy products including milk, cheese, yogurt, etc.
• beverages - preferably water and other beverages that are not caffeinated.
END OF PART A
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