4 Writing Test- Doctors Time Allowed: 40 minutes Read the case notes below and complete the writing task which @ follows. Patient: Mr Henry Lawson DOB 1 April, 1926" 20,3.'05 Subjective: Wife died two months ago Hadn't cooked until wife's death Lives on sandwiches and canned soup Suffers from constipation Takes 2 Beecham’s pills at night Objective: Underweight: Ht 180 cm; Wt 62kg, BM! 19.1 BP 150/100; P 80 reg = Urinalysis N Assessment: _ idiopathic constipation Treatment: Arrange for council to provide meals on wheels jowders to increase weight Patient told to avoid laxatives 18.405 Subjective: about wife's death Objective: Weight 60 kg Assessment: _ reactive depression constipation Treatment: Explanation of precipitating causes Advised to_T fibre in diet ‘Advised to T weight Advised to | alcohol intake Advised to éstablish bowel routine Rx Sterculla (bulk laxative). Drinking 1 bottle Scotch per day Forgets to take protein powders & Sterculia Suffering from piles and itchy anusObjective: Weight 58 kg Assessment: Non compliance with constipation and weight gain regime Treatment: Refer to dietician at district nursing home Encourage to have bran rich diet WRITING TASK Using the information in the case notes, write a letter of referral to the Registrar, Flemington Nursing Home, Flemington Road, Parkville 3052 . The main part of the letter should be 180 — 220 words long. Do NOT use note form in the letter. Expand the case notes where relevant into full sentences.© Writing Test- Doctors Time Allowed: 40 minutes Read the case notes below and complete the writing task that follows. Patient History: George Whitcroft is a 22 year old man (DBO 15.9.1983) who has been a patient of your practice for most of his life. Apart from the usual childhood illnesses such as measles, he has been fit and healthy. 13.3,'06 Subjective: Noted severe frontal headache last 6 hours. Mild assoc nausea, no vomiting; lightly blurred vision but no aura. Otherwise well recently. No other symptoms. No photophobia/neck stiffness. No past history or family history of migraine. Objective: P 96; BP 125/85, Fundi normal. Cervical spine movement normal, Exam otherwise normal Assessment: Probable tension headache Treatment: rest and simple analgesia (Paracetamol 500 q4h) 26/3/'06 Subjective: Complaining of ongoing headaches ~ six over last two weeks. Frontal and left-sided with visual blurring. Today severe left-sided throbbing headache — severe pain. Vomited three times with headache Complaining of slight paraesthesia R side Objective: Distressed: P110. BP 150/95. Fundi normal. PNS. Normal. No reflex changes of other sensory signs. Assessment: 7? severe migraine headache Treatment: Pethidine 100mg IM Maxalon 10mg IM R/V 24hrs if not settling 29/3/'06 Subjective: Urgent home visit Collapsed at home after another left-sided severe headache started 3 hrs ago. Now in pain; weakness in'R arm & leg. Conscious state depressed, speech slurredObjective: P 100. BP 155/90. Periphery — R arm flexion 4/5 power; extension 4/5 power. R knee flexion 4/5. R knee jerk increased Assessment: —_? space occupying lesion or other intracranial pathology Treatment: Urgent assessment in Emergency Dept. WRITING TASK Using the information in the case notes, write a letter of referral to Dr James Browning, neurologist, Emergency Dept, St Brendan's Hospital, Smythe Street, Colac 3707. The main part of the letter should be 180 - 220 words long. Do NOT use note form in the letter. Expand the case notes where relevant into full sentences,@ Writing Test- Doctors Time Allowed: 40 minutes Read the case notes below and complete the writing task which follows. Patient History: Mr John Collingwood is a patient in your general practice. 20.3.99 Subjective: 52-year-old bank manager Lives with wife, Mary Had chronic bronchitis since age of 25 Lots of chest ifecsons Objective: BP 145/85 P 80 regular Overweight Ht 175cm Wt 110kg Cardivascular examination done ‘Treatment: Advise re weight loss, quit smoking Gave patient Pulmicort 200mcg, 2 puffs b.d. 18.4,99 Subjective: Cut smoking to 10 daily Drinking a lot of beer Morning cough with wheeze Objective: BP 150/90 Treatment: Pulmicort continued — same dosage Respolin 30mls gid20.5.99 Subjective: ‘Tightness in chest ‘Smoking increased — 20/day Rapid breathing _ Difficulty speaking Objective: BP 155/100 _ Assessment: Severe acute asthma Treatment: Patient advised to cease smoking Pulmicort tds You decide to send this man to the Emergency Department at the Royal Melbourne Hospital Writing Task Using the information in the case notes, write a letter of referral to the Registrar in the Emergency Department of the Royal Melbourne Hospital, Flemington Road, Parkville 3052 In your answer: * Expand the relevant case notes into complete sentences + Do not use note form * The body of the letter should be approximately 200 words + Use correct letter formatjriting Test- Doctors Time Allowed: 40 minutes Read the case notes below and complete the writing task which follows. eo olok Patient: 2ackeilichols, male, DOB 10.1'06 PMH: aL UosilaeiieamsineSSes zl Et ee eee sgn sppen fr red (Needs to be chased up) No other signif. Injuries NOBHEISHAAGITIAE of visual disturbances before MCA. hts, espaiiaiiiniigs. Subjective: fs, eons ; gg etc. Also occur when under g 36 Bis Currently learning to drive again — seems to cause 2 rel Biol No other neurological symptoms apart from minor visual blurring, Claims to have no eyesight troubles. (No glasses) Objective: O/E Well. Concentration drifts at times BP 120/80 P 70 reg Chest clear Abdo: NAD ‘Assessment: Neuro: 1 serial 7's, 1 short term memory (phone numbers) Cranial nerves — normal Fundi: ? giabimisarenaisc? PD:WRITING TASK Using the information in the case notes, write a letter of referral to neurologist, Prof Henry Higgins at the Alfred Hospital. The main part of the letter should be 180 — 220 words long. Do NOT use note form in the letter, Expand the case notes where relevant into full sentences,Writing Test- Doctors Time Allowed: 40 minutes Read the case notes below and complete the writing task which follows. Patient History: Abdul Hassan is a patient in your General Practice. 3.7.02 Subjective: 44-year-old (bank tellerwas a ‘check up’. Smokes 1¥/2 packets of cigarettes per day Hen Bisel pressive past No ragular exercise Father died aged 50 of acute MI Pence No medication No known allergies Objective: BP 150/100 P 80 regular Overweight, Ht 167cm, Wt 97kg BMI 34.8 cocioreiae snd respiratory examinations normal UrinaysisNAD (me abraciralit eotec re a) Treatment: Advise re weight loss, smoking cessation RIV BP in 1/92 Review 6 25/7/02 Subjective: Still smoking. No increase in exercise. No weight loss Objective: BP 155/100 Assessment: Hypertension _ Treatment: Commence Nifedipine (Calcium channel blocker) 20mg daily Check serum cholesterol; blood glucose Total cholesterol = 6.4 mmol/L” ~10/8/’02 Subjective: Mild ing epigastric pain, radiating retrosternally. Occurs after eating and walking. Objective: BP 155/100 Abdominal and cardiovascular exam otherwise normal Assessment: ? Gastric reflux. Non-compliance with anti-hypertensive medication Treatment: Add Mylanta 30mis gid Increase Nifedipine to 20mg bd 19/8/'02 Subjective: Crushing retrostemnal chest pain. Sweaty. Mild dyspnoea. Onset while walking, present for about one_ Objective: BP 160/100 p64. In obvious distress. Few crepitations at lung bases ECG — inferior acute MI Egge ifarior acute Assessment: acute myocardial infarction Treatment: Oxygen given Anginine given sublingually Morphine 2.5mg given IV stat Maxalon 10mg given IV stat You decide to call an ambulance to send this man to the Emergency Department of the Royal Melbourne Hospital. Using the information in the case notes, write a referral letter to the doctor in the Emergency Department of the Royal Melbourne Hospital, Flemington Road, Parkville 3052 to accompany Mr Hassan.