OCCUPATIONAL ENGLISH TEST

WRITING SUB-TEST: MEDICINE

TIME ALLOWED: READING TIME: 5 MINUTES

WRITING TIME: 40 MINUTES
Read the case notes below and complete the writing task which follows.

Notes:
Patient History Tracy Bowen (Ms)
DOB 22/7/88
PMH Childhood asthma - worse with dust, exercise, smoke, cat hair, change in temperature.
Recurrent bronchitis.
Father heavy smoker - house smoky.
Medications Salbutamol inhaler, beclomethasone pm

28/08/04
Subjective Irregular menstrual periods since menarche. Very Infrequent, up to 90-day
lntermenstrual interval. Frequently with dysmenorrhoea. Stress related to parents'
divorce (2002). Adolescent acne since 3/12 ('pus-filled').
Objective Abdominal exam - NAO
Rectal exam - NAO
FHx - no genetic anomalies
Breast development normal
Assessment Idiopathic oligomenorrhoea, primary dysmenorrhoea
Treatment Oral contraceptive pill (Dlane-35, 2mg - low dose)
Analgesia (naproxen)
Reassurance

21/09/05
Subjective Acne - facial + upper back, shoulders and neck.
Objective OE: deep, inflamed nodules and pus-filled cysts with scarring on face, neck,
upper back and shoulders.
Assessment Deep acne
Treatment Antibiotic therapy: tetracycline 250mg qid; tetracycline ointment 1 % 5g, apply
liberally bd

24/11/05
Subjective Acne - unchanged. Cyst-like, leaves scars. Clo diarrhoea, vaginal candidiasls and
sore tongue since 4/52.
Assessment Cystic acne
Treatment Refer to dermatologist for Roaccutane Osotretinoin) capsules 30mg bd. lsotrex gel
0.05% - apply at night.
R/V2/52.

2
Notes foe Lntervenlna period omitted for clarity.

28/03/14

Subjective Patient married; discontinued OCP January 2013.

Difficulty conceiving. Amenorrhoea; depression; weight gain.

Objective BMI 28 (overweight)

BP 100/60
Hirsutism (has had cosmetic therapy: electrolysis)
* Oral GTT (fasting) 6.5mmoVL (Ref range <5.5mmol/L)
Serum testosterone 2.1nmol/L (Ref range 0.4-2.7)
* SHBG 19nmol/L (Ref range 20-100)
* Free Androgen Index (TE/SHBG ratio) 11.1% (Ref range <8.0)
Serum oestradiol 325pmoVL
(Follicular phase 70-670; Luteal phase 200-600)
FSH 5.1IU/L
(Follicular phase 2.5-10; Luteal phase 1.5-9)
LH 9.0
(Follicular phase <15.0; Luteal phase <15.0)
* Prolactin 115.3µg/L (Ref range <25.0)
TSH 2.8 (Ref range 0.35-5.50mIU/L)

*
Haematology NAO
Vitamin D 57nmol/L (Ref range 60-160)
Iron studies Normal

Assessment ?PCOS (polycystic ovary syndrome)

Treatment Climen (cyproterone with oestradiol) 10mg qd
Patient requests referral to endocrinologist
Pelvic US ordered; copy of results to be sent to endocrinologist

Writing Task:
Using the information given in the case notes, write a letter of referral to Dr Susan Clayton, endocrinologist at
the Women's Health Centre, 11-13 Bell Street, Newtown.

In your answer:
• Expand the relevant notes Into complete sentences
• Do nm use note form
• Use letter format

The body of the letter should be approximately 180-200 words.