Occupational English Test

WRITING SUB-TEST: MEDICINE

TIME ALLOWED: READING TIME: 5 MINUTES
WRITING TIME: 40 MINUTES

Read the case notes and complete the writing task which follows.

Notes

Emma Johnson is an 11-year-old patient in your general practice.

Patient History

30/11/09
History:
Nocturnal cough last 2 wks associated with runny nose and mild
fever
Previously well.
Family history of asthma- mother and older sister aged 15
Past history- nil
Medication- nil
Allergies- none known
Examination:
Slightly flushed, temp 37.80C
Red pharynx, ears normal
Chest- no obvious wheeze, no focal signs
Peak expiratory flow rate (PEFR)- 250 L/min (expected 350 L/min)

Assessment:
Viral upper respiratory infection
Possible associated asthma

Plan:
Paracetamol, fluids for infection
Review if worsens
21/12/09

Examination:
Patient returns with persistent nocturnal cough, Runny nose and
fever, now completely resolved. Cough also noted on exercise.
Chest auscultation – faint basal wheeze, PEFR 230 L/min
Ears, nose and throat normal

Assessment:
Probable asthma

Plan:
Trial inhaled sulbutamol- Ventolin puffer 2 puffs t.d.s
Keep record of morning and evening PEFR readings
Review 3 wks

11/01/10

Examination:
Review symptoms slightly improved: exercise tolerance better
Less nocturnal disturbance
Chest auscultation – no wheeze heard
PEFR 2380 L/min

Assessment:
Improved but asthma still slightly unstable

Plan:
Commence inhaled corticosteroid- Becotide 200 2 puffs t.d.s
Continue Ventolin as required
Continue PEFR monitoring
Review 4 wks
8/02/10

Examination:
Much improved; minimal nocturnal & exercise induced symptoms
Chest auscultation- clear, PEFR 340 L/min

Assessment:
Well controlled asthma

Plan:
Maintain on current therapy
Review 2 mths

10/04/10

Examination:
Worsening shortness of breath & wheezing over last 48 hrs w.
runny nose, fever, loss of appetite
Red throat. ears normal
Obvious difficulty in breathing with use of accessory muscles
Chest auscultation – widespread wheeze, no focal signs
PEFR 140 L/min
Ears, nose and throat normal

Assessment:
Severe asthma triggered by viral respiratory infection.

Plan:
Ventolin nebuliser statim- minimal relief
Urgent assessment at hospital
Writing Task

Using the information given in the case notes, write a letter of referral to Dr B Townsend
in the Emergency Department at the Newtown Children’s Hospital.
Writing Task:
In your answer:

● Expand the relevant notes into complete sentences

●Do not use note form
●Use letter format

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

Notes

Emma Johnson is an 11-year-old patient in your general practice.

Patient History

30/11/09
History:
Nocturnal cough last 2 wks associated with runny nose and mild
fever
Previously well.
Family history of asthma- mother and older sister aged 15
Past history- nil
Medication- nil
Allergies- none known
Examination:
Slightly flushed, temp 37.80C
Red pharynx, ears normal
Chest- no obvious wheeze, no focal signs
Peak expiratory flow rate (PEFR)- 250 L/min (expected 350 L/min)

Assessment:
Viral upper respiratory infection
Possible associated asthma

Plan:
Paracetamol, fluids for infection
Review if worsens
21/12/09

Examination:
Patient returns with persistent nocturnal cough, Runny nose and
fever, now completely resolved. Cough also noted on exercise.
Chest auscultation – faint basal wheeze, PEFR 230 L/min
Ears, nose and throat normal

Assessment:
Probable asthma

Plan:
Trial inhaled sulbutamol- Ventolin puffer 2 puffs t.d.s
Keep record of morning and evening PEFR readings
Review 3 wks

11/01/10

Examination:
Review symptoms slightly improved: exercise tolerance better
Less nocturnal disturbance
Chest auscultation – no wheeze heard
PEFR 280 L/min

Assessment:
Improved but asthma still slightly unstable

Plan:
Commence inhaled corticosteroid- Becotide 200 2 puffs t.d.s
Continue Ventolin as required
Continue PEFR monitoring
Review 4 wks
8/02/10

Examination:
Much improved; minimal nocturnal & exercise induced symptoms
Chest auscultation- clear, PEFR 340 L/min

Assessment:
Well controlled asthma

Plan:
Maintain on current therapy
Review 2 mths

10/04/10

Examination:
Worsening shortness of breath & wheezing over last 48 hrs w.
runny nose, fever, loss of appetite
Red throat. ears normal
Obvious difficulty in breathing with use of accessory muscles
Chest auscultation – widespread wheeze, no focal signs
PEFR 140 L/min
Ears, nose and throat normal

Assessment:
Severe asthma triggered by viral respiratory infection.

Plan:
Ventolin nebuliser statim- minimal relief
Urgent assessment at hospital
 Let's start our case note

Address

1.Doctor's name Dr B Townsend at the

2.Speciality Not Given
3.Name of the Hospital & address Emergency Department
Newtown Children’s Hospital.

4.Today's Date 10/04/10

5.Dear (Doctor’s last Nm) Dear Dr Townsend,
6.Re: Pt name D.O.B/Age Re: Emma Johnson

In letter, we will write,

Dr B Townsend
Emergency Department
Newtown Children’s Hospital

10/04/2010

Dear Dr Townsend,

Re: Emma Johnson

 Introduction
You will select following particular from case note to arrange your
introduction part-

1. Patient's last name

2. Patient age( if not given u can calculate it from D.O.B)/ you can also avoid this.
3. Profession
4. Final assessment/diagnosis/ cause of referral
5. Any specific request

In this case note-

1.Patient’s first name Emma

2.Patient's age 11 years

3.Profession Not applicable

4.Final assessment/ diagnosis/ cause of Severe asthma triggered by viral

referral respiratory infection.

5.Specific request No Request

In letter we will write-

Thank you for seeing (Patient Name), a/an Age-year-old (Profession), whose clinical features
are consistent with/ who has been diagnosed with (diagnosis) (for urgent hospital admission.
Your (further/urgent) assessment and (acute) management would be highly appreciated.

For this case-

Thank you for seeing Emma, an 11-year-old girl, whose clinical features are consistent with
severe asthma due to upper respiratory viral infection. Your urgent assessment and
management would be highly appreciated.
 Today’s visit

You will select following particular from case note to arrange your
Body Part 1 -
1. Complaints & Symptoms
2. Examination finding
3. Treatment -Prescription/advice/investigation/review schedule

Complaints & Symptoms 1. worsening shortness of breath

2. wheezing over last 48 hrs
3. runny nose, fever
4. loss of appetite

Examination finding 1. Red throat. ears normal

2. Obvious difficulty in breathing with
use of accessory muscles
3. Chest auscultation – widespread
wheeze, no focal signs
4. PEFR 140 L/min
5. Ears, nose and throat normal
Treatment & Plan Ventolin nebuliser statim- minimal relief
Urgent assessment

In this letter-

Today, Emma visited with worsening of shortness of breath, generalized wheeze, runny nose and
fever over the last 48 hours. On examination, use of accessory muscles for breathing and widespread
wheeze were noted. In addition, her PEFR reduced to 140 L/mint. Nebulisation with Ventolin showed
minimal relief.
 Initial relevant visit

You will select following particular from case note to arrange your
Body Part 1 -
1. Complaints & Symptoms
2. Examination finding
3. Treatment -Prescription/advice/investigation/review schedule

Complaints & Symptoms 1. Nocturnal cough last 2 wks associated

with runny nose and mild fever (Flu )

Examination finding 1. Slightly flushed, temp 37.80C

Red pharynx
2. Peak expiratory flow rate (PEFR)- 250
L/min

Assessment/ Diagnosis Viral upper respiratory infection

Possible associated asthma

Treatment & Plan Paracetamol, fluids for infection

Review if worsens

In this letter-
Initially on 30/11/2009, Emma presented with flu like symptoms and nocturnal cough for two weeks. On
examination, PEFR was 250 L/mint.
 Subsequent visits
You will select following particular from case note to arrange your
Body Part 3-
1. Condition(improve/deterioration/ new symptom)
2. Examination finding
3. Investigation results
Further changing any medication/ add any advice/recommendation

Significant Change 21/12:

persistent nocturnal cough, Runny nose and fever,
now completely resolved. Cough also noted on
exercise. Chest auscultation – faint basal wheeze,
PEFR 230 L/min
11/01
Review symptoms slightly improved: exercise
tolerance better
Less nocturnal disturbance
Chest auscultation – no wheeze heard
PEFR 280 L/min
08/02
Much improved; minimal nocturnal & exercise induced
symptoms
Chest auscultation- clear, PEFR 340 L/min
Assessment/ Diagnosis 21/12
Probable asthma
11/01
Improved but asthma still slightly unstable
08/02
Well controlled asthma

Treatment & Plan 21/12

Trial inhaled sulbutamol- Ventolin puffer 2 puffs t.d.s
Keep record of morning and evening PEFR readings
Review 3 wks
11/01
Commence inhaled corticosteroid- Becotide 200 2
puffs t.d.s
Continue Ventolin as required
Continue PEFR monitoring
Review 4 wks
08/02
Maintain on current therapy
Review 2 mths
In this letter:
On her next visit, she reported persistent nocturnal and exercise induced cough. At that time, her
PEFR dropped to 230L/mint and faint basal wheeze was found on chest auscultation. Consequently,
she was commenced on salbutamol inhaler with advice to keep record of PEFR. Following two
subsequent visits, her asthma had improved with corticosteroid inhaler as well as PEFR value was
increased to 340L/min. Therefore, she was advised to continue treatment.
 Body Part 4

You will select following particular from case note to arrange your
introduction part-

1. Personal history (maritalstatus/smoker/alcoholic/profession)

2. Medical history
3. Medication history
4. Family history
5. Allergy history

In this case note-

1. Personal history 1. Marital history: Nil

2. Smoking/Alcohol History: Nil

3. Profession: not given

2.Medical history Not given

3. Medication History Not given

4. Family History mother and older sister aged 15

5. Allergy history none known

In this letter-
Her family history is significant for asthma related to her mother and elder sister.
 Conclusion

You will select following particular from case note to arrange your
Conclusion-
1. I believe X is/has been suffering from Y disease/ Mr X has been diagnosed with Y
disease
2. Your further assessment..... include any specific request
3. Should there be any queries, please do not hesitate to contact me.

In this letter-
Emma has been diagnosed with severe asthma due to upper respiratory viral infection. I would be
grateful if you could evaluate her urgently.( or She requires your urgent assistance regarding
management of her condition).

Should there be any queries, please do not hesitate to contact me.

Closing

Yours sincerely,
Doctor
 Complete letter of this case note

Dr B Townsend
Emergency Department
Newtown Children’s Hospital

10/04/2010

Dear Dr Townsend,
Re: Emma Johnson

Thank you for seeing Emma, an 11-year-old girl, whose clinical features are consistent with
severe asthma due to upper respiratory viral infection. Your urgent assessment and
management would be highly appreciated.

Today, Emma visited with worsening of shortness of breath, generalized wheeze, runny nose and
fever over the last 48 hours. On examination, use of accessory muscles for breathing and widespread
wheeze were noted. In addition, her PEFR reduced to 140 L/mint. Nebulisation with Ventolin showed
minimal relief.

Initially on 30/11/2009, Emma presented with flu like symptoms and nocturnal cough for two weeks.
On examination, PEFR was 250 L/mint. On her next visit, she reported persistent nocturnal and
exercise induced cough. At that time, her PEFR dropped to 230L/mint and faint basal wheeze was
found on chest auscultation. Consequently, she was commenced on salbutamol inhaler with advice to
keep record of PEFR. Following two subsequent visits, her asthma had improved with corticosteroid
inhaler as well as PEFR value was increased to 340L/min. Therefore, she was advised to continue
treatment. Please note, her family history is significant for asthma related to her mother and elder
sister.

Emma has been diagnosed with severe asthma due to upper respiratory viral infection. She requires
your urgent assistance regarding management of her condition.

Should there be any queries, please do not hesitate to contact me.

Yours sincerely,
Doctor