NURSAMPLE05

WRITING SUB-TEST – TEST BOOKLET

INSTRUCTIONS TO CANDIDATES
You must write your answer for the Writing sub-test in the Writing Answer Booklet.

You must NOT remove OET material from the test room.

[Link]
© Cambridge Boxhill Language Assessment – ABN 51 988 559 414
Occupational English Test

WRITING SUB-TEST: NURSING

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

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

Notes:

Assume that today’s date is 15 May 2021. You are a nurse in Oldtown Hospital, responsible for the care of an
elderly patient who was admitted after a fall. He is now ready to be discharged.

PATIENT DETAILS:
Name: George Gale (Mr)
DOB: 24 Apr 1936, 85 y.o.
Address: 14 Long Street, Oldtown

Social background:
Retired retail manager
Widower (wife died 2019)
Son, 47 y.o., works abroad
No family close by
Living alone in own flat, level 2, no lift
Socialises w. neighbours
Independent, cooks, daily walks to shops
Social drinker, smoker – 10 cigs/day

Medical history: 2003: Osteoarthritis diag.

2009: Hypertension diag.
2013: GORD (gastro-oesophageal reflux disease) – self treated with antacid tablets
2019: Non-specific colitis – ongoing monitoring, no treatment required

Medications: Paracetamol 500mg 2 tablets 4x/day (osteoarthritis)

Felodipine 5mg 1x/day (hypertension)

Presenting complaint:
Disorientation & fever (following fall)
Hospital admission:
10 May 2021:

Subjective: Pt reports fall 09 May – while brushing teeth, felt weak, ‘legs gave way’, fell backwards w.
headstrike, approx. 5hrs lying on floor
Neighbours heard call for help around 0300 10 May, called ambulance

2 wks before fall: single episode of vomiting, palpitations, dysuria

Objective: Confusion, disorientation

Temp: 38.1°C (high), BP: 155/80 (elevated), Pulse: 86 bpm (normal), RR: 26/min (elevated)
Urinalysis: ≥ 100,000 cfu/ml (high), 2 wbc/hpf

Diagnosis: Urinary tract infection (UTI) – ?cause of fall

Treatment Record:

10 - 14 May 2021:
IV antibiotics: amoxicillin 1 x 750mg/8 hrs & Pt’s regular meds continued
Observations: nil dizziness, nil palpitations
Temp: 37.2°C (normal), BP: 130/80 (normal), Pulse: 86 bpm (normal), RR: 20/min (normal)

15 May 2021: Ready for discharge to nursing home for temporary care
Concerns:
• Pt lives alone, no home help
• Keen to return to own home ASAP
• Significantly lowered mobility 30 min/day of physical activity to be encouraged
• Still episodes of confusion assessment for independent living recommended

Plan: Write to head nurse at nursing home re further care required

Writing Task:
Using the information given in the case notes, write a letter of discharge to Ms Gold, the Head Nurse at Primrose
Nursing Home. In your letter briefly outline Mr Gale’s history as well as your concerns and recommendations.
Address the letter to Ms Jane Gold, Head Nurse, Primrose Nursing Home, 3 Blackwood Street, Oldtown.
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.
 NURSAMPLE05
Occupational English Test

WRITING SUB-TEST: NURSING

SAMPLE RESPONSE: LETTER OF DISCHARGE

Ms Jane Gold
Head Nurse
Primrose Nursing Home
3 Blackwood Street
Oldtown

15 May 2021

Dear Ms Gold

Re: Mr George Gale

DOB: 24 Apr 1936

Thank you for taking over Mr George Gale’s post-fall care. I am writing to provide a brief summary of his background
and plan for temporary residential care upon discharge.

Mr Gale, an 85-year-old widower, lives alone in his own flat. On 9 May, he had a fall at home and hit his head. It was
not till several hours later that his neighbours heard his cry for help and called the ambulance. Mr Gale later said that
he had suddenly felt very weak before he collapsed. He reported a single episode of vomiting, palpitations and dysuria
two weeks prior to this incident. Mr Gale was admitted to Oldtown Hospital with a fever and disorientation: symptoms
later attributed to a febrile urinary tract infection.

Mr Gale has hypertension and osteoarthritis, for which he takes felodipine and paracetamol. He also requires
regular monitoring for his non-specifi c colitis.

Mr Gale now has reduced mobility, therefore he needs to be encouraged to do 30 minutes of daily physical activity to
regain his strength. Despite his UTI being successfully treated with IV antibiotics, he still has episodes of confusion.
Although he is keen to return to his own home, an assessment for independent living is strongly recommended prior to
discharge from your facility.

Your assistance would be greatly appreciated.

Yours sincerely

Nurse
 NURSAMPLE03

WRITING SUB-TEST – TEST BOOKLET

INSTRUCTIONS TO CANDIDATES
You must write your answer for the Writing sub-test in the Writing Answer Booklet.

You must NOT remove OET material from the test room.

[Link]
© Cambridge Boxhill Language Assessment – ABN 51 988 559 414 (2020)
Occupational English Test

WRITING SUB-TEST: NURSING

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

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

Notes:

You are a nurse at a boarding school. Jake Peterson is a male student at your school and has come to you
complaining of hair loss and associated depression.

PATIENT DETAILS:
Name: Jake Peterson
DOB: 17.03.2001 (18 y.o.)
Address: School: Holly House School, Brenkridge

Social background:
Student at boarding school for past 8 yrs
Parents work & live abroad
Father (male-pattern baldness – onset in 50s)
Mother (depression – onset in 40s)
Non-smoker; 20 units alcohol/wk
Karate black belt; champion swimmer

Presenting complaint:
Alopecia – hair loss from 13 y.o.; intermittent cycles (loss and regrowth); aetiology not confirmed –
various possibilities
?Depression

TREATMENT SUMMARY:

Mar 2014 School clinic – presented with hair loss in patches; anxiety
?onset – school bullying incident, Pt said ‘not a major thing’
Referral to trichology specialist

May 2014 Trichologist: no aetiology established; possibly exacerbated by stress

Prescribed steroid cream (betamethasone dipropionate 0.05% cream 1-2x/day for
3mths)
Personality changes, aggression + sleep loss
Medication discontinued

2014 - 2018 No further hair loss; intermittent hair regrowth

Dec 2018 Return of anxiety and pronounced hair loss
General health check – Ô6kg over last 2mths
Recommended to see Dr re hair loss, anxiety, weight loss. Student reluctant, asked about
natural remedies, e.g. homeopathy. Discussion re efficacy, student still keen to try

Feb 2019 No results + cost implications of homeopathic treatment (kalium carbonicum and silicea)Ò
student Ódistress and low mood
Problems forming/maintaining peer relationships
Affecting sports participation

Mar 2019 Referred to school counsellor – did not attend

May 2019 Check-up: Ó alcohol consumption, min 28 units/wk

June - July 2019

Exam time – extreme anxiety (necessary to arrange separate exam room) – Óhair loss

30 Aug 2019 Student concerned about transition to university shortly and independent living
Letter to university medical practice:
• monitor
• organise special exam arrangements

Writing Task:

Using the information given in the case notes, write a letter to Mrs Kullan, a university practice nurse. In your letter,
briefly outline Jake Peterson’s history and your concerns. Address your letter to Monica Kullan, Senior Nurse
Practitioner, University of Marchbank Health Centre, Hillsdunne Rd, Marchbank.
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.
 NURSAMPLE03
Occupational English Test

WRITING SUB-TEST: NURSING

SAMPLE RESPONSE: LETTER

Monica Kullan
Senior Nurse Practitioner
University of Marchbank Health Centre
Hillsdunne Rd
Marchbank

30.08.19

Dear Mrs Kullan

Re: Jake Peterson

DOB: 17.03.2001

I am writing to introduce Mr Jake Peterson, an 18-year-old student at this school who is about to start studying at
Marchbank University. Jake presents with hair loss and associated depression and anxiety.

Jake first presented with hair loss when he was 13. He was referred to a trichology specialist who was unable
to determine a specific aetiology. He was prescribed steroid cream but after experiencing personality changes,
aggression and sleep loss, he was taken off the medication. His condition then stabilised for approximately 4 years,
with no further hair loss and some regrowth. In the last year, hair loss has returned, and over two months, Jake’s
weight has reduced by 6kg. He started taking homeopathic remedies (kalium carbonicum and silicea), but became
upset when there was no improvement. He was referred to a counsellor but failed to attend the appointment.

Over the recent school exam period, Jake suffered extreme anxiety, and a worsening of his hair loss. His alcohol
consumption has increased to 28 units per week.

Jake is anxious about his transition to university and about living independently. I would greatly appreciate it if you
could monitor his condition and ensure special exam arrangements are made.

Yours sincerely

Nurse
 NURSAMPLE01

WRITING SUB-TEST – TEST BOOKLET

INSTRUCTIONS TO CANDIDATES
You must write your answer for the Writing sub-test in the Writing Answer Booklet.

You must NOT remove OET material from the test room.

[Link]
© Cambridge Boxhill Language Assessment – ABN 51 988 559 414 (2019)
Occupational English Test

WRITING SUB-TEST: NURSING

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

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

Notes:
Assume that today's date is 10 February 2019

Mr Lionel Ramamurthy, a 63-year-old, is a patient in the medical ward of which you are Charge Nurse.

Hospital: Newtown Public Hospital, 41 Main Street, Newtown

PATIENT DETAILS:

Name: Lionel Ramamurthy (Mr)

Marital status: Widowed – spouse dec. 6 mths

Residence: Community Retirement Home, Newtown

Next of kin: Jake, engineer (37, married, 3 children <10)
Sean, teacher (30, married, working overseas, 1 infant)

Admission date: 04 Feb 2019

Discharge date: 11 Feb 2019

Diagnosis: Pneumonia

Past medical history:

Osteoarthritis (mainly fingers) – Voltaren (diclofenac)
Eyesight Ô due to cataracts removed 16 mths ago – needs check-up

Social background:
Retired school teacher (history, maths). Financially independent. Lonely since wife died.
Weight loss approx. 4 kg in 6 months – associated with poor diet.

Medical history: 2007: Type 2 diabetes diagnosed (controlled by diet)

04 Mar 2018 Chronic obstructive pulmonary disease (COPD) diagnosed

Medical background:
Admitted with pneumonia – acute shortness of breath (SOB), inspiratory and expiratory wheezing,
persistent cough ( Ò chest & abdominal pain), fever, rigors, sleeplessness, generalised ache. On
admission – mobilising with pick-up frame, assist with ADLs

(e.g., showering, dressing, etc.), very weak, ambulating only short distances with increasing
shortness of breath on exertion (SOBOE).

Medical progress:
Afebrile.
Inflammatory markers back to normal.
Slow but independent walk & shower/toilet.
Dry cough, some chest & abdom. pain.
Weight gain (1.5kg) post r/v by dietitian.
Nursing management:
Encourage oral fluids, proper nutrition.
Ambulant as per physio r/v.
Encourage chest physio (deep breathing & coughing exercises).
Sitting preferred to lying down to ensure postural drainage.

Assessment: Good progress overall

Discharge plan: Paracetamol if necessary for chest/abdom. pain.

Keep warm.
Good nutrition – Ó fluids, eggs, fruit, veg (needs help monitoring diet).

Writing Task:

Using the information given in the case notes, write a discharge letter to Ms Georgine Ponsford, Resident
Community Nurse at the Community Retirement Home, 103 Light Street, Newtown. This letter will accompany Mr
Ramamurthy back to the retirement home upon his discharge tomorrow.
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.
 NURSAMPLE01
Occupational English Test

WRITING SUB-TEST: NURSING

SAMPLE RESPONSE: LETTER OF DISCHARGE

Ms Georgine Ponsford
Resident Community Nurse
Community Retirement Home
103 Light Street
Newtown

10 February 2019

Dear Ms Ponsford,
Re: Lionel Ramamurthy, aged 63

Mr Lionel Ramamurthy was admitted on 4 February 2019 having contracted pneumonia. He is now ready
for discharge back into your care tomorrow.

On admission, he was experiencing fevers and rigors. He suffered dyspnoea, wheezing and sleeplessness. He had
chest and abdominal pain due to prolonged persistent coughing.

After a week in hospital, he has stabilised and his breathing problems are now resolved. However, he still experiences
some chest and abdominal pain, with a dry cough. His nursing management in hospital initially consisted of a walking
frame and assistance with showering and dressing. Mr Ramamurthy is now more independent. He is also able to walk
about slowly without assistance, and shower and use the toilet independently.

Paracetamol may be administered as needed if chest and abdominal pain persists and Mr Ramamurthy should be
kept warm. Please encourage oral fluids, and ensure that he sits up, rather than lies down, whenever possible to
ensure postural drainage. He should ambulate regularly, and continue with deep breathing and coughing exercises.

Mr Ramamurthy was very weak on admission to hospital, but has gained weight with dietitian input. He will
need ongoing monitoring of his diet.
If you have any queries, please contact me.

Yours sincerely,

Charge Nurse
 NURSAMPLE04

WRITING SUB-TEST – TEST BOOKLET

INSTRUCTIONS TO CANDIDATES
You must write your answer for the Writing sub-test in the Writing Answer Booklet.

You must NOT remove OET material from the test room.

[Link]
© Cambridge Boxhill Language Assessment – ABN 51 988 559 414 (2020)
Occupational English Test

WRITING SUB-TEST: NURSING

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

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

Notes:

You are a nurse conducting a Nurse Home Visit as part of routine follow-up care after this patient’s recent
hospital discharge.

PATIENT DETAILS:
Name: Ms Patricia Styles
DOB: 27.04.1957 (Age 62)
Address: 57 Market Drive, Newtown

Social background:
Retired primary school teacher
Lives on her own
Husband died 3 yrs ago (lung cancer); no children

Medical history: Hypertension (HT)

• Diagnosed 2011 – mild 145/95
• 2013 – moderate 168/105, commenced quinapril
• Regular monitoring, currently well managed at around 140/90

Diabetes mellitus (DM) Type 2

• Diagnosed 2013 – Pt counselled re diet/lifestyle, incl. weight loss
• 2014 – commenced oral hypoglycaemics (metformin + gliclazide)
• Well managed generally

Depression
• Diagnosed June 2016
• Triggered by death of husband
• Regular counselling since July 2016 to control mood swings and support DM management

Family medical history:

Mother – HT, DM

Lifestyle: Smoking/Alcohol: Non-smoker; 1-2 glasses wine/wk

Exercise: Walks dog 20mins/day
Diet: Ongoing counselling re DM management to maintain balanced diet

Medications: Quinapril (Accupril) oral 40mg/2xday

Metformin (Diabex) oral 500mg/2xday
Gliclazide (APO-Gliclazide MR) oral 30mg daily
Green Valley Hospital Treatment Record:
23/08/2019 Pt visiting sister for weekend, sister lives 3hrs away from Newtown in Green Valley
Pt admitted to Green Valley Hospital late evening with fever, sharp & pleuritic chest pain (worse
on breathing), general weakness & malaise, tachycardia (rapid heartbeat)
24/08/2019
Assessment: Vital signs RR 29; BP 170/106; HR 98; T 39.3ºC
Full blood examination (FBE): Ó ESR (erythrocyte sedimentation rate), Ó CRP (C-reactive
protein), Ó WCC (white cell count) i.e. inflammation/stress
Throat swab: viral influenza type B
Chest X-ray (CXR) – normal
Echocardiogram – pericarditis

Management: IV saline
Ibuprofen 600mg every 8hrs

Evaluation: Viral influenza type B plus pericarditis

25/08/2019 Pt discharged and advised on self-care at home

Niece drove Pt home & agreed to stay overnight for 3 nights
Follow-up Nurse Home Visit arranged for 30/08/2019

Nurse Home Visit – 30/08/2019:

Observations: Pt unhappy. Reports feeling chest pain (relieved by sitting up), shortness of breath (SOB),
fatigue. Frustrated with progress of recovery
Medication adherence – reports compliance & regular blood glucose monitoring
Vital signs: low-grade fever: T 38.1°C. Elevated RR 28 & HR 115
BP: 125/78 (usual BP 140/90)
Niece no longer staying overnight – work commitments in Green Valley

Assessment: Pt unwell. Nil improvement

?relapse/complications of pericarditis

Plan: Organise urgent hospital transfer to Newtown Hospital (nearest hospital)

Write referral to Emergency Department, include relevant:
• Medications
• Patient history
• Test results/observations

Writing Task:
Using the information in the case notes, write a letter of referral to the Emergency Department Consultant
on Duty, outlining the case and requesting urgent assessment and management for pericarditis. Address
the letter to Emergency Department Consultant on Duty, Newtown Hospital, 100 Main Street, Newtown.
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.
 NURSAMPLE04
Occupational English Test

WRITING SUB-TEST: NURSING

SAMPLE RESPONSE: LETTER OF REFERRAL

Emergency Department Consultant on Duty

Newtown Hospital
100 Main Street
Newtown

30 August 2019

Dear Doctor

Re: Ms Patricia Styles

DOB 27.04.1957

Thank you for seeing Ms Styles, a 62-year-old widow and retired school teacher, who requires your urgent
investigation of a possible relapse of pericarditis.

Today, Ms Styles reports chest pain, relieved by sitting up, shortness of breath and fatigue. She has a low-grade fever
(38.1°C), tachypnea (28bpm) and tachycardia (115bpm). Her blood pressure is 125/78, lower than her usual 140/90.

Ms Styles became unwell on 23 August while visiting her sister in Green Valley. She was admitted to Green Valley
Hospital with fever, pleuritic chest pain, tachycardia and general malaise. Throat swab investigations confirmed
viral influenza type B and an echocardiogram indicated pericarditis. Her chest X-ray was normal and Ms Styles was
managed with IV saline and ibuprofen. She was discharged home on 25 August. A Nurse Home Visit was arranged for
today.

Ms Styles has hypertension, diabetes type 2 and depression, managed with quinapril (Accupril) 40mg twice daily,
metformin (Diabex) 500mg twice a day, and gliclazide (APO-Gliclazide MR) 30mg daily.

I suspect a relapse of pericarditis, perhaps with complications. I refer her to you for urgent assessment and
management.

Yours faithfully

Nurse
 NURSAMPLE02

WRITING SUB-TEST – TEST BOOKLET

INSTRUCTIONS TO CANDIDATES
You must write your answer for the Writing sub-test in the Writing Answer Booklet.

You must NOT remove OET material from the test room.

[Link]
© Cambridge Boxhill Language Assessment – ABN 51 988 559 414 (2019)
Occupational English Test

WRITING SUB-TEST: NURSING

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

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

Notes:
Assume that today's date is 22 January 2019
You are the nurse in a Community Health Centre. A patient you have been monitoring is moving to another city to live
with his daughter.

PATIENT DETAILS:
Name: Mr Peter Dunbar
DOB: 18 Mar 1932

Current medication:
Metformin 500mg t.d.s (oral hypoglycaemic)
Ramipril 5mg daily (anti-hypertensive, ACE inhibitor) – for hypertension
Warfarin variable 3-5mg (anti-coagulant)
Sotalol 40mg daily (beta blocker)

Treatment record:
Sep 2017 Diagnosed with type 2 diabetes August 2016. Fasting blood sugar levels (BSL) = 9
Doctor recommended dietary management: low-fat, low-sugar, calorie
restriction; limit alcohol. ÓExercise
Pt lives at home with wife. Wife cooks. Wife managing dietary requirements, but Pt likes 2-3
glasses wine with meals

Dec 2017 Wife deceased. Pt depressed/grieving. Referred back to doctor for monitoring/medicating
Fasting BSL = 9. Pt non-compliant with diet. Excessive fat, salt, sugar, alcohol (wine/beer)

Mar 2018 Doctor prescribed metformin (oral hypoglycaemic agent). Now Pt cooking for self –
non-compliant with diet. Non-compliant with medication. Blames poor memory
Pt appears unmotivated. Resents having to take medication: ‘always been healthy’
Takes medication intermittently; encouraged to take regularly
Educated regarding need for regular medication and potential adverse effects of intermittent dosing
Discussed strategies of memory aids

Jun 2018 Pt hospitalised (City Hospital, Newtown) with myocardial infarction (MI) following retrosternal pain,
nausea/vomiting, dizziness, sweating. Confirmed by ECG
Treatment: aspirin, streptokinase infusion. Prescribed ramipril 5mg daily. Diagnosed with atrial
fibrillation post MI – commenced sotalol and warfarin

Jun-Aug 2018 Pt attended twice weekly

Oct 2018 Pt now walking with a stick. Signs of diabetic neuropathy. Poor exercise tolerance. Restricted
mobility
Non-compliance with diet continues. Still self-catering. Discussed alternatives
e.g., community-based meal delivery service; moving in with adult children (son/daughter);
retirement village
Had respiratory infection 2 wks ago. Amoxicillin prescribed. Pt discontinued all other medication
as felt unwell. Resumed medications but still only taking intermittently
Again provided education re importance of adherence to drug regimen

22 Jan 2019 Pt attended with daughter. Pt moving to Centreville to live with daughter & her husband.
Daughter will cook – requires education re Pt needs & monitoring
Daughter advises that Pt resistant to dietary alterations and medication regimen.
Still misses or doubles dose – all medication. Refuses to reduce salt, sugar, alcohol, fatty food
Pt continues to require monitoring & encouragement
Letter to transfer the Pt to the care of the community health nurse in Centreville, where the Pt is
moving to live with his daughter

Writing Task:

Using the information given in the case notes, write a letter to the Community Health Nurse in Centreville,outlining
the patient’s history and requesting ongoing monitoring. Address the letter to the Community Health Nurse, Eastern
Community Health Centre, 456 East Street, Centreville.

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.
 NURSAMPLE02
Occupational English Test

WRITING SUB-TEST: NURSING

SAMPLE RESPONSE: LETTER OF TRANSFER

Community Health Nurse

Eastern Community Health Centre
456 East Street
Centreville

22 January 2019

Dear Nurse

Re: Mr Peter Dunbar

DOB 18.03.1932

Thank you for accepting Mr Dunbar into your care for the regular monitoring of his diabetes and encouragement to
comply with his medication and dietary regimens. Mr Dunbar is moving to Centreville to live with his daughter.

Since October 2018, Mr Dunbar has shown signs of diabetic neuropathy and consequently mobilises with a walking
stick. His type 2 diabetes is controlled by metformin and through his diet, however, he remains resistant to any form of
treatment, and has not been compliant with his medication regimen, reporting poor memory as the primary cause of
his neglect. On occasion he also double doses. Contrary to advice, Mr Dunbar has continued to consume excessive
amounts of alcohol, fatty foods, salt and sugar since the death of his wife last year, contributing to his current
condition. While his daughter will now be cooking for him, she will require some guidance related to his needs.

In June 2018, he suffered a myocardial infarction for which he was hospitalised at City Hospital in Newtown. He was
diagnosed with atrial fibrillation on the same admission and was subsequently prescribed warfarin and sotalol. His
hypertension is controlled by Ramipril. As with his other medication, Mr Dunbar is intermittent in his compliance.

Thank you for your continued management of this patient.

Yours faithfully,

Nurse
OCCUPATIONAL ENGLISH TEST
WRITING SUB-TEST: NURSING
TIME ALLOWED: READING TIME: 5 MINUTES
WRITING TIME: 40 MINUTES
Read the case notes and complete the writing task which follows.

Notes:

Mr Gerald Baker is a 79-year-old patient on the ward of a hospital in which you are Charge Nurse.

Patient Details:

Marital Status: Widower (8 years)

Admission Date: 3 September 2010 (City Hospital)

Discharge Date: 7 September 2010

Diagnosis: Left Total Hip Replacement (THR)

Ongoing high blood pressure

Social Background: Lives at Greywalls Nursing Home (GNH) (4 years)

No children

Employed as a radio engineer until retirement aged 65

Now aged-pensioner

Hobbies: chess, ham radio operator

Sister, Dawn Mason (66), visits regularly; v supportive

– plays chess with Mr Baker on her visits

No signs of dementia observed

Medical Background: 2008 – Osteoarthritis requiring total hip replacement surgery

1989 – Hypertension (ongoing management)

1985 – Colles fracture, ORIF

TURN OVER 2
Medications: Aspirin 100mg mane (recommenced post-operatively)

Ramipril 5mg mane

Panadeine Forte (co-codamol) 2 qid prn

Nursing Management and Progress:

daily dressings surgery incision site

Range of motion, stretching and strengthening exercises

Occupational therapy

Staples to be removed in two wks (21/9)

Also, follow-up FBE and UEC tests at City Hospital Clinic

Assessment: Good mobility post-operation

Weight-bearing with use of wheelie-walker; walks length of ward without difficulty

Post-operative disoriention re time and place during recovery, possibly relating to

anaesthetic – continued observation recommended

Dropped Hb post-operatively (to 72) requiring transfusion of 3 units packed red

blood cells; Hb stable (112) on discharge – ongoing monitoring required for anaemia

Discharge Plan: Monitor medications (Panadeine Forte)

Preserve skin integrity

Continue exercise program

Equipment required: wheelie-walker, wedge pillow, toilet raiser. Hospital to provide

walker and pillow. Hospital social worker organised 2-wk hire of raiser from local
medical supplier.

Writing task:

Using the information in the case notes, write a letter to Ms Samantha Bruin, Senior Nurse at Greywalls Nursing Home,
27 Station Road, Greywalls, who will be responsible for Mr Baker’s continued care at the Nursing Home.

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.

3
OCCUPATIONAL ENGLISH TEST
WRITING SUB-TEST: NURSING
SAMPLE RESPONSE: LETTER

Ms Samantha Bruin
Senior Nurse
Greywalls Nursing Home
27 Station Road
Greywalls

(Today’s date)

Re: Mr Gerald Baker, aged 79

Dear Ms Bruin

Mr Baker is being discharged from City Hospital back into your care today. He underwent a left total hip
replacement. He has good mobility and can walk along the ward using a wheelie-walker without difficulty.

Mr Baker was recommenced on 100mg Aspirin daily post-operatively. In addition to his usual treatment
for hypertension, he requires pain relief (Panadeine Forte, max 8 tablets/day) and daily dressing changes.
He is to undergo a series of range-of-motion, stretching and strengthening exercises, and occupational
therapy, to ensure a full recovery. We are sending a walker and wedge pillow with the patient. Our social
worker has organised hire of a toilet raiser for two weeks.

During post-operative recovery Mr Baker appeared disoriented. As there is no record of dementia, this
may relate to the anaesthetic; continued observation is nevertheless recommended. His sister may be
able to comment. Mr Baker’s haemoglobin dropped post-operatively. He was transfused three units of
packed red blood cells, without complication, and his Hb on discharge is stable (112). Please monitor for
signs of anaemia.

Mr Baker will have his staples removed at City Hospital Clinic on 21 September. Follow-up blood tests
(UEC, FBE) will also be conducted.

Please contact me with any queries.

Yours sincerely

Charge Nurse

1
 OCCUPATIONAL ENGLISH
TEST

WRITING SUB-TEST: N​ URSING

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

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

Notes​:

Mr Harley Chapman, an 82-year-old, is a patient in the medical-surgical unit of Barnsley

Hospital, 35 Barnsley, South Yorkshire, England where you are a registered nurse.

Patient Details:

Patient Name: Mr Harley Chapman

Next of kin: Barbara Chapman (76, spouse)

Admission date: 08 April 2018

Discharge date: 28 April 2018

Diagnosis : Right below knee amputation (BKA)

JE PROMETS Education Academy

Hotlines: +91 81570 33 666
Past medical history: Diabetes mellitus Type 2 since 2003
Hypertension
Peripheral vascular disease
Osteoarthritis
Age-related dementia
Moderate cognitive impairment

Social background : Retired postal worker

Little social interaction outside family for 6
months
Needs assistance with medication and
activities of daily living (ADL’s)

On admission : Infected right diabetic foot wound (diabetic

neuropathy).
Gangrene, pus, abscess.
Fever, chills.
Gram-positive cocci- Positive.

Medical progress : Given IV antibiotics

Vascular surgeon recommended BKA

Surgery performed without complication.

Changed to oral antibiotics and opiates for
pain.

Afebrile – wound is clean, dry, intact.

Requires assistance for ADLs

Nursing management: Change dressings daily.

Monitor surgical site for infection/drainage.
Check for fever/chills + other signs of infection.
Encourage oral fluids, nutrition.
Assist with ADLs and mobility.
Avoid decubitus ulcers.

Assessment : Good progress

pain under control
No signs of infection

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Hotlines: +91 81570 33 666
 Blood cultures negative.
Reduced mobility
Requires assistance for ADLs

Discharge plan : Discharge to Skilled Nursing Facility for acute

care and - physiotherapy.

Continue antibiotics and pain medication.

Will need to follow-up with vascular surgeon in
2 weeks.

Physiotherapy and occupational therapy after 4

weeks

Writing Task:

Using the information given in the case notes, write a transfer letter to the receiving
nurse at the skilled care facility, Broomgrove Nursing and Convalescent Home, 30
Broomgrove Road, Sheffield S10 2LR.

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.

JE PROMETS Education Academy

Hotlines: +91 81570 33 666
 OCCUPATIONAL ENGLISH
TEST

WRITING SUB-TEST: N​ URSING

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

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

Notes​:

You are a Charge Nurse at Wentworthville Diabetic Care.

Patient: Mr Paul Schroder

Age: 45 year

Marital Status: Unmarried

Social history: Live alone, separated from family and relatives,

less contact with friends and neighbours.
Chronic alcoholic and chain smoker.

Family history: Type 2 diabetes on his maternal side

JE PROMETS Education Academy

Hotlines: +91 81570 33 666
Admitted: 13-9-2018

Patient was presented with a six-month history

of fatigue and anxiety-type symptoms.

Discharge date: 13-09-2018

Diagnosis: Type 2 diabetes

Medical background: BP-110/70

Urinalysis- negative for glucose and ketones.
BMI- 32 kg/m2
HbA1c of 72 mmol/mol

Medications: ​Metformin 500 mg OD

Nursing Management And progress: Pt was given appropriate counselling about

blood sugar monitoring and hypoglycaemia

Discharge plan: Pt is ready to be discharged

Discharge medicines explained,
Advised to quit smoking and alcoholism
Refer to dietitian for dietary management

A review on 27-09-2018 for general

assessment.

Contact: Dr Keeling in case of emergency

JE PROMETS Education Academy

Hotlines: +91 81570 33 666
Writing Task:

Using the given information write a letter to Brenna Hessel, Dietitian, Care And Cure
hospital, 41 Campbelltown, New South Wales, for care and support at home. West End,
4101.

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.

JE PROMETS Education Academy

Hotlines: +91 81570 33 666
 Nursing • Irrigation with running cool tap water.
management • IV fluids.
OCCUPATIONAL ENGLISH TEST and progress: • High-flow Oxygen.
• Blood: FBC, type and crossmatch, carboxyhaemoglobin, serum
WRITING SUB-TEST: NURSING glucose, electrolytes. Arterial blood gases (normal range).
• Fiberoptic laryngoscopy – intubation deemed unnecessary. Type text here
• Chest X-ray
TIME ALLOWED: READING TIME: 5 MINUTES • Cardiac monitoring (normal ranges).
WRITING TIME: 40 MINUTES • Circulation monitoring to rule out hypovolaemic shock.
• BP (130/80).
Read the case notes below and complete the writing task which follows. • Pt closely monitored for development of stridor, hoarseness, coughing,
wheezing. (None present).
Notes: • Hourly monitoring urinary output - indwelling urinary catheter inserted.
• Elevation of the head and torso.
You are a ward nurse working in the burns unit of Berkeley General Hospital. A patient, Robert
Smithson, has been admitted to your unit from the Emergency Department, after being in a house Medications: Naproxen 500 mg 1 tab orally b.i.d.
fire. Tramadol HCL 50mg 1 tab orally b.i.d. p.r.n.
Gabapentin 300 mg by mouth daily before bed.
Patient: Robert Smithson Tetanus prophylaxis.

Marital status: Single Assessment (09.04.2018): Patient stabilised, breathing normally .

No infection.
Age: 22 Afebrile.
Bloods normal.
Address: 23 Main Street, Berkeley
Discharge plan: Wound cleansing and topical dressings (GP, community nurse, or Burns
Next of kin: Mary Smithson (mother), lives nearby, close Outpatients).
relationship with son. Daily auscultation by GP or community nurse.
Pt given instructions on how to:
Admission date: 06.04.2018 - apply high factor sunscreen when out.
- moisturise and massage area to reduce dryness. Type te
Discharge date: 10.04.2018 (pending consultant’s report). - do deep breathing exercises → lung expansion, drainage
secretions.
Diagnosis: Partial-thickness burns on 18% TBSA (neck and chest). Follow nutritious, light, high-protein diet, plenty of fluids.
Respiratory distress. Light activity, no contact sports.
Follow-up appointment 17.04.2018 (Burns Unit Outpatients).
Medical history: Infectious mononucleosis (16yo).
No current medications.
Tonsillectomy (age 8 yo).
Appendectomy (age 15 yo). Writing task:
Varicocele (age 19 yo) percutaneous embolization.
NIL allergies. Using the information given in the case notes, write a discharge letter to Robert Smithson’s GP, Dr
Martins, 29 Cowslip Avenue, Berkeley.
Medical background: Partial-thickness burns on neck and chest (18% TBSA).
Respiratory distress. Soot in oral cavity. In your answer:
• expand the relevant notes into complete sentences
Social background: Part-time medical student. • do not use note form
Lives alone. • use letter format
Enjoys swimming, amateur dramatics.
Active, eats a healthy diet. The body of the letter should be approximately 180-200 words.
OET NURSING: WRITING TASK-1

Occupational English Test

WRITING SUB-TEST: NURSING

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

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

Notes:

Mr David Lee is a 36-year-old patient on the medical ward of Southwest Hospital. You are the Charge Nurse.

PATIENT DETAILS:

Name: David Lee (Mr)

DOB: 25/01/1986

Marital status: Single

Admission date: 15 August 2022

Discharge date: 2 September 2022

Social background: Software engineer

Married to Lisa Lee
Two children (ages 6 and 4)
Lives in a suburban house

Diagnosis: Type 2 diabetes

Chief complaints: Frequent urination, increased thirst, blurred vision, fatigue, tingling sensation in hands and
feet.

Tests done: Oral glucose tolerance test (OGTT): Type 2 diabetes confirmed on this test. This test
measures the blood glucose level (FBG) after fasting for at least 8 hours and then 2 hours
after drinking a sugary drink (2hBG).
Result: FBG 9.6 mmol/L, 2hBG 15.4 mmol/L

Treatment given: Metformin 500 mg twice daily before meals.

Insulin glargine 10 units once daily at bedtime.
Dietary and lifestyle modifications.
Complications: An episode of low blood sugar (3.4 mmol/L) on 20th August 2022: Dizziness, sweating,
confusion, headache, hunger. Treated with glucose tablets and juice.

Medical history: High cholesterol (2017)

Obesity (BMI 32)
Smoker (10 cigarettes per day)

Family history: Type 2 diabetes (mother)

Progress: No more frequent urination and blurred vision.

Thirst and fatigue have reduced.
Tingling sensation in hands and feet still present.
Blood glucose levels have improved. At discharge: FBG 6.7 mmol/L, 2hBG of 8.4 mmol/L

Discharge Plan: Prescription and insulin to continue as prescribed.

Quit smoking.
See an endocrinologist for further diabetes management and assessment of any
complications he may develop from diabetes.

Writing Task:
Using the information given in the case notes, as a charge nurse of Southwest Hospital, write a referral letter to Dr
Scott F Moore, Endocrinologist of the Summer Breeze Hospital, 1204 Lakeside Drive, Queensland, Australia, for
further evaluation of Mr David Lee.

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.

OET NURSING: WRITING TASK-2

Read the case notes below and complete the writing task which follows:

Notes:

You are a charge nurse in a suburban clinic. Mrs Curran is a new patient in your clinic.

PATIENT DETAILS:

Name: Mrs Briana Curran

DOB: 15/03/1965 (age 58)

Social background: Single, lives alone

Works as a business analyst
Sedentary lifestyle, rarely exercises
Smokes occasionally, drinks moderately

Family history: Mother has Crohn’s disease

Father has hypertension

Medical background: Recurrent urinary tract infections

2019: diagnosed with irritable bowel syndrome (IBS)
Mild anxiety and insomnia

Medication: 2019: started antispasmodic (mebeverine)

2020: started low-dose antidepressant (amitriptyline)

01.07.23
Discussion: Abdominal cramps and bloating – worsened over past 6 months
Pt reports frequent episodes of diarrhoea and constipation
Pt also complains of mouth ulcers

Objective exam: Full exam performed: No positive findings

Wt: 58kg
Budesonide 9 mg/day for 8wks
Ordered stool test and CRP test
Review 3 wks

22.07.23 No improvement in abdominal symptoms

Pt’s main concern is now weight loss and constant fatigue
Wt ↓4kg since last appointment (now 54kg)
New symptoms: rectal bleeding, fever, night sweats
Abdomen tender and swollen on palpation
Bowel sounds increased
Pathology report: Stool test positive for occult blood and calprotectin
CRP 25 mg/L (high)

Discussion: Discussion of examination findings and stool results with Pt

Assessment: ?Crohn’s disease – patient aware of possibility

Plan: Urgent referral to gastroenterologist for assessment and colonoscopy

Writing Task:
Using the information given in the case notes, write a letter of referral to Dr Jones, a gastroenterologist at
Royal Oak Hospital, for assessment of Mrs Curran. Address the letter to Dr Laura Jones,
Gastroenterologist, Royal Oak Hospital, 123 Oak Street, London, SW1A 1AA, UK.
OET NURSING: WRITING TASK-3

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

Notes:

Imagine that today's date is 26 June 2023.

You are a Community Nurse who is the in charge of Ms Lilly Yarwood.

PATIENT DETAILS:

Name: Ms Lily Yarwood

Age: 74 years

Social background: Retired baker

Lives alone in a small cottage
Marital status: widow for 5 yrs
Relatives: son and daughter – live far away in different cities – visit once in a
month
Hobbies: Gardening, knitting, reading

Medical history: H/o hypertension (HTN) for 10 years, on ramipril 5mg daily.

Medical background: Fell in the garden when she was alone on 18 June 2023
Abrasion to right knee, knee is infected
Given antibiotic (flucloxacillin 500mg x4 days) for infected knee abrasion by
GP on 19 June
GP advised home visits for daily dressing and monitoring of infection

Home visits: 21 June 2023

Visited for daily dressing of right knee wound
Patient showed confusion and disorientation
Unable to recognise you and others (asked, Who are you? Where is my
husband?)
Wore night clothes in the mid afternoon
Taken ramipril and antibiotic on time according to pill box
 23 June 2023
Patient still showing confusion and forgetfulness
Room untidy and cluttered with newspapers and magazines
Medicines taken on time according to pill box
Discovered mild bedsores on sacrum and UTI for which she had been under
treatment earlier
Medicines administered for both (over-the-counter meds)
Neatly dressed the bedsores

Today (26 June 2023)

Showing increased confusion and agitation
Disoriented to time and place, but apparently understands who you are
Neighbours reported: Seen in street after you left
Showed unusual behaviour, signs of memory loss and poor judgement
Antibiotics ignored (6 tabs were found on the table when it was to be only 2)
Social detachment and mood swings
Room tidy
Mother had Alzheimer's disease (this information was found from patient's
diary dated 30 December 2001)

Assessment: (?) Dementia

Plan: GP to further investigate and make a definitive diagnosis.

Writing Task:
Using the information in the case notes, write a letter to Ms Yarwood's GP, Dr Jake Palemo, in
Brisbane, Australia 3001, reporting the above-mentioned conditions and requesting further
investigation and treatment. Enclose the list of the medicines administered for UTI and bedsores.
Notes:
Assume that today's date is 18 May 2022
You are a practitioner examining a 45-year old female patient, Ms Jamie
Joyce.

PATIENT DETAILS:

Name: Jamie Joyce (Ms)

DOB: 19 Sep 1977

Details:
Height: 163cm Weight: 75kg BMI: 28.2 (overweight 18/6/18)

Social History:
Teacher (Secondary – History, English)
Divorced, 2 children at home (born 2008, 2010)
Non-smoker (since children born)
Social drinker – mainly spirits

Substance Intake: Nil

Allergies: Codeine; dust mites; sulphur dioxide

Family history:
Mother – hypertension; asthmatic;
Father – peptic ulcer
Maternal grandmother – died heart attack, aged 80
Maternal grandfather – died asthma attack
Paternal grandmother – unknown
Paternal grandfather – died ‘old age’ 94

Previous medical history:

Childhood asthma; chickenpox; measles
1985 tonsillectomy
1992 hepatitis A (whole family infected)
1994 sebaceous cyst removed
1997 whiplash injury
2008 depression (separation from husband); SSRI – fluoxetine 11 mths
2010 overweight – sought weight reduction
2012 URTI (Upper Respiratory Tract Infection)
2014 dyspepsia
2016 dermatitis; prescribed oral & topical corticosteroids

18 May 2022
Presenting complaint: dysphagia (solids), onset 2 weeks ago post-viral (?)
URTI
URTI self-medicated with OTC (over-the-counter) Chinese herbal product -
contents unknown
No relapse/remittent course
No sensation of lump No obvious anxiety
Concomitant epigastric pain radiating to back, level T12 Weight loss: 1-2kg
Recent increase in coffee consumption
Takes aspirin occasionally (2-3 times/month); no other NSAIDs

Provisional diagnosis: gastro-oesophageal reflux +/- stricture

Plan:
Refer gastroenterologist for opinion and endoscopy if required
Ôcoffee/alcohol intake
Cease OTC product
Pantoprazole 40mg daily

Writing Task:
Using the information in the case notes, write a letter of referral for further
investigation and definitive diagnosis to the gastroenterologist, Dr Thor
Odinson, at Saragasso Hospital, 007 The One Street, Saragasso.

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.
OET Writing Case Notes Nursing:
Mr Ivan Thompson is a 35-year-old patient on the surgical ward of Greenville Hospital. You are the Charge Nurse.

PATIENT DETAILS
Name: Ivan Thompson
DOB: 1/8/1984
Marital Status: Married
Admission date: 8/6/2019
Discharge date: 10/6/2019
Social background:
IT worker
Travels a lot for work
Plays football
2 children
Lives in a 3 bedroom rented house
Drinks 2-4 units of alcohol, per week. Socially.
Medical Background:
2004 Colles fracture, ORIF
2001- Appendectomy
Smoker –smokes 5 cigarettes per day. More on weekends.
Reason for Admission:
Perianal abscess. Pt referred by GP. Painful swelling near anus. Pus collection (slightly yellow in colour, no offensive
odour). Pt discomfort. Area swollen.
VS on admission: Temp: 37.6, HR 88 bpm, Sats 98%, RR 22, BP 149/80
Treatment:
9/6/19 Incision and drainage (I & D) under general anaesthetic.
Allergies: NKDA
Medications:– Post- op, paracetamol 1g (QDS, PRN) and ibuprofen 200mg-400mg (TDS, PRN) post procedure. (Patient
advised to not use ibuprofen long term)
Metronidazole: 500mg every 8 hours for 7 days. Course to be completed at home (orally)
Nursing Management and Progress:
Daily dressings (to the right of the anus). Analgesia recommended to be taken before dressing changes first few days.
Currently 2cm in length and 1.5cm in width
Wound being cleaned with pron tosan, packed with kaltostat and tegaderm for sealing.
Assessment: Pt showing no signs of infection on discharge. All observations normal.
Bowels opened post-surgery, aid of stool softener
Discharge Plan:
Daily wound dressings as exudate ++.
Continue with dressing choice as you see fit (see above for current dressing choice)
Monitor for signs of infection
Encourage Pt to finish course of ABX
Refer back to hospital if any concerns with healing
If pt has a lot of pain when opening bowels we have advised to use stool softener and eat a fibre based diet
Pt has a follow up review at Surgical Outpatients Department, Greenville Hospital in 6 weeks.

Writing Task:
Using the information in the case notes, write a letter to the GP Nurse, Greystone General Practice, 57 Sand Lane,
Greystone asking for wound care and monitoring post-discharge.
Expand the relevant notes into complete sentences
Do not use note form
Use letter format
180-200 words
Case Notes

Vamuya Obeki was admitted through the Children’s Emergency Department for acute
meningoencephalitis as a result of complications following mumps.
Patient History:
Address: 75 Walden Road, Broadchurch
Phone: (+44) 070 4477 2674
Date of Birth: 21 May 2017
Gender: Male
Discharged: 12/06/22
Country of birth: Sudan
Diagnosis: Acute meningoencephalitis

Social History:
Parents: Miri & Abdullah Obeki, refugees, arrived in the UK in 2019.
Employment: Abdullah: Golden Circle pineapple factory, shift worker
Miri: Housewife
Accommodation: Recently moved to rental accommodation.
GP: No family doctor
Sibling: 2 year old brother, Saeed
Languages: Dinka, Arabic
Interpreter needs: Abdullah understands spoken English but has limited written skills.
Miri has limited understanding of English. Abdullah attends English classes.
Medical History:
Parents state that both children had some kind of vaccination at birth but records have
been lost since then. Parents unaware of vaccines for mumps.
Discharge plan:
Appears to have fully recovered from mumps and acute meningoencephalitis.
Will need advice regarding recommended vaccines for both children.
Will need a neurological check-up.
Prompt

Using the information in the case notes, write a letter to The Director, Community Child
Health Service, 71 Victoria Road, Broadchurch, requesting follow-up of this family.
In your answer:
 Expand the relevant case notes into complete sentences.
 Do not use note form.
 The body of the letter should not exceed 200 words.
 Use the correct letter format.
Read the case notes below and complete the writing task which follows.
Time allowed: 45 minutes
Mock 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.

Miss Maryam Hassan is a patient in your general practice who is concerned about poor
sleep.

PATIENT DETAILS:
Name: Miss Maryam Hassan
DOB: 27.05.89 (Age 29)
Address: 42 West Street, Easthampton
Social background:
Single, no children
Works in fashion design, sometimes has to work long hours
Family history:
Mother died aged 63 due to traffic accident
Father fit and well
Maternal Grandmother diabetes ?Type 2
Nil else significant
Medical history:
Nil significant
Appendicectomy aged 12 (in France)
Allergic to latex
Never smoked, nil alcohol
Goes to gym 3x per week
Current Drugs:
OTC vitamin D
No other prescribed, OTC, or recreational

Copyright © 2019 [Link]

27/02/19
Discussion:
Concerned re: poor sleeping. Requested sleeping tablet.
Poor sleep hygiene and recent stress at work discussed. Long time at computer in evenings
Occasional headaches and dry eyes after computer use
Slight weight loss (2kg over 2 months, puts down to recent gym membership)
No concerning features of headaches
O/E: Full physical exam: NAD
Weight 62kg, Height 174cm BMI 20.5
BP 125/82
RR 18, HR 85 bpm
Advised sleep hygiene, reduced screen time in evening, reduce caffeine. Advised
risks>benefits for sleeping tablet. For review in 2 weeks if not better. Advised OTC artificial
tears prn
13/03/19
Worsening sleeping pattern, despite improved sleep hygiene and cessation of caffeine. Has
noted occasional palpitations.
Dry eye sensation worsening, although some temporary relief with OTC drops,
O/E: eyes NAD
BP 132/89
RR18, HR 92 bpm (regular)
ECG today: NSR at 88 bpm
Pathology requested: Full profile, TSH. 24 hour ecg,
Review 2 weeks
18/03/19
Pathology report received: TSH 0.3 (low). FBC, U&E, creatinine within normal range. Pt
phoned to come in. 24 hour ECG results pending
20/03/19 Pathology report reviewed with Miss Hassan
Symptoms no better.
Advised possible diagnosis of hyperthyroidism and need for specialist referral

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Concerned around future fertility, wants to start a family in a few years, advised
will need to await investigations

Writing Task:
Using the information in the case notes, write a letter of referral to Dr Dalfo, an
endocrinologist at City Hospital, for additional investigations and management.

Address the letter to Dr Pilar Dalfo, Endocrinologist, City Hospital, Easthampton.

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

Copyright © 2019 [Link]