TIME ALLOWED: READING TIME: 5 MINUTES Task 1

WRITING TIME: 40 MINUTES

Read the case notes below and complete the writing task which follows.
notes:
Hospital: St. Mary’s Public Hospital, 32 Fredrick Street, Proudhurst
Patient Details: Ms Bethany Tailor
Next of Kin: Henry Tailor (father, 65) and Barbara Tailor (mother, 58)
Admission date: 01 March 2018
Discharge date: 18 March 2018
Diagnosis: Schizophrenia

50 MEDICAL WRITING TASK Past medical history:

Hypertension secondary to fibromuscular dysplasia

+ Sample Letters
Primary hypothyroidism Levothyroxine 88 mcg daily
Social background:
Unemployed, on disability allowance for schizophrenia.
History of polysubstance abuse, mainly cocaine and alcohol. Last used cocaine 28/02/18:

Admission 01/03/2018:
Patient self-admitted: decompensated schizophrenia

Medical background:
Not compliant with medications.
Admitted for auditory command hallucinations telling patient to harm self.
Visual hallucinations – shadow figures with grinning faces.
Delusion – personal connections to various political leaders.

01/03/2018 –
agitated and aggressive, responding to internal stimuli with thought blocking and latency.
Commenced antipsychotic meds (rispoderone).
10/03/2018: Dr. Giovanni DiCoccio
Patient ceased reporting auditory or visual- hallucinations.
Proudhurst Family Practice
Less disorganised thinking.
No signs of thought blocking or latency. 231 Brightfield Avenue
Able to minimise delusions and focus on activities of daily living. Proudhurst

Nursing management: 19/03/2018

Assess for objective signs of psychosis.
Redirect patient from delusions. Dear Dr. DiCoccio,
Ensure medical compliance.
Help maintain behavioral control, provide therapy if possible. Re: Bethany Tailor, 35 years of age

Assessment: Your patient, Ms Tailor, admitted herself on 1 March 2018 with decompensated schizophrenia. She
Good progress, chronic mental illness, can decompensate if not on medications or abusing is now ready for discharge and follow-up at your clinic.
substances. Insight good, judgment fair.
On admission, she was experiencing significant thought disorder, including thought blocking and
Discharge plan: latency. She was also exhibiting delusions and experiencing auditory command and visual
Discharge on Risperidone 4g nightly by mouth. hallucinations.
Risperidone 1 milligram available twice daily p.r.n for agitation or psychosis.
back to apartment with follow-up at Proudhurst Mental Health Clinic During her stay in hospital Ms Taylor was placed back on her medications, and her mental condition
has stabilised and she is able to focus on her activities of daily living. Her insight is now good and
Writing Task: judgment fair. Her nursing management in the hospital focused on compliance with her
Ms. Bethany Tailor is a 35-year-old patient in the psychiatric ward where you are working as a antipsychotic medications, behavioral control, and therapy. Since 10 March, she has not reported
doctor visual or auditory hallucinations.

Using the information given in the case notes, write a discharge letter to the patient’s primary care Ms Tailor is on oral Risperidone 4mg nightly. Additional oral risperidone 1mg can be administered as
physician, Dr. Giovanni DiCoccio, Proudhurst Family Practice, 231 Brightfield Avenue, Proudhurst needed twice daily for agitation or psychosis. She will be discharged from the hospital to her
apartment where she lives alone. She will follow-up with you in order to continue her treatment of
In your answer: chronic schizophrenia and to avoid non-compliance of her medications or substance abuse.
● Expand the relevant case notes into complete sentences If you have any queries, please contact me.
● Do not use note form
● Use correct letter format Yours sincerely,
Doctor
The body of your letter should be approximately 200 words. Use correct letter format.
[183 words]
TIME ALLOWED: READING TIME: 5 MINUTES Task 2 Nursing management:
WRITING TIME: 40 MINUTES Encourage oral fluids.
Patient may return to regular diet.
Read the case notes below and complete the writing task which follows.
Ambulation encouraged as per patient tolerance.
notes:
Hospital: Fairbanks Hospital, 1001 Noble St, Fairbanks, AK 99701 Medical progress
Afebrile. Hct, Hgb, Plts, WBC, BUN, Cr, Na, K, Cl, HCO3, Glu all within normal limits.
Name: Mrs Sally Fletcher
Patient sitting comfortably, alert, oriented × 4 (person, place, time, situation).
Date of Birth: 3/10/1993
Assessment:
Marital status: Married, 5 years
Good progress overall.
Appointment date: 25/03/2018
Discharge plan:
Diagnosis: Endometriosis Patient to be discharged when can eat, ambulate, urinate independently.
Past medical history: Patient must be discharged to someone who can drive them home.
Painful periods 3 years
Writing Task:
Wants children, trying 1 year ++
You are a first year resident in a surgical ward. Sally Fletcher is a 25-year-old woman who has
Social background: recently undergone surgery. You are now discharging her from hospital.
Accountant, regular western diet.
Exercises 3 x week local gym Using the information given to you in the case notes, write a letter of discharge to the patient’s
GP, Dr Stevens, Mill Street Surgery, Farnham,GU10 1HA.
Medical background:
Frequent acute menstrual pain localised to the lower left quadrant. In your answer:
Pain persists despite taking OTC = naproxen. ● Expand the relevant case notes into complete sentences
Shy discussing sexual history. ● Do not use note form
Occasional constipation, associated with pain in lower left quadrant.
● Use correct letter format
Trans-vaginal ultrasound showing 6cm cyst, likely of endometrial origin.
Patient recovering post op from laparoscopic surgery(25/03/2018) – nocomplications
The body of your letter should be approximately 200 words. Use correct letter format
Post op care: Keep incisions clean and dry.

Mobility post op:

Showering is permitted 26/03/2018
Driving is prohibited when on analgesics.
Driving can be resumed 24-48 hrs after final dose analgesics.
Sexual activity can be resumed 2 weeks post op.
Dr Stevens TIME ALLOWED: READING TIME: 5 MINUTES Task 3
Mill Street Surgery WRITING TIME: 40 MINUTES
Farnham
GU10 1HA Read the case notes below and complete the writing task which follows.
notes:
25 March 2018
Office: First Family Primary Care, 3959 Abalone Lane, Omaha
Dear Dr Stevens, Patient Details
Re: Mrs Sally Fletcher D.O.B 3/10/1993 Name: Tabitha Taborlin (Ms). Marital status: Single. Next of kin: Gregory Taborlin (69, father).
Your patient, Sally Fletcher, was admitted to the surgical ward of Fairbanks Memorial Hospital on 25 Date seen: 08 April, 2018
March 2018 for the purpose of laparoscopic surgery to treat an endometrial cyst. She is now ready Diagnosis: Type 1 diabetes mellitus
for discharge into the care of her husband.
Past medical history:
When admitted, Sally had been suffering from painful periods over the past 3 years, which she had
Essential hypertension
been attempting to treat with naproxen, but the pain persisted. An ultrasound scan revealed a cyst
Type 1 diabetes mellitus (non-compliant with insulin regimen)
had formed in her abdomen. She arrived at the ward this morning and underwent Multiple episodes of diabetic ketoacidosis (DKA)
laparoscopic surgery, which successfully located and removed a 6cm cyst from her abdomen without
complication. Social background:
School teacher, lives alone in apartment
She has been advised to keep the incision sites clean and dry. She has received narcotic pain
Does not exercise, BMI 18.2 (underweight - 48kg)
medication and has been advised that she is unable to drive while taking this medication. You should
Smokes moderately (2 cigs daily)
monitor her progress, and advise when to cease taking this medication. She may resume driving 24-
48 hours after the last dose is taken. Medical background:
Sally may resume her normal diet today, and is encouraged to drink plenty of fluids. She is also Long history of Type 1 diabetes (since 7 y.o.) and noncompliance with insulin regimen.
On 45 units Lantus nightly and preprandial correctional scale Humalog with 12 unit nutritional
encouraged to walk as much as she can tolerate.
baseline.
Sexual activity can resume in two weeks.
02/04/2018: admitted DKA (glucose 530 mmo/L) IV fluids and insulin administered.
If you have any questions please feel free to contact me. Discharge stable - HbA1c.
Appointment today:
Yours sincerely,
Doing well since discharge.
Doctor Still not using insulin. Has insulin available.
[194 words] Not following recommended diet.
Discussed diabetes education, necessity of glucose testing, insulin administration, smoking
cessation education.
Discussed microvascular/macrovascular complications of diabetes.
Plan:
Discharge today – provide educational pamphlets and refills for Lantus and Humalog. Dr. Sharon Farquad
Referral to endocrine specialist for stricter glycemic control and possible insulin pump. Endocrinologist
Follow-up in 1 month Endocrine Specialists and Associates
115 Burke St.
Writing Task: Omaha
You are a physician OR at a family medical practice. Ms Tabitha Taborlin is a 45-yearold patient at
your practice. 08/04/2018

Dear Dr. Farquad

Using the information given in the case notes, write a referral letter to Dr. Sharon Farquad,
Endocrinologist at Endocrine Specialists and Associates, 115 Burke St. Omaha. Re: Tabitha Taborlin, 45 years of age

In your answer: Thank you for seeing Ms Tablorin as a new patient at Endocrine Specialists and Associates. She is a
● Expand the relevant case notes into complete sentences 45 year old female with a past medical history of essential hypertension and uncontrolled Type 1
● Do not use note form diabetes mellitus.
● Use correct letter format
Ms Tablorin was seen at my clinic today as a follow-up from a hospital admission for diabetic
ketoacidosis with a glucose measure of 530 mmol/L. She has had multiple prior hospitalisations for
the same issue. She also has a long history of being noncompliant with her insulin medications,
The body of your letter should be approximately 200 words. Use correct letter format.
which are 45 units of Lantus nightly, and preprandial correction scale Humalog with 12 units of
nutritional baseline. Her HbA1c is 11.0%.

She has been educated multiple times on diabetes risks and complications, regarding her insulin
regimen, exercise, diet, and tobacco cessation. However, she has continued to ignore these
recommendations and her condition has progressively worsened. It is my recommendation that she
seek a higher level of care, thus I refer her to your practice. Ms Tablorin would likely benefit from a
stricter insulin regimen and glycemic monitoring, as well as an insulin pump for reliability of
medication administration.

If you have any queries, please contact me.

Yours sincerely,

Doctor
[183 words]
TIME ALLOWED: READING TIME: 5 MINUTES Task 4 25/8/10
WRITING TIME: 40 MINUTES Subjective
Read the case notes below and complete the writing task which follows. Had experienced intermittent attacks of pain and swelling of the L/K joint
notes: No fever
Today’s Date 07/11/10 Unable to complete all aspects of his work and as a result income reduced
Patient History Reduced smoking 15/day
Mr David Taylor, 38 years old, married, 3 children
Objective
Landscape Gardener Swelling +
Runs own business. No effusion
No personal injury insurance Tender on the inner-aspect of the L/K joint
Active, enjoys sports Flexion, extension – normal
Drinks 1-2 beers a day. More on weekends. Impaired range of power - passive & active
Smokes 20-30 cigarettes/day
Diagnosis ? Injury of medial cartilage
P.M.H-Left Inguinal Hernia Operation 2008 Investigation – ordered MRI

12/08/10 Management
Subjective Voltarin 50mg bid for 1 week
C/o left knee joint pain and swelling, difficulty in strengthening the leg. Review after 1 week with investigations
Has history of twisting L/K joint 6 months ago in a game of tennis.
At that time the joint was painful and swollen and responded to pain killers. 07/11/10
Finds injury is inhibiting his ability to work productively. Subjective
Worried as needs regular income to support family and home repayments. Limp still present
Patient anxious as has been unable to maintain full time work.
Objective Desperate to resolve the problem
Has limp, slightly swollen L/K joint, tender spot on medial aspect of the joint and no effusion. Weight increase of 5kg
Temperature- normal
BP 120/80 Objective
Pulse rate -78/min Pain decreased, swelling – no change
No new complications
Investigation - X ray knee joint MRI report – damaged medial cartilage
Management
Management Plan
Voltarin 50 mg bid for 1/52
Refer to an orthopaedic surgeon, Dr James Brown to remove damaged cartilage in order to prevent
Advise to reduce smoking
future osteoporosis. You have contacted Dr Brown’s receptionist and you have arranged an
Review if no improvement.
appointment for Mr Taylor at 8am on 21/11/10
 Dr. James Brown
1238 Gympie Rd
Writing Task: Chermside, 4352
You are the GP, Dr Peter Perfect. Write a referral letter to Orthopaedic Surgeon, Dr. James Brown:
1238 Gympie Road, Chermside, 4352. 07/11/10

In your answer: Dear Dr. Brown,

● Expand the relevant case notes into complete sentences
● Do not use note form Re: David Taylor
● Use correct letter format
Thank you for seeing this patient, a 38-year-old male who has a damaged cartilage in the left knee
joint. He is self-employed as a landscape gardener, and is married with 3 children.
The body of your letter should be approximately 200 words. Use correct letter format.
Mr. Taylor first presented on 12 August 2010 complaining of pain and swelling in the left knee joint
associated with difficulty in strengthening the joint. He initially twisted this joint in a game of tennis
6 months previously, experiencing pain and swelling which had responded to painkillers.
Examination revealed a slightly swollen joint and there was a tender spot in the medial aspect of the
joint. Voltarin 50mg twice daily was prescribed.

Despite this treatment, he developed intermittent pain and swelling of the joint. The x-ray showed
no evidence of osteoarthritis. However, the range and power including passive and active
movements was impaired. An MRI scan was therefore ordered and revealed a damaged medial
cartilage.

Today, the pain was mild but the swelling has not reduced. Mr Taylor is keen to resolve the issue as
it is affecting his ability to work and support his family.
In view of the above I believe he needs an arthroscopy to remove the damaged cartilage to prevent
osteoarthritis in the future.

Yours sincerely,

Doctor

[200 words]
 14/05/10
TIME ALLOWED: READING TIME: 5 MINUTES Task 5
WRITING TIME: 40 MINUTES Subjective
No pain, no new complaints
Read the case notes below and complete the writing task which follows.
Objective
notes: IVP-L/kidney-nl R/enlarged kidney which was ectopic. No evidence of stones
Assume Today's Date: 01/06/10 UFR-few red cells
Patient History Advised to drink more fluid especially in hot weather
Tom Cribb D.O.B: 23/5/82 Ordered ultrasound of abdomen to exclude any kidney pathology and review in 2 weeks
Unemployed – builder’s labourer recently made redundant because of lack of work
Married/no children 01/06/10
Wife works full time as shop assistant Subjective
No hobbies Had mild R sided lower abdominal pain 5 days ago, responded to Panadol
Smokes 5-6 cig/day, drinks 2-5u of alcohol per week Ultrasound-severe hydronephrosis? Mass attached to the liver, L/kidney, spleen, pancreases normal
Father has hypertension Rehired as builder’s labourer on new job due to start in two weeks -keen to get back to work.
Mother died at 60 due to breast cancer Objective
No known allergies BP: 140/90
PR: 98 regular
12/05/10
Ab-mass in R/lower abdominal area. RDE-felt a hard mass & kidney situated below normal site.
Subjective
Hydronephrosis +
Very severe pain in lower R abdomen for 3 hrs, radiated to groin, nausea, no vomiting
Plan
No red colour urine - frequency normal
Refer to a urologist for further investigation including CT scan and assessment.
No history of trauma, No fever
Anxious about finding new job ASAP – has to make regular home mortgage repayments
Writing Task:
Objective You are a General Practitioner at a Southport Clinic. Tom Cribb is your patient.
BP: 120/80 Using the information in the case notes, write a letter of referral to urologist for CT scan and
PR: 80 BPM assessment. Address the letter: Dr B Comber, Urologist, Southport Hospital, Gold Coast
Ab-mild tenderness in lower abdo, no guarding and rebound
In your answer:
Plan ● Expand the relevant case notes into complete sentences
Diagnosis? Ureteric colic due to renal stone ● Do not use note form
Diclofenac sodium 50mg suppository dose given and 50mg b.i.d. for 5 days ● Use correct letter format
Advised to drink moderate amount of fluid with regular exercise, especially walking for 2-3 days
Review after 2 days with IVP report, UFR report The body of your letter should be approximately 200 words. Use correct letter format.
 TIME ALLOWED: READING TIME: 5 MINUTES Task 6
Dr. B. Comber WRITING TIME: 40 MINUTES
Urologist
Southport Hospital Read the case notes below and complete the writing task which follows.
Gold Coast notes:
Today’s Date 10/02/10
June 1 2010
Patient History
Dear Doctor, Alison Martin , Female ,28 year old, teacher.
Patient in your clinic for 10 years
Re: Mr. Tom Cribb DOB: 23/05/1982 Has 2 children, 4 years old and 10 months old, both pregnancies and deliveries were normal.
Husband, 30 yr old, manager of a travel agency. Living with husband’s parents.
I am writing to refer Mr. Cribb, a married and unemployed male who has a renal mass. Has a F/H of schizophrenia, symptoms controlled by Risperidone
Smoking-nil
Mr. Cribb first came to see me on the 12/05/10 complaining of severe pain in the right lower
Alcohol- nil
abdomen which was radiating to the groin. It was not associated with urinary or gastrointestinal
symptoms, trauma or fever. His vital signs were normal and his lower abdomen was mildly tender. Use of recreational drugs – nil
He was prescribed diclofenac suppositories 50mg twice a day for 5 days. He was adviced to drink
fluids and walk regularly. The IVP report on the 14/05/10 showed an enlarged and ectopic right 09/01/10
kidney, no stones were reported and the UFR had a few red cells. With regard to his risk factors, he Subjective
is a smoker and drinks alcohol. His father has hypertension and his mother died from breast cancer. c/o poor health, tiredness, low grade temperature, unmotivated at work, not enjoying her work. No
stress, loss of appetite and weight.
On today’s consultation, he complained of right lower abdominal pain of 5 day duration which was
relieved by Panadol. His vital signs were normal and a mass was palpated in the right abdominal Objective
area. His right kidney was below the normal site. The ultrasound showed severe hydronephrosis and Appearance- nearly normal
a mass attached to the liver. He was advised to undergo further CT scan investigations. Mood – not depressed
BP- 120/80
I would appreciate your assessment to Mr. Cribb’s urologic problem.
Pulse- 80/min
Yours sincerely, Ab, CVS, RS, CNS- normal

Management
Doctor
[209 words] Advised to relax, start regular exercise, and maintain a temperature chart. If not happy follow up
visit required
 Probable diagnosis
20/01/10 Schizophrenia and associated disorders
Subjective
Previous symptoms – no change Management plan
Has poor concentration and attention to job activities, finding living with husband’s parents difficult. Refer to psychiatrist for assessment and further management.
Says her mother-in-law thinks she is lazy and is turning her husband against her. Too tired to do
much with her children, mother-in-law takes over. Feels anxiety, poor sleep, frequent headaches. Writing Task:
You are the GP, Dr Ivan Henjak. Write a referral letter to Psychiatrist, Dr. Peta Cassimatis: 1414
Objective Logan Rd, Mt Gravatt, 4222.
Mood- mildly depressed
Little eye contact In your answer:
Speech- normal ● Expand the relevant case notes into complete sentences
Physical examination normal ● Do not use note form
● Use correct letter format
Tentative diagnosis
Early depression or schizophrenia
The body of your letter should be approximately 200 words. Use correct letter format.
Management plan
Relaxation therapy, counselling
Need to talk to the husband at next visit
Prescribed Diazepam 10mg/nocte and paracetamol as required
Review in 2/52

10/02/10
Subjective
Accompanied by husband and he said that she tries to avoid eye contact with other people, reduced
speech output, impaired planning, some visual hallucinations and delusions for 5 days

Objective
Mood – depressed
Little eye contact
Speech – disorganised
Behaviour- bizarre
BP 120/80 , Pulse- 80
Ab, CVS, RS, CNS- normal
 TIME ALLOWED: READING TIME: 5 MINUTES Task 7
Dr. Peta Cassimatis WRITING TIME: 40 MINUTES
1414 Logan Rd
Mt Gravatt, 4222 Read the case notes below and complete the writing task which follows.

10/02/12 notes:
Dear Doctor, Today's Date 16.02.13
Patient History
Re: Alison Martin Miss Cathy Jones - 25 year old single woman
Occupation - receptionist
I am writing to refer Mrs. Martin, a 28-year-old married woman, who is presenting with symptoms Family history of deep vein thrombosis
suggestive of schizophrenia. On progesterone-only pill (POP) for contraception
No previous pregnancies
Mrs. Martin has been a patient at my clinic for the last 10 years and has a family history of
schizophrenia. She is a teacher with two children, aged 4 years and 10 months, and lives with her 15.02.13
husband’s parents. Subjective
Presents to GP surgery at 7 pm, after work
She first presented at my clinic on 9 January 2012 complaining of tiredness, a lack of motivation at Complains of lower abdominal pain since the evening before, worse in right iliac fossa
work and a low grade fever. On review after ten days, she did not show any improvement. She Unsure of last menstrual period, has had irregular bleeding since starting
displayed symptoms of paranoia and was suffering from poor sleep, anxiety and frequent POP 2 months ago, New partner for past 2 months
headaches. In addition, she was mildly depressed with little eye contact. Relaxation therapy and No bladder or bowel symptoms
counselling were started and Diazepam 10 mg at night was prescribed based on my provisional
diagnosis of early depression or schizophrenia. Objective
Mild right iliac fossa tenderness, no rebound / guarding
She presented today accompanied by her husband in a depressed state, showing little eye contact, Apyrexial, pulse 88, BP 110/70
bizarre behaviour and disorganised speech. Despite my management, her symptoms have continued Vaginal examination - quite tender in right fornix. No masses
to worsen with a 5-day history of reduced speech output, impaired planning ability as well as some Assessment
visual hallucinations and delusions. Non-specific abdo pain
Plan: Asks her to return in morning for blood test and reassessment
In view of the above, I would appreciate your attention to this patient.
16.02.13
Yours sincerely, Subjective
Pain has worsened overnight. Now severe constant pain.
Doctor Some slight vaginal bleeding overnight also.
Felt faint while waiting in reception.
On questioning, has left shoulder-tip pain also.
[204 words]
Objective Gynaecology Registrar
Very tender in the right iliac fossa, with guarding and rebound tenderness A&E Department
Apyrexial, Pulse 96, BP 110/70 Spirit Hospital
On vaginal examination, has cervical excitation and markedly tender in the right fornix. South Brisbane
Pregnancy test result positive
Urine dipstick clear 16/02/13

Assessment Dear Doctor,

Suspected ectopic pregnancy
Plan: You ring the on duty Gynaecology Registrar and ask for urgent assessment, and are instructed Re: Cathy Jones
to send her to the A&E Department with a referral letter.
Thank you for seeing this 25-year-old woman, who I suspect has an ectopic pregnancy.
Writing Task:
You are the GP, Dr Sally Brown. Write Referral letter to the Gynaecology Registrar at the Spirit This is her first pregnancy. Ms. Jones presented to the surgery yesterday evening with vague lower
Hospital, South Brisbane. Ask to be kept informed of the outcome. abdominal pain. She started the progesterone-only pill for contraception two months ago, when she
started a new relationship, and has had some irregular bleeding since then. Therefore, she is unsure
In your answer: of her exact last menstrual period. Yesterday, she was mildly tender only and her observations were
● Expand the relevant case notes into complete sentences normal.
● Do not use note form
● Use correct letter format However, on review this morning her pain had worsened overnight, she is very tender in the right
iliac fossa, with rebound and guarding, and on vaginal examination there is cervical excitation, and
marked tenderness in the right fornix. Her pregnancy test is positive.
The body of your letter should be approximately 200 words. Use correct letter format.
I am concerned that she may have an ectopic pregnancy, and would appreciate your urgent
assessment.

Please keep me informed of the outcome.

Yours sincerely,

Doctor
TIME ALLOWED: READING TIME: 5 MINUTES Task 8 Objective
WRITING TIME: 40 MINUTES BP 140/80 P70 regular
Marked increase in swelling in right groin and small swelling in left groin.
Read the case notes below and complete the writing task which follows.
Assessment
notes:
Bilateral inguinal hernia
Today's Date 25.08.12 Advise patient you want to refer him to a surgeon. He agrees but says he wants a
Patient History local anaesthetic as a friend advised him he will have less after effects than with general anaesthetic.
James Warden
DOB 05.07.32
Regular patient in your General Practice Writing Task:
Write a letter addressed to Dr. Glynn Howard, 249 Wickham Tce, Brisbane, 4001 explaining the
09.07.12 patient's current condition.
Subjective
Wants regular check up, has noticed small swelling in right groin. In your answer:
Hypertension diagnosed 5 years ago, non smoker, regularly drinks 2 – 4 glasses of wine nightly and 1 ● Expand the relevant case notes into complete sentences
- 2 glasses of scotch at weekend. ● Do not use note form
Widower living on his own ,likes cooking and says he eats well.
● Use correct letter format
Current medication noten 50 mg daily, ½ aspirin daily, normison 10mg nightly when required, fifty
plus multivitamin 1 daily, allergic reaction to penicillin.

Objective The body of your letter should be approximately 200 words. Use correct letter format.
BP 155/85 P 80 regular
Cardiovascular and respiratory examination normal
Urinalysis normal
Slight swelling in right groin consistent with inguinal hernia.

Plan
Advised reduction of alcohol to 2 glasses maximum daily and at least one alcohol free day a week.
Discussed options re hernia. Patient wants to avoid surgery.
Advised to avoid any heavy lifting and review BP and hernia in 3 months

25.08.12
Subjective
Had problem lifting heavy wheelbarrow while gardening. Has a regular dull ache in
right groin, noticed swelling has increased.
Has reduced alcohol intake as suggested.
Dr. Glynn Howard TIME ALLOWED: READING TIME: 5 MINUTES Task 9
Surgical Department WRITING TIME: 40 MINUTES
249 Wickham Tce
Brisbane 4001 Read the case notes below and complete the writing task which follows.

notes:
25/08/2012
Today's Date 08.08.12
Dear Doctor, Patient History
Dulcie Wood
Re: Mr. James Warden DOB 15.07.46
New patient in your general practice. Moved recently to be near family.
DOB 05/07/32
03.07. 12
I am referring this patient, a widower, who is presenting with symptoms consistent with a bilateral Subjective
inguinal hernia. He has been suffering from hypertension for 5 years for which he takes Noten, Widowed January 06, three children, wants regular check up, has noticed uncomfortable feeling in
Aspirin and multivitamins. He is allergic to penicillin. her chest several times in the last few weeks like a heart flutter.
Mother died at 52 of acute myocardial infarction, non smoker, rarely drinks alcohol
Initially, Mr. Warden presented to me on 09/07/12 for a regular checkup. On examination, he had a Current medication: zocor 20mg daily, calcium caltrate 1 daily
mild swelling of the right groin, his blood pressure was 155/85 and pulse was 80 beats per minute. No known allegeries
Otherwise his condition was normal. He was diagnosed as having an inguinal hernia. I discussed the
possibility of surgery; however, he indicated he did not want an operation. Therefore, I advised that Objective
he avoid heavy lifting and reduce alcohol consumption. A review consultation was scheduled for 3 BP 145/75 P 80 regular
months later. Ht 160cm Wt 61kg
Cardiovascular and respiratory examination normal ECG normal
Today he returned complaining that his right groin had increased in size with a regular dull ache
possibly due to lifting a heavy wheel barrow. The examination revealed a considerable increase in Plan
the swelling in the right groin as well as a mild swelling of the left groin. Prescribe Noten 50 gm ½ tablet daily in am. Advise to keep record of frequency of fibrillation
sensation.
Based on my provisional diagnosis of a bilateral inguinal hernia, I would like to refer him for surgery Review in 2 weeks if no increase in frequency.
as early as possible. Please note that he wishes to have the surgery under local anaesthesia.
17.07.12
Yours sincerely, Subjective
Reports sensations less but woke up twice at night during last 2 weeks
Dr X (GP)
Objective
BP 135/75 P70 regular
Assessment
Increase Noten to 50 gm daily ½ tablet am and ½ tablet pm Dr Vincent Raymond
Advise review in one month. 422 Wickham Tce
Brisbane, 4001
08.08.12
Subjective 08/08/12
Initial improvement but in last 3 days heart seems to be fluttery several times a day and also at
night. Very nervous and upset. Wants a referral to a cardiologist Dr. Vincent Raymond who treated Dear Dr. Raymond,
her sister for same condition
Re: Dulcie Wood DOB: 15/07/46
Objective
BP 180/90 P70 As arranged with your receptionist, I am referring this patient, a 66 year old widow, who has been
demonstrating symptoms suggestive of heart arrhythmia.
Action
Contact Dr. Raymond’s receptionist and you are able to arrange an appointment for Mrs. Wood at Mrs. Woods has seen me on several occasions over the past five months, during which time she has
8am on 14/08/12 had frequent episodes of heart flutter and her blood pressure has been fluctuating.

Writing Task The patient initially responded to Noten 50mg ½ tablet daily in the morning, but she still had
Write a letter addressed to Dr. Vincent Raymond, 422 Wickham Tce, Brisbane 4001 describing the episodes of disturbed sleep during the night. Therefore the dose of Noten was increased to 50mg ½
situation. tablet in the morning and ½ tablet at night, but unfortunately her heart flutter has increased
recently, especially over the last three days. Other current medications are Zocor 20mg and Calcium
In your answer: Caltrate 1 daily.
● Expand the relevant case notes into complete sentences
● Do not use note form Today’s examination revealed a nervous and upset woman with a pulse rate of 70 and blood
● Use correct letter format pressure of 180/90.

Please note that her mother died of acute myocardial infarction and her sister, who is a patient of
yours, has a similar condition.
The body of your letter should be approximately 200 words. Use correct letter format.
In view of the above, I would appreciate it if you provide an assessment of Mrs. Wood and advise
regarding treatment and management of her condition.

Yours sincerely,

Dr Z
[191- words]
TIME ALLOWED: READING TIME: 5 MINUTES Task 10 25.04.12
WRITING TIME: 40 MINUTES Subjective
Feeling better in part due to weight loss
Read the case notes below and complete the writing task which follows.
Objective
notes: BP 140/85
Today's Date 03.07.12 PR 70 regular
Patient History Ht 152cm
Margaret Leon 01 .08. 52 Wt 61 kg
Gender: Female
Regular patient in your General Practice . Assessment
Making good progress with weight. Blood pressure within normal range
14.01.12
Subjective 03.07.12
Wants general check up, single, lives with and takes care of elderly mother. Subjective
Father died bowel cancer aged 50. Saw blood in the toilet bowl on two occasions after bowel motions. Depressed and very anxious.
Had colonoscopy 3 years ago. Clear Believes she has bowel cancer. Trouble sleeping.
Does not smoke or drink
Objective
Objective BP 180/95 P 88 regular
BP 160/90 PR 70 regular Ht 152cm Wt 50 kg
Ht 152cm Cardiovascular and respiratory examination normal.
Wt 69 kg Rectal examination shows no obvious abnormalities.
On no medication
No known allergies Assessment
Need to investigate for bowel cancer
Assessment Refer to gastroenterologist for assessment /colonoscopy.
Overweight. Advised on exercise & weight reduction. Prescribe 15 gram Alepam 1 tablet before bed.
Borderline hypertension Advise patient this is temporary measure to ease current anxiety/sleeplessness.
Review in 3 months Review after BP appointment with gastroenterologist
Writing Task: Dr. William Carlson
Write a letter addressed to Dr. William Carlson, 1st Floor, Ballow Chambers, 56 Wickham Terrace, First Floor
Brisbane, 4001 requesting his opinion. Ballow Chamber
56 Wickham Tce
In your answer: Brisbane 4001
● Expand the relevant case notes into complete sentences
● Do not use note form 03/07/2012
● Use correct letter format
Dear Dr Carlson,
The body of your letter should be approximately 200 words. Use correct letter format.
Re: Margaret Leon DOB 01/08/1952

Thank you for seeing my patient, Margaret Leon, who has been very concerned about blood in her
stools. She has seen blood in the toilet bowl on two occasions after bowel motion. She is very
anxious. as well as being depressed because her father died of bowel cancer and she feels she may
have the same condition.

Margaret has otherwise been quite healthy. She does not drink or smoke and is not taking any
medication. She was slightly overweight six months ago with borderline high blood pressure. At that
time, I advised her to lose weight which she did successfully. Three months later, her weight had
dropped from 69kg to 61kg and blood pressure was back within the normal range.

On presentation today, she was distressed because she believes she has bowel cancer. She has had
trouble sleeping and her weight has reduced a further 11 kg. The rectal examination did not show
any abnormalities. Her blood pressure was slightly elevated at 180/95 but her cardiovascular and
respiratory examination was unremarkable. Alepam, one before bed, was prescribed to control the
anxiety and sleeplessness.

I would appreciate it if you could perform a gastroenterology assessment.

Yours sincerely,

Dr X (GP)
[194 words]
TIME ALLOWED: READING TIME: 5 MINUTES Task 11
WRITING TIME: 40 MINUTES 14.08.12
Subjective
Read the case notes below and complete the writing task which follows. Reduced smoking to 10 per day
Attends gym twice a week, Weight 77 kg
notes:
Complains of discomfort urinating
Today's Date 15.08.12
Patient History Objective
Darren Walker BP 145/80 P76
DOB 05.07.72 DRE hardening and enlargement of prostate
Regular patient in your General Practice PSA reading 10

09.07.12 Plan
Subjective Review BP, smoking reduction in 2 months
Regular check up, Family man, wife, two sons aged 5 and 3 Refer to urologist – possible biopsy prostate
Parents alive - father age 71 diagnosed with prostate cancer 2002.
Mother age 68 hypertension diagnosed 2002. Writing Task:
Smokes 20 cigarettes per day –trying to give up Write a referral letter addressed to Dr. David Booker (Urologist), 259 Wickham Tce, Brisbane 4001.
Works long hours – no regular exercise Ask to be informed of the outcome.
Light drinker 2 –3 beers a week
In your answer:
Objective ● Expand the relevant case notes into complete sentences
BP 165/90 P 80 regular ● Do not use note form
Cardiovascular and respiratory examination normal
● Use correct letter format
Height 173 cm Weight 85kg
Urinalysis normal

Plan The body of your letter should be approximately 200 words. Use correct letter format.
Advise re weight loss, smoking cessation
Review BP in 1 month
Request PSA test before next visit
Dr. David Brooker (Urologist)
The Urology Department TIME ALLOWED: READING TIME: 5 MINUTES Task 12
259 Wickham Tce WRITING TIME: 40 MINUTES
Brisbane, 4001
Read the case notes below and complete the writing task which follows.
15/08/2012 notes:
Today’s Date 21/01/12
Dear Doctor, Patient History
Brendan Cross, Male , DOB: 25/12/2003
Re: Mr. Darren Walker
Has a sister 6 years, brother 3 years
I am writing to refer this patient, a 40 year old married man with two sons aged 3 and 5, who Mother – housewife
requires screening for prostate cancer. Father – Naval Officer currently on active duty in Indonesia
P.M.H- NAD
Initial examination on 09/07/12 revealed a strong family history of related illness as his elderly Brendan is on 50th percentile for height & weight
father was diagnosed with prostate cancer and mother was diagnosed as hypertensive. Mr Walker is Allergy to nuts – hospitalised with anaphylaxis 2 years ago following exposure to peanuts
a smoker and light drinker. He works long hours and does not do any regular exercise. His blood
pressure was initially 165/90 mmhg and pulse was 80 and regular. He is 173cm tall and his weight, at
that time, was 85 kg. He was advised to reduce weight and stop smoking and a prostate specific 14/01/12
antigen test was requested. There were no other remarkable findings. Subjective
Fever, sore throat, lethargy, many crying spells – all for 3 days.
When he came for the next visit on 14/08/2012, Mr Walker had reduced smoking from 20 to 10
cigarettes per day and was attending gym twice a week. He had lost 8kg of weight. His blood Objective
pressure was improved at 165/90mmhg. However digital rectal examination revealed an enlarged
Temperature - 39.8°C
prostate and the PSA reading was 10.
Enlarged tonsils with exudate
In view of the above signs and symptoms, I believe he needs further investigations including a Enlarged cervical L.N.
prostate biopsy and surgical management. I would appreciate your urgent attention to his condition. Ab - NL
CVS – NL
Yours sincerely, RR – NL

Dr.X
Probable Diagnosis
[206 words] Tonsillitis (bacterial)
Management
Oral Penicillin 250mg 6/h, 7days + Paracetamol as required.
Review after 5days if no improvement.
19/1/12
Subjective Writing Task:
Mother concerned – sleepless nights, difficulty coping with husband away – mother-in-law coming You are GP, Dr Joseph Watkins, Greenslopes Medical Clinic, 294 Logan Rd, Greenslopes, Brisbane
4122. Write a referral letter to Dr Alison Grey, Mater Paediatric Centre, Vulture Street, Brisbane
to help.
4101.
Brendan not eating complaining of fever, right knee joint pain, tiredness, lethargy – for 2 days
In your answer:
Objective ● Expand the relevant case notes into complete sentences
Temperature - 39.2°C ● Do not use note form
Hypertrophied tonsils ● Use correct letter format
Cervical limp node – NL
Swollen R. Knee Joint
No effusion The body of your letter should be approximately 200 words. Use correct letter format.
Mid systolic murmur, RR - normal

Investigation
ECG, FBC, ASOT ordered

Treatment
Brufen 100mg tds, review in 2 days with investigation reports

21/1/12
No change of symptoms
ECG – prolonged P-R interval
ESR – increased
ASOT – Increased

Diagnosis
? Rheumatic fever

Plan
Contact Spirit Paediatric Centre to arrange an urgent appointment with Dr Alison Grey, Paediatric
Consultant requesting further investigation and treatment.
 TIME ALLOWED: READING TIME: 5 MINUTES Task 13
Dr. Alison Grey
WRITING TIME: 40 MINUTES
Mater Paediatric Centre
Vulture Street Read the case notes below and complete the writing task which follows.
Brisbane,4101
notes:
21/01/2012 Today's Date 24/08/12
Patient History
Dear Dr. Grey,
Mrs. Jane MacIntyre (DOB 01.03.73)
Re: Brendan Cross
Two children age 5 and 3
Thank you for seeing this 8 year old boy who has demonstrated features consistent with rheumatic Two miscarriages
fever. His developmental and past medical history were unremarkable except for an allergy to
First pregnancy
peanuts. His mother has difficulty in caring for both his illness and two other small children as his
father is away due to his work as a naval officer. developed severe pre-eclampsia
delivered by emergency Caesarean Section at 32 week
He presented with symptoms suggestive of acute bacterial tonsillitis on 14/01/12, when fever and in intensive care for 3 days, required magnesium sulphate
sore throat had occurred over the previous 3 days, associated with lethargy and crying spells. High
baby (Sam) weighed 2.1 kg – in Neonatal Intensive Care Unit 2 weeks
temperature (39.8), enlarged tonsils with exudate and cervical lymphadenopathy were found.
Therefore, oral penicillin and paracetamol were prescribed. did not require ventilation only CPAP (Continuous Positive Airway Pressure)
Second Pregnancy
Regrettably, he returned on 19/01/12 with worsening symptoms. Fever had persisted with right BP remained normal
knee joint pain. He appeared restless, and was finding it difficult to eat and sleep. Examination
baby (Katie) delivered at full term, weighed 3.4kg
revealed hypertrophied tonsils and a swollen right knee joint without signs of effusion. There was
mid-systolic murmur on heart auscultation. Brufen was prescribed but was not effective. Today, Family history of thrombosis
blood tests results reported elevated erythrocyte sedimentation rate and anti-streptolysin O titre. Known to be heterozygous for Factor V Leiden
An abnormal electrocardiogram indicated prolonged P-R interval. Treated with prophylactic low molecular weight heparin in two previous pregnancies
No other medical problems
I believe Brendan needs admission for further investigation and stablisation. I would appreciate your Not on any regular medication
urgent attention to his condition. Negative smear 2010

Yours sincerely, 24/08/12

Subjective
Dr. Watkins Positive home pregnancy test – fifth pregnancy
Thinks she is 8 weeks pregnant
[202 words] Last menstrual period 26.6.12
Painful urination last three days
Request referral to the Spirit Mother's Hospital for antenatal care and birth.
 Writing Task:
Objective You are GP, Dr. Liz Kinder, at a Family Medical Centre. Write referral letter to Dr. Anne Childers
BP:120/80 MBBS FRANZCOG, Consultant Obstetrician, Spirit Mother's Hospital, Stanley Street, South
Weight: 60kg Brisbane.
Height: 165cm
Some dysuria for the past 3 days In your answer:
Urine dipstick: 3+ protein, 2+ nitrites, and 1+ blood ● Expand the relevant case notes into complete sentences
Abdomen soft and non-tender ● Do not use note form
Fundus not palpable suprapubically ● Use correct letter format

Assessment
Needs antenatal referral to an obstetrician in view of her history of severe pre-eclampsia, Caesarean The body of your letter should be approximately 200 words. Use correct letter format.
Section, and her age
Needs to start folic acid
Needs to start tinzaparine 3,500 units daily, subcutaneously, in view of thrombosis risk.
Suspected urinary tract infection based on her symptoms and the urine dipstick result

Plan
Refer Jane to Dr Anne Childers at the Spirit Mother's Hospital
Commence her on folic acid 400 micrograms daily, advise to continue until 12 weeks pregnant
Arrange routine antenatal blood tests – results to be sent to the Spirit Mother's Hospital when
received
Counsel Jane re antenatal screening for Down's Syndrome in view of her age
Jane elects to have a scan for nuchal translucency, which is done between 11 and 13 weeks
Provide information on Greenslopes Screening Centre.
Prescribe tinzaparine 3,500 units daily subcutaneously
Send a midstream urine specimen to laboratory
Prescribe cefalexin 250 milligrams 6-hourly for five days
 TIME ALLOWED: READING TIME: 5 MINUTES Task 14
Dr. Anne Childers WRITING TIME: 40 MINUTES
(MBBS, FRANZCOG)
Consultant Obstetrician Read the case notes below and complete the writing task which follows.
Spirit Mother’s Hospital
Stanley Street notes:
South Brisbane
Today’s Date 14.10.12
24/08/12
Patient History
Dear Dr. Childers, Amina Ahmed aged 8 years – new patient at your clinic Parents – Mother Ayama, house-wife.
Father Talan, cab driver Brothers Dalma aged 4 and Roble aged 2 Family refugees from Somali
Re: Mrs. Jane MacIntyre DOB 01/03/73 2005. Have Australian Citizenship Amina and father good understanding of English, mother has
Thank you for accepting this 39-year-old mother of 2, who is 8 weeks pregnant and has a strong basic understanding of slowly spoken English. Amina had appendicectomy 2 years ago.
history of severe pre-eclampsia in her first pregnancy which resulted in an emergency caesarean No known allergies
section at 32 weeks of gestation. However, her second pregnancy and delivery was normal. In
addition, she has had 2 miscarriages. In view of her age and history, I believe Mrs. MacIntyre needs 09/10/12
urgent specialist assessment and care. Subjective
Fever, runny nose, mild cough, loss of appetite
On presentation today, Mrs. MacIntyre reported that she is heterozygous for Factor 5 Leiden and
Unable to attend school
has a family history of thrombosis. Therefore, I commenced her on trizaparine 3,500 units daily. In
addition, Mrs. MacIntyre complained of difficulty in urination for the previous 3 days and her urine
Objective
dipstick test showed presence of a large amount of protein and nitrate along with slight blood.
Pulse 85/min
Therefore, in view of urinary tract infection, cefalexim 250 miligrams 6 hourly daily for 5 days was
Temperature 39.4
prescribed and mid-stream urine test was ordered.
No rash
Please note, I have commenced Mrs. MacIntyre on folic acid 400 microgram daily and have advised No neck stiffness
her for nuchal translucency scan in order to rule out Down’s syndrome. CVS, RS & abdo – normal

I am happy to share her antenatal care with you, as you think appropriate. Assessment
Yours sincerely, Viral infection

Dr. Liz Kinder Management

Keep home from school
General Practitioner Rest and paracetamol three times daily
Review in 3 days if no improvement
[200 words]
12/10/12 Writing Task:
Subjective You are GP, Dr. Lucy Irving, Kelvin Grove Medical Centre, 53 Goma Rd, Kelvin Grove, Brisbane.
Amina not well Write a referral letter to the Duty Registrar, Emergency Paediatric Unit, Brisbane General Hospital,
Cough +, continuous headache, lethargic, loss of appetite 140 Grange Road, Kelvin Grove, QLD, 4222.
Difficult to control temperature with Paracetamol
Mother worried In your answer:
● Expand the relevant case notes into complete sentences
Objective ● Do not use note form
Fever 39.8 C ● Use correct letter format
No rash or neck stiffness

Management The body of your letter should be approximately 200 words. Use correct letter format.
Prescribe Brufen 200mg as required
FBC & UFR were ordered
Review in two days with results of reports

14/10/12
Subjective
Both parents very concerned
Reported Amina lethargic and listless
Vomited twice last night and headaches worse

Objective
FBC- WBC(18000) and left shift
Urinary Function Report Normal
Temperature 40.2C
Pulse 110/min
Macula-papular rash over legs
Neck Stiffness+

Assessment
Meningococcal meningitis. Penicillin IV given (stat dose)

Plan
Arrange urgent admission to the Emergency Paediatric Unit, Brisbane General Hospital, for
further investigation and treatment.
 The Duty Registrar
The Duty Registrar Emergency Pediatric Unit
Emergency Paediatric Unit Brisbane General Hospital
Brisbane General Hospital 140 Grange Road
140 Grange Road Kelvin Grove QLD 4222
Kelvin Grove, QLD, 4222
14/10/12
14/10/12
Dear Doctor,
Dear Doctor:
Re: Amina Ahmed
Re: Amina Ahmed (8years)
Thank you for urgently seeing this 8-year-old child, who is presenting with features suggestive of
meningococcal meningitis.
I am writing to refer Amina who is presenting with signs and symptoms of meningococcal
meningitis for urgent assessment and management. She is the first child of a family of 5, which
She is the first child of a family of 5, which includes her parents and younger siblings. The family
includes her parents and two younger siblings. They are immigrants from Somalia, although she
immigrated from Somalia 7 years ago. however, they understand English.
and her father understand English.
The patient, accompanied by her parents, initially presented on 09/10/12 complaining of fever,
Initially, accompanied by her parents, she presented to me on 9.10.12 with complaints of fever,
runny nose, mild cough and loss of appetite. On examination, her vitals were normal except for a
runny nose, cough and loss of appetite. She was febrile with a temperature of 39.4 and a pulse rate
temperature of 39.4 Celsius. At that time, neck stiffness or rash were not noticed. After three days,
of 85 beats per minute, but there was no rash or neck stiffness. However, her condition continued
she reported having constant headaches and lethargy with the deterioration of her earlier
to deteriorate over the next two days as the fever could not be controlled by antipyretics.
symptoms. Additionally, her temperature was not responding to the antipyretic. Therefore, blood
Therefore, blood and urine tests were ordered.
and urine tests were ordered.
Regrettably today, Amina became lethargic and listless. She vomited twice last night and had been
Unfortunately, today, Amina became lethargic and listless. Her parents were worried as she vomited
having severe headaches. On examination, she was severely febrile with a temperature of 40.2 and
twice last night and her headaches have been worsening. Examination revealed that she was
a pulse rate of 110 beats per minute. There was macula-papular rash over the legs and neck
severely febrile with a temperature of 40.2 and a pulse rate of 110 per minute. A maculopapular
stiffness was present. Blood test showed leucocytosis with a shift to the left.
rash over the legs and neck stiffness were also observed. The blood test showed elevated WBC with
a left shift. As a result, penicillin IV was commenced.
Based on the above, I believe she needs urgent admission and management. Please note, penicillin
IV has been given as a stat dose.
In view of the above, I believe she needs urgent admission.
Yours sincerely,
Yours faithfully,
Dr. Lucy Irving
Doctor
[208 words]
[203 words]
TIME ALLOWED: READING TIME: 5 MINUTES Task 15 18/6/10
WRITING TIME: 40 MINUTES PC: dysphagia (solids), onset 2/52 ago post viral(?) URTI
URTI self-medicated with OTC Chinese herbal product – contents unknown
Read the case notes below and complete the writing task which follows. No relapse/remittent course
notes: No sensation of lump
Patient: Anne Hall (Ms) No obvious anxiety
DOB: 19.9.1965 Concomitant epigastric pain radiating to back, level T12
Height: 163cm Weight: 75kg BMI: 28.2 (18/6/10) Weight loss: 1-2kg
Recent increase in coffee consumption
Social History: Teacher (Secondary – History, English) Takes aspirin occasionally (2-3 times/month); no other NSAIDs
Divorced, 2 children at home (born 1994, 1996)
Non-smoker (since children born) Provisional diagnosis: gastro-oesophageal reflux +/- stricture
Social drinker – mainly spirits
Plan: Refer gastroenterologist for opinion and endoscopy if required
Substance Intake: Nil
Writing Task:
Allergies: Codeine; dust mites; sulphur dioxide Using the information in the case notes, write a letter of referral for further investigation and
definitive diagnosis to the gastroenterologist, Dr Jason Roberts, at Newtown Hospital, 111
FHx: Mother – hypertension; asthmatic; Father – peptic ulcer High Street, Newtown.
Maternal grandmother – died heart attack, aged 80
Maternal grandfather – died asthma attack In your answer:
Paternal grandmother – unknown ● Expand the relevant case notes into complete sentences
Paternal grandfather – died ‘old age’ 94 ● Do not use note form
● Use correct letter format
PMHx: Childhood asthma; chickenpox; measles
1975 tonsillectomy
1982 hepatitis A (whole family infected) The body of your letter should be approximately 200 words. Use correct letter format.
1984 sebaceous cyst removed
1987 whiplash injury
1998 depression (separation from husband); SSRI – fluoxetine 11/12
2000 overweight – sought weight reduction
2002 URTI
2004 dyspepsia
2006 dermatitis; Rx oral & topical corticosteroids
 TIME ALLOWED: READING TIME: 5 MINUTES Task 16
Dr Jason Roberts WRITING TIME: 40 MINUTES
Newtown Hospital
111 High Street Read the case notes below and complete the writing task which follows.
Newtown notes:
Patient: Mrs Priya Sharma , DOB: 08.05.53 (Age 60)
18/6/10 Residence: 71 Seaside Street, Newtown

Dear Dr Roberts Social Background:

Married 40 years – 3 adult children, 5 grandchildren (overseas). Retired (clerical worker).
Re: Ms Anne Hall, DOB 19.9.1965 Family History:
Many relatives with type 2 diabetes (NIDDM)
Thank you for seeing Ms Hall, a 44-year-old secondary school teacher, who is presenting with a two Nil else signifcant
week history of symptoms of dysphagia for solids, epigastric pain radiating posteriorly to T12 level,
and concomitant weight loss. The symptoms follow a constant course. Medical History:
1994 – NIDDM
Ms Hall believes the problem commenced after an upper respiratory tract infection two weeks ago Nil signifcant, no operations
for which she self-prescribed an over-the-counter Chinese herbal product with unknown ingredients. Allergic to penicillin
However, she has also recently increased her coffee consumption and takes aspirin 2-3 times a Menopause 12 yrs
month. Never smoked, nil alcohol
She has a history of dyspepsia (2004), and dermatitis for which she was prescribed oral and topical No formal exercise
cortisone. There are no apparent signs of anxiety. She has not smoked for the last 15 years. She drinks
socially (mainly spirits), has a family history of peptic ulcer disease and is allergic to codeine. Her BMI Current Drugs:
is currently 28.2. Metformin 500mg 2 nocte
Glipizide 5mg 2 mane
My provisional diagnosis at this point is gastro-oesophageal reflux with possible stricture. I am No other prescribed, OTC, or recreational
therefore referring Ms Hall to you for further investigation.
Thank you for assessment and ongoing management of this woman. If you require any further 29/12/13
information, please do not hesitate to contact me. Discussion:
Concerned that her glucose levels are not well enough controlled – checks levels often (worried?)
Yours sincerely Attends health centre – feels not taking her concerns seriously
Recent blood sugar levels (BSL) 6-18 / Checks BP at home
Doctor Last eye check October 2012 – OK
Wt steady, BMI 24
App good, good diet
Bowels normal, micturition normal
O/E: Writing Task:
Full physical exam: NAD Using the information in the case notes, write a letter of referral to Dr Smith, an
BP 155/100 endocrinologist at City Hospital, for further management of Mrs Sharma’s sugar levels.
No peripheral neuropathy; pelvic exam not performed Address the letter to Dr Lisa Smith, Endocrinologist, City Hospital, Newtown.
Pathology requested: FBE, U&Es, creatinine, LFTs, full lipid profle, HbA1c
Medication added: candesartan (Atacand) tab 4mg 1 mane In your answer:
Review 2 weeks ● Expand the relevant case notes into complete sentences
● Do not use note form
05/01/14 Pathology report received: ● Use correct letter format
FBE, U&Es, creatinine, LFTs in normal range
GFR > 60ml/min
HbA1c 10% (very poor control) The body of your letter should be approximately 200 words. Use correct letter format.
Lipids: Chol 6.2 (high), Trig 2.4, LDLC 3.7

12/01/14 Review of pathology results with Pt Changes in medication recommended

Metformin regime changed from 2 nocte to 1 b.d.
Atorvastatin (Lipitor) 20mg 1 mane added
Glipizide 5mg 2 mane
Review 2 weeks

30/01/14
Home BP in range
Sugars improved
Pathology requested: fasting lipids, full profle

06/02/14 Pathology report received: Chol 3.2, Trig 1.7, LDLC 1.1

10/02/14 Pathology report reviewed with Mrs Sharma

Fasting sugar usually in 16+ (high) range
Other blood sugars 7-8
Refer to specialist at Diabetes Unit for further management of sugar levels
Dr Lisa Smith TIME ALLOWED: READING TIME: 5 MINUTES Task 17
Endocrinologist WRITING TIME: 40 MINUTES
City Hospital
Newtown Read the case notes below and complete the writing task which follows.
notes:
10 February 2014 Mrs Toula Athena, 47, married, two children, home duties
Family history
Dear Dr Smith, Mother diabetes, died stroke 10 years ago aged 67
Re: Mrs Priya Sharma Medical history
71 Seaside Street, Newtown Unremarkable, no medications
DOB 08.05.53 Social History Married 2 children, home duties

Thank you for seeing Mrs Priya Sharma, a type 2 diabetic. I would be grateful if you would assist with 11/11/06
her blood sugar control. Subjective:
4 months thirst, bulimia, nocturia (4 times per night)
Mrs Sharma is 60 years old and has a strong family history of diabetes. She was diagnosed with lethargy 7 weeks
NIDDM in 1994 and has been successfully monitoring her BP and sugar levels at home since then. dizziness
She first attended my surgery on 29/12/13 as she was concerned that her blood sugar levels were no Objective:
longer well controlled. Ht. 1.60 Wt. 95kgs.
Pulse 84 reg, BP 160/95
On initial presentation her BP was 155/100 and she said that her blood sugars were running Plan: Arrange investigations – blood sugar, mid stream
between 6 and 18. Her medication at that time was metformin 500mg x2 nocte and glipizide 5mg x2 urine (MSU)
mane. Dietary advice re weight loss, appropriate foods
Mrs Sharma is allergic to penicillin. A pathology report on 05/01/2014 showed HbA1c levels of 10% 16/12/06
and GFR greater than 60ml/min. Her cholesterol was high (6.2). Subjective:
Reports has followed diet, no weight loss
On 29/12/13, I instituted Atacand 4mg, 1 tablet each morning. Since then her home-monitored BP Symptoms unchanged
has been within range. On 12/01/14, I also prescribed Lipitor 20mg daily, and her lipids have Frequent headaches
improved, with cholesterol falling from 6.2 to 3.2.
Objective:
Mrs Sharma reports that her fasting BSL is in the 16+ range (other blood sugars are 7-8). I am No weight loss
concerned about her fasting blood sugars, which remain high, and would appreciate your advice. BP 170/95
Investigation results: blood sugar 11 mmol / l
Yours sincerely, • no sugar in urine
• albumin in urine + +
Doctor
Plan: Dr Haldon Tristan
prescribe antidiabetic and antihypertensive Melbourne Endocrinology Centre
medications, continue diet 99 Brick Road
East Melbourne VIC 3004
07/01/07 7 January 2007
Subjective:
Complains feeling worse Dear Dr. Tristan,
Blurred vision
Re: Mrs Toula Athena, 47, married, two children, home duties
Sight spots
Objective:
Thank you for seeing Mrs Athena who presents today with symptoms consistent with late onset
BP 165/90
Diabetes Melitis (DM).
Plan:
Please note, the patient’s mother suffered from DM and died of a stroke at the age of 67. Mrs.
Referral Dr. Haldun Tristan, endocrinologist
Athena’s past medical history is unremarkable and she currently takes no medications.
Writing Task:
Mrs. Athena initially presented on 11 November last year with a four-month history of thirst,
Using the information in the case notes, write a letter of referral to Dr Tristan, an endocrinologist
bulimia and nocturia.
at Melbourne Endocrinology Centre, 99 Brick Road, East Melbourne 3004. The main part of the
letter should be approximately 180-200 words long.
She urinated four times a night. Furthermore, she complained of lethargy during the preceding
In your answer:
seven weeks. At that time she was overweight. Dietary advice was given and relevant
● Expand the relevant case notes into complete sentences
investigations arranged.
● Do not use note form
● Use correct letter format On 16 December, the patient re-presented with her symptoms unchanged and raised BP. In
addition, she reported frequent headaches. Her test results showed that her blood sugar was 11
mmol/l and that the albumin in her urine was elevated but without any evidence of sugar.
The body of your letter should be approximately 200 words. Use correct letter format. Antidiabetic and antihypertensive medications were prescribed and she was advised to continue
her diet.

As mentioned above, Mrs. Athena presents today with worsening diabetic symptoms. Moreover,
her vision is blurred and she has sight spots.

I would be grateful for your assessment of this patient. Should you require further information
please contact me directly at my surgery.
Yours sincerely

Doctor
Dr. Haldun Tristan (Endocrinologist) TIME ALLOWED: READING TIME: 5 MINUTES Task 18
Melbourne Endocrinology Centre WRITING TIME: 40 MINUTES
99 Brick Road
East Melbourne, 3004 Read the case notes below and complete the writing task which follows.
notes:
Dear Dr. Tristan, Peter Ludovic, 8 years old
22/12/06
Re: Ms. Toula Athena Complains of sore throat. Mother reports fever, irritable.
Voice hoarse
I am writing to refer this patient to you in order to rule out diabetes. Ms. Athena is a 47-year-old
housewife. She is married and has 2 children. Her risk factors include: hypertension, obesity, O/E:
strong family history (her mother was diagnosed with diabetes and died of stroke 10 years ago), enlarged tonsils, exudate
elevated blood sugar and albuminuria. Tender, large cervical nodes
T 39.5°
Initially, she came to see me two months ago. She had been suffering from thirst, bulimia,
nocturia and dizziness during the previous four months. In addition, she had been lethargic for Assessment: Tonsillitis
the previous 7 weeks. Her blood pressure was elevated at 160/95 mm hg and pulse rate was 84 Plan: Penicillin v 250mg qid 7 days
beats per minute. She was advised to keep on diet in order to reduce weight, blood and urine
tests were ordered. 15/01/07 Mrs.
Ludovic reported son’s urine brown 4 days previously.
One month later, her condition did not improve and her weight was unchanged. Due to her Says Peter is lethargic, no report of frequency, trauma or dysuria.
symptoms and test results antidiabetic and antihypertensive medications were prescribed. O/E: tonsillar hypertrophy
BP 90/60
Regrettably, today Ms. Athena`s condition deteriorated. She complained of blurred vision and Urinalysis – macroscopic haematuria
sight spots. Despite treatment her blood pressure also was elevated at 165/90 mmhg.
Assessment:
I believe she requires admission to the Endocrinology Centre for treatment and stabilization. ? post streptococcal nephritis
Please keep me informed of her condition. ? urinary tract infection

Yours sincerely, Plan:

R/V 2 days
Doctor Fluids, rest
Tests:
Full Blood Examination (FBE), urea and creatinine
[U&E], electrolytes, mid stream urine [MSU]
micro/culture/sensitivity [M/C/S], Antistreptolysin-O Titre [ASOT] and cell morphology
 Dr. Xavier Flannery
18/01/07 Paediatrician
Peter asymptomatic 567 Church Street
O/E: BP 110/90 Springvale, 3171
macroscopic haematuria
18 January 2008
Test results:
FBE normal Dear Dr. Flannery,
U&E↑
ASOT↑+++ Re: Peter Ludovic, 8 years old
MSU – 4X 10 # RBC [red blood cells ] of renal origin
Thank you for seeing Peter who I suspect has post-streptococcal nephritis with early renal
Assessment: failure.
post streptococcal nephritis with early renal failure
Initially, Peter presented on 22 December 2006 with symptoms suggestive of acute bacterial
Plan: Refer to paediatrician tonsillitis. According to his mother, he had been suffering from sore throat, associated with fever
(39.5), hoarse voice and irritable mood. Enlarged tonsils with exudate and cervical
WRITING TASK lymphadenopathy were found, and oral penicillin was prescribed.
Using the information in the case notes, write a letter of referral to Dr Xavier Flannery, a
paediatrician at 567 Church St Springvale 3171. On the second examination 15 January 2007, the patient reported blood in urine over the
previous four days, as well as lethargy. Examination revealed hypertrophied tonsils, and urine
In your answer: analysis showed macroscopic haematuria. Blood pressure was normal.
● Expand the relevant case notes into complete sentences
● Do not use note form Today, blood test results reported elevated urea and creatinin, antistreptilysin-O titre, and mid-
● Use correct letter format stream urine showed red blood cells of renal origin (4x10).

In view of the above signs and symptoms, I would appreciate your urgent assessment and
treatment of this patient.
The body of your letter should be approximately 200 words. Use correct letter format.
Yours sincerely,

Doctor
TIME ALLOWED: READING TIME: 5 MINUTES Task 19 18/01/07
WRITING TIME: 40 MINUTES Expressed anxiety re failure to conceive, says she's "too old"
sleep still a problem
Read the case notes below and complete the writing task which follows. O/E:
notes: crying, pale, fidgety
Vital signs / general exam NAD
Name Mrs. Larissa Zaneeta, Age 38-years-old Pelvic exam, pap smear
Family and social history Assessment: as per previous consultation
Marketing manager, married, Plan:
one child (four-year-old boy). 1-2 Valium b.d.
Suggested she re-present next week accompanied by husband.
Medical history
Unremarkable, no medications 25/01/07
Mr. Zaneeta very supportive of having another child
11/07/05 No erectile dysfunction, libido normal
Complains of tiredness, difficulty sleeping for 2 months due to work stress Mrs. Zaneeta unchanged
Plans another child in 12 months, currently on oral contraceptive pill (OCP) O/E:
O/E: Mr. Zaneeta normal
Appears pale, tired and slightly restless Plan: Check Mr. Zaneeta's sperm count
BP 140/80
No abnormal findings 02/02/07
Assessment: Stress-related anxiety Sperm count normal
Plan: Plan: Refer for specialist advice
advised relaxation techniques, reduce working hours,
prescribe sleeping tablets tds Writing Task:
Using the information in the case notes, write a letter of referral to Dr Elvira Sterinberg, a
15/08/06 gynaecologist at 123 Church St Richmond 3121.
Stopped OCP 4 months earlier, still menstruating
Worried In your answer:
Sleep still difficult, work stress unchanged, not possible to reduce hours ● Expand the relevant case notes into complete sentences
O/E: Tired-looking, slightly teary ● Do not use note form
Assessment: Work stress, growing anxiety failure to conceive ● Use correct letter format
Plan:
discussed nature of conception – takes time, patience
discussed frequency sexual intercourse The body of your letter should be approximately 200 words. Use correct letter format.
discussed methods – temperature / cycle
Dr. Elvira Sterinberg TIME ALLOWED: READING TIME: 5 MINUTES Task 20
Gynaecologist WRITING TIME: 40 MINUTES
123 Church Street
Richmond, 3121 Read the case notes below and complete the writing task which follows.
notes:
02 February 2007 Name Mr Jing ZU
Dear Dr. Sterinberg, Age 72-year-old man

Re: Mrs. Larissa Zanetta, a 38-year-old woman, marketing manager, married, has one child (a four- Family history unremarkable
year-old boy) and Mr. Zanetta, her husband
Medical history
Thank you for seeing my patients who have been trying to conceive for 10 months without any Hypertension 18 years
success. Ischaemic heart disease 10 yrs
Initially, Mrs. Zanetta came to see me on 11/07/05 complaining of tiredness and difficulty sleeping Acute Myocardial Infarction 1999
for the previous 2 months due to work stress. She was on oral contraceptive pill at that time and was Congestive Cardiac Failure (CCF) 5 yrs
planning another pregnancy in 12 months. Her medical history was unremarkable.
Medications
The patient demonstrated signs of anxiety, such as paleness, tiredness and slightly elevated blood Lasix 40mg mane, Enalapril 10mg mane, Slow K TT bd, Nifedipine 10mg tds, Anginine T sl prn
pressure (140/80mmhg). Accordingly, relaxation techniques, reducing work hours and sleeping
tablets were recommended. Social History Job:
retired school teacher
One year later, Mrs. Zanetta visited me again complaining of failure to conceive since she had Home: married
stopped the pill. Sleeping problem and work-related stress persist. Therefore, reassurance was given Activities: gardening
and advice regarding nature of conception was provided. Smoking: no

However, on review six months later the patient had not managed to conceive and her anxiety had 03/01/07
increased. As a result, Valium was prescribed 1-2 tablets at night. Pelvic examination was normal Subjective:
and Pap smear was taken. Next consultation with her husband was organized the following week. Angina on exertion – gardening, relief with rest and Anginine
Sleeps two pillows, no orthopnoea
Examination of Mr. Zanetta was unremarkable and sperm count was normal. Mild postural dizziness

I would be grateful if you could take over the further management of this couple.

Yours faithfully,

Doctor
Objective: 19/01/07
Thin, looks well.
Pulse 84 reg, BP 160/90 lying, 145/80 standing Subjective:
Jugular Venous Pressure (JVP) + 3 cm Dyspnoea “feels a bit better”
Apex beat not displaced Angina 10 min episode on mild exertion yesterday
S1 and S2 no extra sounds nor murmurs
Chest - Bilateral basal crepitations Objective:
Abdomen – normal JVP + 4 cm
Ankles mild oedema, pulses present Chest fewer crepitations to mid zones
ECG - ? ischaemic changes anterolaterally
Assessment: Stable CCF, angina
Assessment: ischaemic heart disease
Plan: Watchful monitoring
Plan:
15/01/07 Referral Dr. George Isaacson, cardiologist, management of ischaemic heart disease

Subjective: ↑ dyspnoea, orthopnoea (sleeps on 4 pillows) Writing Task:

↑ ankle oedemano chest pain Using the information in the case notes, write a letter of referral to Dr Isaacson, a cardiologist
at 45 Inkerman Street Caulfield 3162.
Objective:
BP 140/90 In your answer:
JVP + 6 cm ● Expand the relevant case notes into complete sentences
Chest crepitations to mid zones ● Do not use note form
Heart S1 and S2 ● Use correct letter format
Ankles oedema to knees

Assessment: Deteriorating CCF ? cause The body of your letter should be approximately 200 words. Use correct letter format.
Plan: ECG, ↑Lasix 80 mg mane, R/V 2 days
Dr. George Isaacson Dr. George Isaacson
Cardiologist Cardiologist
45 Inkerman Street 45 Inkerman Street
Caulfield, 3162 Caulfield 3162

19 January 2007 19th January 2007

Dear Dr. Isaacson, Dean Dr. Issacson,

Re: Mr. Jing Zu, Age: 72 years
Re: Mr. Jing Zu
I am writing to refer Mr. Zu, whose features are consistent with ischaemic heart disease. Your
I am writing to refer Mr. Zu, a 72-years-old retired school teacher, to you. Mr. Zu has been suffering further comprehensive management would be highly appreciated.
from ischemic heart disease for ten years, hypertension for 18 years and has had congestive cardiac
failure for five years. He was diagnosed with acute myocardial infarction in 1999. He takes lasix Mr. Zu, is a diagnosed case of hypertension and ischaemic heart disease. Please note, he had a
(40mg), Enalapril (10 mg), Nifedepin (10 mg) and Anginine (as necessary). history of acute myocardial infarction and congestive cardiac failure (CCF).
However, his family history is unremarkable and he is a non-smoker. His current medications are
The patient first came to see me on 03/01/07 complaining of pain in his chest while gardening and Lasix, enalapril, nifedipine, slow KTT and Anginine Tsl.
mild postural dizziness. The pain was easily relieved with rest and Anginine. Stable congestive cardiac
failure with angina was diagnosed, and watchful monitoring was recommended. Initially, on 31/01/07, he presented with angina while gardening, which was relieved with rest and
Anginine. On examination. he was found apparently well along with typical signs of CCF. Therefore,
On the second examination (15/02/2007) his condition had deteriorated. The patient reported stable CCF with angina was diagnosed and watchful monitoring was recommended.
increased dyspnoea with orthopnoea. The oedema on his ankle had worsened. The examination
revealed slightly increased blood pressure (140/90mmhg), chest crepitation to mid zones, and On 15th of January, his condition had deteriorated with worsened symptoms. Examination findings
jugular venous pressure was doubled (+6cm) compared to the previous visit. Therefore, revealed raised JVP (from +3 to +6), crepitations up to mid zones of the chest and ankle oedema up
electrocardiogram was requested, a higher dose of lasix was prescribed (80mg) and another to his knees. Thus, considering deteriorating CCF, Lasix dosage was increased, electrocardiogram
review was scheduled two days later. (ECG) was ordered and a review in 2 days was advised.

Today (19/01/2007) the patient’s condition has improved, however, electrocardiogram shows Today, he reported that he has been feeling better though he had an episode with mild exertion
some ischemic changes anterolaterally. yesterday. Moreover, his JVP was reduced and lesser crepitations were found on the chest.
Furthermore, ECG showed ischaemic changes anterolaterally.
In view of the above, I appreciate your taking over of this patient.
In view of the above, I would appreciate it if you could manage the patient as you feel appropriate.
Yours sincerely,
Yours sincerely,
Doctor
Doctor
[225 words]
TIME ALLOWED: READING TIME: 5 MINUTES Task 21 Assessment
WRITING TIME: 40 MINUTES ? cancer breast

Read the case notes below and complete the writing task which follows. Management
notes: Repeat mammogram and order ultra sound
Today's Date 09/11/17 Advise patient to review in 2 weeks time
Patient History
6/11/17
Somarni Khaze
Pt anxious and worried about results; cannot sleep at night
DOB 12/04/71
BP 150/90 and pulse 88/Min
Works as an operating room nurse at Spirit Hospital
U/S shows 18x 16 MM nodule at left breast with variable echogenecety .The mammogram
Married with 4 children 3 girls aged 17,11 and 7 years and a boy aged 12 years
reveals an area highly suspicious of malignancy at the left breast with multiple nodules at
Has a regular period
the axilla
Sister had cancer breast 7 years ago and was treated by mastectomy and axillary clearance
You counsel the patient about the different options of treatment and you do core biopsy
followed by chemotherapy
to confirm the diagnosis
Past Hx of right breast lump treated by lumpectomy 5 years ago. Dx Benign lesion
Prescribe diazepam 10 mg nocte to calm the patient down
Does not smoke or drink and not using regular medications.
Follow up consultation in 3 days for biopsy result and plan of management.
Did mammogram 2 years ago which showed no suspicions of malignancy.
22/10/17
9/11/17
Subjective
Biopsy result shows moderately differentiated invasive ductal carcinoma of the left breast.
Discovered a left breast lump 6/52 ago
Patient ask to be operated by Breast Surgeon Dr. Alaa Omar who had operated on her
Almond size, not painful and not in size
sister before.
No nipple discharge
Asked about possibility of immediate reconstructive surgery.
Objective
Mildly obese (BMI 31)
Writing Task:
Pulse 74/M regular
You are Dr. Tin Aung a GP at Weller Park Medical Centre, 151 Pring St. Weller Park 4121. Write
BP 120/80 a referral letter to The Breast Surgeon Dr. Alaa Omar: 1414 Wickham Tce. Spring Hill, 4004.
CVS, RS, ABD are all normal In your answer:
Local examination: left breast shows 2x2 CM breast lump hard , non tender with ill defined ● Expand the relevant case notes into complete sentences
margins ● Do not use note form

Palpable mobile axillary lymph nodes ● Use correct letter format

Rt breast is normal except for the scar from previous surgery

The body of your letter should be approximately 200 words. Use correct letter format.
Weller Park Medical Centre TIME ALLOWED: READING TIME: 5 MINUTES Task 22
WRITING TIME: 40 MINUTES
151 Pring St.
Weller Park 4121
Read the case notes below and complete the writing task which follows.
Dr. Alaa Omar
1414 Wickham Tce. notes:
Spring Hill, 4004
Today's Date 20/10/17
09/11/17 You are Dr. Peter Smith, GP covering 3 satellite clinics in a remote mining area of Western
Australia. The nearest tertiary hospital to you is 1250km away in Perth or 2 ½ hours by air
Dear Dr. Omar,
evacuation using the Flying Doctor Service. The nearest poly clinic is in Port Hedland with
Re: Mrs. Somarni Khaze DOB: 12/04/71 radiology and laboratory facilities but it is a 6 hour drive over dirt roads.
I am writing to refer Mrs. Khaze, a 46-year-old married nurse with 4 children who has been
diagnosed with left breast cancer. Patient History
Ammar Moustafawy (DOB: 15/1/61) Male
Mrs. Khaze is a premenopausal woman whose sister was your patient (you treated her for breast Divorced and lives alone
cancer 7 years ago). She is a non-smoker, non-drinker and not on any regular medications. She has a Process Technician at a Copper Mine in the remote Pilbara region of Western Australia
history of benign right breast lump which was treated by lumpectomy 5 years ago and her
Works on rotation with 6 weeks on location and 4 weeks off
mammogram was normal 2 years ago.
Started his present rotation one week ago
Initially, she presented to me on 22/10/17 after she had discovered a left breast lump 6 weeks
previously which was not increasing in size . She was overweight with a body mass index of 31 but Regular overseas holidays
her general examinations were normal. However, a local examination revealed a 2x2 cm hard non- Just returned from the Phillipines 2 weeks ago after spending a 2-week vacation
tender nodule in the left breast accompanied by palpable left axillary lymph nodes while her right Enjoys water sports: scuba diving, sailing
breast showed the scar of the previous surgery. I suspected breast cancer and ordered ultrasound Smokes 20 cigarettes/ day
and mammogram. 2 weeks later, she was anxious and worried with sleep disturbance and the Drinks 14 units/week
results found a 1.6x 1.8 cm nodule in the left breast which was suspected to be malignant with
Walks half an hour every day
multiple axillary lymph nodes. Therefore, I prescribed diazepam 10 mg at night and did a core biopsy
of the nodule. Hx of typhoid fever, (2009) In hospital for 6 days

Today, the biopsy result confirmed the diagnosis of moderately differentiated invasive ductal
Drug history
carcinoma of the left breast.
Not on regular medication
I would appreciate your urgent attention to her condition. Please be advised that Mrs. Khaze has No known allergy
expressed a wish for immediate reconstructive surgery.
Yours sincerely, Family history
Father died of natural causes at 85
Dr. Tin Aung (GP) Mother hypertensive and diabetic aged 76
[253 words] Older sister treated for cancer breast when she was 40 YO
18/10/17 Assessment and plan
Subjective Start IV fluids and medicate Rocephin one gram IV BD and Flagyl 500 MG TDS
Ammar feels unwell, lack of appetite, sense of weakness and lack of energy for 3/7 Contact Flying Doctor Service for urgent US examination or evacuation
Has reduced smoking to 5 cig/day and not drinking for one week Result of US shows enlarged liver 20 CM with a 10x10 cm cystic lesion in the Rt. Lobe of liver
No vomiting but nauseating and passing motion normally You diagnose liver abscess and arrange referral to surgeon in Perth by Flying Doctor Service
Objective escorted by a registered nurse
Patient looks tired, not jaundiced Urgent assessment required including ultrasound guided drainage
Weight 89 kg; Height 193 cm Writing Task:
Pulse 84 regular, BP 130 /80, Temp 37.3° C Refer patient to the Surgical Registrar via the Emergency Department of Perth General
CVS, RS are normal Hospital, 268 Brisbane Rd Cottesloe,Western Australia 6542.
Abdominal examination: lax and mobile with no mass or rebound but tender Rt.
hypochondrium with no organomegaly In your answer:
● Expand the relevant case notes into complete sentences
● Do not use note form
Assessment and planning
● Use correct letter format
Prodromal stage of liver disease or mood swings after changing his drinking and smoking habits
Advise low fat, low protein and rich carbohydrate diet
Order blood, urine and stool tests The body of your letter should be approximately 200 words. Use correct letter format.
Prescribe vitamins B complex tablet one TDS and essential forte capsules 2 TDS
Review in two days for results

20/10/17
Subjective
Ammar is getting worse
Cannot tolerate foods only drinks fruit juice and noticed that the urine is getting darker in
color with chills and rigors
Objective
Temperature 39°C; looks jaundiced and dehydrated
Abdominal examination shows palpable, tender liver
No ascitis
Investigations shows normal stool and 2+ urobilinogin in urine test. Leukocytoses with
increased serum bilirubin and
deranged liver enzymes (ALT And ALP) in blood tests
Surgical Registrar TIME ALLOWED: READING TIME: 5 MINUTES Task 23
via Emergency Department WRITING TIME: 40 MINUTES
Perth General Hospital
268 Brisbane Rd Read the case notes below and complete the writing task which follows.
Cottesloe 6542 notes:
Western Australia Today's Date 15/3/17
20/10/17 Patient Details:
Dear Doctor, Mrs Karen Conway
Re: Mr. Ammar Mostafawy Age 32
DOB: 15/01/1961 Occupation: Solicitor
I am writing to refer Mr. Moustafawy, a 57-year-old male who is a process technician in a copper Husband William - age 33 - Accountant
mine in the Pilbara region. I suspect he is suffering from liver abscess which requires your urgent Karen: previous pregnancy 10 years ago, terminated. William does not know about this.
attention and management. William: no previous pregnancies.
Mr. Moustafawy works on rotation and returned from the Philippines 2 weeks ago. He is a heavy 15/2/17
smoker and heavy drinker but he exercises regularly. Apart from a history of typhoid fever 8 years Subjective
ago, he has no significant medical or family history. Karen reports:
Initially, he presented to me 2 days ago because he had not been feeling well and had felt a sense of Neither she nor William has any significant medical problems.
weakness and nausea over the previous 3 days. He had stopped drinking and reduced smoking Neither smokes
markedly one week ago. His examination was otherwise normal except for tenderness over the right William drinks quite heavily. Also travels regularly with his job.
hypochondrium. Therefore, blood and urine tests were ordered and he was prescribed vitamin B and Married for 3 years, and decided to try for a pregnancy in May 2014, when Karen stopped the
essential forte and advised to increase carbohydrates intake. pill
Unfortunately, his condition deteriorated over the next 2 days. Today, he is dehydrated, jaundiced Was on Microgynon 30 for the previous 5 years.
and febrile with chills and rigors. His temperature reached 39°C and his liver is enlarged and tender
Periods are regular
as [Link] blood test showed leukocytosis and deranged liver functions in addition to increased
urobilinogen in the urine test. The Flying Doctors Agency was contacted and through their ultra No history of gynaecological problems, or sexually transmitted diseases.
sound machine a 10x10 cm liver abscess could be diagnosed. Objective
I started him on intravenous fluids and antibiotics (Rocephine and Flagyl) and arrangements were Karen overweight BMI 28
made to evacuate him by the Flying Doctors to your centre. Pulse and BP normal
I would appreciate your urgent attention to his condition as I believe he will need ultrasound-guided Abdo exam normal
drainage. Vaginal examination normal
Yours Sincerely, Cervical smear taken
Assessment
Dr. Peter Smith (GP) Trying to conceive for only 18 months but Karen clearly anxious
[268 words] Further investigation appropriate
Action Plan
Order blood tests to confirm that hormone levels are normal and that Karen is ovulating Writing Task:
Explain it is necessary to see her husband, William You are Dr Claire Black, GP. Karen Conway has come to consult you as she and her husband have
been trying to conceive for about 18 months without success. She is becoming concerned that
Make a joint appointment
there may be something wrong. Write the referral letter to Dr John Expert MBBS FRANZCOG,
Note - Karen anxious that her history of a termination of pregnancy is not revealed to William. Gynaecologist and IVF Specialist, St Mary's Infertility Centre, Wickham Terrace, Brisbane.

15/3/17 In your answer:

Karen re-attends, accompanied by her husband William Conway. ● Expand the relevant case notes into complete sentences
● Do not use note form
Subjective
Karen states recent home ovulation-prediction test showed positive- likely that she is ● Use correct letter format
ovulating.
William has no significant medical problems
The body of your letter should be approximately 200 words. Use correct letter format.
Contrary to Karen’s opinion he states only drinks 10 units per week
William says works away from home approximately 2 weeks out of 4 - not concerned that
Karen hasn’t conceived -thinks they haven't been trying long enough.
Not keen on being investigated
Objective
Karen's baseline blood tests normal
Ovulation test borderline
Smear test result negative
William refuses to be examined - doesn't think there is a problem.
Assessment
Karen more anxious than before - wants to be referred to an infertility specialist. Her sister
recently had IVF treatment.
William is quite reluctant.
Action Plan
Suggest William do a semen analysis – pressured by Karen he agrees
Reassure Karen no obvious risk factors - not unusual to take up to 2 years to conceive
Karen requests referral to fertility specialist, while waiting for semen analysis results
Give general advice regarding timing of intercourse
Suggest Karen lose some weight
Check Karen taking folic acid, 400 micrograms daily.
Dr. John Expert, MBBS FRANZCOG TIME ALLOWED: READING TIME: 5 MINUTES Task 24
St Mary's Infertility Centre WRITING TIME: 40 MINUTES
Wickham Terrace
Brisbane Read the case notes below and complete the writing task which follows.
notes:
15/03/17
Today's Date 12/09/17
Dear Dr. Expert, Patient History
Arthur Benson
Re: Karen Conway, 32 years old
DOB: 15/04/92
William Conway, 33 years old
Computer Programmer
This couple have requested referral as they have been trying to conceive for approximately 18 Regularly works 55 - 60 hr week
months without success. I have tried to reassure them that there is no reason to be concerned yet, Married with twin boys aged 6 months
particularly as William works away from home regularly and there are no risk factors in their history. Non-smoker and social drinker
However, Karen particularly, was anxious to be referred sooner rather than later. Please note, Karen
Father died at 69 due to stroke
has previously had a pregnancy terminated, which William is unaware of.
Mother is a diabetic on metaformin
Karen has regular periods and has no history of gynaecological problems or sexually transmitted P.M.H.
diseases. She had been using Microgynon 30 as contraceptive pills for 5 years; however, she stopped Asthma since childhood-on steroid inhaler
taking them 18 months ago. Her hormone tests are all normal and ovulation confirmed. I did a smear Allergic to penicillin
test on 15/02/17, which was negative and examination then was normal. She is a little overweight,
with a Body Mass Index of 28 and I have advised that she lose some weight. Karen is taking folic acid 25/08/17
400 mcg daily. Subjective
C/O headache (2/12), mild sensation of pins and needles, no nausea or vomiting
William is a non smoker and drinks 10 units per week, although Karen reports that he drinks heavily. Had a car accident 3 months ago. Hospitalised and discharged after 24 hrs with no
William has no significant medical problems and he declined examination. However, he has agreed complications.
to do na semen analysis, but I don't as yet have the results. I will forward them on in due course. CT scan normal
Objective
Thank you for seeing them and continuing with investigations as you think appropriate. I do wish
O/E-overweight BMI 32
them success.
Gait-normal, has lumbar lordosis
Mild weakness in L/hand
Yours sincerely,
Vision-good
Plan
Dr. Claire Black (GP)
[235 words] Review 2/52
Panadol 2 tab 4/24 and rest 2/52
Advise to reduce weight and increase exercise
06/09/17 Dr. J. Howe
Subjective Neurosurgeon
Feeling better, no new complaints, no worsening of pins and needles sensation Spirit Hospital
Has been walking 30 minutes 3 times a week Wooloongabba
Advised to start work and come back if any concern
Objective 12/09/17
Weight loss 3kg
Dear Doctor,

12/09/17 Re: Arthur Benson

Subjective DOB: 15/04/1992
C/O worsening headaches for 3 days, dizziness, nausea, blurred vision
Pain not responded to Panadol but noticed mild response to Panadeine Forte I am writing to refer Mr Benson, a married computer programmer and father of 6-month-old twins,
Objective who I suspect has a subdural haematoma.
No weight change
Gait-normal Mr Benson first presented to me on 25/08/17 complaining that he had been suffering from
Could not read 2 line of eye chart headaches for the previous two months as well as a sensation of pins and needles. He was
Odematous optic disk on fundi examination overweight but his gait and vision were normal. He had mild weakness in the left hand. He was
BP: 160/70 prescribed Panadol and advised to rest for 2 weeks, reduce weight and increase exercise. He is a
PR: 98bpm non-smoker and social drinker. He has a past history of asthma, which has been treated with steroid
Mild weakness and loss of sensation in medial aspects of L/hand inhaler since childhood.
Reflexes: Elbow-normal, Wrist- no reflexes He is allergic to penicillin and had a car accident 3 months ago at which time he was hospitalised for
Diagnosis: subdural haematoma 24 hours without complications and his CT scan was normal.

Writing Task: On today’s consultation, he complained of severe headache of 3-day duration with mild response to
You are a General Practitioner at a suburban clinic Arthur Benson and his family are regular Panadeine forte. It was associated with dizziness, nausea and blurred vision. His blood pressure was
patients. Using the information in the case notes, write a letter of referral to a neurosurgeon for 160/70, with normal pulse and blurred fundi margins. His gait and elbow reflexes were normal. He
MRI scan. Address the letter: Dr J Howe, Neurosurgeon, Spirit Hospital, Wooloongabba. has mild weakness with loss of wrist reflexes and sensation in the medial aspect of the left hand.

In your answer: I would appreciate your urgent attention to Mr. Benson’s case.
● Expand the relevant case notes into complete sentences
● Do not use note form Yours sincerely,
● Use correct letter format
General Practitioner

[214 words]
The body of your letter should be approximately 200 words. Use correct letter format.
TIME ALLOWED: READING TIME: 5 MINUTES Task 25 Plan
WRITING TIME: 40 MINUTES Diagnosed as left ventricular failure
Broad spectrum antibiotic for 7 days
Read the case notes below and complete the writing task which follows. Frusemide 40 mg/day
notes: Digoxin 0.25 mg/day
Advise to stop smoking and drinking
Today's Date 30/09/17 Review 14 days later
Mild tenderness in lower abdo, no guarding and rebound
Patient History
Mr. Dave Cochrane 25/08/17
D.O.B 20/11/64 Subjective
Smoker: 20 cig/day Feels better
Drinks 12-14u alcohol per week Reduced cig to 10/day and alcohol to 10u week
No reg exercise Objective
Retired at 50 Mild B/L ankle oedema
lives with wife Few crepitations in lung bases
3 children all married Plan
Continue Frusemide and Digoxin
12/08/17 Rest for one week
Subjective
Shortness of breath 30/09/17
tightness in chest Subjective
coughing especially at night Presented with severe shortness of breath, chest pain, sweating for 2 hours
Shortness of breath worse when lying down and feels better when head is raised at end of bed Anxious
Objective Objective
Dyspnoeic Dysponic, B/L ankle oedema
B/L ankle oedema Jugular venous pressure high
High jugular venous pressure No murmurs
Apex beat lateral to mid-clavicular line and in the 6th ICS Apex beat is 6th ICS
Cardiovascular normal Lateral mid-clavicular line
Abdomen normal BP: 120/60
Crepitations in lung base PR: 66 BPM
ECG shows cardiomegaly B/L crepitations in both lung bases
C-xray- features of infection Plan
Needs admission to Cardiology Unit for stabilisation
Writing Task: Emergency Registrar
Using the information in the case notes, write a letter of referral to Emergency Department Emergency Department
QE11 Hospital, 249 Wickham Tce,Brisbane, 4001 explaining the patient's current condition. QE11 Hospital
249 Wickham Tce.
In your answer: Brisbane, 4001
● Expand the relevant case notes into complete sentences
30/09/2017
● Do not use note form
● Use correct letter format Dear Doctor,

RE: Dave Cochrane D.O.B. 20/11/1964

The body of your letter should be approximately 200 words. Use correct letter format. I am referring [Link], who is suffering from an acute left ventricular failure and requires
admission to your Cardiology Unit in order to stabilise his condition.
[Link] retired when he was 50 years old. He smokes 10 cigarettes a day and drinks 10 units of
alcohol per day. He exercises regularly.
On 12/8/2017, [Link] presented with night cough, chest tightness and shortness of breath
which was worse when lying down but improved on raising the head at the end of the bed. On
examination, he was dyspneic. There was bilateral leg oedema, high jugular vein pressure , laterally
deviated apex beat which was located in the 6th intercostal space and basal crepitation on the lung
auscultation. These symptoms were indicative of left ventricular failure. Moreover,
electrocardiography revealed cardiomegaly and the chest X-ray showed features of infection.
Consequently, antibiotic, frusemide and digoxin were prescribed for left ventricular failure. An
appointment in 2 weeks was made.
Two weeks later, the patient's condition had partially improved. Therefore, he was advised to
continue his medications and to rest for one week.
Unfortunately today, [Link] has been suffering from severe shortness of breath, chest pain
and sweating for the last 2 hours. On examination, he was anxious and dyspneic. His blood pressure
was 120/80 mmhg and his pulse was 66. In addition, the same previous signs of left ventricular
failure were observed.
I would appreciate your urgent assessment of this patient.

Yours sincerely,
Doctor
[233 words]
 Symptoms History
TIME ALLOWED: READING TIME: 5 MINUTES Task 26 May 14, 2016
WRITING TIME: 40 MINUTES Jack was first admitted to SHPW with a 6-month history of confusion, difficulty concentrating
on his studies, and frequent mood swings. He stopped attending university and was not in
Read the case notes below and complete the writing task which follows. contact with his friends.
notes:
Diagnosis: Paranoid schizophrenia
Today's Date 27/12/17 He was hospitalised for 2 weeks & stabilised on Haldol 20 mg and sodium valproate 125 mg,
daily.
You are a Psychiatrist at Spirit Hospital Psychiatric Emergency Care Centre (SECC) and Jack Mills Plan
is a patient on the ward. Live with his mother in Parramatta (Sydney area)
Referral to psychiatrist arranged along with weekly group psychotherapy in Spirit Community
Patient Details Mental Health Service,NSW.
Name- Jack Mills, DOB 01/09/1996 Discharged 28/5/16
Marital Status: Single
Admission: 23/11/2017 (Spirit Hospital Psychiatric Emergency Care Centre) August 2017
Discharge: 27/12/2017 Attempted suicide: A possible stressor was that 1 week ago his mother said about ideas to
remarry in the near future
Diagnoses: Paranoid Schizophrenia/Nicotine Dependence
Self-harm through deep cut on both wrists
Family History Hospitalised in ED, surgical tx, under 24hr supervision. Refused to change medication
Jack's parents separated 4 years ago and divorced 2 years ago His attendance in group psychotherapy was irregular.
No other children in the family
November 2017
Psychosocial History He has been increasingly isolated for the past 2 weeks, working on his computer and is very
Completed high school; above-average student; often involved in school and secretive about what he is doing
extracurricular activities He stopped attending his work program, saying that he had “more important work” to do at
He smokes a pack of cigs a day and drinks beer daily. Binge drinking episodes while at home
university. He denies any illicit drug use His mother believes he stopped taking medications
He has a keen interest in computers and collected considerable equipment and software, Jack refuses to eat or talk with his mother; is nervous because of his mother’s plans to remarry)
primarily gifts from his father He was brought to Spirit Hospital Psychiatric Emergency Care Centre (SECC) by his mother on
He has been on Disability Support Pension (DSP) since 2016 23/11/17
He has been irritable, suspicious and stated that he has been hearing multiple voices in his
Medical History head for the past week
Nil
Hospital progression Follow-up
The patient’s sodium valproate was increased to 125 bd and then 250 tds The patient will be living with his mother
His need for intramuscular (IM) medication, or other medication was explained. The patient Will be continued on medication (Sodium valproate 250 bd and Navane 1.5 mg IM q. 4 weeks
fiercely objected about injection, saying, “I am a reliable person, I can always take the (the next dose is due on January 16, 2018)
medicine.” The fact is that he has not been very compliant. After much discussion, the patient LFTs and sodium valproate level to be checked annually
has agreed to take 4 mg of Navane IM, qid Cholesterol level to be regularly controlled
Jack received one-to-one, supportive, and insight-oriented psychotherapy on various issues Diet: Low cholesterol
(importance of compliance,taking meds, and avoiding alcoholic beverages). His participation One-to-one psychotherapy
through the program was less than adequate as he could not concentrate and focus, but he Advise to abstain from alcohol & give up smoking
still participated in psychotherapy group Vocational rehabilitation and "day programs" to improve self-esteem, quality of life,
treatment compliance, and clinical and social stability
Lab tests
Serial FBC for had shown WBC ranging from 9.2 to 12. RBC had ranged from 4.88 to 5.5 Writing Task:
Cholesterol was 5.3 mmoll/L Using the information in the case notes, write a letter to Dr. Twyford, the Psychiatrist at
T4 was 12.1, the next T4 was 10.1 (normal range 10 - 25 pmol/L), T3 was 4, 7(normal range 4.0 Parramatta Spirit Community Mental Health Service, NSW, 2345.
– 8.00 pmol/L), TSH has ranged from 1.2 to 1.5 (normal range 0.4-5.0 mIU/L)
In your answer:
Sodium valproate level was 42 μg/mL (normal range - 50-100 μg/mL)
● Expand the relevant case notes into complete sentences
Urinalysis - normal
● Do not use note form
● Use correct letter format
Condition on discharge
Improving
Ability to manage funds and finances The body of your letter should be approximately 200 words. Use correct letter format.
Improving
Ability to use good judgment
Still impaired
Prognosis
Guarded
Dr. Twyford TIME ALLOWED: READING TIME: 5 MINUTES Task 27
Psychiatrist WRITING TIME: 40 MINUTES
Spirit Community Mental Health Service
Parramatta Read the case notes below and complete the writing task which follows.
NSW 2345 notes:
Today's Date 21/02/17
27/12/2017 Patient Details
Sally Webster
Dear Dr. Twyford,
DOB 10/11/00
Re: Mr. Jack Mills, DOB 01/09/1995 High school student

I am referring this patient, a 22-year-old man who has a history of paranoid schizophrenia. 27/12/16

Jack was initially diagnosed with schizophrenia 18 months ago and has had frequent admissions due Subjective
to recurrent episodes of psychosis including an attempted suicide. His compliance has been poor for 3/12 constipation
medications and structured work programs. With regard to his psychosocial history, he has a history 1 firm bowel action every 4 to 5 days
of nicotine dependence and binge drinking episodes. His parents divorced 2 years ago and he is Diet includes 2 table spoons of bran each morning
currently living with his mother. Furthermore, he has been on disability support pension since 2016.
Has tried laxatives
He was admitted to our hospital on 23/11/2017, with signs of suspiciousness, oversensitivity, Otherwise well
auditory hallucinations and irritable mood. During hospitalisation, sodium valproate and Navane
were used, and psychotherapy was commenced, although his participation was inadequate because Objective
of his difficulties in concentrating. Apart from this, his laboratory tests were unremarkable. Wt. 54kg
BP 100/50
Jack’s condition has generally improved and he will be discharged today. I have advised him to avoid P 70 reg
alcoholic beverages, quit smoking, follow psychotherapy and vocational rehabilitation and have
Abdo: lax, no masses
blood tests annually. Moreover, he will be continued on sodium valproate 250mg twice daily and
Navane 1.5mg every 4 weeks intramuscularly. Please note that the next injection of Navane is on P.R. exam unremarkable
16/01/2018. Advised to increase vegetable, fibres and fluid intake.

I would appreciate it if you could take over his care for ongoing management. 15/02/17
Subjective
Yours sincerely, Presents with mother. Mother concerned about Sally’s lack of appetite and loss of weight.
Much fighting at home about
Psychiatrist habits. Sally claims to feel well and can’t see “ what all the fuss is about”. She just isn’t hungry.
[217 words]
Objective Dr. Midori Yabe
Wt. 48kg Psychiatrist
Pale, thin 48 Wickham Tce
Spring Hill
BP 100/60 Lying and standing
Abdo and urinalysis unremarkable 21/02/17
Plan
Review Sally alone Dear Dr. Yabe,
Tests: FBE/TFT’s U+E/LFT’s
Re: Miss Sally Webster
21/02/17 DOB: 10/11/00
Subjective
Distant, little eye contact. Feels parents are “overreacting”. Feels ideal weight is 40 kg ( I am writing to refer Sally, a 16-year-old high school student who is suffering from anorexia nervosa.
currently 47kg). Denies vomiting.
Vague about laxative use. Initially, she came to see me on 27/12/16, complaining of constipation, and requesting strong
Test Results: All normal laxatives for this problem. Her weight was 54 kg and her vital signs and physical examination were
Assessment normal. Her diet included 2 spoons of bran each morning. Therefore, she was advised to increase
Anorexia Nervosa vegetables, fibre and fluid intake.
Plan
Refer to psychiatrist On the 15/02/17 consultation, despite Sally claiming that she did not believe she had a problem,
her mother reported that she was concerned about Sally’s poor appetite, loss of weight and
Writing Task: argumentative behaviour. Her weight was 48 kg and her vital signs, physical examination and
Using the information in the case notes, write a letter of referral to the Psychiatrist Dr. Midori urinalysis were normal. I requested blood samples for blood chemistry and electrolytes.
Yabe, 48 Wickham Tce, Spring Hill.
On today’s consultation, Sally was interviewed alone. She had poor eye contact and she believes
In your answer: that her parents were overacting about her idea of reducing her weight to 40 kg. She denied
● Expand the relevant case notes into complete sentences vomiting and she was vague reporting about laxative use. Her weight was 47 kg and her blood
tests were normal.
● Do not use note form
● Use correct letter format I would appreciate your urgent assessment of Sally’s case. Please let me know if you need
further information.
The body of your letter should be approximately 200 words. Use correct letter format.
Yours sincerely,

Dr. X

[198 words]
TIME ALLOWED: READING TIME: 5 MINUTES Task 28 09/02/2014
WRITING TIME: 40 MINUTES
Subjective:
Read the case notes below and complete the writing task which follows. Cough increase, thick yellow phlegm
Feels quite run-down
notes:
Not dyspnoeic
: Taking all medications
Mrs May Hong is a 43-year-old patient in your general practice. No cigarettes for last 2 days
07/02/2014 Objective:
Subjective:
Looks worn-out
Noted a productive cough over last 3/7
T: 38.5 ̊C
No dyspnoea or pain
P: 92, AF
Feverish
BP: 120/80
Continues to smoke 10 cigarettes/day
Mild crackles noted at R lung base posteriorly
Occasional scattered crackles. Otherwise unchanged
History:
Rheumatic carditis in childhood, resulting in mitral regurgitation & atrial fibrillation (AF)
Assessment:
Bronchitis increase severity , early R basal pneumonia
Objective: Looks tired
Plan:
T: 38 ̊C
Sputum sample for microscopy and culture (M&C)
P: 80, AF
FBE, chest X-ray
BP: 140/80
Chest physiotherapy
Ear, nose, throat (ENT) – NAD
Prothrombin ratio today (result in tomorrow)
Moist cough
Review tomorrow
Scattered rhonchi through chest, otherwise OK
Apical pansystolic murmur
10/02/2014
Assessment: Subjective:
Acute bronchitis; cigarettes increase condition severity ++ Brought in by son
Plan: Advised – cease smoking Quite a bad night
Amoxycillin 500mg; orally t.d.s. Symptoms
Other medications unchanged (digoxin 0.125mg mane, warfarin 4mg nocte) Pleuritic R-sided chest pain, febrile, dyspnoea
No known allergies (NKA) Prothrombin ratio result 2.4 (target 2.5-3.5)
Review 2/7
Check prothrombin ratio next visit
Objective: Dr L Roberts
Unwell, tachypnoeic Admitting Officer
T: 38 ̊C Newtown Hospital
P: 110, AF 1 Main Street
BP: 110/75 Newtown
Jugular venous pressure (JVP) not elevated
10 February 2014
R lower lobe dull to percussion with overlying crackles
L basal crackles present
Dear Dr. Roberts,
Pansystolic murmur is louder
M&C: gram-positive streptococcus pneumoniae, sensitive – clarithromycin & erythromycin Re: Mrs May Hong
Amoxicillin resistant
Chest X-ray: Opacity R lower lobe Thank you for seeing this 43-year-old patient with right lower lobar pneumonia for assessment.
FBE: Leukocytosis 11.0 x 10 9/L Mrs Hong has a past history of rheumatic carditis, with resultant mitral regurgitation and atrial
fibrillation. Her usual medications are digoxin 0.125mg mane and warfarin 4mg nocte. She has no
Assessment: known allergies. Her last prothrombin ratio taken on 09/02 was 2.4.
R lower lobar pneumonia
Today, she presents with a six-day history of productive cough with associated fever and lethargy.
Plan: This was treated initially with oral amoxycillin (ineffective) and then chest physiotherapy, but today
Urgent hospital admission. Spoke with Dr Roberts, admitting officer, Newtown Hospital Ambulance she has deteriorated with tachypnoea and right pleuritic chest pain. The right lower lobe is dull to
transport organised percussion and crackles are present in both lung fields, worst at the right base. Her temperature is
38 ̊C, BP 110/75,pulse 110 (irregular) and her usual pansystolic murmur is louder than normal.
Writing Task: Sputum M&C showed gram-positive streptococcus pneumoniae. The X-ray showed opacity in the
Using the information given in the case notes, write a letter of referral to Dr L Roberts, the Admitting right lower lobe.
Officer at Newtown Hospital, 1 Main Street, Newtown, for advice, further assessment and treatment.
I believe her rapid deterioration warrants inpatient treatment.
In your answer:
● Expand the relevant case notes into complete sentences I would appreciate your assessment and advice regarding this. I will be in touch to follow her progress.
● Do not use note form
Yours sincerely,
● Use correct letter format
Doctor
The body of your letter should be approximately 200 words. Use correct letter format.
TIME ALLOWED: READING TIME: 5 MINUTES Task 29 23.4.97
WRITING TIME: 40 MINUTES Subjective: Mild burning epigastric pain, radiating retrosternally. Occurs after eating and walking.

Read the case notes below and complete the writing task which follows. Objective: BP 155/100
notes: Abdominal and cardiovascular exam otherwise normal.

20.3.97 Assessment: ? Gastric reflux. Non-compliance with anti-hypertensive medication.

Patient History Plan: Add Mylanta 30 mls q.i.d.

Derek Romano is a patient in your General Practice. Increase nifedipine to 20 mg twice daily.

Subjective: 46 year old insurance clerk wants “check up” smokes 1 pkt cigarettes per day 30.4.97
high blood pressure in past Subjective: Crushing retrosternal chest pain. Sweaty. Mild dyspnoea.
no regular exercise Onset while walking, present for about one hour.
father died aged 48 of acute myocardial infarction
married, one child Objective: BP 160/100 P 64 in obvious distress
no medications or allergies Few crepitations at lung bases.
ECG – inferior acute myocardial infarction.
Objective: BP 150/100 P 80 regular
Overweight Ht – 170 cm Wt – 98 kg
Assessment: Acute myocardial infarction
Cardiovascular and respiratory examination normal
Urinalysis normal
Plan: Oxygen given
Anginine given sublingually
Plan: Advise re weight loss, smoking cessation
Morphine 2.5 mg given IV stat
Review BP in 1 month
Maxolon 10 mg given IV stat
You decide to call an ambulance and send this man to the Emergency Department, at the Royal
8.4.97
Melbourne Hospital.
Subjective: Still smoking, no increase in exercise
Writing Task:
Objective: BP 155/100
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.
Assessment: Hypertension
In your answer:
Plan: Commence nifedipine (calcium channel blocker) 20 mg daily ● Expand the relevant case notes into complete sentences
Check blood glucose, serum cholesterol ● Do not use note form
Cholesterol = 6.4 mmol/L ● Use correct letter format
– WRITING SUBTEST
The body of your letter should be approximately 200 words. Use correct letter format.
Emergency Department TIME ALLOWED: READING TIME: 5 MINUTES Task 30
Royal Melbourne Hospital WRITING TIME: 40 MINUTES
Flemington Road
Parkville 3052 Read the case notes below and complete the writing task which follows.
notes:
The Registrar 30 April, 1997 Today's Date: 15/03/10

Dear Doctor, Patient History

Mrs Karen Conway has consulted you, her GP, as she and her husband have been trying to conceive
Re: Mr Derek Romano for about 18 months without success, and she is becoming concerned that there may be something
wrong.
I am writing to refer Mr Romano, a patient of mine to you. Mr Romano, is 46 years old and is an Karen is a 32 year old solicitor.
insurance clerk, he is married with one child, and is suffering from his first episode of ischaemic (or Her husband, William, is a 33 year old accountant.
cardiac) chest pain. The patient first attended me six months ago. His risk factors include: Karen: previous pregnancy 10 years ago, terminated. William does not know about this.
hypertension, smoking (one packet per day), obesity, strong family history (father died of an acute William: no previous pregnancies.
myocardial infarction aged 48) and hypercholesterolemia (Total cholesterol = 6.4 mmol). He has no
known allergies. 15/02/10
Subjective
After persistently elevated blood pressure readings around 150/100, patient was commenced on Karen attends on her own. She reports that neither she or William have any significant medical
nifedipine and this was recently increased to 20 mg twice daily. He also uses Mylanta for reflux problems. Neither partner smokes, although she reports that William drinks quite heavily. Also he
oesophagitis. A cardiovascular examination on 23.4.97 was normal. has to travel regularly with his job.
Married for 3 years, and decided to try for a pregnancy in May 2006, when Karen stopped the pill.
Today Mr Romano presented following a minimum of one hour of crushing, retrosternal chest pain. Was on Microgynon 30 for the previous 5 years.
He felt nauseated and sweaty with mild dyspnoea. Examination revealed a distressed and anxious Periods are regular
man with a pulse of 64 (sinus rhythm) and blood pressure of 160/100. Crepitations were noted on No history of gynaecological problems, or sexually transmitted diseases.
chest auscultation. Electrocardiography revealed changes consistent with an inferior myocardial
infarction. Objective
Karen overweight BMI 28.
Oxygen was given and one anginine sublingually followed by morphine 2.5mg intravenously. His pain Pulse and BP normal.
has now settled but I consider he requires admission to the Coronary Care Unit for stabilisation. I will Abdo exam normal.
telephone later to check on his condition. As is some time since she last had a smear test, you do a vaginal examination, which is normal, and
take a cervical smear.
Yours sincerely,
Assessment
Dr X Although the couple have only been trying to conceive for 18 months, Karen is clearly very anxious,
and so you decide that further investigation is appropriate.
Plan Writing Task:
Blood tests for Karen required to confirm that her hormone levels are normal and that she is You are her GP, Dr Claire Black. Write the referral letter to Dr John Expert MBBS FRANZCOG,
ovulating. You explain to Karen that it is necessary for you to see her husband, William also, and ask Gynaecologist and IVF Specialist, St Mary's Infertility Centre, Wickham Terrace, Brisbane.
her to make an appointment for him. Karen anxious that you do not reveal her history of a In your answer:
termination of pregnancy to him. ● Expand the relevant case notes into complete sentences
● Do not use note form
15/03/10 ● Use correct letter format
Karen re-attends, accompanied by her husband William Conway.
The body of your letter should be approximately 200 words. Use correct letter format.
Subjective
Karen's baseline blood tests are normal, except the test for ovulation is borderline. However Karen
informs you that she has used a home ovulation-prediction test which did show positive, so it is
likely that she is ovulating. Smear test result negative.
As Karen reported, William has no significant medical problems. He says he only drinks 10 units per
week, which does not agree with Karen's previous comments that he drinks heavily. He also explains
that he works away from home approximately 2 weeks out of 4, so he is not so concerned that Karen
has not conceived yet, as he thinks that it is because they haven't been trying long enough.
Therefore not keen on being investigated.

Objective
William refuses to be examined as he doesn't think there is a problem.

Assessment
Karen is even more anxious that when first seen and wants to be referred to an infertility specialist,
whereas William is quite reluctant. She tells you that her sister has recently had IVF treatment.

Plan
You suggest that William do a semen analysis, to which he agrees reluctantly, under pressure from
Karen. You try to reassure Karen that it is not unusual to take up to 2 years to conceive, and there
are no obvious risk factors, however at Karen's insistence, you agree to refer them to a specialist,
while awaiting the results of the semen analysis. You give them some general advice regarding
timing of intercourse, and suggest to Karen that she should try to lose some weight. Lastly you check
that Karen is taking folic acid, 400 micrograms daily.
Dr John Expert, MBBS, FRANZCOG
St Mary's Infertility Centre
Wickham Terrace TIME ALLOWED: READING TIME: 5 MINUTES Task 31
Brisbane WRITING TIME: 40 MINUTES

15.3.10 Read the case notes below and complete the writing task which follows.
notes:
Dear Dr Expert,
Patient History
Re: Karen Conway, DOB 1.2.78 John Haywood DOB 23.5.85. On holidays after overseas trip – staying with his parents in Brisbane for
several weeks before returning to Melbourne his normal residence. You are his parents regular GP.
William Conway, DOB 2.1.77 He has experienced pains in his right calf since arriving from UK four days ago. States pain has
become increasingly severe and his calf is tender to touch.
This couple have requested referral as they have been trying to conceive for approximately 18
months without success. I have tried to reassure them that there is no reason to be concerned yet, 07.01.08
particularly as William works away from home regularly and there are no risk factors in their history, Single, Monash University student studying commerce.
however Karen, particularly, was anxious to be referred sooner rather that later. Smokes 8 – 10 cigarettes a day. Social drinker (4 – 6 small beers) mainly at the weekend.
Plays squash and walks regularly.
Karen has regular periods and has no history of gynaecological problems or sexually transmitted Currently not on any medication.
diseases. Her hormone tests are all normal, and ovulation confirmed. I did a smear test on 15.2.08 No known allergies
which was negative, and examination then was normal. She is a little overweight, with a Body Mass
Index of 28, and I have advised that she lose some weight. Karen is taking folic acid 400 mcg daily. Objective
BP 120/70 P 74 regular
William also has no significant medical problems and he declined examination. However, he has Cardiovascular and respiratory examination normal
agreed to do a semen analysis, but I don't as yet have the results. I will forward them on in due Tenderness and swelling in right calf
course.
Assessment
Thank you for seeing them and continuing with investigations as you think appropriate. I do wish Suspected Deep Vein Thrombosis – Send to Queensland Xray for Ultra Sound.
them success.
Action
Yours sincerely, Schedule appointment for 8.1. 08 to review results

Dr Claire Black (GP)

[184 words]
 Assessment
08.01.08 Advised patient to cease Fragmin injections. To take ½ an aspirin daily. Flight to Melbourne in early
Results 4 cm thrombus in soleal vein 16 cm below knee crease in right calf. February OK Elastic stockings and exercise during flight recommended. Fragmin injection prescribed
to be given pre and post flight. Regular GP to be contacted before ceasing daily aspirin dosage.
Action
Explain diagnosis and treatment to John. Provide literature on “stop smoking’ initiatives. Prescribe Writing Task:
Clexane 40mg/0.4ml injections twice daily for three weeks. Arrange for nurse practitioner at your Write a letter to John’s regular GP - Dr. Sue Cairns, 291 Rae Street. Fitzroy North Melbourne 3068.
clinic to teach John how to self inject. Advise John to avoid further flights for at least 4 – 6 weeks In your answer:
depending on response to Clexane. ● Expand the relevant case notes into complete sentences
● Do not use note form
14. 01.08 ● Use correct letter format
Subjective
John comes to your surgery to report what he thinks is an allergic reaction to the injection. The body of your letter should be approximately 200 words. Use correct letter format.
Advises he has succeeded in reducing cigarettes to two a day.

Objective
BP 120/75 P 74 regular
Cardiovascular and respiratory examination normal
Red rash, bruising and welts around injection site.

Decision
Change prescription from Clexane to Fragmin 5000u/0.2ml injections twice daily. Prescribe soothing
cream for rash. Arrange appointment for Ultra Sound to monitor progress on 22.1 08

23.01.08
John comes to surgery for results of latest Ultra Sound. Advises he has not smoked at all since last
visit. He is keen to fly back to Melbourne in early February when his university course recommences.

Results
Persistent soleal thrombus - no significant change but evidence of small decrease in size

Objective
BP 130/70 P 72 regular
Decrease in tenderness and swelling in right calf.
Injection site improved but still some redness and irritation of the skin.
Dr. Sue Cairns TIME ALLOWED: READING TIME: 5 MINUTES Task 32
291 Rae Street WRITING TIME: 40 MINUTES
Fitzroy,
Victoria, 3068 Read the case notes below and complete the writing task which follows.
notes:
23/01/2008 Patient History
Constance Maxwell is a patient in your General Practice
Dear Doctor Cairns, DOB 08.08.38 Married, 3 adult children

Re: John Haywood 21.02.10

DOB 23/05/1985 Subjective
Complains of inflamed, sticky and weeping eyes.
Mr Haywood came and saw me because he has been experiencing pain in his right calf after his long Thyroidism diagnosed Feb 07
flight from Melbourne. He normally studies in Melbourne and was visiting his parents in the UK for a High blood pressure June 09
couple of weeks. He smokes 8-10 cigarettes a day, is a social drinker and is not on any medication. Hip replacement July 09
Medications – Thyroxine 1mg daily, Atacand 4mg daily, Fosamax 10mg daily
On examination today, his right calf was tender. I suspected a deep vein thrombosis which was No known allergies
confirmed by ultrasound. The imaging showed a 4cm thrombis in the soleal vein 16 cm below the
knee extending into the right calf. I advised that he stop smoking and prescribed 40mg clexane twice Objective
daily. Unfortunately he developed an allergy to this treatment one week later. I changed the BP 135 /75 P 74
medication to fragmin 5000 IV twice daily and decided to review his condition with a new ultrasound Both eyes – red, watery discharge right eye worse than left
in two weeks. Assessment
Bilateral conjunctivitis –likely viral
Today the report showed that the thrombis has decreased in size. Furthermore the tenderness and Chlorsig Drops 4hrly
swelling has decreased. I put him on half an aspirin daily and recommended that he inject fragmin
before and after his flight back to Melbourne which he has planned in early February. 03.03.10
Subjective
I advised him to contact you regarding further management of his condition. No improvement to eyes, blurred vision
Yours sincerely, Objective
Odema eye lids ++
Dr X (GP) Marked conjunctival congestion

Plan
Chloramphenicol 0.5% sterile 1 drop 3 times daily
Bion Tears 1 drop each eye 4 hrly
Review 2 weeks
05.06.10 The Emergency Department
Royal Melbourne Eye Hospital
Subjective Alexandra Parade
Accompanied by husband. Very distressed. Has lost most sight in both eyes –can make out light or Fitzroy
dark shapes but unable to read or watch TV.
05/06/10
Objective
Marked odema upper and lower lids Dear Doctor
White sticky discharge Unable to read eye chart Re. Mrs Constance Markwell

Plan I am writing to refer Mrs Howell, a 72 year old married mother of 3 adult children who is presenting
Refer immediately Emergency Dept, Royal Melbourne Eye Hospital. with a visual impairment.
Husband will drive to hospital
Initially, she presented to me on 21/2/10, complaining of inflamed, sticky and weeping eyes. Both
WRITING TASK her eyes were reddish with watery discharge. However, her right eye was worse than the left eye.
Therefore she was prescribed chlorisig drops 4 hourly. She has had thyroidism for 3 years, high blood
Using the information in the case notes, write a letter of referral to the Registrar, Emergency pressure for 1 year and a hip replacement was done in 2009. Her current medications are Thyroxin 1
Department, Royal Melbourne Eye Hospital, Alexandra Tce, Fitzroy, Melbourne 3051 mg, Atacand 4 mg and Fosamax 10 mg daily. She has no known allergies.

In your answer: On review after 2 weeks, she had made no improvement. In addition she had blurred vision with
● Expand the relevant case notes into complete sentences odematous eye lids and conjunctival conjestion., so chloramphenicol was prescribed 0.5% one drop
● Do not use note form three times daily and Bion tears one drop 4 hourly.
● Use correct letter format
Unfortunately, today she was accompanied by her husband with complaints of impaired vision in
both eyes and an inability to read books or watch television. There was oedema in both eyelids with
white discharge. She could not read the eye chart.
The body of your letter should be approximately 200 words. Use correct letter format.
In view of the above signs and symptoms I believe she needs immediate eye care facilities. I would
appreciate your urgent attention to her condition.

Yours sincerely

Dr X

[211 words]
TIME ALLOWED: READING TIME: 5 MINUTES Task 33 Assessment: Ischaemic heart disease/angina
WRITING TIME: 40 MINUTES Viral upper respiratory tract infection

Read the case notes below and complete the writing task which follows. Plan: Commence on lipitor, nitrates(imdur), aspirin and prn anginine
Educate anginine use
notes:
Review in 2/52
John Elvin is a 48-year-old patient in your General Practice
5/05/11
26/5/11
Subjective: Complaint of occasional mild central chest pain on exertion
Subjective: Chest pain for the last week
Has mild asthma but otherwise previously well
Still c/o frequent mild wheeze
Nil family history of cardiac disease
Often forgets to take seretide puffers because of ETOH consumption
1 pack day smoker and drinks 10 standard drinks 5/7
Under significant stress with own business
Objective Mild bilateral wheeze still present
Medications – seretide two puffs BD salbutamol two puffs prn
Allergies - Nil
Assessment Mild Asthma 2⁰ to ↓ compliance with medication
Alcohol dependence now affecting medication compliance
Objective: Nil chest pain O/E
ECG NAD
Plan Emphasised importance of preventative anti-asthma meds
Troponin level NAD
Recommended pt write put a reminder for asthma and all medications on his fridge.
Encouraged pt to use prn salbutamol until asthma improves
Assessment: Early stages of IHD
Offered ETOH dependence treatment pharmacotherapy- will consider this.
D/D - stress related chest pain
Alcohol dependence but not interested in changing
1/6/11
Subjective: Passing by medical centre and c/o sudden onset crushing chest pain on background
Plan: Check serum lipids
of URTI and worsening asthma since last
Refer for exercise stress test
Not relieved by anginine
Review in 1 week
Very audible wheeze
12/5/11
Examination ECG – mild ST elevation in anterior leads. ST 120
Subjective: Still only very occasional chest pain on exertion
Lungs – O/A moderate wheeze and mild bilateral crackles. SP O2 86% on R/A
Has runny nose & pharyngitis at present with ↑asthma symptoms
Heart – Slight S3 sound +ve
Attended stress test with very mild chest pain at high exercise load
Assessment Likely anterior AMI; ? triggered by respiratory issues
Objective: Some very slight ischaemic changes present in exercise test
Acute exacerbation of asthma 2⁰ to URTI
Mild bilateral wheeze present
? Mild APO
Cholesterol mildly ↑
 Dr Jeremy Barnett
Plan Paramedic transfer to ED The Emergency Registar on Duty
O2 15L via non-rebreather (pt isn’t CO2 retainer) Maroubra Hospital
GTN patch applied Lakes Road
IV morphine 5mg given Maroubra
Ipatropium Bromide 500ug given via nebuliser in view of tachycardia
29/06/2018
Frusemide 40mg given
Dear Dr Barnett,
Writing Task:
Using information provided in the case notes, write a referral letter to Dr Jeremy Barnett, the Re: Mr John Elvin,
Emergency Registrar on duty at Maroubra Hospital, Lakes Rd, Maroubra.
I am writing to refer Mr. Elvin, a 48-year-old businessman who is presenting with signs and symptoms
In your answer: suggestive of anterior myocardial infarction and acute exacerbation of asthma. Your urgent treatment and
● Expand the relevant case notes into complete sentences assessment would be greatly appreciated.
● Do not use note form
Mr Elvin presented to the general practice on 5/05/11 complaining of associated mild central chest pain on
● Use correct letter format
exertion. He has a history of mild asthma for which he takes seretide and salbutamol inhalers. He smokes 1
pack daily and consumes about 10 drinks 5/7. In addition, he is under significant stress with his own
business. Please note, there are no family history and allergies.
The body of your letter should be approximately 200 words. Use correct letter format.
On his subsequent visits, exercise stress test revealed very slight ischemic changes. Also, mild bilateral
wheeze was presented due to viral upper respiratory tract infection. He was commenced on Lipitor,
nitrates, aspirin and Anginine. I gave him some advice regarding improving his compliance with medications.

Today, Mr Elvin presented complaining of sudden onset of crushing chest pain and very audible
wheeze. Cardiovascular examinations showed mild ST elevation in anterior leads with ST 20 and slight S3
sound. Moreover, mild bilateral crackles were noted. GTN patch, IV morphine 5 mg, Ipatropium bromide
500 mg via nebulizer and Frusemide 40 mg were given.

In view of the above, my provisional diagnosis is acute myocardial infarction with exacerbation of asthma.
and have requested a paramedic transfer. If you have any queries, please do not hesitate to contact me.

Yours sincerely,

Doctor X

[241 words]
 3.03.11
TIME ALLOWED: READING TIME: 5 MINUTES Task 34 Mental health team used interpreter and concur with provisional diagnosis of mania.
WRITING TIME: 40 MINUTES They state the following: no immediate dangers to self/others; MH keen for GP involvement due to
language issues and they will monitor pt. daily; they are keen to avoid hospitalisation as pt.
Read the case notes below and complete the writing task which follows. very afraid of idea of psych. ward due to stigma of the same in China
Today pt’s uncle accompanied pt. to GP surgery get blood results.
notes:

O/E
Yuxiang Meng is a 21 year old overseas student chef from China in your general practice. He only
* Bloods NAD except mildy ↓protein & mild hypokalaemia (3.2 K+)
speaks very basic English and sees you because you are a GP from a Chinese background and speak
*CT NAD
Mandarin.
*MSE – still tangential and delusional about same theme, but only mildly elevated since sleeping
well post diazepam
2.03.11
Chief complaint - URTI symptoms for 5 days.
Assessment: Likely non-organic mania
O/E:
Plan:
*Mild pharyngitis & rhinorrhea. T 37.5
*Commence pt. on quetiapine 50mg BD (starting dose)
*C/O chronic insomnia
*↓diazepam to 10mg either BD or TDS depending on MH team’s assessment.
*Observed to be elevated in mood, tangential & ? delusional about fixing the world’s nuclear waste
*R/V in 3/7; likely ↑of quetiapine.
problem
*Commence pt on K+ (Span K) tablets.
*Nil obvious signs of organic syndromes
7.03.11
Assessment: Mild viral illness & ? mania/1st episode BPAD
Pt. was relatively settled for 3/7 but uncle suspects he has secreted & discarded meds.
Last night stayed up all night singing Chinese revolutionary songs (not usual behaviour) and
Plan: Nil treatment for URTI, just rest & ↑fluid intake. Referral made to local community
running naked down his street. Uncle didn’t want to call MH for fear of ‘getting locked up’.
mental health for urgent assessment. Pt. escorted home by his uncle. Diazepam 10mg
QID prescribed & to be given with community MH team’s supervision.
O/E
Investigations ( exclude organic pathology & baseline)
* Pt very elevated in mood, pressured in speech, loose in associations and fixated on having
-FBC
to rid Australia of all nuclear waste by tomorrow.
-UEC
Believes he can draw power from Mao Ze
-TFTs
Dong’s spirit to achieve this.
-LFTs
*Pt stripped naked in front of GP and tried to hug him.
-CMP
-urgent CT scan
Assessment Acute manic episode
 Dr Ben Hinds
Plan: Psychiatry Register
Offered stat quetiapine 100 mg & diazepam 20mg but refused. Maroubra Hospital
Schedule pt under MHA Lakes Rd
Have uncle accompany pt with ambulance & police to RNSH ED Maroubra
Refer to on call psych reg Dr Ben Hinds
Update local MH team. 7/3/2011
Long term – try to refer to Chinese speaking psychiatrist.
Dear Dr Hinds,
Re: Yuxiang Meng
Writing Task:
Using information provided in the case notes, write a referral letter to Dr Ben Hinds, the Psychiatry I am writing to refer Mr Meng, a 21-year old student who is presenting with signs and symptoms
Registrar on duty at Maroubra Hospital, Lakes Rd, Maroubra. suggestive of an acute manic episode. It is important to note that he only speaks very basic English.

In your answer: On 2/03/11, the patient initially presented with his first episode of mania complaining of chronic
● Expand the relevant case notes into complete sentences insomnia where he was found to be elevated in mood and had tangential as well as delusions thoughts.
● Do not use note form Therefore, he was referred to local community mental health, and diazepam 10 mg 4 times a day was
● Use correct letter format prescribed. In addition, routine investigations were ordered to exclude organic pathology.

A day later, Mr Meng was still tangential and delusional, but he was sleeping well with diazepam.
The body of your letter should be approximately 200 words. Use correct letter format. Investigation results were normal except mildly decreased protein and mild hypokalemia.
At that time, the diagnosis of mania was confirmed by mental health team. Accordingly, quentiapine
50 mg two times a day and Span K tablets were commenced, but diazepam was adjusted to 10 mg
either two or three times a day.

Today, the patient presented with worsening symptoms, was pressured in speech with abnormal
behavior and refused to take medications. Consequently, I have referred him to KNSH ED. Please note
that his uncle who accompanies him suspects non-compliance with medicines.

Based on the above, I believe that this patient needs a psychiatric consultation and would appreciate
your assessment and management of his condition. For further information, please feel free to contact
me.

Yours sincerely,

Doctor
[222 words]
TIME ALLOWED: READING TIME: 5 MINUTES Task 35 Assessment: ?? biliary colic ?? peptic ulcer
WRITING TIME: 40 MINUTES
Plan:
Read the case notes below and complete the writing task which follows. Liver Function Tests (LFTs)
notes: Biliary ultrasound (US)
Mrs. Daniela STARKOVIC R/V 3/7
45 years old, married 2 children
Past history 23/01/07
Migraines
Medications - nil Subjective:
No further episodes
20/01/07 Patient anxious re possibility cancer
Subjective
presents with abdominal pain Objective:
doesn’t like fatty foods LFTs – bilirubin 12 (normal range 6-30)
otherwise well Alkaline phosphatase (ALP) 120 (normal < 115)
Aspartate transaminase (AST) 20 (normal 12-35)
10 days ago
- epigastric pain radiating to R side 1 hour after dinner Assessment: ? mild obstruction
- associated nausea, no vomiting / regurgitation US – small contracted gallbladder, multiple gallstones
- pain constant for 1 hour Common bile duct diameter normal
- no medications Normal liver parenchyma
- no change bowel habits, no fever, no dysuria
Assessment: cholelithiasis
Last night
- recurrence similar pain, worse Plan:
- duration 2 hours Reassurance re cancer
- vomited X 1, no haematemesis Referral Dr. Andrew McDonald (general surgeon) assessment, further
- pain constant, colicky features management, possible cholecystectomy
- aspirin X 2 taken, no relief

Objective:
overweight
T 37° P 80 reg, BP 130/70
Medicine Letter 3mild tenderness R upper quadrant abdomen
no masses, no guarding, no rebound, bowel sounds normal
Murphy’s sign neg
Urine – trace bilirubin
Writing Task: Dr Andrew McDonald
Using the information in the case notes, write a letter of referral to Dr Andrew General Surgeon
McDonald a general surgeon at North Melbourne Private Hospital 86 Elm Road North North Melbourne Privet Hospital
Melbourne 3051. 86 Elm Road
North Melbourne
In your answer:
● Expand the relevant case notes into complete sentences 23/01/2007
● Do not use note form
● Use correct letter format Dear Doctor,

The body of your letter should be approximately 200 words. Use correct letter format. Re: Mrs. Daniel STARKOVIC

I am writing to refer this patient, a 45-year old lady who is presenting with signs and symptoms
suggestive of cholelithiasis.

On 20/01/07, Mrs. Starkovic first presented with abdominal pain. 10 days earlier, she had the first
episode of the epigastric pain radiating to the right side, which occurred one hour of her dinner and
was associated with nausea. This pain was constant and colicky in character and lasted for one hour.
However, in the previous night, she had worsening of symptoms with pain of 2 hours’ duration and
vomited once. On examination, mild tenderness over the right upper quadrant was noticed and
bilirubin was observed in her urine sample.
Therefore, LFTs and US were ordered and a review consultation was scheduled for 3 days later. It is
important to note that she is overweight.

Upon today’s review, US revealed a small contracted gallbladder as well as multiple gallstones, and
alkaline phosphatase was 120 but all the other findings were normal.

Based on the above, I would be grateful if you could assess and manage her condition with possible
cholecystectomy. For further information, please feel free to contact me.

Yours faithfully,

Doctor

[184 words]
TIME ALLOWED: READING TIME: 5 MINUTES Task 36 Provisional Diagnosis: Type II diabetes mellitus
WRITING TIME: 40 MINUTES
Plan: Refer to diabetologist/podiatrist for further treatment.
Read the case notes below and complete the writing task which follows.
notes: Writing Task:
Patient History: Using the information in the case notes, write a letter of referral for further treatment to the
Name: Mr. Antonite Scott diabetologist/podiatrist, Dr. Britto, at City Hospital.
Date of Birth: 18th March 1950
Height: 160cm In your answer:
Weight: 74kg ● Expand the relevant case notes into complete sentences
Allergies: Shellfish ● Do not use note form
Substance Intake: Nil ● Use correct letter format
Dentures: Nil

Social History: The body of your letter should be approximately 200 words. Use correct letter format.
Patient lives with his wife. All of their children live away. He is a smoker and an
alcoholic. He works as a bar tender.
Depression: controlled by medication
Family History:
Mother: History of Pneumonia
Father: Died of CVA (Cerebro Vascular Accident) recently.
Maternal Grandmother: Died of COPD
Maternal Grandfather: Unknown
Paternal Grandmother: Hypertensive
Paternal Grandfather: Known patient of depression

Past Medical History:

1990: Typhoid, followed by a jaundice attack
1996: HBsAg Positive
2006: Diagnosed with depression and kept on medicine to control it.

Present Symptoms:
Diabetic (blood sugar levels increasing continuously)
UTI (burning micturation and incontinence)
Cellulitis (swollen and painful legs)
 TIME ALLOWED: READING TIME: 5 MINUTES Task 37
Dr. Britto WRITING TIME: 40 MINUTES
City Hospital
(Near to 154 Newcastle St) Read the case notes below and complete the writing task which follows.
Perth WA notes:
Australia Patient History:
Name: Mrs. Suzanne Mario
(Today’s date) Date of Birth: 5th January, 1978.
Dear Dr. Britto, Height: 158cm
Weight: 60kg
Re: Mr. Antonite Scott, DOB 18th March 1950 Allergies: dust, vinegar
Substance Intake: sleeping pills
Mr. Antonite Scott is being discharged from our hospital into your care today. He has been a Dentures: upper
regular patient at our hospital for many years and has just been diagnosed as diabetic; there was
an increase in his blood pressure when the patient was admitted into our hospital recently. Social History:
Patient lives alone, not married. She is a smoker and drinks occasionally
The patient also complained of feeling a burning sensation while passing urine. The problem was too. She works as an assistant manager for a non-profit organization.
diagnosed by our team of doctors as a urinary tract infection (UTI), with burning micturation and Peptic ulcer: controlled by medication.
incontinence. The patient took several days to begin to recover, as the problem of the increase
in sugar was a continuous one. Family History:
Mother: history of cervical cancer
The patient displayed problems with walking as well; his legs are swollen and he feels pain. Father: died in an accident two years ago.
These symptoms can be attributed to the increase in blood sugar. Maternal Grandmother: history of cancer
Maternal Grandfather: had LRTI twice
The patient has no significant medical history and none of his family members were diabetic. The Paternal Grandmother: Unknown
patient once suffered from typhoid followed by an attack of jaundice in 1990 and was also Paternal Grandfather: died at the age of 92
diagnosed as HBsAg positive in 1996. He was also diagnosed with depression in 1996 and takes
medication to control this condition. Past Medical History:
2000: Irregular menstruation
The patient was feeling well at the time of discharge but there is still a necessity to control his 2008: Removal of cyst from right breast
blood sugar levels.
Please, contact me with any queries. Present Symptoms:
Pain in the sides of both breasts
Yours sincerely, Can feel lumps
Doctor Provisional Diagnosis: breast cancer
Plan: refer to Oncologist for further examination and treatment.
 Dr. Ansari
Writing Task: Lake Hospital
Using the information in the case notes, write a letter of referral for further treatment to the 14 Lake View Street
Oncologist, Dr. Ansari, at Lake hospital, 14 Lake View Street, Card Well City. Card Well City

In your answer: (Today’s date)

Expand the relevant notes into complete sentences
Do not use note form Dear Dr. Ansari,
Use letter format
Re: Mrs. Suzanne Mario, DOB 5th January 1978
The body of the letter should be approximately 180-200 words.
Mrs. Suzanne Mario is being discharged from our hospital into your care today. She has been a
patient of cancer for several years now and has recently complained of intense pain in both of
her breasts; she could feel lumps in her breasts as well. She had a cyst removed from her right
breast in 2008 and the reports on the provisional diagnosis showed the possibility of breast
cancer.

There are two other cases of cancer in her family history: her mother had cervical cancer and her
maternal grandmother also had a cancer related problem, but we don’t have the full details
about this.

The patient has no medical history apart from the problems related to irregular menstruation,
noted in the year 2000. The patient takes sleeping pills and she smokes and drinks occasionally.
There is a necessity to tackle this problem as the patient is experiencing a lot of pain as well as
anxiety about the potential diagnosis. The patient lives alone and is not married.

Please, contact me with any queries.

Yours sincerely,

Doctor
TIME ALLOWED: READING TIME: 5 MINUTES Task 38 Provisional Diagnosis: DVT
WRITING TIME: 40 MINUTES
Plan: refer to a general surgeon for further treatment.
Read the case notes below and complete the writing task which follows.
notes: Writing Task:
Patient History: Using the information in the case notes, write a letter of referral for further treatment to the
Name: Mr. Roberto Carlos General Surgeon, Dr. Christo, at Wood Park Hospital, 18 Park street, Richmond City.
Date of Birth: 19th April 1948
Height: 164cm In your answer:
Weight: 94kg Expand the relevant notes into complete sentences
Allergies: iodine Do not use note form
Substance Intake: pain killers and sleeping pills Use letter format
Dentures: upper and lower
The body of the letter should be approximately 180-200 words.
Social History:
Patient is married and has two children. Children are settled away from parents.
They live alone. He is a chain smoker and a chronic alcoholic. He worked as a Professor before he
retired.
Tonsillitis: had tonsillectomy.

Family History:
Mother: was healthy, no medical problems.
Father: heart attack (died at the age of 88).
Maternal Grandmother: unknown.
Maternal Grandfather: unknown.
Paternal Grandmother: was a hypertensive patient.
Paternal Grandfather: had a history of varicose veins.

Past Medical History:

1990: Protrusion of veins and leg cramps.
Diagnosed as DVT and kept on treatment.
Started weight reduction treatment.
Present Symptoms:
Intolerance of leg cramps
Dr. Christo TIME ALLOWED: READING TIME: 5 MINUTES Task 39
Wood Park Hospital WRITING TIME: 40 MINUTES
18 Park Street
Richmond City Read the case notes below and complete the writing task which follows.
notes:
(Today’s date) Patient History:
Name: Mrs. Agnes Rosario
Dear Dr. Christo, Date of Birth: 5th September 1972
Height: 152cm
Re: Mr. Roberto Carlos, DOB 19th April 1948 Weight: 56kg
Allergies: Nil
Mr. Roberto Carlos is being discharged from our hospital into your care today. The patient is Substance Intake: pain killers
suffering from intolerable leg cramps; on complaints of intense pain and cramps, the patient was Dentures: Nil
admitted into our hospital. Reports on the provisional diagnosis showed the possibility of DVT
(deep vein thrombosis). Social History:
Patient is married and has no children. She works as an English Teacher for an
Several years ago, the patient suffered from the same problem of cramping. Due to protrusion of International School.
veins and leg cramps, the patient was diagnosed to have DVT in 1990 and a treatment plan was
suggested too – he began weight reduction treatment. Several years on, the patient is now Family History:
complaining of the same problem. Mother: history of PCOD
Father: history of asthmatic attack.
The patient is a chain smoker and he is alcoholic as well. Additionally, he sometimes uses pain Maternal Grandmother: PCOD
killers and sleeping pills as well; however, the names were not mentioned by the patient, nor the Maternal Grandfather: unknown.
purpose or reason for taking them. Paternal Grandmother: was diabetic
Paternal Grandfather: had a history of URTI
The patient was well at the time of discharge from our hospital, apart from the problem related to Past Medical History:
DVT. 1998: irregular menstruation, acne. Had treatment for two months.
Please, contact me with any queries. 1999: menorrhagia for about 25 days.

Yours sincerely, Present Symptoms:

Menorrhagia and severe lower back abdominal pain
Doctor Provisional Diagnosis: PCOD
Plan: refer to gynecologist and obstetrician for further treatment.
Writing Task: Dr. Amanda
Using the information in the case notes, write a letter of referral for further treatment to the Whitus Hospital
Gynecologist and Obstetrician, Dr. Amanda, at Whitus Hospital, 112 Bill street, Emerald City. 112 Bill Street
Emerald City
In your answer:
Expand the relevant notes into complete sentences (Today’s Date)
Do not use note form
Use letter format Dear Dr. Amanda,

The body of the letter should be approximately 180-200 words. Re: Mrs. Agnes Rosario, DOB 5th September 1972

Mrs. Agnes Rosario is being discharged from our hospital into your care today. The patient is
suffering from severe menorrhagia and lower back abdominal pain. The reports on the provisional
diagnosis showed the possibility of polycystic ovary syndrome (PCOS) as well.

This is not the first time that the patient has been admitted into our hospital due to menorrhagia.
She also experienced the same problem of menorrhagia in 1999, treatment of which lasted for
about 25 days.

In the past, the patient has complained of irregular menstruation and acne and she underwent
treatment for this condition which lasted for about two months.

Her family history showed the presence of PCOS; her mother suffered from PCOS and her
maternal grandmother also showed signs of a PCOS related problem.

The patient was well at the time of discharge from our hospital, apart from the problem related
to menorrhagia or PCOS.

There is a need to take great care as the problem is severe this time and the patient is in a lot of
pain.

Please, contact me with any queries.

Yours sincerely,

Doctor
TIME ALLOWED: READING TIME: 5 MINUTES Task 40 Writing Task:
WRITING TIME: 40 MINUTES Using the information in the case notes, write a letter of referral for further treatment to the
General Physician, Dr. Mario, at City hospital, 15 River Street, Herberton City.
Read the case notes below and complete the writing task which follows.
notes:
In your answer:
Patient History: Expand the relevant notes into complete sentences
Name: Mr. Stephen Brook Do not use note form
Date of Birth: 9th December 1987 Use letter format
Height: 168cm
Weight: 66kg The body of the letter should be approximately 180-200 words.
Allergies: barley
Dentures: Nil

Social History:
Patient is not married. He is a gym instructor for an international school.

Family History:
Mother: history of jaundice.
Father: history of peptic ulcer
Maternal Grandmother: was a healthy woman
Maternal Grandfather: CA prostate
Paternal Grandmother: had chickenpox during her childhood
Paternal Grandfather: had a history of UTI’s

Past Medical History:

2010: food poisoning and vomiting - had treatment.
2011: burning sensation and pain at xiphoid process and radiating to back, regurgitation,
vomiting. Had treatment but discontinued after six months – reasons unknown.

Present Symptoms:
Burning sensation and pain at xiphoid process and radiating to back during
mid night, vomiting.

Provisional Diagnosis: pancreatitis

Plan: refer to a general physician for further treatment.

Dr. Mario TIME ALLOWED: READING TIME: 5 MINUTES Task 41
City Hospital WRITING TIME: 40 MINUTES
15 River Street
Herberton City Read the case notes below and complete the writing task which follows.
notes:
(Today’s Date) Patient History:
Patient: Mary Reylon
Dear Dr. Mario, DOB: 4th Sept 1963
Allergies: dust / penicillin
Re: Mr. Stephen Brook, DOB 9th December 1987
Social History: Professor at the university (teaches physics)
Mr. Stephen Brook is being discharged from our hospital into your care today. He was admitted Lives with her husband (Winston Reylon)
into our hospital due to a problem related to his pancreas and the reports on the provisional Works for women rights organization
diagnosis showed the presence of pancreatitis. Family History:
Mother – high BP, rheumatoid.
The patient was suffering from an intense pain and burning sensation at the xiphoid process. Father – liver failure
There was an increase in this pain and burning sensation during the night time and the patient Maternal Grandmother- died of a heart attack (75)
also complained of vomiting. Maternal Grandfather – died of heart attack (81)
Paternal Grandfather – a patient of high BP
Mr. Stephen Brook suffered from and was treated for food poisoning in 2010. He had faced a Paternal Grandmother – died at the age of 65 due to an accident
similar kind of problem related to pancreatitis (the burning sensation and pain) earlier as well, in
2011. The treatment for this was not completed; it was discontinued after six months, but we Past medical history:
are unaware of the reasons why at this stage. RSV illness (1965)
Chicken pox (1973)
The patient was well at the time of discharge from our hospital, apart from the problem related Tonsils removed (1981)
to pancreatitis. Miscarriage due to an accident (1987)
Hyperthyroid (1989)
There is a need to take great care as the problem is severe this time.
12 June 2009
Please, contact me with any queries. Injury to the head (fell down the stairs)
Tourniquet applied (to stop the flow of blood)
Yours sincerely, Dizziness and queasiness
Large bump on the head
Doctor Patient complained of pain even after two days
Unable to sleep (for a week)
Took slipping pills three times (as suggested by the doctor), no effect
Other signs:
Persistent or worsening headaches Dr. Wilson
Imbalance London Bridge Hospital
Vomiting 27 Tooley St London
Greater London
Inference: Suggestive of intracranial hematoma
(Today’s date)
Plan: CT scan is the definitive tool for accurate diagnosis of an intracranial hemorrhage.
Dear Dr. Wilson,
Writing Task:
Using the information in the case notes, write a letter of referral for further investigation and Re: Mrs. Mary Reylon, DOB 4th Sept 1963
definitive diagnosis to the neurologist, Dr. Wilson, at London Bridge Hospital, 27 Tooley St
London, Greater London. Mrs. Mary Reylon is a patient, who was admitted into our hospital on the 12thof June 2009.

In your answer: Mrs. Mary Reylon fell from the staircase and suffered an injury to her head. As she was profusely
Expand the relevant notes into complete sentences bleeding, a tourniquet was also applied around her head, to stop the flow of blood. The patient
Do not use note form began to feel dizziness and queasiness after that and a large bump on her head developed too.
Use letter format The patient began to complain of pain even though pain killers were given.

The body of the letter should be approximately 180-200 words. The patient has not been able to sleep for about a week now; the patient even tried sleeping pills
to get enough sleep but the sleeping pills have proven to be ineffective for her. The patient has
also complained of persistent headaches, imbalance and vomiting, which are all suggestive of
intracranial hematoma. The CT scan is the definitive tool for accurate diagnosis of intracranial
hemorrhage. Hence, it is requested that the scan is taken so that proper action can be taken.

Please, contact me with any queries or if you would like to know more about the patient.

Yours sincerely,

Doctor
 High fever and sweats
TIME ALLOWED: READING TIME: 5 MINUTES Task 42
WRITING TIME: 40 MINUTES Plan: Abdominal CT scan suggested for accurate diagnosis of abdominal pain.

Read the case notes below and complete the writing task which follows. Writing Task:
notes:
Using the information in the case notes, write a letter of referral for further investigation
Patient History: and a definitive diagnosis to Dr. Ralph Emerson, at Royal London Hospital, Whitechapel Rd,
Patient: Nicole Katie Greater London E1 1BB, United Kingdom.
DOB: 12 July, 1971
In your answer:
Social History: Expand the relevant notes into complete sentences
Lives with her husband (Ivan) and their daughter (Lydia Imogen) Do not use note form
House wife (left work after she was married) Use letter format
Family history: No family history
But mother died of kidney failure The body of the letter should be approximately 180-200 words.
Past medical history:
Suffered severe attack of TB (1983)
Appendices (1987)
Depression (due to the sudden death of the first baby – 1992)
Allergic reactions (uterine infection - 1997)

15 April 2005
Failure in digestion
Unable to eat properly due to pain in the stomach
Took pain relievers, analgesics (for two continuous days)
Problem worsened
Felt pain, radiating back to the lower abdomen
Change in coloration of urine (yellowish)
Loss of appetite
Weight loss – 2.5 kg within 15 days
Vomited twice
18 April, 2005
Other signs:
Severe pain, lasted for several hours
Pain and vomiting, shortness of breath
Blood in bowel motions and urine
Dr. Ralph Emerson TIME ALLOWED: READING TIME: 5 MINUTES Task 43
Royal London Hospital WRITING TIME: 40 MINUTES
Whitechapel Rd
Greater London E1 1BB Read the case notes below and complete the writing task which follows.
United Kingdom notes:
Patient History:
(Today’s date) Mark Henry is 53-year-old patient at your General Practice. Just recently, he complained of acute
onset of double vision and right eyelid droopiness.
Dear Dr. Ralph Emerson,
Social History:
Re: Mrs. Nicole Katie, DOB 12 July 1971 The patient lives with his wife
Works as a car mechanic
Mrs. Nicole Katie is a patient, who was admitted into our hospital on the 15th of April 2005. Denies use of illicit drugs or tobacco
Nicole Katie was suffering from some kind of digestion problem, which was undetected. Rarely drinks
Family History:
The patient was not able to eat properly and was feeling a lot of pain in her stomach. The His mother suffered from migraines (died at the age of 83 due to heart attack)
patient took some pain relievers (names are mentioned in the attached report) which, in fact, His paternal father had a stroke at the age of 67
worsened the problem. The patient began to feel pain which radiated back to her abdomen and No other family history of strokes or vascular diseases
also noted a change in the color of her urine. The patient had lost her appetite, causing her to
lose almost 2.5 Kg within the course of 15 days. 9/07/2009
Was sitting in his room; felt sensation in eye lids
During her stay at our hospital from April 15 to April 18, the condition of the patient continued Noticed blurred vision
deteriorating; especially on the 18th of April, when the patient complained of much more severe Appearance of double vision (with objects appearing side by side)
pain which lasted for hours. She experienced pain, shortness of breath and vomiting. Blood in Pain in both the eyes
her bowel motion and urine was also noted. The patient has had a high fever and has been Transferred to the hospital by his son
suffering from severe sweating. Intermittent pounding bifrontal headache
Rated the pain as 7 or 8 on a scale of 1 to 10
Hence, it is requested that the abdominal CT scan should be taken for an accurate diagnosis of
the abdominal pain, as a matter of urgency. General physical examination:
The patient is significantly overweight.
Please, contact me with any queries. Temperature is 37.6.
Blood pressure is 130/60.
Yours sincerely, Pulse is 85.
There is no tenderness over the scalp or neck and no bruits over the eyes or on the neck.
Doctor No proptosis, lid swelling, conjunctival injection, or chemosis.
Cardiac exam shows a regular rate and no murmur.
Dr. Martin
Past Medical History: National Hospital for Neurology
1) Migraine headaches, as described in HPI. 33 Queen Square London WC1N 3BG
2) Depression. United Kingdom
There is no history of diabetes or hypertension.
(Today’s date)
Allergies: None. Dear Dr. Martin,
Re: Mr. Mark Henry, acute onset of double vision and right eyelid droopiness.
Medications: Zoloft 50 mg daily, ibuprofen 600 mg a few times per week, and vicodin a few
times per week. Mr. Mark Henry is a patient, who was admitted into our hospital on 9 / 7 / 2009 with complaints
of acute onset of double vision and right eyelid droopiness.
Other necessary information
He denies associated vomiting, nausea, numbness, weakness, photophobia, loss of vision, seeing On 9 / 7 / 2009, the patient was sitting in his room when he felt a strange sensation in his
flashing lights or zigzag lines etc. eyelids; he began to feel pain in his eyes as well. He also complained of the sudden appearance
His recent headaches differ from his “typical migraines” (occurred 4 -5 in his entire life time). of double vision and an intermittent pounding bifrontal headache.
He has never taken anything for these headaches (other than ibuprofen or vicodin).
Reports on the general examination were clear: his pulse was 85 and BP 130 / 60; there was no
Writing Task: swelling of the lids or proptosis.
Using the information in the case notes, write a letter of referral for further investigation and a
definitive diagnosis to Dr. Martin, at National Hospital for Neurology, 33 Queen Square, His medical history shows that he has suffered from migraines (headaches) and depression.
London WC1N 3BG, United Kingdom. The patient was prescribed Zoloft (50 mg - daily) and ibuprofen (600 mg - a few times per week).

In your answer: The patient denied associated vomiting, nausea, numbness or weakness or loss of vision etc. but
Expand the relevant notes into complete sentences said that his recent headaches differ from his typical migraines, which actually only occurred 4-5
Do not use note form times in his whole life time. The patient has never taken anything for the headaches, except
Use letter format ibuprofen or vicodin.

The body of the letter should be approximately 180-200 words. As the problem presented by the patient is a complex one, further investigation and a definitive
diagnosis is required.

Please, contact me with any queries.

Yours sincerely,

Doctor
TIME ALLOWED: READING TIME: 5 MINUTES Task 44 Writing Task:
WRITING TIME: 40 MINUTES Using the information in the case notes, write a letter of referral for further investigation and a
definitive diagnosis to Dr. Robert Frances, at St. George’s Hospital, Black Shaw Road, London
Read the case notes below and complete the writing task which follows. SW17 0QT, United Kingdom.
notes:
Patient History: In your answer:
Joseph Malcolm is a patient at your General Practice. Just recently, he started complaining of Expand the relevant notes into complete sentences
occasional breathlessness and difficulty in breathing. Do not use note form
Age: 42 Use letter format
Gender: male
Occupation: office manager The body of the letter should be approximately 180-200 words.
Subjective Patient Complaints:
Adult onset asthma- dyspnea, cough
Occasional wheezing symptoms upon increased exercise or when under stress.

Prior contributory health history:

1) Seasonal upper respiratory allergies
2) Occasional loose stools when under stress
3) Occasional episodes of mild eczema (dermatitis)
4) Reports a history of being healthy, aside from this recent asthma problem

What provokes the symptoms?

Provoked by exercise, emotional/physical stress
Cigarette smoke
Seasonal respiratory allergies

Site of symptomatology:
Bronchial, lung, chest/thoracic region
Time of day/duration of symptoms:
Daily episodes of dyspnea
Symptoms often worsen at 3-5 AM (coughing increases)

Medications:
Symptoms temporarily eased with prescription (bronchial inhaler medication).
Dr. Robert Frances TIME ALLOWED: READING TIME: 5 MINUTES Task 45
St. George’s Hospital WRITING TIME: 40 MINUTES
Black Shaw Road
London SW17 0QT Read the case notes below and complete the writing task which follows.
United Kingdom notes:
Patient History:
(Today’s date) Mr. Marques is a patient at your general practice who has recently complained of abdominal pain.
Name of the patient: Mr. Marques , Age: 65
Dear Dr. Robert Frances, October 7, 2006
Chief complaint: abdominal pain
Re: Mr. Joseph Malcolm, age 42 Complained of a sharp, epigastric abdominal pain (gradually worsening over the past 1-2 months).
Pain is located in the epigastric region and left upper quadrant of the abdomen.
Mr. Joseph Malcolm is a patient at our hospital who visits regularly. Just recently, he complained
Doesn’t radiate.
of occasional breathlessness and difficulty in breathing. The patient’s health history shows
The pain is relatively constant throughout the day and night (but does vary in severity).
seasonal upper respiratory allergies and occasional episodes of mild eczema.
Rated the pain as 6/10 at its worst.
The patient is reported to be healthy, apart from this recent asthma related problem.
He has not tried taking any medicines to relieve the pain.
This problem related to asthma, or breathlessness, in the words of the patient, increases with The pain is not associated with food or eating (but occasional heartburn).
exercise, emotional or physical stress and cigarette smoking. Denies any abdominal trauma or injury.
Complained of weight loss (5lb weight loss over the past 1-2 months).
The patient has been experiencing problems related to dyspnea for many days (dates are not The patient has experienced some nausea with the abdominal pain but has not vomited.
mentioned). The symptoms often get worse in between 3-5 am; the patient coughs a lot and he
is not able to have full control over his daily activities. Family History:
Father died due to a heart attack.
Sometimes, the above symptoms temporarily go away when the patient uses bronchial inhaler Mother’s medical history is not known.
medication; but when the patient doesn’t pay attention to medication or gets involved in any No known family history of colon cancer.
kind of physical activity, then the same problem of difficulty in breathing occurs.
Social History:
Further investigation and a definitive diagnosis is vital here as the patient has not been feeling The patient is a retired lecturer.
well for quite a while now. He lives with his wife and two grandchildren.
He denies past or present tobacco and illicit drug use.
Please, contact me with any queries. He denies alcohol use.

Yours sincerely, Past Medical History: other active problems

High blood pressure, diagnosed two years ago, but well-controlled now.
Doctor Depression poorly controlled; started prozac 2 months ago, but still feels depressed.
Hospitalizations: MI, 2003.
Dr. Ivan Gonz
Willington Hospital
Surgeries/procedures: Cardiac catheterization, post-MI, 2003.
Central Building
21 Wellington Road
Medications:
St John's Wood London
Aspirin 81mg po qd, since his MI 3 years ago
Metoprolol 100mg po qd, for two years (Today’s date)
Prozac 20mg po qd, started 2 months ago
Dear Dr. Ivan Gonz,
Allergies: No known drug allergies.
No food or insect allergies.
Re: Mr. Marques, age 65
Other information Mr. Marques has been a patient with us for several months now. Just recently, he complained of
Pulmonary – denies shortness of breath, denies cough. severe abdominal pain; the patient complained of a sharp, epigastric abdominal pain which he
Cardiovascular – denies chest pain, denies palpitations. says has increased over the last two months.
Genitourinary – denies dysuria, denies increased frequency or urgency of urination.
The pain is located in the epigastic region and left upper quadrant of the abdomen. This pain is
Writing Task: relatively constant throughout the day, but may sometimes vary in severity. The patient has
Using the information in the case notes, write a letter of referral for further investigation and a rated this pain as 6 on a scale of 1-10 and hasn’t taken anything to relieve the pain. He has
definitive diagnosis to Dr. Ivan Gonz, at Willington Hospital, Central Building, 21 Wellington denied any abdominal trauma or injury.
Road, St John's Wood London.
The patient’s medical history includes the fact that he has been a BP patient for over two years;
In your answer: his blood pressure is now well controlled. In addition, he has been suffering from depression
Expand the relevant notes into complete sentences related problems too; he started taking prozac two months ago, but he still feels depressed. The
Do not use note form patient is reported to have no drug allergies or food or insect allergies.
Use letter format
Mr. Marques was once hospitalized for myocardial infarction, in 2003, and he has been on
medications regularly since then. Presently, the patient is taking aspirin - 81mg po qd, and has
The body of the letter should be approximately 180-200 words.
been since his MI, 3 years ago; and metoprolol 100 mg po qd, which he has been taking for the
past two years.

There is a need for further investigation and a definitive diagnosis.

Please, contact me with any queries.

Yours sincerely,
Doctor
TIME ALLOWED: READING TIME: 5 MINUTES Task 46 Diagnosis
WRITING TIME: 40 MINUTES Chest X-ray - not cleared
CT-Scan - positive
Read the case notes below and complete the writing task which follows. Stage 2A (lung cancer)
notes: The tumor is 5.5 cm
Cancer cells spread across lymph nodes
Patient History:
Name: Jennet Berritto Plan: Refer to Dr. Bryan Hardy for further treatment
Date of Birth: 22 April, 1971
Height: 163 cm Writing Task:
Weight: 75kg Using the information in the case notes, write a letter of referral for further treatment to
Allergies: Nil Pulmonologist, Dr Bryan Hardy, at EMR Hospital,v25 Rocklands Rd North Sydney NSW,
Australia, outlining the details of the patient.
Social History:
Lives with her husband In your answer:
Likes gardening Expand the relevant notes into complete sentences
Doesn’t drink / smoke Do not use note form
Sometimes takes betel leaves Use letter format
Family History: None to report
The body of the letter should be approximately 180-200 words.
Medical History
Type 2 diabetes mellitus (2/10/2001)
Hypertension (5/4/2006)
Stomach ulcers (12/7/2007)
Ankle injury (22/5/2008)
COPD (27/6/2011)

Present Symptoms:
Intense coughing
Pain in the chest, shoulder and back
Shortness of breath
Change in voice
Harsh sounds with each breath
Change in color and volume of sputum
Dr. Bryan Hardy TIME ALLOWED: READING TIME: 5 MINUTES Task 47
EMR Hospital WRITING TIME: 40 MINUTES
25 Rocklands Rd
North Sydney NSW Read the case notes below and complete the writing task which follows.
Australia notes:
Patient History:
(Today’s date) Name: Christian Aula
Date of Birth: 12/9/1975
Dear Dr. Bryan Hardy, Height: 159 cm
Weight: 69 kg
Sub: Jennet Berritto, DOB 22 April 1971 Allergies: Nil

Jennet Berritto is an elderly woman who visited our hospital due to complaints of intense Social History:
coughing, shortness of breath, change in her voice etc. She was feeling pain in the chest and pain Lives with her daughter and son-in-law
around her shoulder as well. This pain was accompanied by back pain as well and she was aware Enjoys walking
of a harsh sound with each breath. The patient complained of a change in color and volume of Doesn’t drink / smoke
sputum too. Family History:
Mother - died of heart attack (had a TIA stroke as well)
Her medical history reveals that she has been a patient of diabetes for over 14 years now. She has Father - died of liver failure
also been a patient of hypertension (5/4/2006) and has problems related to COPD (27/6/2011).
Medical History:
X-rays taken were not clear so a CT scan was suggested. The reports on the CT were positive; the Allergic rhinitis
diagnosis showed that she has lung cancer - stage 2A). The tumor seemed to be growing and History of advanced, home oxygen (02) - dependent COPD and heart failure
presently measures at 5.5 cm. Cancer cells are spreading across the lymph nodes. Benign essential hypertension
Chronic respiratory failure
The patient doesn’t drink or smoke but she is habituated to taking betel leaves.
Present Medications
Prednisone 5 mg qd, montelukast 10 mg every evening, albuterol-ipratropium MDI 2 puffs q4h prn
The condition of the patient at the time of discharge was as good as can be expected.
SOB, carvedilol 3.125 mg bid, bumetanide 2 mg bid, fluticasonesalmeterol 500-50 mcg/dose disk
with device 2 puffs bid, potassium chloride 20 mEq tablet ER bid, tiotropium bromide 18-mcq
I would like to request for you to look into this case and provide a suitable treatment. Please, do
capsule one inhalation every morning, albuterol/ipratropium hand-held nebulizer q4h prn SOB.
let me know if you would like any further details about the patient.
Present Symptoms:
Yours sincerely, Weakness, numbness or paralysis in the face (left side) Slurred or garbled speech / difficulty in
understanding others
Doctor Adams Double vision
Dizziness
Loss of balance or coordination
Diagnosis Dr. Sally Anderson
TIA (Transient Ischemic Attack) Confirmed Hypertension Specialist
BP Checked: 150/95 millimeters of mercury (mm Hg) Community Hospital
33 Albany St Crows Nest NSW
Plan: Refer to Dr. Sally Anderson for further treatment Australia

Writing Task: (Today’s date)

Using the information in the case notes, write a letter of referral for further treatment to the
Hypertension Specialist, Dr. Sally Anderson, at Community Hospital, 33 Albany St Crows Nest Dear Dr. Sally Anderson
NSW, Australia, outlining the details of the patient.
Sub: Christian Aula, DOB 12/9/1975
In your answer:
Expand the relevant notes into complete sentences Christian Aula is an elderly woman who was admitted to our hospital due to weakness,
numbness or paralysis on the left side of her face. The patient was not able to speak properly
Do not use note form
(garbled speech) and was displaying difficulty in understanding people around her. She
Use letter format
complained of double vision, dizziness and loss of balance and coordination as well.
The body of the letter should be approximately 180-200 words.
The diagnosis confirmed the presence of TIA - transient ischemic attack. Her BP was checked at
the time of admission and was recorded as 150/95 millimeters of mercury (mm Hg).

Her medical history reveals that she has allergic rhinitis, has problems related to COPD and
benign essential hypertension. The list of her medications include the following: prednisone 5
mg qd, montelukast 10 mg every evening; albuterolipratropium MDI 2 puffs q4h prn SOB;
carvedilol 3.125 mg bid; bumetanide 2 mg bid; fluticasone-salmeterol 500-50 mcg/dose disk with
device 2 puffs bid;
potassium chloride 20 mEq tablet ER bid; tiotropium bromide 18-mcq capsule one
inhalation every morning; albuterol/ipratropium hand-held nebulizer q4h prn SOB.

The condition of the patient at the time of discharge was good, aside from the symptoms listed above.

I would like to request that you look into this case and provide suitable treatment.
Please, do let me know if you require any further information about the patient.
Yours sincerely,

Doctor
TIME ALLOWED: READING TIME: 5 MINUTES Task 48 Present Symptoms:
WRITING TIME: 40 MINUTES Indigestion
Dull, burning pain in the stomach
Read the case notes below and complete the writing task which follows. Burning sensation in the chest
notes: Pain elevates after eating, drinking or taking antacids
Patient History: Weight loss (has lost about 5 kgs in the course of 15-20 days)
Name: Huang Bowra Loss of appetite
Date of Birth: 27/7/1981 Not wanting to eat because of pain
Height: 168 cm Nausea
Weight: 79 kg Vomiting
Allergies: sulfa drugs / tetracyclines Burping
Bloating
Social History:
Lives alone Diagnosis
Drinks a lot Endoscopy confirmed the presence of stomach ulcers
Smokes 2ppd of cigarettes daily Ulcers - one half inch in diameter
Family History:
No family history Plan: Refer to Dr. Mathew Corrado for further treatment.
Medical History:
Anxiety, depression (1999 - due to sudden death of his mother) Writing Task:
Using the information in the case notes, write a letter of referral for further treatment to Dr.
Medicine Writing Tests 11 – 15 with Mathew Corrado, at Flivo Hospital, 9 Mount Street Hunters Hill NSW, Australia, outlining the
Sample Answers details of the patient.
Obesity (2000)
Urinary incontinence (2003) In your answer:
Hypertension (2007) Expand the relevant notes into complete sentences
Insomnia (2009) Do not use note form
Use letter format
Present Medications
Norvasc 5 mg daily for hypertension The body of the letter should be approximately 180-200 words.
Lorazepam 1 mg HS for insomnia
Vistaril 25 mg BID PRN for anxiety (only when required)
Celexa 10 mg daily for depression (only when required)
Dr. Mathew Corrado TIME ALLOWED: READING TIME: 5 MINUTES Task 49
Flivo Hospital WRITING TIME: 40 MINUTES
9 Mount Street
Hunters Hill NSW Read the case notes below and complete the writing task which follows.
Australia notes:
(Today’s date) Patient History:
Name: Abora Qualin
Dear Dr. Mathew Corrado, Date of Birth: 7/8/1979
Height: 179cm
Sub: Huang Bowra, DOB 27/7/1981 Weight: 81 kg
Huang Bowra is an elderly man who visited our hospital with complaints of symptoms which Allergies: sulfa drugs
were related to stomach ulcers. The patient complained of indigestion, a dull, burning pain in his Social History:
stomach and a burning sensation in his chest. Lives with her son
The pain elevated when he was eating or drinking and when he took antacids. Drinks a lot
Quit smoking three months ago
The patient had also lost about 5 Kgs within the course of 15-20 days, probably resulting from his Family History:
loss of appetite; it was painful for the patient to eat. He also complained of nausea, vomiting, Data not available
burping and bloating and he was quite distressed upon admission to hospital.
Past Medical History
An endoscopy confirmed the presence of stomach ulcers which are one half inch in diameter. Hypertension (2001)
Therefore, a course of treatment needs to be put into place. Urinary tract infection (2003)
The patient’s medical history shows that he has had problems related to obesity and urinary Type 2 diabetes mellitus (2007)
incontinence. He is currently taking medicine for hypertension, insomnia, anxiety and Dyslipidemia (1 year ago)
depression. Constipation (1 year ago)
Vital Signs
The list of present medications includes the following: norvasc 5 mg daily for hypertension; BP: 124/76, P: 89, RR: 18, T: 37.2°C
lorazepam 1 mg HS for insomnia; vistaril 25 mg BID PRN for anxiety (only when required); and List of Medications
celexa 10 mg daily for depression (only when required). Lantus 10 units QHS, lisinopril 10 mg, glipizide XL 7.5 mg, ASA 81 mg,
hydrochlorothiazide 12.5 mg, simvastatin 80 mg, docusate 100 mg PRN.
The condition of the patient at the time of discharge was good, but his stomach ulcers need so
be treated as a matter of urgency. Present Symptoms:
Complaining of severe back pain / groin pain
I would like to request for you to look into this case and provide suitable treatment. Vomiting
Please, do let me know if you require any further information about the patient. Fever
Yours sincerely, Chills
Nausea
Doctor Painful urination
Diagnosis Dr. Katherine Mathel
Urine sample - positive (presence of white blood cells in abundance) Marino Kidney Center
Ultrasound - obstructions in the urinary tract 3/77 South Terrace Como WA
Australia
Result: UTI confirmed
(Today’s date)
Plan: Refer to Dr. Katherine Mathel for further analysis and treatment.
Dear Dr. Katherine Mathel,
Writing Task:
Using the information in the case notes, write a letter of referral for further treatment to Dr. Sub: Abora Qualin, DOB: 7/8/1979
Katherine Mathel, at Marino Kidney Center, 3/77 South Terrace Como WA, Australia, outlining
Abora Qualin is an elderly woman who visited our hospital with complaints of symptoms which
the details of the patient.
were related to a UTI. Upon admission, the patient complained of severe back pain and groin
pain, vomiting and nausea. The patient was also suffering from a fever and was feeling pain
In your answer:
whilst passing urine. Consequently, a urine test was done which confirmed the presence of a
Expand the relevant notes into complete sentences
urinary tract infection.
Do not use note form
Use letter format
The patient’s medical history shows that she had this urinary tract infection at an earlier date as
well; she first experienced this problem in the year 2003. For the last year, she has been
The body of the letter should be approximately 180-200 words.
suffering from problems related to dyslipidemia and constipation as well. She has high BP, which
was diagnosed in the year 2001, and high blood sugar levels as well, diagnosed in the year 2007.

The medications which she is taking at the moment include the following: lantus 10 units QHS;
lisinopril 10 mg; glipizide XL 7.5 mg; ASA 81 mg; hydrochlorothiazide 12.5 mg; simvastatin 80 mg;
and docusate 100 mg PRN.

The patient is reported to be allergic to sulfa drugs.

The condition of the patient at the time of discharge was good, aside from the symptoms related
to the UTI.

I would like to request for you to look into this case and provide suitable treatment.
Please, do let me know if you require any further details about the patient.

Yours sincerely,

Doctor Lewis
 Present Symptoms
TIME ALLOWED: READING TIME: 5 MINUTES Task 50 Shortness of breath
WRITING TIME: 40 MINUTES Severe headaches
Severe anxiety
Read the case notes below and complete the writing task which follows. Nose bleeding (occurred twice in the last three days)
notes:
Patient History: Diagnosis
Name: Marcello Caprige High blood pressure noted (170/110)
Date of Birth: 12/2/1979 Result: Hypertension (Stage 2)
Height: 168 cm Plan: Refer to Dr. Avelin Cooper for further analysis and treatment.
Weight: 73 kg
Allergies: Nil Writing Task:
Using the information in the case notes, write a letter of referral for further treatment to Dr.
Social History: Avelin Cooper, at MKZ Hospital, 697 Beaufort St Mt Lawley WA, Australia, outlining the details
Married / Lives with his wife and son of the patient.
Doesn’t drink
Smokes In your answer:
Chews tobacco Expand the relevant notes into complete sentences
Family History: no family history Do not use note form
Use letter format
Past Medical History
Hypertension The body of the letter should be approximately 180-200 words.
Type 2 diabetes mellitus
Depression
Osteoarthritis
Hyperlipoproteinemia

List of Medications
Metformin 1,000 mg PO BID, atorvastatin 20 mg PO QHS, lisinopril 20 mg PO QD,
furosemide 20 mg PO QD, aspirin 81 mg PO QD, glimepiride 2 mg PO QAM, venlafaxine
75 mg PO TID, fish oil 1,200 mg PO QD.

Present Medical Condition:

Change in blood pressure (last recorded 150/100)
Dr. Avelin Cooper
MKZ Hospital
697 Beaufort St
Mt Lawley WA
Australia
(Today’s date)
Dear Dr. Avelin Cooper,
Sub: Marcello Caprige, change in blood pressure (last recorded 150/100)

Marcello Caprige is an elderly man who was admitted into our hospital due to a significant
change in his blood pressure. The patient was not able to breath properly and was experiencing
a shortness of breath. In addition, he was suffering from severe headaches and anxiety. The
patient also complained of nose bleeding, which has occurred twice in the last three days.

After thorough testing, the diagnosis revealed that the patient was at hypertension stage 2. His
blood pressure, which was noted at that time, was very high (170/110).
His medical history shows that he has diabetes as well (type 2 diabetes mellitus) and that he has
been suffering from depression, osteoarthritis and hyperlipoproteinemia as well.

The list of the medications which the patient is taking at present include the following:
metformin 1,000 mg PO BID; atorvastatin 20 mg PO QHS; lisinopril 20 mg PO QD; furosemide 20
mg PO QD; aspirin 81 mg PO QD; glimepiride 2 mg PO QAM; venlafaxine 75 mg PO TID; and fish
oil 1,200 mg PO QD.

The patient does not drink alcohol but he does smoke and chew tobacco.
The condition of the patient at the time of discharge was good, apart from his symptoms related
to high blood pressure.
I would like to request that you look into this case and provide suitable treatment.
Please, don’t hesitate to contact me if you require any further information about the patient.
Yours sincerely,

Doctor