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

Patient: Mr. Jones

Personal History: 
• Plumber for 30 years.
• DoB: 05 January 1972.
• 20 cigarettes a day since age 12.
• Divorced – 7 years ago.
• Father died of cardiac arrest.
PMHx:
• 1990: Broke Arm. No doctor visits since then.
• 2014: Smokers cough without blood. No wheeze.
• Stable weight
April 2018:
• Progressive breathlessness on exertion.
• No chest tightness on exertion
• No fist clubbing.
• Abundant tar staining.
• Pulse: Sinus rhythm. Hard to feel.
• BP: 108/88 mm Hg
• Auscultation: crepitation at left base.
• High Hb
Diagnosis:
• Respiratory disorder suspected (Lung carcinoma suspected)
• Stenosis suspected (Hb – upper end)
Plan:
• Refer to a cardiologist for an opinion on possible Aortic Stenosis.
Writing Task:
• Using the information in the case notes, write a letter of referral for
further investigation and definitive diagnosis to the cardiologist, Dr. Janet,
London Hospital, 11 Baker’s Street, London.

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Dr. Janet,
London Hospital
11 Baker’s Street
London.
 
(Today’s date – April 2018)
Dear Dr. Janet,

Re: Mr. Jones, DoB 05 January 1972.

Thank you for seeing Mr. Jones, a 46 years old plumber, who has been smoking 20
cigarettes a day for the last 20 years and is experiencing from progressive
breathlessness during the past few days. (Organise the contents of body paragraphs
before deciding on possible reason and most important issue.)

Though Mr. Jones does not feel chest tightness on exertion and has no fist
clubbing, further examination revealed that he has abundant tar staining. Moreover,
auscultation revealed crepitation at left base. His systolic blood pressure is 108
mm Hg and diastolic blood pressure is 88 mm Hg. While his pulse is hard to feel, it
has Sinus rhythm. Since 2014 he has been experiencing smoker’s cough without blood
and wheezing. He also has a high hemoglobin level. (Write the recent symptoms and
examination by connecting them in the right order of chronology and importance
through proper cohesive devices.)
My provisional diagnosis is that he is suffering from lung carcinoma. However, his
father suffered a cardiac arrest and his high hemoglobin suggests the possibility
of Stenosis. Therefore, I am referring him for further investigation. (Justify why
you’re referring.)

If you require any further information, please do not hesitate to contact me.
Yours Sincerely,
Doctor.