Dr.

Alison Grey

Pediatric Departmant

Mater Paediatric Centre, Vulture Street, Brisbane 4101

21/01/10

Dear Registrar,

Re: Brendan Cross

I am writing to refer Brendan Cross, an 8-year-old boy, who is demonstrating signs and symptoms
suggestive of rheumatoid arthritis for urgent assessment.

Initially, accompanied by his parents, Brendan presented to our GP Clinic on 14.01.10 with
complaints of fever and sore throat while he was lethargic and having crying spells for 3 days.

On examination, he was febrile with a temperature of 39.8, had enlarged tonsils with exudation with
inflated cervical lymph nodes. Other I prescribed him Penisillin 250 mg 6/h for 7 days , paracetamol
and advise her mother to return if there are no improvement.

Unfortunately, after 5 days there were no improvement on his condition, fever couldn’t be controlled
by antipiretics and he had swollen and painful joint in his right knee. He also had mid systolic
murmur. Therefore ECG, FBC and ASOT were ordered. ECG showed prolonged P-R interval. He also
had high level of ESR and ASOT in his blood test.

In view of the above history and physical findings, I believe he needs further investigations and
management. I would appreciate it if you could offer your expert assessment for him.

Your sincerely,

Dr Joseph Watkins,

Greenslopes Medical Clinic, 294 Logan Rd,

Greenslopes, Brisbane 4122