OCCUPATIONAL ENGLISH TEST WRITING SUB-TEST: MEDICINE TIME ALLOWED: READING TIMI 5 MINUTES WRITING TIME: 40 MINUTES Reead the case notes below and complete the writing task which follows. Your long-term patient, Mrs We'shman, has attended your GP surgery with her daughter. Both are concemed about Mrs Welshman's memory. Pationt: Mrs Patricia Welshman (0.0.8: 26/03/1930) Address: 24 Kenneth St, Newtown Marital status: Widowed, 5 adult children Next of kin: Christine ~ daughter Diagnosis: Osteoporosis. Dementia (7early stage Alzheimer's) Social background: Widowed 40yrs, Lives alone, children within 10km radius. Medication: _OsteVit-D 10001U, atorvastatin (Lipitor) 20mg mane, ibuprofen (Bruen) 200mg pin, ‘metoprolol (Metrol) 100mg b.d., paracetamol (Panadol) 500mg prn Past Medical History: 2007-2013 Regular GP visits to this clinic, Pathology, BP — stable 10June 2014 Fail ~ bruised nose only. X-ray ~ NAD. Will begin to take it easy, slow down. 27 July 2014 Occupetional Therapist (OT) home assessment: Evaluated shower rails, ramp. Bed ok. Rev 4-6miths Discussed shower with OT. Allok Shower every other day to avoid falls ‘Community Support: Home care provided by local council, 1ortnight 14 December 2014 BP 145185 Pathology: BE, USEs, LFTs — all NAD Lipi Total cholesterol 4.¢mmol. (< 5.8) HOL cholesterol 1.4mmolf. (0.9-2.2) *LDL cholesterol 2.9mmoVL(< 2.0) Triglycerides 1.1mmolA.(0.5-2.0) LDUHOL 2.1 ChovHiDL 3.4 *Vitamin D < 54 (60-160nmoVL) Discussions: Spare scripts — not filing them or taking medication regularly. ‘Assures me she is taking medication regularly. ‘Suggested Webster pack (a folder used to store medication on a weekly basis), reluctant, promised to adhere to medication regime. Rev 2 months, post-pathology. 21413 February 2015 Pathology: FBE, U&Es, LFTs~ all NAD ‘Total cholesterol 5.3 mmol/L ( < 5.5) HDL cholesterol 1.8mmol/L.(0.9-2.2) *UDL cholesterol 3.5mmol/. (< 2.0) Triglycerides 1.2mmoV/L (0.5-2.0) LDUHDL 2.7 ChovHDL 4.1 ‘Vitamin D <20 (60-160nmolL) Discussions: BP 130/80 ¥ encouraged. Vit DY, LDL 1 — agreed to use Webster pack. Rev 2 months, post-pathology. 19 April 2015 BP 130/70, Vit v & Lipids v Medication sorted, Daughter with Pt, both want to discuss memory issues. Poor memory noted ++, e.g., forgetting hair dresser, dinner engagements, missing social events, Behavioural changes, decision-making issues. Family concerned, ‘Mini memory assessment: Poor short-term memory, day & date — several attempts, no result. Month - 3 attempts. Confirmed the year correctly, Quite worried. Requested further assessment. Family history of Alzheimer’s. [Asked about dementia — explained difference between Alzheimer's (disease — ‘1 amyloids in brain) and dementia (symptom). Alzheimer's ~ common cause of dementia, More assessments before diagnosis. Referred —> Memory Clinic. Rey, post-assessment. Using the information glven in the case notes, write a letter of referral to Dr Jones atthe Newton Memory Clinic, 400 Fail Rd, Newtown, to provide him with your bref assessment and request full mamory assesement and agnosis. In your answer: + Expand the relevant notes into complete sentences + Do not use note form + Use letter format ‘The body of the letter should be approximately 180-200 words. 215Ms Jane Graham Newtown Occupational Therapy 10 Johnston St Newtown 20/06/2015 Dear Ms Graham, Re: Mr. Barry Jones, DOB: 01/04/1972 Tam writing regarding Mr. Jones, a-44-year-old forklift driver, who wants to return to work after a back injury. Your assessment of his workplace would be highly appreciated. Mr. Jones, who is married, is a father of three. His work requires prolonged sitting and occasional heavy-lifting. On 21/03/2015, Mr. Jones initially presented with lower back pain following heavy-lifting. His X-ray revealed no abnormalities; therefore, he was referred to a physiotherapist and was given sick-leave for 30 days. On the subsequent visits, he came complaining of persistent pain along with stiff movement despite his compliance with exercises. Thus, he was given another 30 days off work Today, Mr. Jones' condition showed mild improvement as his range of movement is increasing gradually. He also reported that the pain becomes worse when sitting, lying down or walking for 30 minutes. Apart from that, he was bored and wanted to return to work. Thus, I advised him to return to work as long as he would take breaks regularly and would not lift heavy objects. Given the previous history, I would be grateful if you could advise Mr. Jones regarding the duties he can perform and is workplace. For any queries, please contact me. Yours sincerely, DoctorOCCUPATIONAL ENGLISH TEST WRITING SUB-TEST: MEDICINE TIME ALLOWED: READING TIME: 5 MINUTES WRITING TIME: 40 MINUTES Read the case notes below and complete the writing task which follows. You are a doctor working in the Stillwater Hospital Emergency Department. Today you treated Ms Garcia, who was referred by her General Practitioner (GP), Dr Bradbury. Patient Details Name: Ms Isabel Garcia, . pos: 01.01.1995 Address: 29 Greontiold Road, Stitwater Medical history: 2007 Fracture R arm 2009 Unexplained weight gain, ?stress 2014 Difficulty sleeping Allergies: Certain washing detergents cause skin irritation. Medications: —_Doxyiamine pm (encouraged not to use), Family history: Mother ~ breast cancer, age 38, ‘Soctal nistory: University student (2nd year). Reason or referrat: Suspected meningitis. ‘Treatment Record 23 May 2015 ‘Subjective: Painful, stif joints for 1 wk. Sensitivity to light bruising. Headache, neck stiffness, photophobia, rash. (On examination: Atebilo. Bruising L arm, Petectial rash abdomon and logs. Unable to touch chin to chest when lying supine. Tests ordered: Full blood count (FBC), renal function, liver function test (LFT), C-reactive protein (CRP), lumbar puncture, blood cultures.Results: White cell count: 14.0x10"2. C-reactive protein: 150 ‘Lumbar puncture: White cell count 1000 (elevated) Polymorphonuciear (PMN) predominance Glucose: 10mgidl (reduced) Protein: TOmgidl (elevated) ‘Subsequent microscopy and culture: Neisseria meningitidis Diagnosis: Bacterial Meningitis, ‘Treatment: Ceftriaxone 2g IV bd while awaiting lumbar puncture culture results. Dexamethasone 10mg IV before first dose of antibiotics, then 10mg IV every hrs for 4 days. Following lumbar puncture results: benzylpericilin 1.89 IV every 4hre for § days. Pt responding well to treatment. Department of Human Services notified. Discussed with family re: ensure family immunised. Plan: Letter to GP, recommend: : Contact close family & friends of Pt: + Seek medical attention ASAP — observation for any signs of unexplained ltiness required, + chemoprophylaxis tor people in recent close contact with Pt. Using the information given in the case notes, write a letter to Dr Bradbury, the doctor who referred Ms Garcia, to update her on the patient's status and follow-up treatment that may be required in the future. Address the letter to Dr Lorna Bradbury, Stillwater Medical Clinic, 12 Main Street, Stitwater, In your answer: + Expand the relevant notes into complete sentences + Do not use note form + Use letter format ‘The body of the lottor should be approximately 180-200 words. 220 :Dr Lorna Bradbury General Practitioner Stillwater Medical Clinic 12 Main Street Stillwater 23/05/2015 Dear Dr Bradbury, Re: Ms Isabel Garcia, DOB: 01/01/1995 1am writing to update you regarding Ms Garcia who was referred with suspected meningitis. Your further follow-up would be highly appreciated as her diagnosis is now confirmed On 25/05/2015, Ms Garcia was presented with neck stiffness, headache photophobia as well as rash. On examination, bruising along with petechial rash was detected and signs of meningitis were positive; however, she was afebrile. Thus, dexamethasone followed by empirical antibiotics had been given before receiving results of lumber puncture and culture. According to the lumber puncture result, an elevated WBCs count together with high protein level was detected. On the other hand, glucose levels were low. Subsequently, microscopic examination and culture were done which came positive for Neisseria-meningitides. Therefore, she was commenced on benzyl penicillin which successfully improved her condition. Apart from that, the Department of Human Services was notified as well as her family immunization was insured. In view of the above, I would appreciate if you would advise Ms Garcia's family on seeking medical advice in case of any signs of an unexplained illness. Moreover, chemoprophylaxis for her close contacts is highly recommended. In case of any queries, please contact me. Yours sincerely, DoctorOCCUPATIONAL ENGLISH TEST WRITING SUB-TEST: MEDICINE TIME ALLOWED: READING TIME: 5 MINUTES WRITING TIME: 40 MINUTES Read the case notes below and complete the witting task which follows. Cr Mrs Mary Clarke (born on 17 September 1960) Patient details patient in your General Practice. Name: Mrs Mary Clarke Address: 26 Marine Drive : + Riverside Social background: 54-year-old office clerk Married, ves at home with husband and 20-year-old son ‘Smokes 30-35 cigarottos por day (>30 yrs) Family/medical history: Mother died 66 y.0. ~ laryngeal carcinoma Father (coal miner) died &4 yo. - mining-telated lung disease Nl mediation No known allergies 04.07.15 Patient presented with sore throat, body aches, fever and cough. Prescription: Augmentin (ponicilin) 22.08.16 Presenting complaint: 7-week Hx of dry non-productive cough (no haemoptysis) Cough commenced with fu-tke symptoms ~> cleared with Augmentin, ‘Associated mild shortness of breath (esp. at nigh’) and “strange sensation of heaviness” in chest Nil fever, night sweats or rigors Exorcige tolerance OK — chores, shopping, could walk up 2 sets of stairs Examination: T: 96.7°C, P: 80 regular, Ht: 165cm, Wt: 68kg Respiratory exam — signs of consolidation associated with monophonic wheeze in mid-zone ‘No cyanosis/4yspnoea/ascites 'No hoarse voice/Horner's eyndromo ‘No cervical lymphadenopathy ‘No hepatosplenomegaly/bone pain ‘Systems review ~ GIT & CV normal ‘Sputum eytology ~ normal Chest Xray and CT — R middle lobe atelectasis, enlarged R hilum 2312of2 ‘Assessment: 7Bronchogenic carcinoma Plan: Counselied on potentiai diagnosis and need for further investigations eter to thoracic surgeon for follow-up investigations (bronchoscopy, biopsy) and assessment Using the information given in the case notes, write a letter of referral to the thoracic surgeon, Dr Penny Con, seeking follow-up investigations and assessment. Address the letter to: Dr Penny Citton, Department of Cardiothoracic Surgery, Central Hospital, Main Street, Stilwater. In your answer: + Expand the relevant notes into complete sentences ‘ + Do notuse note form + Use letter format ‘The body of the letter should be approximately 180-200 words.Dr Penny Clifton Thoracic Surgeon Department of Cardiothoracic Surgery Central Hospital Main Street Stillwater 22/8/2015 Dear Dr Clifton, Re: Mrs. Mary Clarke, DOB: 17/9/1960 Thank you for seeing Mrs. Clarke, a 54-year-old office clerk, whose features are consistent with bronchogenic carcinoma. Your further assessment would be highly appreciated. Mrs. Clarke, who is married and has one child, is a heavy smoker. Her past medical history is unremarkable, and she has no known allergies. Regarding her family history, her mother died of laryngeal carcinoma, while her father died of a mining-related lung disease. On 22/5/2015, Mrs Clarke presented with a 7-week-history of dry a cough associated with flu- like symptoms which was treated successfully with Augmentin. Moreover, she reported that she had had shortness of breath along with a heavy sensation in her chest. However, she denied having fever, night sweats, rigors or haemoptysis. On examination, there were signs of consolidation together with wheezes in the right middle lobe. On her chest X-ray and CT, right middle lobe atelectasis and an enlarged right hilum were detected. Otherwise, the rest of her examination and investigations were normal. Given the abovementioned findings, my presumptive diagnosis is bronchogenic carcinoma. Therefore, I am referring Mrs. Clarke for a possible bronchoscopy and biopsy. Your further management would be greatly valued. For any queries, please contact me. Yours sincerely, DoctorWRITING SUB-TEST: MEDICINE TIME ALLOWED: READING TIME: 5 MINUTES WRITING TIME: 40 MINUTES Read the case notes below and complete the writing task which follows. cag apah ap og gel fl ‘Tracy Bowen (Ms) 227788 Chidhood asthma - worse with dust, exercise, smoke, cat hair, change in temperature. Recurrent bronchitis. Father heavy smoker ~ house smoky, ‘Salbutamo! inhaler, beclomethasone prn Irregular menstrual periods since menarche. Very infrequent. up to 90-day Intermenstrual interval. Frequently with dysmenorrhoea, Stress related to parents’ divorce (2002). Adolescent acne since 3/12 (pus-filed’). ‘Abdominal exam - NAD Rectal exam - NAD FHix-no genetic anomalies ‘Breast development normal Idiopathic oligomenorthosa, primary dysmenorthoea (Oral contraceptive pil Oiane-35, 2mg - low dose) ‘Analgesia (naproxen) Reassurance: Nae Neal 1 ae ak OMIT AN ed ee bah ao aR on OOH EIS Neate Bing gir steven ereemt 1H hy apply ame re = emery Cyt ere BOT 1/5 her tnee, cree swretiehasis and aot ong Ce A bye me He 1S SEER OF foto prey ee mmpenien 20 gy bd Botrex gel LOAM - aml rege rea.Subjective Patient married; discontinued OCP January 2013. Difficulty conceiving. Amenorthoea: depression; weight gain. Objective BMI 28 (overweight) BP 100/60 Hirsutism (has had cosmetic therapy: electrolysis) + Oral GTT (fasting) 6.5mmoVA. (Ret range <5.SmnoV/) Serum testosterone 2.1 nmol/L (Ref range 0.4-2.7) ‘* SHBG 19nmol/. (Ref range 20-100) ‘ Free Androgen Index (TE/SHBG ratio) 11.19% (Ret range <8.0) ‘Serum cestrado! 325pmo/ (Follicular phase 70-670; Luteal phase 200-600) FSH S.11UAL Pep RIE Le hea pina phan Saad a ‘® Prolactin 115.39. (Ret range <25.0) TSH 2.8 (Ref range 0.35-5.50mIUA) Haematology NAD * Vitamin D STnmov/L (Ret range 60-160) tron studies Normal Assessment, PCOS (polycystic ovary syndrome) ‘Treatment ‘Climen (cyproterone with oestradiol) 10mg qd Patient requests referral to endocrinologist Pelvic US ordered: copy of results to be sent to endocrinologist ion Using the information given in the case notes, write a letter of reterral to Dr Susan Ciayton, endocrinologist at the Women's Health Centre, 11-13 Bell Steet, Newtown. In your answer: + Expand the relevant notes into complete sentences * Do not use note torm * Use letter format ‘The body of the letter should be approximately 180-200 words.Dr. Susan Clayton Endocrinologist Women's Health Center 11-13 Bell Street Newtown 28/03/14 Dear Dr. Clayton, Re: Mrs. Tracy Bowen, DOB: 22/07/88 Tam writing to refer Mrs. Bowen, a 26-year-old married woman whose features are suggestive of polycystic ovarian syndrome. Mrs. Bowen has been a patient of mine for the past 9 years. She has a medical history of asthma which has been managed accordingly. The patient initially presented to me, on 28/8/04 complaining of irregular, infrequent menstrual cycles. Her periods were also associated with dysmenorrhea; therefore, she was commenced on OCPs and analgesia. However, three weeks later, the patient attended with a new complaint of acne over multiple areas of her body. Examination showed deep inflamed nodules and pus- filled cysts. As a result, she was managed with antibiotics which did not help as she came back after 2 months with no signs of improvement. Consequently, she was referred to a dermatologist. On review today, the patient requested to be referred to an endocrinologist as she has been having difficulty in conceiving after OCP cessation since January 2013, amenorrhea and weight gain. Investigations showed a decreased level of vitamin D and elevated levels of androgens, prolactin and oral GGT; thus, Climen was prescribed. Moreover, pelvic ultrasound was requested and a copy of the result will be sent to you. In light of the above, I am referring her for your further assessment. If you require any further information, please do not hesitate to contact me. Yours sincerely, DoctorOCCUPATIONAL ENGLISH TEST WRITING SUB-TEST: MEDICINE TIME ALLOWED: READING TIME: 5 MINUTES WRITING TIME: 40 MINUTES Read the case notes below and complete the wating task which follows, Patient Name: Patient History: Social History: 11 December 2013: T August 2014 2 September 2014 7 September 2014 Dolores Hoffmann (Ms) DOB 22.06.1986 ‘Allergic to peniciin. ‘Single woman — no family in Australia; lives with long-term boyltiend, Sales assistant — ladioswear in a department store. ‘At pub last night with friend. 2 glasses wine + several cocktails. Then tainted ‘5-10mins unconscious > vomited once. No Hx fits/seizurés/incontinence. ‘No symptoms gastroentortis or URTI. Work very busy/stresstul. Feols “woozy" today. No appetite. Requested check-up. OE: sightiy palo; T 36°, P 72 reg, BP 120/70, medical certificate (Med. Cert.) 1 day, rest, watch for new symptoms. Blood tosts (FBE, LFT, URE}: normal ‘Skin check. Several moles L and Ri neck — ok. Advised to monitor for changes. URT! since 2/52, yellow-green sputum; SOB, tight chest, wheezy; lethargic. ‘Smoker. ‘Anxious ro. EBV (Epstein-Bar virus) ~ work colleague is off with it. Reassurance. Rec. rest. Mod. Cort. given for 2 days. Ordered bloods, HAEMATOLOGY: Haemoglobin 124gh. (115-165) REC 48x10" ——(8.80-5.50x 10") Pov 037 (0.35-0.47) Mcv a8 fl (78-99) MCH 30 pg (27-2) ‘White Cell Count 7Ox 10% — (4,011.0 10°) Neutrophils 88x 10% —(2.0-8.0x 10") Lymphocytes 28x10" — (1.0.4.0 10") Monocytes: 04x10" = (< 1.0 x 10) Eosinophils 03x10 — (<0.6x 10") Basophits 00x10 — (<02x 10°) Platolets 250x 10% (180-450 x 10%.) Paul BunnelViatex screening test for IM (infectious mononucleosis): negative Rix erythromycin 250mg gia 19922 November 2014 Orofacial HSV-1 for 3 days. Rx: aciclovir 200mg — 4hrly for five days + topical acicolvir 3% — gid Job stress+++ causing depression, nightmares, insomnia, difficulty getting up, loss of appetite, low libido, Poor memory and concentration; loss of pleasure; loss of confidence. Low tolerance for alcohol. Split up with boyfriend. Now living alone. Considering quitting job. Wants a break from working. Recommended referral to psychiatrist — Pt resistant. Rx: temazepam 20mg — 30mins before bed RIV: 1 week 29November 2014 Diagnosis: reactive depression and anxiety Pt has not filled temazepam script - not keen on drug Rx. Pt has agreed to a referral to psychiatrist. Using the information in the case notes, write a letter of referral to Dr John McLennan, psychiatrist, Royal Mental Health Clinic, 177 Park Avenue, Newtown. In your answer: + Expand the relevant notes into complete sentences + Do not use note form + Use letter format The body of the letter should be approximately 180-200 words.Dr John McLennan Psychiatrist Royal Mental Health Clinic 177 Park Avenue Newtown 29/11/2014 Dear Dr McLennan, Re: Ms Dolores Hoffman, D.O.B: 22/06/1986 Thank you for seeing Ms Hoffmann, a 28-year-old sales assistant, whose features are consistent with reactive depression along with anxiety. Your further assessment would be highly appreciated. Ms Hoffman, who has no family in Australia, lives alone after splitting up with her boyfriend recently. She is a smoker and a drinker. Please note, she is allergic to penicillin. On 11/12/2013, Ms Hoffmann initially presented with dizziness and loss of appetite after she had fainted and vomited at a pub on the previous day due to excessive drinking. On examination, she was slightly pale. Thus, she was received sick-leave for one day. Following this visit, she came on different occasions for other medical issues. On 22/11/2014, Ms Hoffmann reported that she had experienced depression, sleeping troubles, low libido and low alcohol tolerance. Moreover, she reported having loss of appetite, pleasure and confidence together with poor memory. As a result, she wanted to quit her job. Consequently, temazepam was prescribed after she had refused a referral toa psychiatrist. Today, it became apparent that Ms Hoffman was not keen on taking the temazepam and her script has not been filled. However, she agreed to be referred to a psychiatrist. In view of the above, I would be grateful if you would take over Ms Hoffmann's care. For any queries,please contact me. Yours sincerely, DoctorTask 3 Case Notes: Dulcie Wood Read the cases notes below and complete the writing task which follows: Time allowed: 40 minutes Today's Date 08.08.09 Patient History Dulcie Wood DOB 15.07.43 New patient in your General Practice. Moved recently to be near family. 03.07. 09 Subjective Widowed January 06, three children, wants regular check up, has noticed uncomfortable feeling in 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 Current medication: zocor 20mg daily, calcium caltrate 1 daily No known allegeries Objective BP 145/75 P 80 regular Ht 160cm Wt 61kg Cardiovascular and respiratory examination normal ECG normal Plan Prescribe Noten 50 gm 1 tablet daily in am. Advise to keep record of frequency of fibrillation sensation. Review in 2 weeks if no increase in frequency. 17.07.09 Subjective Reports sensations less but woke up twice at night during last 2 weeks Objective BP 135/75 P70 regularAssessment Increase Noten to 50 gm daily ¥2 tablet am and ¥2 tablet pm Advise review in one month. 08.08.09 Subjective 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 her sister for same condition Objective BP 180/90 P70 Action Contact Dr Raymond's receptionist and you are able to arrange an appointment for Mrs Wood at 8am on 14/08/09 Writing Task Write a letter addressed to Dr. Vincent Raymond, 422 Wickham Tce, Brisbane 4001 describing the situation. In your answer: Expand the relevant case notes into complete sentences Do not use note form The body of the letter should not be more than 200 words Use correct letter formatTask 3 Model Letter : Dulcie Wood 08/08/09 Dr Vincent Raymond 422 Wickham Tce Brisbane, 4001 Dear Dr Raymond, Re: Dulcie Wood DOB: 15/07/43 As arranged with your receptionist, I am referring this patient, a 66 year old widow, who has been demonstrating symptoms suggestive of heart arrhythmia. Mrs. Woods has seen me on several occasions in the past five months, during which time she has had frequent episodes of heart flutter and her blood pressure has been fluctuating. The patient initially responded to Noten 50mg ‘2 tablet daily in the morning, but she still had episodes of disturbed sleep during the night. Therefore the dose of Noten was increased to 50mg ¥2 tablet in the morning and ¥% 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 Caltrate 1 daily. Today’s examination revealed a nervous and upset woman with a pulse rate of 70 and blood 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. 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, DrzNOTES: Susan Forrest is a female patient in your general practice. Patient: Susan Forrest DOB: 19/05/97 (age 24) Address: 88 Ridge Road, Dandenong East Social History: Single, graphic designer Youngest in family Social drinker Smoker - 7 years, 10-15/day Family History: Father also has asthma Mother - hypertension Younger brother - ADHD Grandfather - type 2 diabetes Medical History: Asthma, since age 4. Two previous asthma related hospital admissions, most recent 2015 Allergic rhinitis Eczema Anxiety disorder Fractured tibia (2002)Current Drugs: Ventolin (albuterol) ‘symbicort (budesonide/formoterol) - twice daily Zyrtec (cetirizine) 12/3/17 Mild food poisoning - diarrhoea Encouraged electrolytes Medical certificate written for work 25/8/17 Short of breath - ongoing Nocturnal cough 7 nights p/w Ventolin use + 2/9/17 Abdomen lax & non-tender P:76 bpm T:36.5°C BP: 110/70 Notes Noncompliance with preventive inhaler - “forgets” Discussed smoking cessation options (nicotine patches, support services) Treatment Plan Assess and evaluate Continue w. current meds. WRITING TASK:Using the information given in the case notes, write a referral letter to Pulmonologist, Dr Jan Walker, at “Epstein Clinic”, 393 Victorian Road, Richmond, Melbourne In your answer: + Expand the relevant notes into complete sentences +Do not use note form + Use letter format The body of the letter should be approximately 180 - 200 words.SS a Susan Forrest asnwer.pdf 2September 2017 Dr Jan Walker Epstein Clinic 393 Victorian Road Richmond Melbourne Dear Dr Walker, Re: Ms Susan Forrest, DOB: 19.05.1997 Thank you for seeing Ms Susan Forrest, who presents with ongoing shortness of breath, nocturnal coughing and worsening asthma control, for your assessment and evaluation. Ms Forrest was first diagnosed with asthma at age four and hasbeen hospitalised on two occasions with severe exacerbations, mostrecently in 2015 She is currently prescribed for its management Symbicort (twice daily), however her compliance with this is variable as she often “forgets” to take it. Ventolin is also prescribed, for which she reports an increase in its use, and she also takes Zyrtec. In addition, she smokes 10 -15 cigarettes per day. On examination today, Ms Forrest’ s chest x-ray and FBE were normal and her peak flow was 400L/min. Ihave reinforced with Ms Forrest the importance of taking her inhibitor regularly and the need to cease smoking. However, | feel that a more complete management plan is required. Given her current symptoms and long history of asthma | would be very grateful ifyou could please assess and evaluate Ms Forrest's lung function further in order to provide her with guidance on how this condition should best be ed =2September 2017 Dr Jan Walker Epstein Clinic 393 Victorian Road Richmond Melbourne Dear Dr Walker, Re: Ms Susan Forrest, DOB: 19.05.1997 Thank you for seeing Ms Susan Forrest, who presents with ongoing shortness of breath, nocturnal coughing and worsening asthma control, for your assessment and evaluation. Ms Forrest was first diagnosed with asthma at age four and hasbeen hospitalised on two occasions with severe exacerbations, mostrecently in 2015 She is currently prescribed for its management Symbicort (twice daily), however her compliance with this is variable as she often “forgets” to take it. Ventolin is also prescribed, for which she reports an increase in its use, and she also takes Zyrtec. In addition, she smokes 10 -15 cigarettes per day. On examination today, Ms Forrest’ s chest x-ray and FBE were normal and her peak flow was 400L/min. Ihave reinforced with Ms Forrest the importance of taking her inhibitor regularly and the need to cease smoking. However, | feel that a more complete management plan is required. Given her current symptoms and long history of asthma | would be very grateful if you could please assess and evaluate Ms Forrest’s lung function further in order to provide her with guidance on how this condition should best beNOTES: Andy Williams is a 65-year-old man who presented on 15/06/2018 at the clinic in which you work. Clinic: Eastern Medical Centre, Melbourne 3002 Patient: Andy Williams Age: 65 Height: 183cm Weight: 155.5kg BMI: 46.6kg/m? Social History: Radiologist Recently divorced Depressed about financial problems/stressful changes at work. Partner does all cooking and shopping Family history: Family history positive for obesity (father and older sister obese) Mother healthy; normal weight Grandfather - gout2of3 Medical history: Type 2 diabetes Hypertension Gout Sleep apnea BG levels (morning): 100 - 130 mg/dl Hemoglobin Ax: (A1C) level: 6.1%, (WNL) Triglyceride: 201 mg/dl Serum insulin: 19 ulU/ml Medications: 30 and 70 units NPH insulin before breakfast/before or after dinner 850 mg metformin twice daily Atorvastatin 10mg Lisinopril, nifedipine Allopurinol Over-the-counter vitamin B,2 supplement Weight history: Childhood obesity Reports gaining weight every decade At highest adult weight Participated in commercial and medical weight-loss programs Regained weight within months of discontinuing programs. Consulted registered dietician Reluctant to consider weight-loss surgery in past, concerned about complications from bariatric surgery Diet/Food intake: 3meals/day Dinner, his largest meal of the day, 7:30 p.m. Reports limited fast-food consumption/restaurants 2 nights/weekNo alcohol Reports binge eating triggered by stress - “maybe once a month” Plan: Pt concerned about health/wants to get life under control Wants to learn about surgical options. Partner encouraging Referral to The Weight Centre for evaluation of obesity, recommendations for treatment Will consider surgery if The Weight Centre recommends WRITING TASK: Using the information given in the case notes, write a referral letter to surgeon, Dr D Kurac, at The Weight Centre, 393 Victorian Road, Richmond, Melbourne. In your answer: + Expand the relevant notes into complete sentences +Do not use note form + Use letter format The body of the letter should be approximately 180 - 200 words.(Today's date) Dr D Kurac ‘Surgeon The Weight Centre 393 Victorian Road Richmond, Melbourne Dear Dr Kurac, Re: Andy Williams, aged 65 years lam referring this patient to you, a long-term sufferer of obesity, for evaluation and treatment including the possible option of weight-loss surgery. Mr Williams has been obese since childhood and has experienced a steady increase in weight throughout his life. His current weight is 155.5kg with a BMI of 46.6kg/m2. On investigation today, his BG levels (morning) were 100-130mg/dl, and triglyceride and serum insulin were 201 mg/dl and 19uLU/ml respectively. There is also a strong family history of obesity. Inaddition, he is currently diabetic and hypertensive, for which he is taking 30 and 70 units of NPH insulin before breakfast/before or after dinner, 850mg metformin twice daily, atorvastatin 10mg, lisinopril and nifedipine. Mr Williams’ diet includes no alcohol and only occasional fast-food. However, he does binge-eat when stressed and, after a recent divorce, he reports that work and financial pressures are apparently causing him some depression. Please note that despite advice from a dietician and attendance at various weight-loss programs, there has been no improvement. In view of the above, kindly evaluate Mr Williams’ condition and discuss with him the best course of action for control of his weight, including the possibility of surgery.NOTES: This patient was seen and treated at ABC Base Hospital Accident and Emergency Department. Patient Mrs Anne Jenkins (DOB: 20/4/1929) Admission date 7/8/18 Social Background Lives alone, widow 23 years Own home 2dogs ‘Flo’ and ‘Bessie’ 3cats ‘Lou’, ‘Tiger’ and ‘Toggsie’ Daughter interstate, ‘works in high finance’, ‘very busy and important’ Son in Canada Receives Meals on Wheels but ‘doesn’t like them’, ‘I make better food for my dogs’ No home help Ambulates with wheelie walker or stick, does own shopping Has ‘good ‘neighbours Patient history Appendectomy Total Abdominal Hysterectomy BSO TIA - transient ischemic attack 2014 Atrial Fibrillation HT (hypertension) Hypothyroid OA (osteoarthritis)Medications Oroxine 100mcg/50 meg alt days Atenolol 25mg daily Digoxin 62.5mg 2daily Astrix 100mg daily Panadol osteo 2 tds Allergies Elastoplast Admission diagnosis 90 yo woman BIBA Presented after fall at home this am NOF (no injury found) Neighbour heard crying for help Ambulance obs WNL Unable to get up from ground by self Slightly dishevelled, dried food scraps on dressing gown Orientated to place / person but not date / day “it's all the same to me, dear” Warm, well-perfused Rang neighbour who says a few recent falls needing help up Unable to contact Pt children - message left on daughter's message bank Although concerns of self-care and recent falls pt. competent to make decisions Objective SL esm non-radiating s1 PR67 reg. BP 145/80 lying 135/85 standing Chest scattered rhonchi, nil focal Abdo soft nil pain bs nil UAtrace leuks nil else Full rom bilat hips. No shortening /abnormal rotation of legsNo clinical # noted hips lower limbs or elsewhere noted Healing grazes and bruise elbows noted Ambulates without pain BSL 6.7 ECG AF rate 67 nil acute CAR ectatic unfolded aorta, borderline cardiomegaly, nil consolidation /frank LVF Pelvis and hip x ray’s nil # seen, osteoporosis noted FBE, uge nil TFT and dig level TF MSU sent. *Allresults available 9/8 Discharge plan Letter to gp to follow up: TFTs Digoxin test MSU Gerirv Home help / placement WRITING TASK: You are an ED resident who has seen and written up this patient. Write a discharge summary to patient's GP Dr Arnold Zeimer at 10 Hotham Street, St Kilda, 3002 regarding Mrs Jenkins’ required follow up. In your answer: + Expand the relevant notes into complete sentences +Do not use note form + Use letter format The body of the letter should be approximately 180 - 200 wordsDr Arnold Zeimer 10 Hotham Street, St Kilda, 3002 Dear Dr Zeimer, Re: Mrs Anne Jenkins, DOB: 20/4/1929 Mrs Anne Jenkins is a 90-year-old patient of yours who was brought into our emergency department today by ambulance after a fall at home. We could find no specific injuries but have some concerns about her general level of self-care we would like you to follow up on. In our assessment, we noted some mild memory loss, long standing atrial fibrillation and some leukocytes in her ward urine test. We did note some older bruising and grazes of her elbows consistent with previous falls. X-rays of her pelvis and hips were normal and she is able to ambulate without pain. CT brain, CXR, pelvis and hip X-rays and basic bloods were essentially normal. Aneighbour reported that she has suffered a number of recent falls requiring assistance and a general declinein self-care. We were unable to contact her children today, although | did leave a message on her daughter's message bank. Could you please follow up and act on her TFT, digoxin levels, and MSU result? The results will be available in two days’ time. In addition, would you kindly consider her for a geriatric review? She may require some home help or even placement into care. Please let me know if you have any questions or concerns Yours sincerely,SS a Tom Riddle.pdf NOTES: Tom Riddle has been presenting to your clinic with symptoms of asthma. Patient: Tom Riddle DOB: 19/05/98 (age 20) Address: 88 Ridge Road, Dandenong East Social History: Student Non-smoker Social drinker Sports: Indoor football Family History: Father - shoulder reconstruction (25/08/2014) Mother - hypertensive Grandfather - asthmatic Younger sister- IgA nephropathy Medical History: Childhood asthma - nil episodes 8 years Eczema (periodic) No known allergies 1/6/18: 2wks- breathlessness ‘needs tosit up’ Persistent coughing/wheezing, eyes itching Missing classes Td =Notes: New accommodation-two cats, dusty old carpet, sleeps on floor 2/6/18: CKR: Clear Pre-bronchodilator - FEV1: 3.61 Post-bronchodilator - FEV1: 4.35 Response positive - 20% Diagnosis: Asthma Plan: Oral prednisone 50 mg - 10 days Albuterol inhaler 2x day symbicort (Budesonide/Formoterol) Advised allergen management Return 4 weeks or as needed 14/6/18: Sleep disruption + 7 nights p/w Albuterol + 5/6 times daily Eczema flare T:37°C (98.7°) BP: 190/88 mm Hg P: 122 beats/minute Respiratory rate: 32 breaths/minute Oxygen saturation (02 sat): 88% ABG: Pa0.62 mm Hg (below normal range), PaCO,: 42 mm Hg Auscultation: bilaterally diminished lung sounds Expiratory wheezing - upper/lower fields. Administered oxygen 3 L, attained O2 sat 93% Albuterol hourly, lV. corticosteroid - Positive response17/6/18: Education - discussed environmental triggers, proper inhaler technique Refer to allergist- allergenic testing, guidance on environmental management WRITING TASK Using the information in the case notes, write a letter of referral to Dr Robson, an allergist at Central Hospital, for testing and identification of Mr Riddle’s allergies. Address the letter to Dr lan Robson, Allergist, Central Hospital, Oldtown. In your answer: + Expand the relevant notes into complete sentences +Do not use note form + Use letter format The body of the letter should be approximately 180 - 200 words.17/06/18 Dr lan Robson Allergist Central Hospital Oldtown Dear Dr Robson, Re: Mr Tom Riddle, DOB: 19/05/98 lam writing to refer Mr Riddle into your care, who has moderate persistent bronchial asthma. He requires further testing and identification of his allergies. On 01/06/18 Mr Riddle presented with a two-week history of breathlessness associated with persistent coughing, eye itching and wheezing that resulted in his absence from college. He had an assessment for his lung function on 2/06/2018 that showed a pre- bronchodilator FEV1: 3.61 and a post-bronchodilator FEV1: 4.35 with a 20% positive response, which was treated with a short course of prednisone and inhalers. Twelve days later, he presented again with an acute exacerbation of bronchial asthma that was treated with oxygen, hourly albuterol and intravenous corticosteroids. Subsequent to this visit he was educated about possible environmental triggers and proper inhaler technique. Please note, his past medical history is significant for childhood asthma with good control over the last 8 years. He has eczema, but no known allergies. He has recently moved into new accommodation where he keeps two cats. In addition, he owns a dusty old carpet at home and sleeps on thefloor. | would appreciate it if you could help with Mr Riddle’s allergenic testing and provide guidance on environmental management. Ifyou have any questions please do not hesitate to contact me. Yours sincerely, DoctorNOTES: Julian McDonald (Mr) is a 68-year-old male recovering from total left knee joint replacement and needing transfer from your acute care hospital (The Alfred, 55 Commercial Rd, Melbourne VIC 3004) to the rehabilitation hospital (Cabrini Hopetoun Rehabilitation) who will take over his care. Mr B Mossley is the name of the specialist who performed the surgery. Patient details Name: Julian McDonald (Mr) DOB: 12/1/50 Other: Gold Card Veterans Affairs, DVA234965 Admission date: 20/7/18 for elective L TKR Transfer date: 24/7/18 Reason for transfer: Rehabilitation care Transfer type: One-way Patient history Osteoarthritis (past 10 years) Gout (since 2010) Smoker - 20cigs/day Htn Obesity- BMI 35 Hypocholesteraemia PTSD Alcohol > 6-10 SD /dayDischarge medications Zyloric 300 mg daily Lipitor 20mg nocte Karvina 300mg daily Mogadon 5mg nocte (ceased) Paracetamol 1gm qid Ibuprofen 400mg tds Nicabate 21 mg patch Targin 20/10 bd Oxycodone 5-10mg q4hr prn Allergies Penicillin allergy rash as child Social Lives alone in caravan back of friend’s property w. 3 dogs, 6 chickens, cat Outdoor shower Uses BBQ to cook Reg'd w. Dept. Vet. Affairs Divorce, 2 estranged children, few friends Operative report Medial prepatellar approach Stryker triathlon x3 Prosthesis Reinfusion drains in situ Spinal plus GA Post op Significant post op pain requiring a no. of medical reviews Morphine PCA inadequate 48 hr ketamine infusion used w effect Ongoing pain followingAmitriptyline commenced - difficulty urinating so ceased w effect Significant somnolence and snoring noted despite inadequate analgesia, needs formal sleep studies CSU grew Staph saphrolyticus - prob. contaminant - specialist v concerned 5d Keflex given in addition to normal 24 hr post op antibiotics ‘Some mild agitation and insomnia noted Not significant alcohol withdrawal Nicotine replacement instituted Slow to mobilize partly from pain Treatment plan ROS at d10 Specialist at 6w (appointment made 7/9/18) Significant rehab including physiotherapy and occupational therapy home visit to assess suitability and fitness of returning to caravan Social work Drug and Alcohol input appreciated Sleep studies? OSA Transfer plan Immediate one-way transfer to the Cabrini Hopetoun Rehabilitation hospital for immediate treatment WRITING TASK Mr McDonald was admitted 4 days ago for knee surgery at the Alfred Hospital where you work. Using the information in the case notes, write a transfer letter to the Admissions Officer at Cabrini Hopetoun Rehabilitation, 2-6 Hopetoun Street, Elsternwick, Vic 3185, for Mr McDonald’s immediate treatment. In your answer:+ Expand the relevant notes into complete sentences +Do not use note form + Use letter format The body of the letter should be approximately 180 - 200 words24/7/2018 Admissions Officer Cabrini Hopetoun Rehabilitation 2-6 Hopetoun Street Elsternwick, Vic 3185 Dear Admissions Officer, Thank you for accepting this 68-year-old man who has recently undergone post left total knee joint replacement for rehabilitation and assessment for suitability to return to his home. His background medical issues include obesity, hypertension, hypercholesterolemia, gout, cigarette smoking and excess alcohol intake. As a child he experienced a rash when given penicillin, Mr McDonald underwent a routine joint replacement with specialist Mr B Mossley on 20/7/18. Postoperatively he experienced significant analgesic issues, and a possible catheter-related UTI which has been treated. In addition, we noted signs consistent with sleep apnoea His discharge medications are Zyloric, Karvina, Lipitor, paracetamol, ibuprofen, and a Nicabate patch. Included the opiates Targin and oxycodone. (Please see the attached list of dosages) Please provide Mr McDonald rehabilitation including physiotherapy as needed as well as preparation for his return to living at home in a caravan. We anticipate his rehabilitation may be slow given the pain issues, and his isolated home situation will be problematic. Occupational therapy home visits and some social work input will be needed, as well as the possibility of drug and alcohol counselling and sleep studies arranged while an inpatient with your team.OCCUPATIONAL ENGLISH TEST WRITING SUB-TEST: MEDICINE TIME ALLOWED: READING TIME: 5 MINUTES WRITING TIME: 40 MINUTES Read the case notes below and complete the writing task which follows. Mr George Poulos is a 45-year-old man who has hurt his back. He presented at your general practice surgery for the first time in late June. Severe lower back pain of 2 days duration: 2 days ago at home lifting logs (approx. weight each 20-30kg) from ground Into wheelbarrow. ‘Action: bending, iting and rotation. ‘Sudden severe pain — mid lower back. Thought he felt a click. Was locked in serni-flexed position, almost impossible to walk, Wile helped him into house and bed. ‘Took 2x Panadeine Forte, repeated 4 hours later. Disturbed sleep, Pain only low back, no radiation to thighs. Yesterday pain less severe, able to ambulate around house. Today again pain less severe. Patient History: Stockbroker — 45 yo. Married ~3 children secondary school, 1 primary school. ‘App: Goad. Diet regular. Bowels: Normal. Diarthoea if stressed. Mict: Normal. Wr Varies - BMI 27. Sex: Often too tired. Exercise: Nil Tobacco: 25/day. ‘Alcohol: Frequently 10+ to 15+ std drinks/day. Allergies: Pethidine, penicillins, radiographic contrast agent (unspecified) 7? iodine. Family History: NoCa bowel, no diabetes, no cardiovascular. HPI: Head injury (football) approx 15yrs ago. MRI brain. NAD. Reacted to contrast medium, 4anObjective: Plan: 28/06/14 Objective: 5/07/14 Writing Task: Full examination CVS, RS, RES, CNS: NAD. P 68pm reg. BP 135/80. ‘Musculo-skeletal: Stands erect. No scoliosis. ‘Loss of lumbar lordosis Lumbar spine: Floxion fingertips to patella. Expression of pain Extension limited by pain Lateral flexion: L.& F full. FRotation: L & ful No sensory loss. Reflexes: Patelar & Ankle L+ Re. SLR (straight leg raise): L 90 R 90. ‘Take time off work. Analgesia: paracetamol 500mg 2x 4nrly max 8 in 24hrs or Panadeine Forte, or 1 of each, Wamed ~ risk of constipation with Codeine. Review 1 week. Has now developed pain which extends down back of F thigh, lateral calf and into dorsum of foot. Examination. As before except that now lumbar flexion imited to fingers to mid thigh and SLR: L 85 R 60. Review 1 week. Pain worse. ‘Almost immobile. Severe pain down R leg. Tingling in R calf Examination. Lumbar flexion almost nil. Other mavts more restricted by pain. SLR: 70 R50. Loss of light touch sensation lateral distal calf & plantar aspect of foot, Loss of R ankle reflex. Diagnosis: Low back pain, probably discogenic, with raciculopathy. Refer to neurosurgeon & request that the neurosurgeon order an MRI and provide advice regarding the possibilty of surgery. Using the information given in the case notes, write a letter of referral to Dr B White, Neurosurgeon, City Hospital, Newtown. {In your answer: ‘+ Expand the relevant notes into complete sentences Do not use note form Use letter format ‘The body of the letter should be approximately 180-200 words. 181Dr. B White Neurosurgeon City Hospital Newtown 05/07/14 Dear Dr. White, Re: Mr. George Poulos Lam writing this letter to refer Mr. Poulos, a 45-year-old male whose features are suggestive of lower back discogenic radiculopathy. Mr. Poulos is a married stockbroker. He is a smoker and drinks alcohol. Moreover, the patient is allergic to pethidine, penicillin and an unknown radiographic contrast agent. On 21/06/14, the patient attended my clinic complaining of a sudden severe lower back pain that began after bending his back to lifi heavy logs from the ground. His examination showed an expression of back pain on extension and flexion. Therefore, he was advised to rest and take paracetamol. After one week, the pain extended to the back of his right thigh, lateral calf and dorsum of the foot. At that time, his examination revealed worsened lumbar flexion and decreased angle in the SLR test from 90 to 85 plus from 90 to 60 in the left and right leg, respectively. Unfortunately, today, his pain has deteriorated even more as he is now nearly unable to perform lumbar flexion. Additionally, loss of light touch sensation in the lateral distal calf and plantar aspect of the foot was noticed. In view of the above, I am referring this patient to see if he requires any surgical intervention, Please note, he needs an MRI scan. Yours sincerely, DoctorOCCUPATIONAL ENGLISH TEST WRITING SUB-TEST: MEDICINE TIME ALLOWED: —- READINGTIME: 5 MINUTES WRITING TIME: 40 MINUTES Read the case notes below and complete the writing task which follows. Mr James Seymour is 60-yeer-old man presenting in your general practice with @ swollen left large toe. Patient detaits: James Seymour 4 Powet Drive, Clayfield 19/09/58 (Age 60) Retired academic (computer science) Divorced, no children, lives alone Non-smoker since 1994 Heavy drinker 5-6 beers and 3 wines/day BP 115/70mmHg, HR 68, RR 18, T37.4°C Nil known Father ~ rheumatoid arthritis (RA) ~ 28 yrs old. Died 75yrs. Mother ~ smoker, died chest infection aged 7 yrs. Grandparents’ history unknown, died when old. PMHx: Appendicectomy 1963 Childhood — recurrent bronchitis Annual influenza vaccine Regular episodes of inflammation (gout 1st toe) since 2010 - consulted several doctors Medication: Colchicine (Lengout) ~ 500mog 2 tabs (sta! on attack) then 1 tab each 2/24 unt relist. Total dose = 6mag in 4 days. Indomethacin (Indocid) ~ 25mg 2 tabs, twice/day. On allopurinol after last acute attack — after several mths w/o symptoms ceased meds (a couple of mths before current episode).‘Treatment record: 25/08/14 ~ 4 wks into current bout of gout. Colchicine started 2 wks into bout, only taken at sub-therapeutic levels. Indocid taken erratically. 3rd bout in 8 mths. No allopurinol for a couple of mths. Modifies diet to +purines. Sometimes wakes at night. Given father’s Hx Pt wants referral to rheumatologist to exclude RA. Pt thinks gout meds not working (unikely).. Onexamination: Moderately inflamed, red first L toe. V painful ~ Pt iritated. No evidence of involvement of other joints. PLV insistent on possibility of RA; poor compliance with gout management much more likely. Treatment: + Encouraged to comply with gout meds: - resume full dose colchicine. ~ resume full dose indomethacin. Cease either if gastrointestinal (Gl) side effects (diarthoea from colchicine; upper Gl upset from indomethacin). + Regular paracetamol (4g/day for 3 days, then prn), + Take oxycodone Smg bedtime only if sore and can't sleep; try to cease ASAP. + Improve dietary compliance and + alcoho! intake. + Xray L foot, FBE, ESR, LFT, U&E, SUA, CRP. + Rey. 1/52 to discuss results & roferral. 03/05/14 Xray ~ minor degenerative changes of L first metatarsophelangeal joint. FBE: "MCH 32.3pg (Ref Range: 27.0 - 32.0). All other NAD. “Urate 0.48mmol/L (Ref Range: 0.18 — 0.47mmol/L). “CRP 6.0mg/L (Ref Range: < 3.0). Gout episode subsiding. No drug side effects apart from brief diarrhoea. Only needed night time oxycodone 8 nights. Provisional Diagnosis: Gout. Treatment: * Discussed ?synovial fluid sample stat next episode. + Start allopurinol now, long term; reinforce messages re: diet & alcohol. + Referral to Rhaumatologist on patient's insistence with copy of pathology results. Wri ies Using the information given in the case notes, write a letter to Dr Malcolm Stil, Rheumatologist at 5 Grant St, Fairmont, for further treatment or investigations. In your answer: * Expand the relevant notes into complete sentences * Donotuse note form © Use fetter format ‘The body of the letter should be approximately 180-200 word:Dr Malcolm Still Rheumatologist 5 Grant St Fairmont 03/05/2014 Dear Dr Still, Re: Mr. James Seymour, D.O.B: 19/09/1953 Thank you for seeing Mr. Seymour, a 60-year-old retired academic, whose features are consistent with gout. Your further assessment would be highly appreciated. Mr. Seymour lives alone and he is a heavy drinker. He has been suffering from recurrent attacks of gout in his first toe since 2010. Thus, he is on colchicine, indomethacin and allopurinol. He has a strong family history of rheumatoid arthritis. On 25/04/2014, Mr. Seymour presented with a four-week history of an attack of gout after stopping allopurinol two months earlier. On examination, his first toe was inflamed and painful. He was concerned about having rheumatoid arthritis, but it was believed to be due to non-compliance wiyh drug. Consequently, he was advised on being compliant with his medication along with reducing alcohol intake. In addition, some investigations were requested. Today, Mr. Seymour's condition showed improvement. His X-ray revealed mild degenerative changes in the first left metatarsophalangeal joint. Moreover, high levels of MCH, urate and CRP were detected. Therefore, the possibility of a synovial fluid sample in the next episode was discussed. In view of the above, I am referring Mr. Seymour for further investigations and treatment. Please note, a copy of his test results has been attached for your convenience. For any queries, please do not hesitate to contact me. Yours sincerely, DoctorOCCUPATIONAL ENGLISH TEST 1yIAITING SUB-TEST: MEDICINE TIME ALLOWED: READING TIME: 5 MINUTES WRITING TIME: 40 MINUTES Read the case notes below and complete the writing task which follows. Mrs Katherine Walter is a patient in your general practice. History: Name: Mrs Katherine Walter pos: 26 November, 1975 Height: 170m ‘Asthma — since childhood; budesonide (Pulmicort) inhaler, since 26/06/09 Chronic fungal skin infections (both feet) — currently clotrimazole (Canesten) Moderate family Hx depression (father, sister, aunt, uncle) Married; two children (8 & 11 yrs) Home duties No hobbies or sport Family (parents, husband's parents & siblings) live In other states Subjective: Here for ‘check-up’. Seems well, happy, volunteers at her children’s school. Reports feeling tired. Asthma controlled, more attacks this year. Fungus on feet flares up periodically — Pt reports no creams seem effective. Overweight. Examination; BP 110/95 Heart rate ~ 76 bpm Breast check — no palpable mass found ‘Skin check — no suspicious lesions found Wt— 82kg BMI-28.4 Pap smear cBc Ptappears well. Needs to Wweight, Texercise. Monitor BMifitness/ifestyle. Advise Pt re lifestyle changes to weight, Texercise. Pt to phone for test results int wk. Recommend miconazole (Daktarin) for fungus. R/V appt 3 mths to assess fungal infection, weight and fitness. ‘| 22728/05/15 “Subjective: 2of2 Examination: 25/07/15 Examination: Plan: anne Using the information in Road, South Seatown. In your answer: RW. Ptreports feeling well and energetic: Too busy to come to scheduled rv 8 mth didn’t think it was necessary. Asthma flared up about two months ago but no attacks since then. Fungus improved. Reports Ninvolvement with school (now president of parents’ association). Hes lost weight, joined gym (trains daily). BP - 108/90 Heart rate - 66 bpm Wt-69.5kg BMI-24 CBC ~ all resutts in normal range (results of test 19/11/14) Pap smear —no abnormalities found (results of test 19/11/14) Reports feelings of nat coping and of wanting to die. Feels tired, but sleeps badly. No energy to complete household tasks, e.g., cooking and cleaning, looking after children, . Feels overwhelmed with responsibilities. Doesn't want to eat. BP - 120/90 Heart rate — 78 bpm Wt 50kg BMI-17.3 ‘Temp -37.5°C Depression — severe / ?bipolar disorder. Requires urgerit treatment. Refer to psychiatrist for urgent assessment and treatment for depression/ bipolar disorder and suicidal thoughts. Contact husband to discuss chid care, household maintenance, etc. a the case notes, write a letter of referral to the psychiatrist, Dr M Jones, 23 Sandy Expand the relevant notes into complete sentences Do not use note form Use letter format ‘The body of the letter should be approximately 180-200 words. 228SS PCy x Katherine Walter z.pdf i=] Dr M Jones Psychiatrist 23 Sandy Road 25/7/2015 Dear Dr Jones, Re: Mrs. Katherine Walter, DOB: 26/11/1975 Thank you for seeing Mrs. Walter, a-40-year-old woman, whos severe depression and possible bipolar disorder. Your urgent as appreciated. features are suggestive of ssment would be highly Mrs. Walter is married and has two children. Her past medical history is unremarkable except for asthma which is well-controlled. Kindly note, she has a strong family history of depression. On 19/11/2014, Mrs. Walter initially visited my clinic for a regular check-up. At that time she looked well, happy and energetic. On examination there were no abnormalities apart from being overweight. Thus, she was advised to reduce her weight which she successfully managed to do six months later and her BMI fell to 24. Apart from that, she increased her social activities. Today, Mrs. Walter came complaining of depression, tiredness, sleeping troubles along with suicidal thoughts. Moreover, she reported that she had no energy to do her home duties and was overwhelmed with r Furthermore, she had lost a further 9 kilograms over the last two months due to | Given the previous history, I strongly believe that Mrs. Walter needs your urgent management. I would be grateful if you would discuss child care and household maintenance with her husband. For any queries, please contact me. Yours sincerely, DoctorOCCUPATIONAL ENGLISH TEST WRITING SUB-TEST: MEDICINE TIME ALLOWED: READING TIM 5 MINUTES WRITING TIME: 40 MINUTES Read the case notes below and complete the writing task which folows. Mrs Mary Clarke (born on 17 September 1960) is a patient in your General Practice. Patient details Name: Mrs Mary Clarke Address: 26 Marine Drive . . Riverside Social background: 54-year-old office clerk Married, tives at home with husband and 20-year-old son Smokes 30-35 cigarettes per day (>30 yrs) Family/medical history: Mother died 66 y.0. ~ laryngeal carcinoma Father (coal miner) died 54 yo. ~ mining-related lung disease Nil medication No known allergies 04.07.45 Patient presented with sore throat, body aches, fever and cough. Prescription: Augmentin (penicillin) 22.08.15 Presenting compl: 7-week Hx of dry non-productive cough (no haemoptysis) Cough commenced with flu-like symptoms ~> eared with Augmentin Associated mild shortness of breath (esp. at night) and “strange sensation of heaviness’ in chest Nil fever, night sweats or rigors Exercise tolerance OK — chores, shopping, could walk up 2 sets of stairs Examination: T: 96.7°C, P: 80 regular, Ht: 165m, Wt: 68kg Respiratory exam — signs of consolidation associated with monophonic wheeze in mid-zone No cyanosis/dyspnoea/ascites No hoarse voice/Horner’s syndrome No cervical lymphadenopathy No hepatosplenomegaly/bone pain Systems review - GIT & CV normal ‘Sputum cytology ~ normal Chest X-ray and CT — R middle lobe atelectasis, enlarged A hilum 231Assessment: ?Bronchogenic carcinoma Plan: Counselled on potential diagnosis and need for further investigations Refer to thoracic surgeon for follow-up investigations (bronchoscopy, biopsy) and assessment Using the information given in the case notes, write a letter of referral to the thoracic surgeon, Dr Penny Clifton, seeking follow-up investigations and assessment. Address the letter to: Dr Penny Clifton, Department of Cardiothoracic Surgery, Central Hospital, Main Street, Stillwater. In your answer: + Expand the relevant notes into complete sentences , + Donotuse note form + Use letter format The body of the letter should be approximately 180-200 words.Dr. Penny Clifton Department of Cardiothoracic Surgery Central Hospital Main Street Stillwater 22/08/15 Dear Dr. Clifton, Re: Mrs. Mary Clarke, DOB: 17/09/60 Tam writing this letter to refer Mrs Clarke, a 54-year-old married woman whose signs and symptoms are suggestive of bronchogenic carcinoma. Mrs Clarke is a heavy smoker and works as an office clerk. In terms of her family history, her father died of a mining-related lung disease at the age of 54 while her mother died of laryngeal carcinoma at the age of 66. On 04/07/15, she came to my clinic and reported having a sore throat, body aches, fever and cough; thus, Augmentin was commenced. Regrettably, today she attended my clinic with complaints of a seven-week history of dry non-productive cough associated with shortness of breath especially at the night and chest heaviness. However, the patient did not report fever, night sweating or chills. Her examination was unremarkable except for signs of consolidation plus monophonic wheezing in the right middle zone of her lung. In addition, chest x-ray and CT scan revealed atelectasis in the right middle lobe and an enlarged right hilum. In light of the above, I am referring Mrs Clarke for your further investigations and assessment. Please note, a biopsy and bronchoscopy might be required. Yours sincerely, Doctor‘spiow 00¢-bi Aoyewnoudde oq Pinoys sone} ax 0 Kpog ou, yewuo}san91 96 uso} iou esa oued + seouses sjojdu09 owt sejou yuenys: ou PUES woupeon pe woussos posueb.o podsuen cousrauy e1ds0H UnvEN Seow Cuguupe ‘sueaou 44 ym ayodg UASSUAPE adsox WoEN suo euounoud ego) -0¥0)y——_OUBHOSSY ose. ooudtype mun ‘an20140, (e52:08e) yz. ons UWA :ongootang stoze00 ‘rx 8049 4 on aims pue Kdoosoons 1) 888 winds sia ‘muownoud orgy Aueo"s sisEUOK aU peOueypun sisuowio Seppo pov evOse200 ‘uouatsod eso Bur 8 pa}u sapoeN pH et 48 Wed aseed rowan 907 snnaaiao, ongootans 102060 son) (200 Buy we yeN ‘aveu Ewe 9 unobp) poELEAUN svONEEIPEW OO a swowsssesy ruin 2,1248464 ody =onpoolao, "9 uopeyindo eau u Buyrses"pocypy> ui spe wes 0 paul on Le 1010 gino omnpoud © PON, ‘nnootans etozeoc0 soe 210006 snoK uy woHed pO-RaK-y #5 BUD AEN SIL ‘soy uous Guru oy ecuio pus jeg SoU a9 Oy POL, SSLNNI OF ‘SWI ONILIUM SHINNINS -3WLONIGVSH = :daMOTIV SIL ANIOIGAW «LSa1-aNS ONLINM LSAL HSITONA IWNOILWdND90OCCUPATIONAL ENGLISH TEST WRITING SUB-TEST: MEDICINE SAMPLE RESPONSE: LETTER OF REFERRAL 10 February 2014 DrL Roberts Admitting Officer Newtown Hospital 1 Main Street Newtown Dear Dr Roberts, Re: Mrs May Hong Thank you for seeing this 43-year-old patient with right lower lobar pneumonia for assessment. 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 known allergies. Her last prothrombin ratio taken on 09/02 was 2.4. Today, she presents with a six-day history of productive cough with associated fever and lethargy. This was treated initially with oral amoxycilin (neffective) and then chest physiotherapy, but today she has deteriorated with tachypnoea and right pleuritic chest pain. The right lower lobe is dull to 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. Sputum M&C showed ‘gram-positive streptococcus pneumoniae. The X-ray showed opacity in the right lower lobe. | believe her rapid deterioration warrants inpatient treatment. | would appreciate your assessment and advice regarding this. | will be in touch to follow her progress. Yours sincerely, Doctor ‘wow occupationalenglishtest.org, B14 Writing Candidate Answer 1 sn/oz/2014 Dr. LRoberts ‘Admitting Officer Newtown Hospital 1 Main Street Newtown Dear Dr Roberts Re: Mrs May Hong am writing to refer this patient, a 43 year-old lady who has symptoms and signs of right lower lobar pneumonia for admission and further management. Mrs, Hong has rheumatic cartitis since childhood associated with mitral regurgitation and atrial fibrillation. She isa light ‘smoker and currently is on digoxin 0.125 mg AM and warfarin 4 mg PM. Initially, on 07/02/2014 she presented to me complaining of productive cough forthe last 3 days and associated with fever. On examination, she appeared tired, febrile with a temperature of 38.0 C, pulse was 80 beat per minutes with atrial fibrillation, BP was 140/80 mmblg, She had moist cough, searttered ronchi through the chest and apical pansystolic murmur on consult Therefore, Amoxicillin SOO mgorally t.d.s was prescribed based on my provisional diagnosis, and she was advised to stop smoking, Two days later, unfortunately her condition continued to deteriorate, with increased productive cough with yellow phlegm. On examine, she looked exhausted, with a temperature of 38.5”, pulse 92beats per minute with arial fibrillation, and BP 120/80. On chest consultation, there was a mild crakles at right lung base posteriorly and occasional scattered crackles. Therefore, blood tests, sputum sample for culture and sensitivity, and a chest xray were requisted. Regrettably, on 10/02/2014, her symptoms had worsened. She had right lower lobe dull to percusion. her blood tests results, revealed gram-positive no streptococcus pneumonia which sensetive to clarithromycin, In view of the above, | believe she needs urgent admission and further management. | appreciate your attention to her condition, Yours sincerely, Or Ahmed www.occupationalenglishtest.org