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. Joshua Vance Male ats Normal vaginal delivery at 38 weeks’ gestation No perinatal or neonatal complications Birth weight 3250 Parents: Pamela Vance (mother) ~ first child ‘Stewart Vance (father) 31/12/13 Routine 6-week baby check History: Mother concerned regarding bowel actions: anly one bowel action every 3 days; stools a litle hard. Is breastfed. Making wet nappies, feeding well, demand feeding, sleeping through the night. Examination: _6-week check — good tone, hands & feet normal, hips normal, genitalia male, no herniae, no evidence of spina bifida occulta, abdominalichesthheart exam normal, fontanelles normal, red reflex present, nose & ears normal, palate intact. Perianal examination normal, no fissures. Weight 3900g, Assessment: Mild constipation in breastfed baby; otherwise normal 6-week check. Plan: Reassurance ~ bowel habit variable in infants & can often settle. Try expressing milk from one feed a day & giving it in a bottle with some water (boiled & cooled to body temp). Review 2/52 19/01/14 History: Still hard stools every 3 days. Now waking up crying, pulling legs up to chest ‘every haif hour throughout the night. Pulls away from breast halfway through feeds. No vomiting. No fevers. No respiratory symptoms. Making wet nappies. Examination: Hydration status normal. Abdominal examination: hard faeces, Perianal examination normal, no fissures, Weight 42009, Assessment: Constipation no better. Has put on weight. Plan: Trial of Coloxyl drops dally. Express mik from two feeds a day & give itin a bottle with some water (boiled & cooled to body temp). Review 1/5218/01/14 History: Has not passed a bowel action for last 5 days. Refusing feeds. No wet nappies today. Vomit x 1, No fevers Examination: Irritable 8¥4-week-old Mildly dehydrated: dry mucous membranes, tissue turgor & capillary return normal; P 120; RR 30. ‘Abdominal examination: mild generalised tenderness, no guarding or rebound tenderness. Weight 41009. Constipation & mild dehydration, Refusing feeds. Needs review at Children’s Hospital ED for rehydration & further assessment regarding constipation. [iene Using the information given in the case notes, write a letter of referral to the Admitting Officer at the Emergency Department, Children’s Hospital, Newtown. In your answer: ‘+ Expand the relevant notes into complete sentences + Donot use note form ‘* Use letter format The body of the letter should be approximately 180-200 words.