Adam Knowles OET Letter

You can find the case notes below.

Notes:

You are a doctor in a city clinic. Mr Knowles is a new patient in your surgery.

PATIENT DETAILS:

Name: Mr Adam Knowles

DOB: 22 Aug 1951 (age 68)

Social background:

Married, two grown-up children

Recently retired management consultant

Physically active, plays tennis/walks dog

Non-smoker for past 10 years

Social drinker

Family history:            Nil significant

Medical background:

Severe childhood eczema

2008: gall bladder removed due to gallstones

History of depression past 4 years

Medication:    2016: started SSRI (fluoxetine)

02 Aug 2019

Discussion: Heartburn/indigestion – OTC antacids – ineffective

Pt concerned ?hernia

Objective exam: Full exam performed: NAD

Wt: 94kg

Omeprazole PPI 20 mg 2x/day for 8wks

Ordered FBC and liver function test

Review 4 wks

Occupational English Test

WRITING SUB-TEST: MEDICINE

TIME ALLOWED: READING TIME: 5 MINUTES

WRITING TIME: 40 MINUTES

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

Assume that today’s date is 30 August 2019.

30 Aug 2019 No improvement in reflux symptoms

Pt’s main concern is now back pain

New symptoms: diarrhoea, pale stools, abdominal pain on eating, fatigue

Wt Ô2kg since last appointment (now 92kg)

Abdomen tender on palpation, slightly swollen

Yellow discolouration skin and eyes

Pathology report:

Bilirubin 9mg/dL (high)

Amylase 400 u/L (high)

ALT 60 u/L (slightly high)

Albumin 6 g/dL (high)

Alkaline phosphatase 120 u/L (slightly high)

Discussion:      Discussion of examination findings and blood results with Pt

Plan: Urgent referral to gastroenterologist for assessment and endoscopy

Pancreatic malignancy – patient aware of possibility

Writing Task:

Using the information given in the case notes, write a letter of referral to Dr Desai, a gastroenterologist at City

Hospital, for assessment of Mr Knowles. Address the letter to Dr Dev Desai, Gastroenterologist, City Hospital, Easton.

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.

Sample letter

Dr. Dev Desai

Gastroenterologist

City Hospital

Easton

30 August 2019

Dear Dr. Desai

Re: Mr. Adam Knowles, DOB: 22 August 1951

I am writing to refer Mr. Knowles who is probably suffering from pancreatic malignancy. He requires further assessment and endoscopy.

Mr. Knowles visited my office / consulted me my office for the first time on 2nd August 2019 with complaints of heartburn and indigestion. He tried OTC antacids which were ineffective. A thorough objective examination was performed which showed normal results. He was prescribed omeprazole for 8 weeks and ordered to undertake an FBC and liver function test. A review was arranged 4 weeks later.

He visited my office on 30 August 2019 with no improvement in reflux symptoms. He developed new symptoms such as back pain, diarrhea, pale stools, abdominal pain on eating and fatigue. He had yellow discoloration of skin and eyes. The abdomen was slightly swollen and tender on palpation. The patient’s pathology reports show raised liver enzymes.

Please note that Mr. Knowles had his gall bladder removed due to gall stones in 2008. He has been suffering from depression for four years and he takes fluoxetine to manage it. There is no significant family history. The patient is a social drinker and had quit smoking 10 years ago.

I request you to conduct further assessment and endoscopy in order to make a definite diagnosis. In addition, I would like to inform you that the patient is aware of the possibility of a pancreatic malignancy.

If you need any more information, please do not hesitate to contact me.

Yours sincerely

Doctor