(Medicine)
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.
Writing Task:
Using the information in the case notes, write a letter of referral to the pulmonologist at the same hospital, requesting further assessment of Mr. Hawk and additional treatment. Address the letter to Dr. James Cyriax, Hillside Medical Hospital, 123 Meadow Lane, Greenville, GS 78901, United Kingdom.
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.
Note: You Can Highlight Keywords In the Reading Text
Notes:
Assume that today’s date is 19 June 2023.
You are an ER physician at Hillside Medical Hospital, and the following patient came to the
ER with breathing issues.
PATIENT DETAILS
Patient: Mr. Thomas Hawk
Date of Birth: 22 July 1963 (60 years old)
Medical History:
• Appendectomy when 8 yrs old
• Hyperlipidemia (diagnosed 5 yrs ago)
• Chronic Obstructive Pulmonary Disease (COPD) (Dx 3 yrs ago)
• Hepatitis A (2021)
• Allergies: Gluten, pollen
• Drug allergies: NIL
Current Medications:
• Atorvastatin 40mg daily (for high cholesterol)
• Salbutamol inhaler bid prn (for COPD)
Family History
• Asthma (late father)
• T2 diabetes (late mother)
Social History:
• Retired accountant
• Lives alone in ground-floor apartment
• Three children (live in other cities)
• Smoker (20 cigs/day for 40 years), quit last year
• Non-drinker
• Loves dogs, plays chess, enjoys gardening
Subjective:
• Difficulty breathing
• Mild chest tightness during physical exertion
• Feeling tired
Assessment:
Vital Signs:
• BP: 160/100 mmHg, Pulse: 110 bpm, Respiratory Rate: 30 breaths/minute
• Oxygen Saturation: 88% on room air
Physical Examination:
• Appears anxious, respiratory distress• Use of accessory muscles for breathing
• Auscultation – B/L wheezing
• Peripheral edema
Investigations:
• Chest x-ray: hyperinflated lungs
• Arterial Blood Gas (ABG): hypoxemia (low blood oxygen)
• Routine blood tests ordered: CBC, electrolytes, liver function tests (results pending)
Assessment/Impression: ? COPD exacerbation
Treatment Received:
• Oxygen via nasal cannula at 4L/min (till oxygen saturation >90%)
• Nebulized Salbutamol treatment
• Cardiac monitor attached
Plan of Care: Refer to pulmonologist
• Further assessment, pt. may need continuous positive airway pressure (CPAP)
therapy
• Patient education on COPD management
• (Note: Blood test results to be sent when received)