(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 referral letter to the rheumatology specialist, Dr. John Miller, at City Rheumatology Clinic, 789 Maple Avenue, Metropolis, requesting further evaluation and management of Mr. Thompson’s acute gout flare-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.
Note: You Can Highlight Keywords In the Reading Text
Assume that today’s date is 10 December 2023.
You have been Mr. Thompson’s GP for five years.
PATIENT DETAILS::
Patient: Mr. David Thompson
Date of Birth: 22/03/1987 (37 years old)
Medical History:
- Hypertension (diagnosed 3 years ago, managed with medication)
- Hyperlipidemia (diagnosed 2 years ago, on statin therapy)
- Chronic gout (diagnosed 5 years ago)
- Previous appendectomy at age 25
- No known drug allergies
Regular Medications:
- Amlodipine 5 mg daily (for hypertension)
- Atorvastatin 20 mg daily (for hyperlipidemia)
- Colchicine 0.6 mg BID (initiated after flare-up)
- Ibuprofen 400 mg Q6h PRN (pain relief)
Social History:
- Lives with wife & two young children
- Works as software engineer
- Frequent international travel – has long periods of immobility (? reason for flare-ups)
- Regular exercise – running & cycling
- Non-smoker since quitting 5 yrs ago
- Occasional alcohol consumption
Family History:
- Cardiovascular disease (father diagnosed at 55)
- Gout (paternal uncle)
Today’s Visit (10 Dec 2023):
Presenting Complaint(s):
- Severe pain & swelling in R big toe – onset 3 days ago – returned from business trip abroad – long-haul flight
- Redness & warmth over affected joint
- Difficulty walking due to pain – not adequately controlled with ibuprofen
Investigations:
- Serum uric acid: 8.5 mg/dL (↑)
- CBC: Normal WBC, no signs of infection
- R foot x-ray : No erosions or joint deformities
- Joint aspiration: Report pending, but history consistent with gout
Impression: Uncontrolled acute gout flare-up
Recommendations:
- ↑ dosage of colchicine 0.6 mg to TID
- Advice given – rest, ice application (pain relief)
- Dietary advice – avoid purine-rich foods and alcohol
Reason for Referral:
- Persistent and severe symptoms despite standard treatment for acute gout
- Evaluation of potential underlying causes of frequent flare-ups
- Consideration for alternative therapies in long-term gout management
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