See the sample letter and compare it with yours.

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.

Notes:
Assume that today's date is 10 April 2024.
You are a pediatrician, and the following male child has been your patient for 3 years.

PATIENT DETAILS
Patient: Ethan Thompson

Date of Birth: July 3, 2019 (4 yo)

Medical History:

• Asthma (2022), hospitalizations for asthma exacerbations in 2022 and 2023
• Allergic Rhinitis (2023)

Current Medications:

• Albuterol inhaler with spacer q4h PRN for asthma
• Loratadine 5 mg PO daily for allergic rhinitis

Social History:

• Attends daycare 2/7
• Ethan lives with parents & older brother (6 yo)
• Non-smoking household & healthy lifestyle
• Family pet: Dog (hypoallergenic breed)
• Recent vacation (Mar 2024): Family trip to the mountains

10 Apr 2024

Presenting complaints:Fever, cough, & difficulty breathing (for 3 days)
Assessment:

Vital Signs:Temperature: 39.2°C, BP: 100/60 mmHg, Pulse: 120 bpm, Respiratory Rate: 30 breaths/min

Physical Examination:

• Increased work of breathing with intercostal retractions
• Wheezing heard B/L on auscultation
• Nasal flaring
• Mild cyanosis around lips
• Mild abdominal distension

Investigations:

• Pulse oximetry – o2sats 92% on room air
• Chest x-ray - hyperinflation and parabronchial cuffing (asthma exacerbation)
• CBC: ↑ WBC indicating possible infection
• Blood culture pending
• Respiratory viral panel pending

Diagnosis:

• Acute asthma exacerbation with ?viral infection

Plan:

• Medication:
  • Prednisolone 10 mg PO daily for 5/7
  • Ibuprofen 200 mg PO PRN for fever
  • Saline nasal spray PRN for nasal congestion
• Refer to pediatric pulmonologist
  • Further investigations, Pt. may need allergenic testing
  • Educate parents on possible asthma triggers & appropriate management
  • (Note: Pending test results to be sent to pulmonologist when received)

Writing Task:

Using the information in the case notes, write a letter of referral to a pediatric pulmonologist, Dr. Sarah Lee, at Riverside Children's Hospital, 456 Wellness Street, Townsville, requesting further assessment and appropriate management.

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.

Notes:
Assume that today’s date is 15 July 2024.
You have been the following patient’s general practitioner for one year.

PATIENT DETAILS:

Name: John Smith (Mr)

DOB: 15 May 1969 (55 yrs)

BMI: 30.6, borderline obese (Ht: 178 cm, Wt: 101kg)

Social history

• Accountant, divorced, 3 children (born 1995, 1998, 2001) stays with mother
• Work stress, long working hours, no regular exercise, eating fast food mostly
• Smoker - 10 cigs/day
• Occasional drinker
• Substance Intake: Nil
• Allergies: Penicillin, latex
• Hobbies: Basketball, fishing

Family history:

• Father – myocardial infarction at age 60
• Mother – type 2 diabetes

Previous medical history:

• 1980 – Appendectomy
• 1995 – Fractured wrist (sports injury)
• 2008 – Hypertension (amlodipine 5mg daily)
• 2015 – Hypercholesterolemia (atorvastatin 10mg daily)

Treatment record

25 Jan 2024

• Sore Rt leg after basketball game
• Advice:  Ibuprofen, R.I.C.E (Rest, Ice, Compression, Elevation), Refer to physio

17 Mar 2024

• Sore throat for 1 week, green phlegm
• Advice: Rest, plenty of warm fluids, salt water gargles

Â15 Jul 2024

Presenting complaints:

• Symptom: Chest pain, onset 3 days ago, described as tight, squeezing pain
• Location: Central chest, radiating to Lt arm & jaw
• Duration: Lasts 10-15 mins, occurs during physical activity, relieved by rest
• Associated symptoms: Shortness of breath, sweating
• No recent infections or significant stressors

Assessment:

Vitals:BP 120/95, Pulse 110, RR 23, O2 Sat 91%, Temp. 37.1 C

Provisional diagnosis: Angina pectoris

Management:Administered nitroglycerin sublingual

Plan:

• Refer to cardiologist
  • further evaluation and possible angiography
  • review current medications
  • recommend lifestyle modifications (smoking cessation, formal exercise regime & diet changes)

Writing Task:

Using the information in the case notes, write a letter of referral for further investigation and a definitive diagnosis to the cardiologist, Dr. Sarah Brown, at Central Heart Clinic, 123 Health Street, Cityville.

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.

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.

Notes:
Assume that today’s date is 14 July 2024.
You are a general surgeon at Riverbank General Hospital, 456 Oakwood Drive, Lakeside, LS 54321, United Kingdom. You are discharging a 24-year-old female patient, Ms. Emma Taylor, after an appendectomy.

PATIENT DETAILS:

Name:Emma Taylor (Ms)
DOB:03.03.2000
Ht:165 cm, Wt:60 kg, BMI:22.0 (normal range)

Social History:

• University student, single, lives in a shared apartment
• Smoking:Non-smoker
• Alcohol:Occasional wine
• Substance Intake:Nil
• Allergies:None known

Family history:Father – hypertension; Mother – hypothyroidism

Previous medical history:

• 2010 – Tonsillectomy
• 2018 – Anemia, treated with iron supplements

Date of Admission (11.07.2024)

• Pt. brought to ER with acute abdominal pain in lower Rt quadrant, severe and worsening, onset 2 days ago
• Also had nausea, vomiting (2 episodes), fever

Objective: Rt lower quadrant guarding & rebound tenderness

Investigation:WBC ↑ at 15,000/mm³, CRP ↑

U/S scan:Inflamed appendix with diameter >6mm, appendiceal wall thickening

Diagnosis: Acute appendicitis

Admitted to medicine ward for laparoscopic appendectomy on 12.07.2024

Date of Surgery (12.07.2024)

Hospital Course:

• Surgery details:Uncomplicated laparoscopic appendectomy
• Post-operative course:Uncomplicated recovery, pain managed with paracetamol, Wound care provided
• Mobilizing well, tolerating diet
• Vital signs:Stable throughout hospital stay
• Current medications:Paracetamol 500mg every 6 hours as needed for pain

ÂDate of discharge (14.07.2024)

• Blood tests:Post-operative WBC and CRP levels normal
• Incision:Healed well, no signs of infection
• Discharge instructions
  • Wound care: Keep the incision dry
  • Pain management: paracetamol 500mg as needed
  • Balanced diet
  • Avoid heavy lifting and strenuous activities for 4-6 weeks
  • F/U (follow-up) appointment in 2 weeks (27.07.2024) to assess recovery
• Request GP to assess pt.'s progress prior to F/U

Writing Task:

Using the information in the case notes, write a letter to Ms. Taylor's general practitioner, Dr. Lucy Adams, at Riverside Health Clinic, 456 Wellness Street, Townsville, providing details of her hospital stay and discharge plan.

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.

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.

Notes:
Assume that today’s date is 20 July 2024.
You are a general practitioner examining a 30-year-old female patient, Laura Green, who has been diagnosed with an ectopic pregnancy.

PATIENT DETAILS:

Name: Laura Green
DOB: 15.05.1994
BMI: 25.9 (overweight)
Social History:

• Married for 3 yrs, no children, lives with husband
• Non-smoker, Alcohol: nil, substance intake: nil
• Allergies: Nil

Family history: Mother – hypertension; Father – myocardial infarction at 58

Previous medical history:

• • 2012 – Chlamydia infection, treated
  • 2017 – Left ovarian cyst, resolved with medication
  • 2019 – Seasonal allergies, uses antihistamines as needed
  • 2021 – Mild asthma, uses an inhaler occasionally

20 Jul 2024

Presenting complaints:

• Worsening lower abdominal pain, vaginal bleeding & dizziness for 3 days, headache for 1 week
• Nausea, shoulder tip pain, occasional chest discomfort
• Last menstrual period: 6 weeks ago, positive pregnancy test at home
• Additional information:
  • Recently started a new exercise routine and diet
  • Recent travel history: Returned from a business trip 2 weeks ago

Examination and investigation findings:

• Abdominal examination: Tenderness in lower abdomen, especially on Rt side
• Vital signs: BP 90/60 mmHg, HR 110 bpm
• Ultrasound: Empty uterus, adnexal mass on Rt side
• hCG levels: Elevated, not doubling as expected
• Blood tests: Normal CBC and electrolytes

Provisional diagnosis: Ectopic pregnancy

Plan:

• Immediate referral to the hospital for further evaluation and appropriate surgical intervention
• Counseling on future pregnancies prior to discharge

Writing Task:

Using the information in the case notes, write a letter of referral to the gynecologist, requesting urgent admission of the patient to the hospital for appropriate management. Address the letter to Dr. Emily Foster at City Hospital, 789 Health Avenue, Metropolis.

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.

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Dairy and Antibiotics

Dairy products, including milk, cheese, and yogurt, can interfere with the absorption of certain antibiotics, particularly tetracyclines (such as doxycycline) and fluoroquinolones (such as ciprofloxacin). The calcium in dairy products binds to these antibiotics in the digestive tract, forming an insoluble complex that cannot be easily absorbed into the bloodstream. This binding significantly reduces the effectiveness of the antibiotics, as the drug is not available in sufficient concentrations to fight the bacterial infection. Consequently, this can lead to prolonged or ineffective treatment, potentially worsening the infection or contributing to antibiotic resistance. For this reason, it is generally recommended to avoid consuming dairy products a few hours before and after taking these specific types of antibiotics. Always follow the advice of your healthcare provider or pharmacist regarding any dietary restrictions when prescribed antibiotics to ensure the medication works as intended.

 

Question 1

What is the main reason to avoid consuming dairy products with certain antibiotics?

Severe chest pain is a symptom that should never be ignored, as it can indicate a range of serious medical conditions, including heart attacks, angina, pulmonary embolisms, or gastrointestinal issues like esophageal spasms or gastroesophageal reflux disease (GERD). Only a trained medical professional can accurately diagnose the underlying cause of chest pain through a combination of physical examination, medical history, and diagnostic tests such as electrocardiograms (ECGs), blood tests, and imaging studies. Prompt diagnosis is crucial because if the chest pain is related to a heart attack or another life-threatening condition, immediate treatment can significantly improve the chances of survival and reduce the risk of complications.

Question 2

Why is it essential to seek immediate medical attention for severe chest pain?

Proper disposal of expired medications is critical for both safety and environmental protection. Expired medications can pose significant risks if they are ingested accidentally, particularly by children, pets, or the elderly, who may mistake them for current medications or candy. Consuming expired medications can lead to poisoning, adverse reactions, or ineffective treatment, as the potency of the drug may be compromised. Furthermore, improper disposal of medications, such as flushing them down the toilet or throwing them in the trash, can lead to environmental contamination. Many pharmaceuticals are not fully removed by wastewater treatment plants, and as a result, they can enter rivers, lakes, and drinking water supplies, potentially harming aquatic life and affecting human health. To mitigate these risks, it is important to follow recommended disposal methods.

Question 3

What is the primary reason for ensuring proper disposal of expired medications?

Staying hydrated is crucial when taking medications because water plays an essential role in the absorption and metabolism of drugs in the body. When you are dehydrated, your body's ability to absorb medications can be impaired, potentially reducing the effectiveness of the treatment. Dehydration can slow down the digestive process, leading to delayed absorption of oral medications, which might result in suboptimal blood levels of the drug. Additionally, some medications, such as those used to manage blood pressure, pain, or infections, can cause or worsen dehydration as a side effect, making it even more important to maintain adequate fluid intake. Proper hydration ensures that the medication is dissolved and absorbed efficiently in the gastrointestinal tract and then distributed throughout the body as needed. It also helps in the elimination of drugs and their metabolites through the kidneys, reducing the risk of toxicity. Therefore, it is important to drink enough water when taking medications, unless otherwise directed by your healthcare provider, to ensure the drug's efficacy and minimize potential side effects.

Question 4

Why is it important to stay hydrated when taking certain medications?

Electronic health records (EHRs) are digital versions of patients' paper charts that provide real-time, secure access to comprehensive patient information for authorized healthcare providers. The primary benefit of using EHRs in patient care is that they streamline the sharing of information among different healthcare providers, improving coordination and continuity of care. EHRs allow for easy access to a patient's medical history, including diagnoses, medications, lab results, and imaging studies, regardless of where the care was provided. This comprehensive and up-to-date information helps healthcare providers make more informed decisions, reduces the likelihood of errors, and eliminates the need for duplicate tests or procedures, which can save time and reduce costs.

Question 5

ÂWhat is the main benefit of using electronic health records (EHRs) in patient care?

Frequent urination and excessive thirst are classic symptoms of diabetes, a chronic condition that affects the way the body regulates blood sugar (glucose). In diabetes, the body either does not produce enough insulin (as in type 1 diabetes) or cannot effectively use the insulin it produces (as in type 2 diabetes). As a result, glucose builds up in the bloodstream, leading to high blood sugar levels. The kidneys work harder to filter and absorb the excess glucose, but when they cannot keep up, the glucose is excreted in the urine, which draws more water from the body, leading to frequent urination. This increased urination can cause dehydration, triggering excessive thirst as the body tries to replenish lost fluids. Ignoring these symptoms can lead to severe complications, including diabetic ketoacidosis (a life-threatening condition), cardiovascular disease, kidney damage, nerve damage, and vision problems.

Question 6Â

Why should you not ignore frequent urination and excessive thirst?