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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.