(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 transfer letter to the palliative care specialist, Dr. Emily Harris, at Serenity Palliative Care Center, 789 Comfort Lane, Meadowville, outlining the patient’s condition and requesting end-of-life care for her.
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 12 August 2024.
The following patient has been diagnosed with end-stage metastatic pancreatic cancer, and you are the oncologist treating her.
PATIENT DETAILS
Patient: Mrs. Margaret Collins
Date of Birth: 15/08/1942 (82 years old)
Admission Date: 10 Aug 2024
Medical History:
- Hypertension (diagnosed 20 years ago)
- Type 2 Diabetes (diagnosed 10 years ago)
- Osteoarthritis (diagnosed 5 years ago)
- Hysterectomy 30 years ago
- Previously treated for breast cancer (10 years ago, in remission)
- No known allergies
Current Medications:
- Metformin 500mg twice daily (for diabetes)
- Lisinopril 10mg daily (for hypertension)
- Paracetamol 500mg PRN (for osteoarthritis pain)
- Insulin as needed
Social History:
- Lives alone in a retirement community
- Widowed for 15 years
- Two children who live abroad
- Non-smoker, occasional glass of wine
10 Aug 2024Presenting complaints:Severe weight loss, fatigue, & excruciating abdominal pain
Assessment:
Vital Signs:BP: 140/85 mmHg, Pulse: 90 bpm, Respirations: 20 breaths/minute, Temp: 37.0°C
Physical Examination:
- Appears pale & weak
- Abdominal tenderness on palpation
- Cachexia (severe weight loss)
- Limited mobility due to osteoarthritis
Admitted to internal medicine for further investigations:
- CT Scan: Large mass in the abdomen suggestive of advanced-stage cancer
- Blood tests: Anemia (low hemoglobin), elevated liver enzymes
- Biopsy: Confirmed Dx of metastatic pancreatic cancer
Diagnosis: End stage Metastatic Pancreatic Cancer
Plan:
- Referral to palliative care for better quality of life
- Pain management: Morphine 5mg Q4h PRN
- Regular medications to continue
- Provide nutritional support & hydration
- Educate patient about disease progression and palliative care options
- Arrange follow-up at oncology dept every 2/52
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