Occupational English Test PPP MEDSAMPLE06
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 23 March 2019
You are a doctor at Eastham Hospital treating a woman admitted with chest pain.
PATIENT DETAILS:
Name: Doreen Atkins (Mrs)
DOB: 12 Mar 1953 (65 y.o.)
Residence: 29 Oldberry Road, Eastham
Social Background:
Widow (3 yrs), no children
Retired office administrator
Interests: reading, watching TV, socialising w. friends
Sedentary lifestyle
Family history: Mother – diabetes mellitus, hypothyroidism (dec. 70 y.o.)
Father - lung cancer, heavy smoker, coronary artery disease (dec. 59 y.o.)
Sister – hypothyroidism
Medical history: 1997 R radius fracture → osteosynthesis
2000 gall bladder removal
2002 dyspepsia
2014 hypertension
2014 hyperlipidemia
NSAIDs allergy
Ex-smoker: quit 1 yr ago (20 cigs/day 18→64 y.o.)
Excessive alcohol consumption (last 5 yrs: 30-35 units/wk)
Current medications:
Losartan 50mg PO 1x/day (hypertension)
Atorvastatin 40mg PO 1x/day (hyperlipidemia)
Aspirin 100mg PO 1x/day (hypertension)
Omeprazole 20mg PO 1x/day (dyspepsia)
©Cambridge Boxhill Language Assessment Pty Ltd 2020
PPP MEDSAMPLE06
Presentation at Emergency Dept. 14 Mar 2019
Presenting problem:
Atypical chest pain (<10 min): 1st episode, diaphoresis, dizziness
Treatment record:
Oxygen, morphine, aspirin, nitroglycerin (sublingual) →pt. reports
↓pain/symptoms
Test results: EKG: normal (monitored during admission)
Troponin: negative (repeated pre-discharge: negative)
Chest X-ray: normal
Pt. discharged same day w. aspirin - follow-up with regular doctor 1 wk.
21 Mar 2019 Re-presentation at ED: new episodes of chest pain reported (>2 to <10 min) regular doctor
phone call advice →ED
w. physical activity →need to rest to↓pain
No pain at rest, no other symptoms
Test results: CBC - total cholesterol 250mg/dl (↑), LDL 160 (↑), HDL 35 (↓), glycemia & renal
function normal
EKG monitoring
Actions taken: ↑atorvastatin to 40mg/day, continue aspirin
Pt given dietary advice to stop hypertension
(DASH): ↓alcohol/salt consumption
Exercise tolerance test ordered
Pt. admitted for observation
23 Mar 2019 Pt. still experiencing ↑chest pain w. stress/physical activity
pain presents w. mild dyspnea (<10 min), no fainting
Ex. tolerance test result: ↓ST on EKG in V1, V2 & V3 (reversible ischemia detected)
Provisional diagnosis: Stable angina
Plan: Refer to cardiologist for angiography/?angioplasty
Writing Task:
Using the information given in the case notes, write a letter of referral to Dr Gaffney, consultant cardiologist,
requesting further investigation of Mrs Atkins’ chest pain. Address the letter to Dr Sarah Gaffney, Consultant
Cardiologist, Eastham Hospital, Eccleston Lane, Eastham.
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.
©Cambridge Boxhill Language Assessment Pty Ltd 2020
23rd March 2019
Dr Sarah Gaffney
Consultant Cardiologist
Eastham Hospital,
Eccleston Lane,
Eastham
Dear Dr Gaffney,
Re: Doreen Atkins, DOB: 12.03.1953
I am writing regarding Mrs Atkins, who has signs and symptoms suggestive of stable angına. She
now requires your further investigation of her condition.
Today, Mrs Atkins reported experiencing chest pain, which increased during stress and physical
activity, along with mild dyspnea. Her exercise tolerance test showed decreased ST levels in V1,
V2, and V3, which indicates reversible ischemia.
On 14th March, Mrs Atkins presented to the Emergency Department with an episode of chest
pain, which lasted less 10 minutes, diaphoresis, and dizziness. As a result, she was treated with
oxygen, morphine, aspirin and sublingual nitroglyserin, which helped her pain and symptoms. Due
to having an normal EKG, chest X-ray, and negative troponin, she was discharged with aspirin.
On 21st March, Mrs Atkins presented to the ED with new episodes of chest pain during physical
activity, which decreased after resting. Her blood results revealed increased total cholesterol, 250
mg/dl, LDL, 160 and decreased HDL, 35, levels, for which her atorvastatin doses were increased.
Additionally, she was informed regarding her diet and recommended to decrease her alcohol and
salt consumption. She was admitted to our facility for observation and EKG monitoring.
Regarding her social background, she is a retired Office administer and has a sedentary lifestyle.
Medically, she has hypertension and hyperlipidemia since 2014. She has a family history of
diabetes, hypothyroidism and coronary artery disease. She ceased smoking last year but smoked
20 cigarettes per day for 46 years and she has been drinking alcohol, 30-35 unites per week, in the
last 5 years. In terms of her medications, she is taking losartan, aspirin, atorvastatin, and
omeprazole.
Given the above, it would be appreciated if you could provide further investigation of Mrs Atkins’
chest pain and an angiography with possibility of an angioplasty.
Should you require further information, please do not hesitate to contact me.
Yours sincerely,
Doctor
