Occupational English Test
Writing Sub-Test: Medicine
Reading Time: 5 minutes; Writing Time: 40 minutes
Read the case notes and complete the writing task which follows:
Patient: Mr. Jones
Personal History:
- Plumber for 30 years.
- DoB: 05 January 1972.
- 20 cigarettes a day since age 12.
- Divorced – 7 years ago.
- Father died of cardiac arrest.
PMHx:
- 1990: Broke Arm. No doctor visits since then.
- 2014: Smokers cough without blood. No wheeze.
- Stable weight.
April 2018:
- Progressive breathlessness on exertion.
- No chest tightness on exertion
- No fist clubbing.
- Abundant tar staining.
- Pulse: Sinus rhythm. Hard to feel.
- BP: 108/88 mm Hg
- Auscultation: crepitation at left base.
- High Hb
Diagnosis:
- Respiratory disorder suspected (Lung carcinoma suspected)
- Stenosis suspected (Hb – upper end)
Plan:
- Refer to a cardiologist for an opinion on possible Aortic Stenosis.
Writing Task:
Using the information in the case notes, write a letter of referral for further investigation and definitive diagnosis to the cardiologist, Dr. Janet, London Hospital, 11 Baker’s Street, London.
Please read the sample answer HERE.
ELTEC English 
Dr. Janet,
London Hospital
11 Baker’s Street
London.
(Today’s date – April 2018)
Dear Dr. Janet,
Re: Mr. Jones, DoB 05 January 1972. ( 42 years)
Thank you for seeing Mr Jones, a 42 year old plumber who has presented with progressive breathlessness on exertion; therefore, needs a further evaluation of his symptoms.
Mr Jones reports no chest tightness on exertion however, upon examination he had abundant tar staining with crepitations at the left lung base. His pulse was hard to feel but was in normal sinus rhythm with an optimal blood pressure of 108/88mm hg.
Mr jones has been smoking 20 cigarettes since the age of twelve and he has had a smokers cough without haemoptysis or wheeze since 2014.He has also been working as a plumber for 30 years. His haemoglobin levels are high however, he is weight stable. Given this , lung carcinoma has been suspected with possible Aortic stenosis as his haemoglobin levels are on the upper end.
Your opinion on evaluating Mr Jones for possible Aortic stenosis is highly appreciated especially also given that his father died from a cardiac arrest.
If you do require further information, do not hesitate to contact me.
Yours Sincerely,
Doctor
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