Urgent Referral Letter From GP

Urgent referral letter from GP to ER doctor, duty registrar or specialist
Task 1 Referral letter to the ER Duty Registrar for admission of patient with meningitis
Task 2 Referral letter to Surgical Registrar via the ER for urgent assessment of patient with liver abscess
Task 3 Referral letter to ER for Cardiology Unit admission and stabilization of patient with left VF
Task 4 Referral letter for Urgent hospital admission and treatment of patient with pneumonia.
Task 5 Referral letter to ER Registrar for admission to Cardiology Unit and stabilization of MI patient
Task 6 Referral letter to ER Registrar for immediate eye care of patient with a visual impairment
Task 7 Referral letter to ER Registrar for urgent treatment of MI patient with exacerbation of asthma
Task 8 Referral letter to Gynaecology Registrar for urgent assessment patient with an ectopic pregnancy
Task 9 Referral letter for urgent Pediatrician appointment of patient with rheumatic fever
Task 10 Referral letter for urgent Obstetrician assessment and care of patient with pre-eclampsia
Task 11 Referral letter to Breast Surgeon for urgent assessment of patient with breast cancer .
Task 12 Referral letter to Neurosurgeon for urgent assessment of patient with a subdural haematoma.
Task 13 Referral letter to Psychiatrist for urgent assessment of patient with Anorexia Nervosa
Task 14 Referral letter to paediatrician for urgent treatment of patient with PSGN with early RF
TIME ALLOWED: READING TIME: 5 MINUTES Task 1
WRITING TIME: 40 MINUTES
Read the case notes below and complete the writing task which follows.
notes:
Today’s Date 14.10.12
Patient History
Amina Ahmed aged 8 years – new patient at your clinic Parents – Mother Ayama, house-wife.
Father Talan, cab driver Brothers Dalma aged 4 and Roble aged 2 Family refugees from Somali
2005. Have Australian Citizenship Amina and father good understanding of English, mother has
basic understanding of slowly spoken English. Amina had appendicectomy 2 years ago.
No known allergies
09/10/12
Subjective
Fever, runny nose, mild cough, loss of appetite
Unable to attend school
Objective
Pulse 85/min
Temperature 39.4
No rash
No neck stiffness
CVS, RS & abdo – normal
Assessment
Viral infection
Management
Keep home from school
Rest and paracetamol three times daily
Review in 3 days if no improvement
12/10/12
Subjective
Amina not well
Cough +, continuous headache, lethargic, loss of appetite
Difficult to control temperature with Paracetamol
Mother worried
Objective
Fever 39.8 C
No rash or neck stiffness
Management
Prescribe Brufen 200mg as required
FBC & UFR were ordered
Review in two days with results of reports
14/10/12
Subjective
Both parents very concerned
Reported Amina lethargic and listless
Vomited twice last night and headaches worse
Objective
FBC- WBC(18000) and left shift
Urinary Function Report Normal
Temperature 40.2C
Pulse 110/min
Macula-papular rash over legs
Neck Stiffness+
Assessment
Meningococcal meningitis. Penicillin IV given (stat dose)
Plan
Arrange urgent admission to the Emergency Paediatric Unit, Brisbane General Hospital, for
further investigation and treatment.
Writing Task:
You are GP, Dr. Lucy Irving, Kelvin Grove Medical Centre, 53 Goma Rd, Kelvin Grove, Brisbane.
Write a referral letter to the Duty Registrar, Emergency Paediatric Unit, Brisbane General Hospital,
140 Grange Road, Kelvin Grove, QLD, 4222.
In your answer:
● Expand the relevant case notes into complete sentences
● Do not use note form
● Use correct letter format
The body of your letter should be approximately 200 words. Use correct letter format.
The Duty Registrar
Emergency Paediatric Unit
Brisbane General Hospital
140 Grange Road
Kelvin Grove, QLD, 4222
14/10/12
Dear Doctor:
Re: Amina Ahmed (8years)
I am writing to refer Amina who is presenting with signs and symptoms of meningococcal
meningitis for urgent assessment and management. She is the first child of a family of 5, which
includes her parents and two younger siblings. They are immigrants from Somalia, although she
and her father understand English.
Initially, accompanied by her parents, she presented to me on 9.10.12 with complaints of fever,
runny nose, cough and loss of appetite. She was febrile with a temperature of 39.4 and a pulse rate
of 85 beats per minute, but there was no rash or neck stiffness. However, her condition continued
to deteriorate over the next two days as the fever could not be controlled by antipyretics.
Therefore, blood and urine tests were ordered.
Regrettably today, Amina became lethargic and listless. She vomited twice last night and had been
having severe headaches. On examination, she was severely febrile with a temperature of 40.2 and
a pulse rate of 110 beats per minute. There was macula-papular rash over the legs and neck
stiffness was present. Blood test showed leucocytosis with a shift to the left.
Based on the above, I believe she needs urgent admission and management. Please note, penicillin
IV has been given as a stat dose.
Yours sincerely,
Dr. Lucy Irving
[208 words]
The Duty Registrar
Emergency Pediatric Unit
Brisbane General Hospital
140 Grange Road
Kelvin Grove QLD 4222
14/10/12
Dear Doctor,
Re: Amina Ahmed

Thank you for urgently seeing this 8-year-old child, who is presenting with features suggestive of
meningococcal meningitis.
She is the first child of a family of 5, which includes her parents and younger siblings. The family
immigrated from Somalia 7 years ago. however, they understand English.
The patient, accompanied by her parents, initially presented on 09/10/12 complaining of fever,
runny nose, mild cough and loss of appetite. On examination, her vitals were normal except for a
temperature of 39.4 Celsius. At that time, neck stiffness or rash were not noticed. After three days,
she reported having constant headaches and lethargy with the deterioration of her earlier
symptoms. Additionally, her temperature was not responding to the antipyretic. Therefore, blood
and urine tests were ordered.
Unfortunately, today, Amina became lethargic and listless. Her parents were worried as she vomited
twice last night and her headaches have been worsening. Examination revealed that she was
severely febrile with a temperature of 40.2 and a pulse rate of 110 per minute. A maculopapular
rash over the legs and neck stiffness were also observed. The blood test showed elevated WBC with
a left shift. As a result, penicillin IV was commenced.
In view of the above, I believe she needs urgent admission.
Yours faithfully,
Doctor
[203 words]
notes:
Today's Date 20/10/17
You are Dr. Peter Smith, GP covering 3 satellite clinics in a remote mining area of Western
Australia. The nearest tertiary hospital to you is 1250km away in Perth or 2 ½ hours by air
evacuation using the Flying Doctor Service. The nearest poly clinic is in Port Hedland with
radiology and laboratory facilities but it is a 6 hour drive over dirt roads.
Patient History
 Ammar Moustafawy (DOB: 15/1/61) Male
 Divorced and lives alone
 Process Technician at a Copper Mine in the remote Pilbara region of Western Australia
 Works on rotation with 6 weeks on location and 4 weeks off
 Started his present rotation one week ago
 Regular overseas holidays
 Just returned from the Phillipines 2 weeks ago after spending a 2-week vacation
 Enjoys water sports: scuba diving, sailing
 Smokes 20 cigarettes/ day
 Drinks 14 units/week
 Walks half an hour every day
 Hx of typhoid fever, (2009) In hospital for 6 days
Drug history
 Not on regular medication
 No known allergy
Family history
 Father died of natural causes at 85
 Mother hypertensive and diabetic aged 76
 Older sister treated for cancer breast when she was 40 YO
18/10/17
Subjective
 Ammar feels unwell, lack of appetite, sense of weakness and lack of energy for 3/7
 Has reduced smoking to 5 cig/day and not drinking for one week
 No vomiting but nauseating and passing motion normally
Objective
 Patient looks tired, not jaundiced
 Weight 89 kg; Height 193 cm
 Pulse 84 regular, BP 130 /80, Temp 37.3° C
 CVS, RS are normal
 Abdominal examination: lax and mobile with no mass or rebound but tender Rt.
hypochondrium with no organomegaly
Assessment and planning

 Prodromal stage of liver disease or mood swings after changing his drinking and smoking habits
 Advise low fat, low protein and rich carbohydrate diet
 Order blood, urine and stool tests
 Prescribe vitamins B complex tablet one TDS and essential forte capsules 2 TDS
 Review in two days for results
20/10/17
Subjective
 Ammar is getting worse
 Cannot tolerate foods only drinks fruit juice and noticed that the urine is getting darker in
color with chills and rigors
Objective
 Temperature 39°C; looks jaundiced and dehydrated
 Abdominal examination shows palpable, tender liver
 No ascitis
 Investigations shows normal stool and 2+ urobilinogin in urine test. Leukocytoses with
increased serum bilirubin and
 deranged liver enzymes (ALT And ALP) in blood tests
Assessment and plan
 Start IV fluids and medicate Rocephin one gram IV BD and Flagyl 500 MG TDS
 Contact Flying Doctor Service for urgent US examination or evacuation
 Result of US shows enlarged liver 20 CM with a 10x10 cm cystic lesion in the Rt. Lobe of liver
 You diagnose liver abscess and arrange referral to surgeon in Perth by Flying Doctor Service
escorted by a registered nurse
 Urgent assessment required including ultrasound guided drainage
Writing Task:
Refer patient to the Surgical Registrar via the Emergency Department of Perth General
Hospital, 268 Brisbane Rd Cottesloe, Western Australia 6542.
In your answer:
Surgical Registrar
via Emergency Department
Perth General Hospital
268 Brisbane Rd
Cottesloe 6542
Western Australia
20/10/17
Dear Doctor,
Re: Mr. Ammar Mostafawy
DOB: 15/01/1961
I am writing to refer Mr. Moustafawy, a 57-year-old male who is a process technician in a copper
mine in the Pilbara region. I suspect he is suffering from liver abscess which requires your urgent
attention and management.
Mr. Moustafawy works on rotation and returned from the Philippines 2 weeks ago. He is a heavy
smoker and heavy drinker but he exercises regularly. Apart from a history of typhoid fever 8 years
ago, he has no significant medical or family history.
Initially, he presented to me 2 days ago because he had not been feeling well and had felt a sense of
weakness and nausea over the previous 3 days. He had stopped drinking and reduced smoking
markedly one week ago. His examination was otherwise normal except for tenderness over the right
hypochondrium. Therefore, blood and urine tests were ordered and he was prescribed vitamin B and
essential forte and advised to increase carbohydrates intake.
Unfortunately, his condition deteriorated over the next 2 days. Today, he is dehydrated, jaundiced
and febrile with chills and rigors. His temperature reached 39°C and his liver is enlarged and tender
as well.His blood test showed leukocytosis and deranged liver functions in addition to increased
urobilinogen in the urine test. The Flying Doctors Agency was contacted and through their ultra
sound machine a 10x10 cm liver abscess could be diagnosed.
I started him on intravenous fluids and antibiotics (Rocephine and Flagyl) and arrangements were
made to evacuate him by the Flying Doctors to your centre.
I would appreciate your urgent attention to his condition as I believe he will need ultrasound-guided
drainage.
Yours Sincerely,
Dr. Peter Smith (GP)

[268 words]
notes:
Patient History
 Mr. Dave Cochrane
 D.O.B 20/11/64
 Smoker: 20 cig/day
 Drinks 12-14u alcohol per week
 No reg exercise
 Retired at 50
 lives with wife
 3 children all married
12/08/17
Subjective
 Shortness of breath
 tightness in chest
 coughing especially at night
 Shortness of breath worse when lying down and feels better when head is raised at end of bed
Objective
 Dyspnoeic
 B/L ankle oedema
 High jugular venous pressure
 Apex beat lateral to mid-clavicular line and in the 6th ICS
 Cardiovascular normal
 Abdomen normal
 Crepitations in lung base
 ECG shows cardiomegaly
 C-xray- features of infection
Plan
 Diagnosed as left ventricular failure
 Broad spectrum antibiotic for 7 days
 Frusemide 40 mg/day
 Digoxin 0.25 mg/day
 Advise to stop smoking and drinking
 Review 14 days later
 Mild tenderness in lower abdo, no guarding and rebound
25/08/17
Subjective
 Feels better
 Reduced cig to 10/day and alcohol to 10u week
Objective
 Mild B/L ankle oedema
 Few crepitations in lung bases
Plan
 Continue Frusemide and Digoxin
 Rest for one week
30/09/17
Subjective
 Presented with severe shortness of breath, chest pain, sweating for 2 hours
 Anxious
Objective
 Dysponic, B/L ankle oedema
 Jugular venous pressure high
 No murmurs
 Apex beat is 6th ICS
 Lateral mid-clavicular line
 BP: 120/60
 PR: 66 BPM
 B/L crepitations in both lung bases
Plan
 Needs admission to Cardiology Unit for stabilisation
Writing Task:
Using the information in the case notes, write a letter of referral to Emergency Department
QE11 Hospital, 249 Wickham Tce,Brisbane, 4001 explaining the patient's current condition.
In your answer:
Emergency Registrar
Emergency Department
QE11 Hospital
249 Wickham Tce.
Brisbane, 4001
30/09/2017
Dear Doctor,
RE: Dave Cochrane D.O.B. 20/11/1964

I am referring Mr. Cochrane, who is suffering from an acute left ventricular failure and requires
admission to your Cardiology Unit in order to stabilise his condition.
Mr. Cochrane retired when he was 50 years old. He smokes 10 cigarettes a day and drinks 10 units of
alcohol per day. He exercises regularly.
On 12/8/2017, Mr. Cochrane presented with night cough, chest tightness and shortness of breath
which was worse when lying down but improved on raising the head at the end of the bed. On
examination, he was dyspneic. There was bilateral leg oedema, high jugular vein pressure , laterally
deviated apex beat which was located in the 6th intercostal space and basal crepitation on the lung
auscultation. These symptoms were indicative of left ventricular failure. Moreover,
electrocardiography revealed cardiomegaly and the chest X-ray showed features of infection.
Consequently, antibiotic, frusemide and digoxin were prescribed for left ventricular failure. An
appointment in 2 weeks was made.
Two weeks later, the patient's condition had partially improved. Therefore, he was advised to
continue his medications and to rest for one week.
Unfortunately today, Mr.Cochrane has been suffering from severe shortness of breath, chest pain
and sweating for the last 2 hours. On examination, he was anxious and dyspneic. His blood pressure
was 120/80 mmhg and his pulse was 66. In addition, the same previous signs of left ventricular
failure were observed.
I would appreciate your urgent assessment of this patient.
Yours sincerely,
Doctor
[233 words]
notes:
Mrs May Hong is a 43-year-old patient in your general practice.
07/02/2014
Subjective:
 Noted a productive cough over last 3/7
 No dyspnoea or pain
 Feverish
 Continues to smoke 10 cigarettes/day
History:
 Rheumatic carditis in childhood, resulting in mitral regurgitation & atrial fibrillation (AF)
Objective: Looks tired

 T: 38 ̊C
 P: 80, AF
 BP: 140/80
 Ear, nose, throat (ENT) – NAD
 Moist cough
 Scattered rhonchi through chest, otherwise OK
 Apical pansystolic murmur
Assessment:
 Acute bronchitis; cigarettes increase condition severity ++
Plan: Advised – cease smoking

 Amoxycillin 500mg; orally t.d.s.
 Other medications unchanged (digoxin 0.125mg mane, warfarin 4mg nocte)
 No known allergies (NKA)
 Review 2/7
 Check prothrombin ratio next visit
09/02/2014
Subjective:
 Cough increase, thick yellow phlegm
 Feels quite run-down
 Not dyspnoeic
 Taking all medications
 No cigarettes for last 2 days
Objective:
 Looks worn-out
 T: 38.5 ̊C
 P: 92, AF
 BP: 120/80
 Mild crackles noted at R lung base posteriorly
 Occasional scattered crackles. Otherwise unchanged
Assessment:
 Bronchitis increase severity , early R basal pneumonia
Plan:
 Sputum sample for microscopy and culture (M&C)
 FBE, chest X-ray
 Chest physiotherapy
 Prothrombin ratio today (result in tomorrow)
 Review tomorrow
10/02/2014
Subjective:
 Brought in by son
 Quite a bad night
 Symptoms
 Pleuritic R-sided chest pain, febrile, dyspnoea
 Prothrombin ratio result 2.4 (target 2.5-3.5)
Objective:
 Unwell, tachypnoeic
 T: 38 ̊C
 P: 110, AF
 BP: 110/75
 Jugular venous pressure (JVP) not elevated
 R lower lobe dull to percussion with overlying crackles
 L basal crackles present
 Pansystolic murmur is louder
 M&C: gram-positive streptococcus pneumoniae, sensitive – clarithromycin & erythromycin
 Amoxicillin resistant
 Chest X-ray: Opacity R lower lobe
 FBE: Leukocytosis 11.0 x 10 9/L
Assessment:
 R lower lobar pneumonia
Plan:
 Urgent hospital admission. Spoke with Dr Roberts, admitting officer, Newtown Hospital Ambulance
transport organised
Writing Task:
Using the information given in the case notes, write a letter of referral to Dr L Roberts, the Admitting
Officer at Newtown Hospital, 1 Main Street, Newtown, for advice, further assessment and treatment.
In your answer:
Dr L Roberts
Admitting Officer
Newtown Hospital
1 Main Street
Newtown
10 February 2014
Dear Dr. Roberts,
Re: Mrs May Hong
Thank you for seeing this 43-year-old patient with right lower lobar pneumonia for assessment.
Mrs Hong has a past history of rheumatic carditis, with resultant mitral regurgitation and atrial
fibrillation. Her usual medications are digoxin 0.125mg mane and warfarin 4mg nocte. She has no
known allergies. Her last prothrombin ratio taken on 09/02 was 2.4.
Today, she presents with a six-day history of productive cough with associated fever and lethargy.
This was treated initially with oral amoxycillin (ineffective) and then chest physiotherapy, but today
she has deteriorated with tachypnoea and right pleuritic chest pain. The right lower lobe is dull to
percussion and crackles are present in both lung fields, worst at the right base. Her temperature is
38 ̊C, BP 110/75,pulse 110 (irregular) and her usual pansystolic murmur is louder than normal.
Sputum M&C showed gram-positive streptococcus pneumoniae. The X-ray showed opacity in the
right lower lobe.
I believe her rapid deterioration warrants inpatient treatment.
I would appreciate your assessment and advice regarding this. I will be in touch to follow her progress.
Yours sincerely,
Doctor
notes:
20.3.97
Patient History
Derek Romano is a patient in your General Practice.
Subjective: 46 year old insurance clerk wants “check up” smokes 1 pkt cigarettes per day
high blood pressure in past
no regular exercise
father died aged 48 of acute myocardial infarction
married, one child
no medications or allergies
Objective: BP 150/100 P 80 regular

Overweight Ht – 170 cm Wt – 98 kg
Cardiovascular and respiratory examination normal
Urinalysis normal
Plan: Advise re weight loss, smoking cessation

Review BP in 1 month
8.4.97
Subjective: Still smoking, no increase in exercise
Objective: BP 155/100
Assessment: Hypertension
Plan: Commence nifedipine (calcium channel blocker) 20 mg daily

Check blood glucose, serum cholesterol
Cholesterol = 6.4 mmol/L
23.4.97
Subjective: Mild burning epigastric pain, radiating retrosternally. Occurs after eating and walking.
Objective: BP 155/100
Abdominal and cardiovascular exam otherwise normal.
Assessment: ? Gastric reﬂux. Non-compliance with anti-hypertensive medication.
Plan: Add Mylanta 30 mls q.i.d.

Increase nifedipine to 20 mg twice daily.
30.4.97
Subjective: Crushing retrosternal chest pain. Sweaty. Mild dyspnoea.
Onset while walking, present for about one hour.
Objective: BP 160/100 P 64 in obvious distress

Few crepitations at lung bases.
ECG – inferior acute myocardial infarction.
Assessment: Acute myocardial infarction
Plan: Oxygen given

Anginine given sublingually
Morphine 2.5 mg given IV stat
Maxolon 10 mg given IV stat
You decide to call an ambulance and send this man to the Emergency Department, at the Royal
Melbourne Hospital.
Writing Task:
Using the information in the case notes, write a letter of referral to the Registrar in the Emergency
Department of the Royal Melbourne Hospital, Flemington Road, Parkville, 3052.
In your answer:
Emergency Department
Royal Melbourne Hospital
Flemington Road
Parkville 3052
The Registrar 30 April, 1997
Dear Doctor,
Re: Mr Derek Romano
I am writing to refer Mr Romano, a patient of mine to you. Mr Romano, is 46 years old and is an
insurance clerk, he is married with one child, and is suffering from his first episode of ischaemic (or
cardiac) chest pain. The patient first attended me six months ago. His risk factors include:
hypertension, smoking (one packet per day), obesity, strong family history (father died of an acute
myocardial infarction aged 48) and hypercholesterolemia (Total cholesterol = 6.4 mmol). He has no
known allergies.
After persistently elevated blood pressure readings around 150/100, patient was commenced on
nifedipine and this was recently increased to 20 mg twice daily. He also uses Mylanta for reﬂux
oesophagitis. A cardiovascular examination on 23.4.97 was normal.
Today Mr Romano presented following a minimum of one hour of crushing, retrosternal chest pain.
He felt nauseated and sweaty with mild dyspnoea. Examination revealed a distressed and anxious
man with a pulse of 64 (sinus rhythm) and blood pressure of 160/100. Crepitations were noted on
chest auscultation. Electrocardiography revealed changes consistent with an inferior myocardial
infarction.
Oxygen was given and one anginine sublingually followed by morphine 2.5mg intravenously. His
pain has now settled but I consider he requires admission to the Coronary Care Unit for stabilisation.
I will telephone later to check on his condition.
Yours sincerely,
Dr X
notes:
Patient History
Constance Maxwell is a patient in your General Practice
DOB 08.08.38 Married, 3 adult children
21.02.10
Subjective
Complains of inflamed, sticky and weeping eyes.
Thyroidism diagnosed Feb 07
High blood pressure June 09
Hip replacement July 09
Medications – Thyroxine 1mg daily, Atacand 4mg daily, Fosamax 10mg daily
No known allergies
Objective
BP 135 /75 P 74
Both eyes – red, watery discharge right eye worse than left
Assessment
Bilateral conjunctivitis –likely viral
Chlorsig Drops 4hrly
03.03.10
Subjective
No improvement to eyes, blurred vision
Objective
Odema eye lids ++
Marked conjunctival congestion
Plan
Chloramphenicol 0.5% sterile 1 drop 3 times daily
Bion Tears 1 drop each eye 4 hrly
Review 2 weeks
05.06.10
Subjective
Accompanied by husband. Very distressed. Has lost most sight in both eyes –can make out light or
dark shapes but unable to read or watch TV.
Objective
Marked odema upper and lower lids
White sticky discharge Unable to read eye chart
Plan
Refer immediately Emergency Dept, Royal Melbourne Eye Hospital.
Husband will drive to hospital
WRITING TASK
Using the information in the case notes, write a letter of referral to the Registrar, Emergency
Department, Royal Melbourne Eye Hospital, Alexandra Tce, Fitzroy, Melbourne 3051
In your answer:
The Emergency Department
Royal Melbourne Eye Hospital
Alexandra Parade
Fitzroy
05/06/10
Dear Doctor
Re. Mrs Constance Markwell
I am writing to refer Mrs Howell, a 72 year old married mother of 3 adult children who is presenting
with a visual impairment.
Initially, she presented to me on 21/2/10, complaining of inflamed, sticky and weeping eyes. Both
her eyes were reddish with watery discharge. However, her right eye was worse than the left eye.
Therefore she was prescribed chlorisig drops 4 hourly. She has had thyroidism for 3 years, high blood
pressure for 1 year and a hip replacement was done in 2009. Her current medications are Thyroxin 1
mg, Atacand 4 mg and Fosamax 10 mg daily. She has no known allergies.
On review after 2 weeks, she had made no improvement. In addition she had blurred vision with
odematous eye lids and conjunctival conjestion., so chloramphenicol was prescribed 0.5% one drop
three times daily and Bion tears one drop 4 hourly.
Unfortunately, today she was accompanied by her husband with complaints of impaired vision in
both eyes and an inability to read books or watch television. There was oedema in both eyelids with
white discharge. She could not read the eye chart.
In view of the above signs and symptoms I believe she needs immediate eye care facilities. I would
appreciate your urgent attention to her condition.
Yours sincerely
Dr X
[211 words]
notes:
John Elvin is a 48-year-old patient in your General Practice
5/05/11
Subjective: Complaint of occasional mild central chest pain on exertion
Has mild asthma but otherwise previously well
Nil family history of cardiac disease
1 pack day smoker and drinks 10 standard drinks 5/7
Under significant stress with own business
Medications – seretide two puffs BD salbutamol two puffs prn
Allergies - Nil
Objective: Nil chest pain O/E

ECG NAD
Troponin level NAD
Assessment: Early stages of IHD

D/D - stress related chest pain
Alcohol dependence but not interested in changing
Plan: Check serum lipids

Refer for exercise stress test
Review in 1 week
12/5/11
Subjective: Still only very occasional chest pain on exertion
Has runny nose & pharyngitis at present with ↑asthma symptoms
Attended stress test with very mild chest pain at high exercise load
Objective: Some very slight ischaemic changes present in exercise test

Mild bilateral wheeze present
Cholesterol mildly ↑
Assessment: Ischaemic heart disease/angina
Viral upper respiratory tract infection
Plan: Commence on lipitor, nitrates(imdur), aspirin and prn anginine

Educate anginine use
Review in 2/52
26/5/11
Subjective: Chest pain for the last week
Still c/o frequent mild wheeze
Often forgets to take seretide puffers because of ETOH consumption
Objective Mild bilateral wheeze still present
Assessment Mild Asthma 2⁰ to ↓ compliance with medication

Alcohol dependence now affecting medication compliance
Plan Emphasised importance of preventative anti-asthma meds

Recommended pt write put a reminder for asthma and all medications on his fridge.
Encouraged pt to use prn salbutamol until asthma improves
Offered ETOH dependence treatment pharmacotherapy- will consider this.
1/6/11
Subjective: Passing by medical centre and c/o sudden onset crushing chest pain on background
of URTI and worsening asthma since last
Not relieved by anginine
Very audible wheeze
Examination ECG – mild ST elevation in anterior leads. ST 120

Lungs – O/A moderate wheeze and mild bilateral crackles. SP O2 86% on R/A
Heart – Slight S3 sound +ve
Assessment Likely anterior AMI; ? triggered by respiratory issues

Acute exacerbation of asthma 2⁰ to URTI
? Mild APO
Plan Paramedic transfer to ED
O2 15L via non-rebreather (pt isn’t CO2 retainer)
GTN patch applied
IV morphine 5mg given
Ipatropium Bromide 500ug given via nebuliser in view of tachycardia
Frusemide 40mg given
Writing Task:
Using information provided in the case notes, write a referral letter to Dr Jeremy Barnett, the
Emergency Registrar on duty at Maroubra Hospital, Lakes Rd, Maroubra.
In your answer:
Dr Jeremy Barnett
The Emergency Registar on Duty
Maroubra Hospital
Lakes Road
Maroubra
29/06/2018
Dear Dr Barnett,
Re: Mr John Elvin,
I am writing to refer Mr. Elvin, a 48-year-old businessman who is presenting with signs and symptoms
suggestive of anterior myocardial infarction and acute exacerbation of asthma. Your urgent treatment and
assessment would be greatly appreciated.
Mr Elvin presented to the general practice on 5/05/11 complaining of associated mild central chest pain on
exertion. He has a history of mild asthma for which he takes seretide and salbutamol inhalers. He smokes 1
pack daily and consumes about 10 drinks 5/7. In addition, he is under significant stress with his own
business. Please note, there are no family history and allergies.
On his subsequent visits, exercise stress test revealed very slight ischemic changes. Also, mild bilateral
wheeze was presented due to viral upper respiratory tract infection. He was commenced on Lipitor,
nitrates, aspirin and Anginine. I gave him some advice regarding improving his compliance with medications.
Today, Mr Elvin presented complaining of sudden onset of crushing chest pain and very audible
wheeze. Cardiovascular examinations showed mild ST elevation in anterior leads with ST 20 and slight S3
sound. Moreover, mild bilateral crackles were noted. GTN patch, IV morphine 5 mg, Ipatropium bromide
500 mg via nebulizer and Frusemide 40 mg were given.
In view of the above, my provisional diagnosis is acute myocardial infarction with exacerbation of asthma.
and have requested a paramedic transfer. If you have any queries, please do not hesitate to contact me.
Yours sincerely,
Doctor X
[241 words]
notes:
Today's Date 16.02.13
Patient History
Miss Cathy Jones - 25 year old single woman
Occupation - receptionist
Family history of deep vein thrombosis
On progesterone-only pill (POP) for contraception
No previous pregnancies
15.02.13
Subjective
Presents to GP surgery at 7 pm, after work
Complains of lower abdominal pain since the evening before, worse in right iliac fossa
Unsure of last menstrual period, has had irregular bleeding since starting
POP 2 months ago, New partner for past 2 months
No bladder or bowel symptoms
Objective
Mild right iliac fossa tenderness, no rebound / guarding
Apyrexial, pulse 88, BP 110/70
Vaginal examination - quite tender in right fornix. No masses
Assessment
Non-specific abdo pain
Plan: Asks her to return in morning for blood test and reassessment
16.02.13
Subjective
Pain has worsened overnight. Now severe constant pain.
Some slight vaginal bleeding overnight also.
Felt faint while waiting in reception.
On questioning, has left shoulder-tip pain also.
Objective
Very tender in the right iliac fossa, with guarding and rebound tenderness
Apyrexial, Pulse 96, BP 110/70
On vaginal examination, has cervical excitation and markedly tender in the right fornix.
Pregnancy test result positive
Urine dipstick clear
Assessment
Suspected ectopic pregnancy
Plan: You ring the on duty Gynaecology Registrar and ask for urgent assessment, and are instructed
to send her to the A&E Department with a referral letter.
Writing Task:
You are the GP, Dr Sally Brown. Write Referral letter to the Gynaecology Registrar at the Spirit
Hospital, South Brisbane. Ask to be kept informed of the outcome.
In your answer:
Gynaecology Registrar
A&E Department
Spirit Hospital
South Brisbane
16/02/13
Dear Doctor,
Re: Cathy Jones
Thank you for seeing this 25-year-old woman, who I suspect has an ectopic pregnancy.
This is her first pregnancy. Ms. Jones presented to the surgery yesterday evening with vague lower
abdominal pain. She started the progesterone-only pill for contraception two months ago, when she
started a new relationship, and has had some irregular bleeding since then. Therefore, she is unsure
of her exact last menstrual period. Yesterday, she was mildly tender only and her observations were
normal.
However, on review this morning her pain had worsened overnight, she is very tender in the right
iliac fossa, with rebound and guarding, and on vaginal examination there is cervical excitation, and
marked tenderness in the right fornix. Her pregnancy test is positive.
I am concerned that she may have an ectopic pregnancy, and would appreciate your urgent
assessment.
Please keep me informed of the outcome.
Yours sincerely,
Doctor
notes:
Today’s Date 21/01/12
Patient History
Brendan Cross, Male , DOB: 25/12/2003
Has a sister 6 years, brother 3 years
Mother – housewife
Father – Naval Officer currently on active duty in Indonesia
P.M.H- NAD
Brendan is on 50th percentile for height & weight
Allergy to nuts – hospitalised with anaphylaxis 2 years ago following exposure to peanuts
14/01/12
Subjective
Fever, sore throat, lethargy, many crying spells – all for 3 days.
Objective
Temperature - 39.8°C
Enlarged tonsils with exudate
Enlarged cervical L.N.
Ab - NL
CVS – NL
RR – NL
Probable Diagnosis
Tonsillitis (bacterial)
Management
Oral Penicillin 250mg 6/h, 7days + Paracetamol as required.
Review after 5days if no improvement.
19/1/12
Subjective
Mother concerned – sleepless nights, difficulty coping with husband away – mother-in-law coming
to help.
Brendan not eating complaining of fever, right knee joint pain, tiredness, lethargy – for 2 days
Objective
Temperature - 39.2°C
Hypertrophied tonsils
Cervical limp node – NL
Swollen R. Knee Joint
No effusion
Mid systolic murmur, RR - normal
Investigation
ECG, FBC, ASOT ordered
Treatment
Brufen 100mg tds, review in 2 days with investigation reports
21/1/12
No change of symptoms
ECG – prolonged P-R interval
ESR – increased
ASOT – Increased
Diagnosis
? Rheumatic fever
Plan
Contact Spirit Paediatric Centre to arrange an urgent appointment with Dr Alison Grey, Paediatric
Consultant requesting further investigation and treatment.
Writing Task:
You are GP, Dr Joseph Watkins, Greenslopes Medical Clinic, 294 Logan Rd, Greenslopes, Brisbane
4122. Write a referral letter to Dr Alison Grey, Mater Paediatric Centre, Vulture Street, Brisbane
4101.
In your answer:
Dr. Alison Grey
Mater Paediatric Centre
Vulture Street
Brisbane,4101
21/01/2012
Dear Dr. Grey,
Re: Brendan Cross
Thank you for seeing this 8 year old boy who has demonstrated features consistent with rheumatic
fever. His developmental and past medical history were unremarkable except for an allergy to
peanuts. His mother has difficulty in caring for both his illness and two other small children as his
father is away due to his work as a naval officer.
He presented with symptoms suggestive of acute bacterial tonsillitis on 14/01/12, when fever and
sore throat had occurred over the previous 3 days, associated with lethargy and crying spells. High
temperature (39.8), enlarged tonsils with exudate and cervical lymphadenopathy were found.
Therefore, oral penicillin and paracetamol were prescribed.
Regrettably, he returned on 19/01/12 with worsening symptoms. Fever had persisted with right
knee joint pain. He appeared restless, and was finding it difficult to eat and sleep. Examination
revealed hypertrophied tonsils and a swollen right knee joint without signs of effusion. There was
mid-systolic murmur on heart auscultation. Brufen was prescribed but was not effective. Today,
blood tests results reported elevated erythrocyte sedimentation rate and anti-streptolysin O titre.
An abnormal electrocardiogram indicated prolonged P-R interval.
I believe Brendan needs admission for further investigation and stablisation. I would appreciate your
urgent attention to his condition.
Yours sincerely,
Dr. Watkins
[202 words]
notes:
Patient History
Mrs. Jane MacIntyre (DOB 01.03.73)
Two children age 5 and 3
Two miscarriages
First pregnancy
 developed severe pre-eclampsia
 delivered by emergency Caesarean Section at 32 week
 in intensive care for 3 days, required magnesium sulphate
 baby (Sam) weighed 2.1 kg – in Neonatal Intensive Care Unit 2 weeks
 did not require ventilation only CPAP (Continuous Positive Airway Pressure)
Second Pregnancy
 BP remained normal
 baby (Katie) delivered at full term, weighed 3.4kg
Family history of thrombosis
Known to be heterozygous for Factor V Leiden
Treated with prophylactic low molecular weight heparin in two previous pregnancies
No other medical problems
Not on any regular medication
Negative smear 2010
24/08/12
Subjective
Positive home pregnancy test – fifth pregnancy
Thinks she is 8 weeks pregnant
Last menstrual period 26.6.12
Painful urination last three days
Request referral to the Spirit Mother's Hospital for antenatal care and birth.
Objective
BP:120/80
Weight: 60kg
Height: 165cm
Some dysuria for the past 3 days
Urine dipstick: 3+ protein, 2+ nitrites, and 1+ blood
Abdomen soft and non-tender
Fundus not palpable suprapubically
Assessment
Needs antenatal referral to an obstetrician in view of her history of severe pre-eclampsia, Caesarean
Section, and her age
Needs to start folic acid
Needs to start tinzaparine 3,500 units daily, subcutaneously, in view of thrombosis risk.
Suspected urinary tract infection based on her symptoms and the urine dipstick result
Plan
Refer Jane to Dr Anne Childers at the Spirit Mother's Hospital
Commence her on folic acid 400 micrograms daily, advise to continue until 12 weeks pregnant
Arrange routine antenatal blood tests – results to be sent to the Spirit Mother's Hospital when
received
Counsel Jane re antenatal screening for Down's Syndrome in view of her age
Jane elects to have a scan for nuchal translucency, which is done between 11 and 13 weeks
Provide information on Greenslopes Screening Centre.
Prescribe tinzaparine 3,500 units daily subcutaneously
Send a midstream urine specimen to laboratory
Prescribe cefalexin 250 milligrams 6-hourly for five days
Writing Task:
You are GP, Dr. Liz Kinder, at a Family Medical Centre. Write referral letter to Dr. Anne Childers
MBBS FRANZCOG, Consultant Obstetrician, Spirit Mother's Hospital, Stanley Street, South
Brisbane.
In your answer:
Dr. Anne Childers
(MBBS, FRANZCOG)
Consultant Obstetrician
Spirit Mother’s Hospital
Stanley Street
South Brisbane
24/08/12
Dear Dr. Childers,

Re: Mrs. Jane MacIntyre DOB 01/03/73
Thank you for accepting this 39-year-old mother of 2, who is 8 weeks pregnant and has a strong
history of severe pre-eclampsia in her first pregnancy which resulted in an emergency caesarean
section at 32 weeks of gestation. However, her second pregnancy and delivery was normal. In
addition, she has had 2 miscarriages. In view of her age and history, I believe Mrs. MacIntyre needs
urgent specialist assessment and care.
On presentation today, Mrs. MacIntyre reported that she is heterozygous for Factor 5 Leiden and
has a family history of thrombosis. Therefore, I commenced her on trizaparine 3,500 units daily. In
addition, Mrs. MacIntyre complained of difficulty in urination for the previous 3 days and her urine
dipstick test showed presence of a large amount of protein and nitrate along with slight blood.
Therefore, in view of urinary tract infection, cefalexim 250 miligrams 6 hourly daily for 5 days was
prescribed and mid-stream urine test was ordered.
Please note, I have commenced Mrs. MacIntyre on folic acid 400 microgram daily and have advised
her for nuchal translucency scan in order to rule out Down’s syndrome.
I am happy to share her antenatal care with you, as you think appropriate.
Yours sincerely,
Dr. Liz Kinder
General Practitioner
[200 words]
notes:
Patient History
 Somarni Khaze
 DOB 12/04/71
 Works as an operating room nurse at Spirit Hospital
 Married with 4 children 3 girls aged 17,11 and 7 years and a boy aged 12 years
 Has a regular period
 Sister had cancer breast 7 years ago and was treated by mastectomy and axillary clearance
followed by chemotherapy
 Past Hx of right breast lump treated by lumpectomy 5 years ago. Dx Benign lesion
 Does not smoke or drink and not using regular medications.
 Did mammogram 2 years ago which showed no suspicions of malignancy.
22/10/17
Subjective
 Discovered a left breast lump 6/52 ago
 Almond size, not painful and not in size
 No nipple discharge
Objective
 Mildly obese (BMI 31)
 Pulse 74/M regular
 BP 120/80
 CVS, RS, ABD are all normal
 Local examination: left breast shows 2x2 CM breast lump hard , non tender with ill defined
margins
 Palpable mobile axillary lymph nodes
 Rt breast is normal except for the scar from previous surgery
Assessment
 ? cancer breast
Management
 Repeat mammogram and order ultra sound
 Advise patient to review in 2 weeks time
6/11/17
 Pt anxious and worried about results; cannot sleep at night
 BP 150/90 and pulse 88/Min
 U/S shows 18x 16 MM nodule at left breast with variable echogenecety .The mammogram
reveals an area highly suspicious of malignancy at the left breast with multiple nodules at
the axilla
 You counsel the patient about the different options of treatment and you do core biopsy
to confirm the diagnosis
 Prescribe diazepam 10 mg nocte to calm the patient down
 Follow up consultation in 3 days for biopsy result and plan of management.
9/11/17
 Biopsy result shows moderately differentiated invasive ductal carcinoma of the left breast.
 Patient ask to be operated by Breast Surgeon Dr. Alaa Omar who had operated on her
sister before.
 Asked about possibility of immediate reconstructive surgery.
Writing Task:
You are Dr. Tin Aung a GP at Weller Park Medical Centre, 151 Pring St. Weller Park 4121. Write
a referral letter to The Breast Surgeon Dr. Alaa Omar: 1414 Wickham Tce. Spring Hill, 4004.
In your answer:
Weller Park Medical Centre
151 Pring St.
Weller Park 4121
Dr. Alaa Omar
1414 Wickham Tce.
Spring Hill, 4004
09/11/17
Dear Dr. Omar,
Re: Mrs. Somarni Khaze DOB: 12/04/71

I am writing to refer Mrs. Khaze, a 46-year-old married nurse with 4 children who has been
diagnosed with left breast cancer.
Mrs. Khaze is a premenopausal woman whose sister was your patient (you treated her for breast
cancer 7 years ago). She is a non-smoker, non-drinker and not on any regular medications. She has a
history of benign right breast lump which was treated by lumpectomy 5 years ago and her
mammogram was normal 2 years ago.
Initially, she presented to me on 22/10/17 after she had discovered a left breast lump 6 weeks
previously which was not increasing in size . She was overweight with a body mass index of 31 but
her general examinations were normal. However, a local examination revealed a 2x2 cm hard non-
tender nodule in the left breast accompanied by palpable left axillary lymph nodes while her right
breast showed the scar of the previous surgery. I suspected breast cancer and ordered ultrasound
and mammogram. 2 weeks later, she was anxious and worried with sleep disturbance and the
results found a 1.6x 1.8 cm nodule in the left breast which was suspected to be malignant with
multiple axillary lymph nodes. Therefore, I prescribed diazepam 10 mg at night and did a core biopsy
of the nodule.
Today, the biopsy result confirmed the diagnosis of moderately differentiated invasive ductal
carcinoma of the left breast.
I would appreciate your urgent attention to her condition. Please be advised that Mrs. Khaze has
expressed a wish for immediate reconstructive surgery.
Yours sincerely,
Dr. Tin Aung (GP)

[253 words]
notes:

Patient History
 Arthur Benson
 DOB: 15/04/92
 Computer Programmer
 Regularly works 55 - 60 hr week
 Married with twin boys aged 6 months
 Non-smoker and social drinker
 Father died at 69 due to stroke
 Mother is a diabetic on metaformin
P.M.H.
 Asthma since childhood-on steroid inhaler
 Allergic to penicillin
25/08/17
Subjective
 C/O headache (2/12), mild sensation of pins and needles, no nausea or vomiting
 Had a car accident 3 months ago. Hospitalised and discharged after 24 hrs with no
complications.
 CT scan normal
Objective
 O/E-overweight BMI 32
 Gait-normal, has lumbar lordosis
 Mild weakness in L/hand
 Vision-good
Plan
 Review 2/52
 Panadol 2 tab 4/24 and rest 2/52
 Advise to reduce weight and increase exercise
06/09/17
Subjective
 Feeling better, no new complaints, no worsening of pins and needles sensation
 Has been walking 30 minutes 3 times a week
 Advised to start work and come back if any concern
Objective
 Weight loss 3kg
12/09/17
Subjective
 C/O worsening headaches for 3 days, dizziness, nausea, blurred vision
 Pain not responded to Panadol but noticed mild response to Panadeine Forte
Objective
 No weight change
 Gait-normal
 Could not read 2 line of eye chart
 Odematous optic disk on fundi examination
 BP: 160/70
 PR: 98bpm
 Mild weakness and loss of sensation in medial aspects of L/hand
 Reflexes: Elbow-normal, Wrist- no reflexes
 Diagnosis: subdural haematoma
Writing Task:
You are a General Practitioner at a suburban clinic Arthur Benson and his family are regular
patients. Using the information in the case notes, write a letter of referral to a neurosurgeon for
MRI scan. Address the letter: Dr J Howe, Neurosurgeon, Spirit Hospital, Wooloongabba.
In your answer:
Dr. J. Howe
Neurosurgeon
Spirit Hospital
Wooloongabba
12/09/17
Dear Doctor,
Re: Arthur Benson

DOB: 15/04/1992
I am writing to refer Mr Benson, a married computer programmer and father of 6-month-old twins,
who I suspect has a subdural haematoma.
Mr Benson first presented to me on 25/08/17 complaining that he had been suffering from
headaches for the previous two months as well as a sensation of pins and needles. He was
overweight but his gait and vision were normal. He had mild weakness in the left hand. He was
prescribed Panadol and advised to rest for 2 weeks, reduce weight and increase exercise. He is a
non-smoker and social drinker. He has a past history of asthma, which has been treated with steroid
inhaler since childhood.
He is allergic to penicillin and had a car accident 3 months ago at which time he was hospitalised for
24 hours without complications and his CT scan was normal.
On today’s consultation, he complained of severe headache of 3-day duration with mild response to
Panadeine forte. It was associated with dizziness, nausea and blurred vision. His blood pressure was
160/70, with normal pulse and blurred fundi margins. His gait and elbow reflexes were normal. He
has mild weakness with loss of wrist reflexes and sensation in the medial aspect of the left hand.
I would appreciate your urgent attention to Mr. Benson’s case.
Yours sincerely,
General Practitioner
[214 words]
notes:
Patient Details
 Sally Webster
 DOB 10/11/00
 High school student
27/12/16
Subjective
 3/12 constipation
 1 firm bowel action every 4 to 5 days
 Diet includes 2 table spoons of bran each morning
 Has tried laxatives
 Otherwise well
Objective
 Wt. 54kg
 BP 100/50
 P 70 reg
 Abdo: lax, no masses
 P.R. exam unremarkable
 Advised to increase vegetable, fibres and fluid intake.
15/02/17
Subjective
 Presents with mother. Mother concerned about Sally’s lack of appetite and loss of weight.
Much fighting at home about
 habits. Sally claims to feel well and can’t see “ what all the fuss is about”. She just isn’t hungry.
Objective
 Wt. 48kg
 Pale, thin
 BP 100/60 Lying and standing
 Abdo and urinalysis unremarkable
Plan
 Review Sally alone
 Tests: FBE/TFT’s U+E/LFT’s
21/02/17
Subjective
 Distant, little eye contact. Feels parents are “overreacting”. Feels ideal weight is 40 kg (
currently 47kg). Denies vomiting.
 Vague about laxative use.
 Test Results: All normal
Assessment
 Anorexia Nervosa
Plan
 Refer to psychiatrist
Writing Task:
Using the information in the case notes, write a letter of referral to the Psychiatrist Dr. Midori
Yabe, 48 Wickham Tce, Spring Hill.
In your answer:
Dr. Midori Yabe
Psychiatrist
48 Wickham Tce
Spring Hill
21/02/17
Dear Dr. Yabe,
Re: Miss Sally Webster

DOB: 10/11/00
I am writing to refer Sally, a 16-year-old high school student who is suffering from anorexia nervosa.
Initially, she came to see me on 27/12/16, complaining of constipation, and requesting strong
laxatives for this problem. Her weight was 54 kg and her vital signs and physical examination were
normal. Her diet included 2 spoons of bran each morning. Therefore, she was advised to increase
vegetables, fibre and fluid intake.
On the 15/02/17 consultation, despite Sally claiming that she did not believe she had a problem,
her mother reported that she was concerned about Sally’s poor appetite, loss of weight and
argumentative behaviour. Her weight was 48 kg and her vital signs, physical examination and
urinalysis were normal. I requested blood samples for blood chemistry and electrolytes.
On today’s consultation, Sally was interviewed alone. She had poor eye contact and she believes
that her parents were overacting about her idea of reducing her weight to 40 kg. She denied
vomiting and she was vague reporting about laxative use. Her weight was 47 kg and her blood
tests were normal.
I would appreciate your urgent assessment of Sally’s case. Please let me know if you need
further information.
Yours sincerely,
Dr. X
[198 words]
notes:
notes:
Peter Ludovic, 8 years old
22/12/06
Complains of sore throat. Mother reports fever, irritable.
Voice hoarse
O/E:
enlarged tonsils, exudate
Tender, large cervical nodes
T 39.5°
Assessment: Tonsillitis
Plan: Penicillin v 250mg qid 7 days
15/01/07 Mrs.
Ludovic reported son’s urine brown 4 days previously.
Says Peter is lethargic, no report of frequency, trauma or dysuria.
O/E: tonsillar hypertrophy

BP 90/60
Urinalysis – macroscopic haematuria
Assessment:
? post streptococcal nephritis
? urinary tract infection
Plan:
R/V 2 days
Fluids, rest
Tests:
Full Blood Examination (FBE), urea and creatinine
[U&E], electrolytes, mid stream urine [MSU]
micro/culture/sensitivity [M/C/S], Antistreptolysin-O Titre [ASOT] and cell morphology
18/01/07
Peter asymptomatic
O/E: BP 110/90
macroscopic haematuria
Test results:
FBE normal
U&E↑
ASOT↑+++
MSU – 4X 10 # RBC [red blood cells ] of renal origin
Assessment:
post streptococcal nephritis with early renal failure
Plan: Refer to paediatrician
WRITING TASK
Using the information in the case notes, write a letter of referral to Dr Xavier Flannery, a
paediatrician at 567 Church St Springvale 3171.
In your answer:
Dr. Xavier Flannery
Paediatrician
567 Church Street
Springvale, 3171
18 January 2008
Dear Dr. Flannery,
Re: Peter Ludovic, 8 years old

Thank you for seeing Peter who I suspect has post-streptococcal nephritis with early renal
failure.
Initially, Peter presented on 22 December 2006 with symptoms suggestive of acute bacterial
tonsillitis. According to his mother, he had been suffering from sore throat, associated with fever
(39.5), hoarse voice and irritable mood. Enlarged tonsils with exudate and cervical
lymphadenopathy were found, and oral penicillin was prescribed.
On the second examination 15 January 2007, the patient reported blood in urine over the
previous four days, as well as lethargy. Examination revealed hypertrophied tonsils, and urine
analysis showed macroscopic haematuria. Blood pressure was normal.
Today, blood test results reported elevated urea and creatinin, antistreptilysin-O titre, and midstream
urine showed red blood cells of renal origin (4x10).
In view of the above signs and symptoms, I would appreciate your urgent assessment and
treatment of this patient.
Yours sincerely,
Doctor

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What are the signs and symptoms of meningococcal meningitis?

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What information is included in a referral letter?

What information is included in a referral letter?

Urgent referral letter from GP to ER doctor, duty registrar or specialist

Today’s Date 14.10.12

● Do not use note form

● Use correct letter format

Re: Amina Ahmed (8years)

Dr. Lucy Irving

Re: Amina Ahmed

In view of the above, I believe she needs urgent admission.

Assessment and planning

● Do not use note form

● Use correct letter format

Dr. Peter Smith (GP)

Today's Date 30/09/17

RE: Dave Cochrane D.O.B. 20/11/1964

Objective: Looks tired

Plan: Advised – cease smoking

Dear Dr. Roberts,

Re: Mrs May Hong

I believe her rapid deterioration warrants inpatient treatment.

Objective: BP 150/100 P 80 regular

Plan: Advise re weight loss, smoking cessation

Plan: Commence nifedipine (calcium channel blocker) 20 mg daily

Assessment: ? Gastric reﬂux. Non-compliance with anti-hypertensive medication.

Plan: Add Mylanta 30 mls q.i.d.

Objective: BP 160/100 P 64 in obvious distress

Assessment: Acute myocardial infarction

Plan: Oxygen given

The Registrar 30 April, 1997

Re: Mr Derek Romano

● Do not use note form

● Use correct letter format

Objective: Nil chest pain O/E

Assessment: Early stages of IHD

Plan: Check serum lipids

Objective: Some very slight ischaemic changes present in exercise test

Plan: Commence on lipitor, nitrates(imdur), aspirin and prn anginine

Objective Mild bilateral wheeze still present

Assessment Mild Asthma 2⁰ to ↓ compliance with medication

Plan Emphasised importance of preventative anti-asthma meds

Examination ECG – mild ST elevation in anterior leads. ST 120

Assessment Likely anterior AMI; ? triggered by respiratory issues

● Do not use note form

● Use correct letter format

Re: Mr John Elvin,

Re: Cathy Jones

Please keep me informed of the outcome.

Dear Dr. Grey,

Re: Brendan Cross

Dear Dr. Childers,

Dr. Liz Kinder

Dear Dr. Omar,

Re: Mrs. Somarni Khaze DOB: 12/04/71

Dr. Tin Aung (GP)

Today's Date 12/09/17

Re: Arthur Benson

I would appreciate your urgent attention to Mr. Benson’s case.