The task
Assume that today's date is 6 November 2026. Mrs Ogbuehi is being discharged home today in the United Kingdom. This is original independent practice material; patient details, findings and individual treating-team arrangements are fictional case facts, not general clinical recommendations. Allow 45 minutes: 5 minutes for reading and 40 minutes for writing.
You are the doctor discharging Mrs Chinelo Ogbuehi from the stroke unit. Using the case notes, write to her regular general practitioner, Dr Ozioma Okeke, explaining her residual functional needs and requesting ongoing community review and secondary prevention. Clarify which investigations and treatment decisions remain with the stroke team. Address the letter to Dr Ozioma Okeke, General Practitioner, 18 High Street, SW19 4AB, United Kingdom. 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.
Length: the body of the letter should be about 180–200 words. You have 45 minutes in the test: 5 minutes to read, 40 to write. Letter type: Discharge letter.
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Which case notes belong in this letter?
Recovery after ischaemic stroke: discharge
You are the doctor discharging Mrs Chinelo Ogbuehi from the stroke unit. Using the case notes, write to her regular general practitioner, Dr Ozioma Okeke, explaining her residual functional needs and requesting ongoing community review and secondary prevention. Clarify which investigations and treatment decisions remain with the stroke team. Address the letter to Dr Ozioma Okeke, General Practitioner, 18 High Street, SW19 4AB, United Kingdom. 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.
Mark every line: Include keeps the specific detail; Compress keeps the relevant gist in fewer words; Omit leaves it out. Then compare your choices with our reviewed analysis. Some choices are optional.
Download practice checklist (PDF)
One-page worksheet. Answers and reasons are on the linked webpage, so you can practise before checking.
Case notes
Patient details
- Name: Mrs Chinelo Ogbuehi
- DOB: 14/03/1957 (69 yrs)
- Admitted 21/10/26; discharge home 06/11/26
- Regular GP: Dr Ozioma Okeke; established history known
Social background
- Lives with husband; daughter nearby
- Daughter staying initially; agrees to supervise medicines and assist dressing
- Previously independent; retired librarian; enjoys crosswords
- Complained about ward meals
Medical history
- Hypertension; amlodipine unchanged
- Hypercholesterolaemia; previously declined statin
- Appendicectomy 1989
- No known drug allergies
Admission and investigations
- 21/10: L hemispheric ischaemic stroke; R weakness, expressive dysphasia
- MRI: L middle cerebral artery territory infarct
- Initial CT: no haemorrhage
- CT angiography: no large-vessel occlusion
- Carotid imaging: mild bilateral plaque; no significant stenosis
- Inpatient telemetry: no AF detected; cause remains uncertain
- Echocardiogram: no intracardiac thrombus
Treatment and progress
- Medically stable; no recurrent neurological symptoms during rehabilitation
- Residual R hand weakness, mild expressive dysphasia; comprehension preserved
- Transfers independently; stick indoors, supervision outdoors; help dressing/medicines
- Swallow assessment: ordinary diet, thin fluids
- OT home assessment completed; recommended equipment installed before discharge
- Team plan: long-term clopidogrel + atorvastatin commenced; acute aspirin ceased; complete, reconciled discharge medication list incl. individual doses, routes, frequencies, durations and changes enclosed with letter to GP
- Discharge medicines supplied; daughter practised supervised administration
- Patient/husband taught FAST: call 999 for sudden new stroke symptoms, even if resolving
Discharge plan
- GP review requested 13/11: BP, adherence, tolerability; ongoing prevention prescribing per enclosed medication list/risk-factor management
- Stroke team to arrange ambulatory ECG, review result and decide treatment changes; clinic 04/12
- Home rehabilitation accepted: physiotherapy, OT, speech therapy; first visit 09/11
- Tearful about dependence; no suicidal thoughts; GP to review mood
- Does not drive
Who is reading, and what do they need?
Dr Ozioma Okeke is Mrs Chinelo Ogbuehi’s regular GP and already knows her established history. Prioritise current function, community services, prevention prescribing using the enclosed reconciled medication list, and allocated follow-up. Her age, unchanged amlodipine, previous statin refusal and allergy status are optional context; identifiers should establish the patient and episode without displacing the requests.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| 21/10: left hemispheric ischaemic stroke with right weakness and expressive dysphasia. | Establishes the admission diagnosis underlying the functional handover and secondary prevention requests. |
| Residual right hand weakness and mild expressive dysphasia; comprehension preserved. | Defines persisting deficits and helps the GP communicate appropriately without assuming impaired understanding. |
| Independent transfers; stick indoors, supervision outdoors; assistance with dressing and medicines. | Specifies practical support needs and prevents independent transfers being mistaken for complete functional independence. |
| Long-term clopidogrel and atorvastatin commenced; acute aspirin ceased; complete, reconciled discharge medication list enclosed for GP. | Identifies treatment changes and directs the GP to the individual prescription details needed for continuing treatment. |
| GP review 13/11: BP, adherence, tolerability; ongoing prevention prescribing per enclosed medication list and risk-factor management. | Gives the recipient the requested review date, assessment priorities and continuing responsibilities. |
| Stroke team: arrange ambulatory ECG, review results, decide treatment changes; clinic 04/12. | Assigns investigation and subsequent treatment decisions to the responsible team, avoiding an ambiguous handover. |
| Home physiotherapy, OT and speech therapy accepted; first visit 09/11. | Shows which rehabilitation services are arranged and when community input begins. |
| Tearful about dependence; no suicidal thoughts; GP mood review requested. | Adds a specific community review need while preserving the distinction between documented distress and a psychiatric diagnosis. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Complained about ward meals. | Does not affect the GP’s post-discharge assessments, functional support or prevention prescribing. |
| Appendicectomy in 1989. | Remote surgery has no stated connection to the current stroke handover. |
| CT: no haemorrhage; angiography: no large-vessel occlusion; echocardiogram: no intracardiac thrombus. | These completed inpatient results look relevant but need not occupy space required for current needs and allocated follow-up. |
| Retired librarian; enjoys crosswords. | Occupation and hobbies do not direct the requested care; previous independence may be compressed separately to contextualise dependence. |
| Patient and husband already taught FAST. | Completed education is optional background in this focused handover; review requests and unresolved investigation ownership take priority. |
| Does not drive. | No driving-related action is requested or documented for the GP in this case. |
A paragraph plan for this case
Open with patient identifiers, the 21 October admission and 6 November home discharge after ischaemic stroke; medical stability and MRI confirmation can be compressed if useful. Next describe residual deficits and practical assistance, followed by arranged rehabilitation; optionally compress the husband’s presence, nearby daughter staying initially to supervise medicines and assist dressing, ordinary diet with thin fluids, and completed home assessment with equipment installed. Finish with the 13 November GP review, continuing prevention prescribing according to the enclosed reconciled medication list and mood review, then separately allocate ambulatory ECG arrangement, result review and treatment decisions to the stroke team, with clinic on 4 December.
Where candidates slip on this task
- Do not treat telemetry without detected AF or mild carotid plaque without significant stenosis as establishing the stroke’s cause; the notes explicitly retain uncertainty and stroke-team investigation.
- Distinguish new long-term clopidogrel and atorvastatin from stopped acute aspirin and unchanged amlodipine. Refer to the enclosed complete, reconciled medication list for individual prescription details; do not invent doses or frequencies. Supplied medicines and the daughter’s practised administration describe discharge readiness, not transfer of prescription information.
- Retain outdoor supervision and dressing/medicine assistance despite independent transfers; ordinary diet, thin fluids, installed equipment and initial family help can be compressed without declaring unrestricted independence.
No model letter is published here. Write for the named reader from the case notes in the timed editor, then get it marked.
Write it in the timed editor and get marked on the 6 criteria
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Your profession's guide: OET Medicine. Layout and structure: OET letter format.
Questions about this task
Must every inpatient investigation appear in this discharge letter?
No. Prioritise the stroke diagnosis, residual needs and outstanding ambulatory ECG responsibilities. MRI confirmation and selected investigation context may be compressed or omitted. If discussing telemetry, preserve the limited finding of no AF detected and the documented uncertainty about the cause.
How should GP and stroke-team responsibilities be separated?
Group the GP’s 13 November BP, adherence and tolerability review with ongoing prevention prescribing according to the enclosed reconciled medication list, risk-factor management and mood review. Separately identify stroke-team ownership of ambulatory ECG arrangement, result review and treatment decisions, alongside the 4 December clinic appointment. Do not transfer those decisions to the GP.
Sources
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