The task
Original independent practice. All patient details, investigation results and care arrangements are fictional. Assume that today's date is 3 November 2026. Ms Yousafzai requires assessment for prevention of further fractures.
You are Ms Nadia Yousafzai's general practitioner. Write a referral to Dr Imelda Evangelista, Fracture Liaison Physician, Specialist Bone-Health Clinic, Suite 2, 26 High Street, AB10 1AA. Request secondary fracture prevention, summarising her investigation and treatment history and the practical barriers to sustained treatment. 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: Referral letter.
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Which case notes belong in this letter?
Fragility fracture and osteoporosis: referral
You are Ms Nadia Yousafzai's general practitioner. Write a referral to Dr Imelda Evangelista, Fracture Liaison Physician, Specialist Bone-Health Clinic, Suite 2, 26 High Street, AB10 1AA. Request secondary fracture prevention, summarising her investigation and treatment history and the practical barriers to sustained treatment. 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: Ms Nadia Yousafzai
- DOB: 09/05/1954 (72 yrs)
- Address: 30 Station Road, AB10 1AA
Social and medical background
- Main carer for husband; morning routine unpredictable
- Daughter can provide transport if given notice
- Frequent clinic attendance difficult because of caring responsibilities
- Mother sustained hip fracture in later life
- No smoking; minimal alcohol; no long-term systemic steroids
- Previous cataract surgery; no current visual complaints
Bone-health history
- 12/2024: DXA report documented osteoporosis; copy available
- 01/2025: alendronic acid trial begun following discussion with GP
- Stopped after several doses because of troublesome heartburn
- Fasting administration instructions difficult around husband's care
- No alternative bone-protective treatment started
Fracture and progress
- 04/10/26: tripped on rug; fall from standing height
- Left distal radius fracture; managed in cast
- No preceding dizziness or loss of consciousness
- Orthopaedic follow-up already arranged for ongoing fracture management
- 28/10: satisfactory alignment; pain improving
- 30/10 GP review: seeks prevention of another fracture
- Willing to discuss alternative treatment; reluctant to restart same tablets
Investigations and current support
- Calcium and renal function within laboratory reference ranges, 30/10
- Vitamin D result pending; GP to forward when available
- No current calcium/vitamin D supplements; dietary intake not assessed
- DXA and recent blood results to accompany referral
- Falls assessment arranged; rug removed from home
- Walking less since fracture; previously walked to shops most mornings
- Pt complained that fracture-clinic seating was uncomfortable
- Retired librarian; prefers historical novels
Plan
- 03/11: refer fracture liaison physician for secondary prevention and practical treatment plan
Who is reading, and what do they need?
Dr Evangelista needs a new referral explaining the basis for secondary prevention and what has prevented sustained treatment. Name and age support identification; the address belongs in the heading. Orthopaedics already manages the fracture. Prioritise osteoporosis evidence, the standing-height fall and left distal radius fracture, treatment experience, relevant investigations and caring constraints so the specialist can consider a practical ongoing plan.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| December 2024 DXA documented osteoporosis; report available. | This provides the established investigation basis for bone-health treatment and identifies supporting documentation. |
| 4 October standing-height fall after tripping on rug; left distal radius fracture, cast. | The fall mechanism and left distal radius fracture establish the reason for secondary prevention; cast treatment details may be omitted. |
| Alendronic acid started January 2025; stopped after several doses because of troublesome heartburn. | The specialist needs the previous treatment and specific reason for discontinuation when considering alternatives. |
| Fasting tablet administration difficult around husband's care and unpredictable mornings. | This identifies a practical administration barrier that a sustainable treatment plan must address. |
| No alternative bone protection; willing to discuss alternatives, reluctant to restart same tablets. | The treatment gap and stated preferences guide discussion without implying refusal of all preventive treatment. |
| Calcium/renal function within ranges, 30 October; vitamin D pending; DXA/results accompanying, pending result forthcoming. | These distinguish available investigation findings from an outstanding result and support continuity of specialist assessment. |
| Frequent attendance difficult; daughter can provide transport with notice. | These practical constraints can help the specialist organise feasible appointments and sustained care. |
| Fracture liaison referral for secondary prevention and a practical treatment plan. | This states the specialist action required and keeps the referral focused on preventing further fractures. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Previous cataract surgery; no current visual complaints. | The resolved eye history has no documented current bearing on the prevention request. |
| Complaint about uncomfortable fracture-clinic seating. | The seating complaint does not explain medication intolerance or the practical barriers to ongoing treatment. |
| Retired librarian; prefers historical novels. | Occupation and reading preferences do not assist secondary fracture prevention. |
| Satisfactory fracture alignment and improving pain, 28 October. | Compress or omit routine healing detail because orthopaedics already manages the fracture and this referral concerns prevention. |
| Maternal hip fracture; no smoking, minimal alcohol, no long-term systemic steroids. | Optional compact risk context can follow the established osteoporosis, fracture and treatment barriers without becoming a lengthy inventory. |
A paragraph plan for this case
Open with identification and the request for secondary prevention, supported by documented osteoporosis and the left distal radius fracture following a standing-height fall; cast treatment details are optional. Summarise the alendronic acid trial, heartburn-related discontinuation, fasting-administration difficulty and absence of alternative treatment, then connect caring responsibilities and appointment constraints with the need for a practical plan. Close with the calcium and renal findings, pending vitamin D result and accompanying reports; existing orthopaedic follow-up, absent fall prodrome, supplement and dietary status, falls support and reduced walking are optional context rather than separate compulsory paragraphs.
Where candidates slip on this task
- Describe heartburn as the documented reason alendronic acid was stopped, alongside difficult fasting administration; do not label this an allergy or refusal of every preventive treatment.
- Limit the reassuring blood results to calcium and renal function on 30 October; vitamin D remains pending, and dietary intake has not been assessed.
- Keep secondary prevention distinct from cast management already assigned to orthopaedics; request a feasible treatment plan without prescribing an unrecorded alternative drug, dose or appointment schedule.
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
Does the referral need to recommend a particular replacement medicine?
No replacement is documented. The referral should give the specialist the prior alendronic acid experience, heartburn, fasting-administration difficulty, treatment gap and willingness to discuss alternatives. These facts support a request for a practical plan without inventing a preferred drug, dose or treatment eligibility.
Which social details matter for this specialist?
Prioritise the husband's care, unpredictable mornings, difficulty attending frequently and transport available with notice, because they affect treatment feasibility. The former occupation and preference for historical novels add no comparable value. Even useful social details may be compressed when the main practical barriers remain clear.
Sources
Last checked 22 Oct 2026. Rules and prices change: confirm on the official page before you book or apply.
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