The task
Assume that today's date is 3 November 2026. Ms Maribel Gonzales is attending follow-up after an incidental CT finding. Allow 45 minutes: 5 minutes for reading and 40 minutes for writing.
This is original independent practice. You are Ms Maribel Gonzales's general practitioner. Write a referral letter to Dr Lynn Murunga, Consultant Respiratory Physician, Lung Nodule Clinic, 42 Clinic Road, VIC 3000, Australia. Request assessment of the incidental pulmonary nodule, accurately communicating the radiology report, diagnostic uncertainty and availability of current and previous imaging. 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?
Incidental pulmonary nodule: referral
This is original independent practice. You are Ms Maribel Gonzales's general practitioner. Write a referral letter to Dr Lynn Murunga, Consultant Respiratory Physician, Lung Nodule Clinic, 42 Clinic Road, VIC 3000, Australia. Request assessment of the incidental pulmonary nodule, accurately communicating the radiology report, diagnostic uncertainty and availability of current and previous imaging. 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 Maribel Gonzales
- DOB: 12/02/1968 (58 yrs)
- GP review 03/11/26 following ED investigation
Social and medical background
- Smoked 15 cigarettes/day for 24 yrs; stopped 2018
- No personal cancer history; no known asbestos exposure
- Independent; walks daily without limitation
- Mother died with lung cancer; patient anxious about CT
- Complained about parking charge at imaging appointment
- Resolved shoulder strain in 2024
Presentation and imaging
- 29/10: acute breathlessness after long flight → ED
- CT pulmonary angiogram: no pulmonary embolism
- Incidental solitary 9 mm solid non-calcified nodule, posterior RUL
- Nodule margins mildly irregular
- No enlarged thoracic lymph nodes or pleural effusion
- Report: indeterminate nodule; benignity/malignancy not established
- Radiologist recommends respiratory review and comparison with prior imaging
- No comparison study available to reporting radiologist
Previous imaging chronology
- 2022: chest CT performed for a resolved respiratory infection
- Previous imaging provider confirms study retained
- 30/10: current practice requested prior images and report
- 03/11: neither received; no documented nodule comparison
- Current report enclosed; current images electronically accessible
- Practice will forward old study and report once received
Current assessment
- 03/11: breathlessness resolved; chest examination unremarkable
- No persistent cough, haemoptysis or unexplained weight loss
- Appetite maintained; no recurrent chest infections
- Patient asks whether nodule definitely represents cancer
- Explained uncertainty; specialist assessment and follow-up needed
Plan
- Refer Dr Lynn Murunga: assess nodule; advise investigation/surveillance
- Do not label nodule new, growing or stable without comparison
- New haemoptysis → urgent review; severe breathing difficulty → emergency care
- Patient happy for daughter to attend specialist consultation
Who is reading, and what do they need?
Dr Murunga needs the reported nodule characteristics, relevant background and exact imaging availability to assess investigation or surveillance. Identify Ms Gonzales by name and date of birth, then distinguish observed findings from conclusions awaiting comparison. Smoking and family history inform assessment without establishing malignancy. Daughter attendance is optional consultation logistics.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Respiratory assessment requested for incidental nodule; advise investigation or surveillance. | States the specialist decision required without prescribing an investigation or follow-up interval absent from the notes. |
| Solitary 9 mm solid non-calcified posterior RUL nodule with mildly irregular margins. | Preserves every reported lesion characteristic needed for the respiratory physician’s assessment. |
| Indeterminate nodule; benignity/malignancy unestablished; reporting radiologist had no comparison study. | Communicates the report’s uncertainty and prevents unsupported conclusions about diagnosis or temporal change. |
| 2022 CT retained; requested 30/10; images/report still unreceived 03/11; no documented comparison. | Explains the outstanding comparison and distinguishes a retained historical study from one available for current review. |
| Current report enclosed and images accessible electronically; previous study/report to follow. | Shows what the clinic can review immediately and what the practice will forward later. |
| 15 cigarettes/day for 24 years; stopped 2018; no cancer history or known asbestos exposure. | Provides relevant background without converting exposure history into a diagnosis or inventing risk estimates. |
| Breathlessness resolved; unremarkable chest; no persistent cough, haemoptysis or unexplained weight loss. | Describes current clinical context without implying that symptom absence establishes a benign nodule. |
| Maternal lung cancer history; patient anxious; uncertainty and need for specialist follow-up explained. | Identifies the documented concern the consultation should address while preserving the distinction between family history and diagnosis. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Parking charge at the imaging appointment. | The complaint does not help assess the nodule or coordinate imaging review. |
| Resolved shoulder strain in 2024. | The unrelated resolved injury contributes nothing to the respiratory assessment. |
| Long-flight breathlessness; CTPA negative for pulmonary embolism. | Compress to the reason imaging occurred if useful; detailed embolism investigation should not dominate the incidental-nodule referral. |
| Independent; walks daily without limitation. | Optional functional context can be omitted when current respiratory assessment already provides sufficient orientation. |
| Advice about future haemoptysis or severe breathing difficulty. | Prior symptom counselling is optional correspondence detail; it must not replace accurate radiology and imaging-availability information. |
A paragraph plan for this case
Open with the request for nodule assessment, investigation or surveillance, followed by the exact reported lesion features and indeterminate interpretation; the radiologist’s recommendation and absence of enlarged thoracic lymph nodes or pleural effusion are useful optional additions. Explain that no comparison was available, the retained 2022 CT was requested but remains unreceived, current images and report are available, and the practice will forward the old study and report. Close with selected smoking, exposure and family history, current symptoms and examination, and documented anxiety; maintained appetite, absent recurrent infections and daughter attendance are optional.
Where candidates slip on this task
- No prior study has reached the practice or been compared with the current scan; avoid calling the nodule new, growing or stable on this evidence.
- Mildly irregular margins and maternal lung cancer history do not establish malignancy, while symptom absence does not establish benignity; retain the radiologist’s explicitly indeterminate assessment.
- Distinguish the enclosed current report and electronically accessible images from the retained 2022 study still awaited; do not imply that previous images accompany this referral.
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
Can the nodule be described as new because it was found incidentally?
No. Incidental discovery describes how the nodule was detected, not when it developed. The reporting radiologist had no comparison study, and the practice still awaits the retained 2022 images and report. Neither growth nor stability has been documented.
Should the referral request a specific scan interval or biopsy?
No specific interval or procedure is recorded. Ask for assessment and advice on investigation or surveillance, supported by the exact CT description and imaging-access details. Smoking history and the patient’s anxiety are useful context, but neither determines a management decision.
Sources
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