The task
Assume that today's date is 5 November 2026. This is original independent practice. All patient-specific findings, laboratory results and management decisions are fictional; the reference intervals are drawn from published laboratory sources.
You are a general practitioner. Using the case notes, write a referral letter to Dr Luana Pujadas, Endocrinologist, Specialist Endocrine Clinic, Level 2, 28 High Street. Request assessment of Ms Lina Velazquez for possible primary hyperparathyroidism, including interpretation of the two laboratory reports and advice on further investigation and management. 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?
Primary hyperparathyroidism under assessment: referral
You are a general practitioner. Using the case notes, write a referral letter to Dr Luana Pujadas, Endocrinologist, Specialist Endocrine Clinic, Level 2, 28 High Street. Request assessment of Ms Lina Velazquez for possible primary hyperparathyroidism, including interpretation of the two laboratory reports and advice on further investigation and management. 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 Lina Velazquez
- DOB: 18/03/1968 (58 yrs)
- Address: 9 Station Road
Social background
- Lives with husband; independent with daily activities
- Retired librarian; enjoys embroidery and crossword puzzles
- Daughter privately disclosed marital difficulties; pt unaware
Medical history
- Hypertension; amlodipine only regular medication
- Appendicectomy 2001; uncomplicated recovery
- No lithium, thiazides, calcium, vitamin D or biotin supplements
- No known drug allergies
Laboratory A — 12/10/26
- Bloods requested during investigation of fatigue
- Albumin-adjusted calcium 2.72 mmol/L; reference interval 2.20–2.60 mmol/L
- Concurrent intact PTH 8.3 pmol/L; normocalcaemic reference interval 1.6–6.9 pmol/L
Laboratory B — 29/10/26
- Repeat bloods; different laboratory used for convenience
- Total calcium 11.0 mg/dL; reference interval 8.6–10.2 mg/dL; albumin within laboratory interval
- Concurrent intact PTH 74 pg/mL; reference interval 15–65 pg/mL
- Different assays/units/calcium reporting conventions; direct trend unestablished; original reports enclosed
Review — 05/11/26
- Fatigue + intermittent constipation for 3/12
- No vomiting or confusion
- Oral intake maintained; clinically well hydrated
- No previous renal stones or fragility fractures
- Renal function within laboratory reference interval on both occasions
- Vitamin D not yet measured
- Urinary calcium not yet measured
- No known family history of hypercalcaemia
- No DXA or renal imaging performed
- Worried larger PTH number means deterioration
- Possible primary hyperparathyroidism → endocrine interpretation, diagnostic assessment and management advice
Plan
- Advised against self-imposed dietary calcium restriction
- Complained receptionist was unfriendly during telephone booking
- GP to continue clinical review pending specialist appointment
Who is reading, and what do they need?
Dr Luana Pujadas is the endocrinologist receiving Ms Lina Velazquez’s initial referral; the notes do not establish prior involvement. She needs the paired biochemical findings and their laboratory context to assess possible primary hyperparathyroidism and advise on investigation and management. Age 58 or DOB 18 March 1968 provides identification; supporting history should be selective.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Possible primary hyperparathyroidism; endocrine interpretation, diagnostic assessment and management advice requested. | Defines the diagnostic uncertainty and the specialist’s requested contribution. |
| 12 October: albumin-adjusted calcium 2.72 mmol/L; reference interval 2.20–2.60 mmol/L. | Provides the first calcium finding with the reporting basis needed for interpretation. |
| Concurrent intact PTH 8.3 pmol/L; normocalcaemic reference interval 1.6–6.9 pmol/L. | Allows interpretation alongside the first calcium result while preserving the reference interval’s qualification. |
| 29 October: total calcium 11.0 mg/dL (8.6–10.2 mg/dL); albumin within laboratory interval. | Provides the second calcium finding without confusing total calcium with the earlier adjusted measurement. |
| Concurrent intact PTH 74 pg/mL; reference interval 15–65 pg/mL. | Completes the second biochemical pair using that laboratory’s units and interval. |
| Different laboratories, assays, units and calcium conventions; direct trend unestablished; original reports enclosed. | Prevents an unsupported deterioration claim and directs the specialist to the original reporting details. |
| Fatigue investigated; fatigue and intermittent constipation present for three months. | Provides useful clinical context for the biochemical investigation without attributing symptoms to an unconfirmed diagnosis. |
| Vitamin D and urinary calcium unmeasured; no DXA or renal imaging performed. | Identifies investigation gaps relevant to the request for further assessment, subject to available space. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Lives with husband; independent with daily activities. | Household arrangements and independence do not materially explain the laboratory findings or requested endocrine assessment. |
| Retired librarian; enjoys embroidery and crossword puzzles. | Occupation and hobbies do not help this specialist interpret the biochemical findings. |
| Daughter privately disclosed marital difficulties; patient unaware. | Unrelated confidential third-party information has no established role in the endocrine referral. |
| Appendicectomy in 2001; uncomplicated recovery. | Although surgical history can appear relevant, this remote resolved operation adds no useful endocrine context. |
| Receptionist reportedly unfriendly during telephone booking. | An administrative complaint does not assist diagnostic assessment or management. |
| Address: 9 Station Road. | May appear in identifying details, but need not consume space in the clinical body. |
A paragraph plan for this case
Open with the referral purpose, then organise the two dated calcium/PTH pairs with their respective intervals, reporting differences and enclosed reports; her concern about the larger PTH number can be briefly acknowledged. Use the middle paragraph for fatigue/constipation and selected supporting context: hypertension treated with amlodipine; no lithium, thiazides, calcium, vitamin D or biotin supplements; renal function within laboratory interval twice; and, if useful, no known drug allergies, previous renal stones, fragility fractures or known family hypercalcaemia, no vomiting or confusion, and maintained oral intake with clinically adequate hydration. Close with the outstanding investigations and assessment/management request, optionally noting advice against self-imposed dietary calcium restriction and continued GP clinical review pending the appointment.
Where candidates slip on this task
- Do not treat 74 pg/mL as an increase from 8.3 pmol/L: different assays, units and calcium reporting conventions mean a direct trend is unestablished.
- Keep each calcium and concurrent PTH result with its date, units and reference interval; preserve adjusted versus total calcium and the first PTH interval’s normocalcaemic label.
- Request assessment for possible primary hyperparathyroidism without presenting a confirmed diagnosis; distinguish unmeasured vitamin D and urinary calcium from investigations already completed.
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
How should the concern about the larger PTH number be handled?
If retained, identify it as the patient’s concern rather than evidence of deterioration. Present both dated results in their original units with their respective intervals. The notes explicitly state that different assays, units and calcium reporting conventions leave a direct trend unestablished.
Must every supporting clinical note be included?
No. Within 180–200 words, prioritise both dated reports, reporting differences and the specialist request. Fatigue/constipation, medication and supplement history, renal function, complication history and outstanding investigations can support assessment. Select these according to space; do not turn every recorded negative or background detail into a requirement.
Sources
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