The task
This is an original independent practice task. Assume that today's date is 6 November 2026. Jost Dirksen is attending for review following completed urinary tract imaging.
You are a general practitioner. Using the case notes, write a referral to Dr Susanna Reidy, Paediatric Urologist, Specialist Children's Clinic, 18 Clinic Road, VIC 3000, Australia. Request assessment of Jost Dirksen's recurrent febrile urinary tract infections and advice on further investigation and management. Summarise the confirmed episodes, completed imaging and prevention advice, accurately stating his current antibiotic status. 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?
Recurrent febrile urinary tract infections: referral
You are a general practitioner. Using the case notes, write a referral to Dr Susanna Reidy, Paediatric Urologist, Specialist Children's Clinic, 18 Clinic Road, VIC 3000, Australia. Request assessment of Jost Dirksen's recurrent febrile urinary tract infections and advice on further investigation and management. Summarise the confirmed episodes, completed imaging and prevention advice, accurately stating his current antibiotic status. 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: Jost Dirksen; boy, DOB 12/03/2019 (7 yrs)
Social background
- Lives with mother; attends primary school
- Enjoys model trains; school art prize last term
- Mother complained about clinic parking charges
- Mother disclosed private disagreement with child's uncle
Medical history
- No known drug allergies; no regular medicines
- Antenatal scans reportedly normal
- No previous urinary surgery; no known neurological condition
- Toilet-trained; sometimes postpones voiding at school
- Previously hard stools; now soft with dietary changes
Confirmed episodes
- 08/03/26: fever, dysuria, R loin pain; pre-antibiotic urine: pyuria, pure E. coli growth
- Clean-catch specimen; assessed as upper UTI
- Culture-sensitive cefalexin course completed; symptoms resolved
- 04/06/26: fever, dysuria, L loin pain; pre-antibiotic urine: pyuria, pure E. coli growth
- Clean-catch specimen; second episode assessed as upper UTI
- Again cefalexin-sensitive; prescribed course completed; clinically recovered
- Both episodes documented in attached clinical records
- No further febrile or urinary symptoms since June
Completed investigations
- 25/06/26 renal/bladder USS: normal kidneys, no dilatation; minimal post-void residual
- 28/10/26 DMSA: no cortical defects; symmetrical renal uptake
- Imaging reports enclosed; no MCUG performed
Current assessment
- Today: well, afebrile; abdomen soft, non-tender
- Growth maintained; no palpable bladder
- Mother keen to reduce recurrence without unnecessary medicines
Advice and plan
- Advice given: adequate water, regular voiding; avoid postponing urination
- Discussed continued constipation prevention and unrestricted school toilet access
- Mother advised prompt medical review for recurrent fever/urinary symptoms
- No prophylactic antibiotic prescribed; prevention discussion was behavioural advice only
- Refer for assessment of recurrent febrile UTIs and advice on further investigation/management
Who is reading, and what do they need?
Dr Reidy needs sufficient evidence of recurrent febrile infection, completed imaging and present treatment to advise on further investigation and management. Do not assume she has reviewed the enclosed reports. His mother and school setting matter mainly for prevention; household detail is secondary. Past urinary surgery and neurological history provide optional background rather than the main reason for referral.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Assessment of recurrent febrile UTIs; advice on further investigation and management | Defines the specialist's requested action and gives the clinical history a clear purpose. |
| 08/03/26: fever, dysuria, right loin pain; pre-antibiotic pyuria and pure E. coli growth | Establishes the first documented febrile infection with symptoms and microbiological evidence supporting the referral. |
| 04/06/26: fever, dysuria, left loin pain; pre-antibiotic pyuria and pure E. coli growth | Establishes recurrence through a second distinct, microbiologically supported febrile episode. |
| 25/06/26 renal/bladder ultrasound: normal kidneys, no dilatation, minimal post-void residual | Provides the completed structural assessment needed when considering further investigation. |
| 28/10/26 DMSA: no cortical defects; symmetrical renal uptake | Supplies the completed cortical imaging findings without implying that further assessment is unnecessary. |
| Both cefalexin-sensitive courses completed; no prophylactic antibiotic prescribed | Separates previous infection treatment from current prevention and prevents an incorrect assumption of ongoing antibiotics. |
| Adequate water; regular voiding; avoid postponement; continued constipation prevention; unrestricted school toilet access | Summarises the behavioural measures already discussed so the specialist can build on existing prevention. |
| No further febrile or urinary symptoms since June; currently well and afebrile | Distinguishes a referral for recurrence assessment from treatment of an active symptomatic episode. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Enjoys model trains; school art prize last term | Personal interests and school recognition do not help the urologist assess infection recurrence or management. |
| Mother complained about clinic parking charges | An administrative complaint does not affect the clinical assessment or requested specialist advice. |
| Mother's private disagreement with the child's uncle | No connection to urinary care is documented, so disclosing this private matter serves no referral purpose. |
| Antenatal scans reportedly normal | This historical report looks relevant but adds less than the completed current imaging; omit or compress. |
| Both episodes documented in attached clinical records | An attachment reference is optional administrative context and cannot replace the concise episode summaries. |
| Mother advised prompt review for recurrent fever or urinary symptoms | Detailed previous recurrence counselling can be omitted from this specialist referral once current status and the assessment request are clear. |
A paragraph plan for this case
Open with the assessment request and brief identification, then present the two clean-catch, culture-confirmed upper UTIs chronologically, their completed treatment and recovery. Follow with ultrasound and DMSA findings, enclosed imaging reports and absence of MCUG; keep the soft, non-tender abdomen, maintained growth and absence of a palpable bladder brief if used. Close with current antibiotic status and behavioural prevention, linking these to school voiding postponement and previously hard, now soft stools; the mother's preference can be compressed.
Where candidates slip on this task
- Keep completed cefalexin treatment separate from present medication status: no regular medicines and no prophylactic antibiotic; behavioural prevention must not be described as antibiotic prophylaxis.
- Normal ultrasound and DMSA findings do not establish absence of reflux or eliminate further investigation; no MCUG was performed, so request specialist advice without prescribing an investigation.
- Use Jost's age as seven on 6 November 2026; school voiding postponement and previously hard, now soft stools support prevention discussion without proving why infections occurred.
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
Should normal ultrasound and DMSA findings reduce the emphasis on the referral request?
Keep the assessment request prominent despite the imaging findings. Summarise each investigation accurately, including its date, and avoid interpreting the results as excluding reflux or making specialist review unnecessary. The referral concerns two confirmed febrile infections and advice on further investigation and management.
How should completed antibiotics and prevention advice be distinguished?
Present the completed cefalexin courses as treatment of the March and June episodes. State the absence of prescribed prophylaxis separately. Group hydration, regular voiding, avoiding postponement, continued constipation prevention and school toilet access as behavioural advice, without suggesting that preventive antibiotics were started.
Sources
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