The task
Original independent practice. All patient details and events are fictional. Assume that today's date is 3 November 2026. Ms Stradivari has returned with recurrent symptoms.
You are Ms Donna Stradivari's general practitioner. Using the case notes, write a referral to Dr Gaetano Manzoni, ENT Specialist, Balance Outpatient Clinic, Suite 4, 18 High Street, AB10 1AA. Request assessment and management of her recurrent positional vertigo, distinguishing the brief movement-triggered episodes from the documented absence of neurological warning features. 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 positional vertigo: referral
You are Ms Donna Stradivari's general practitioner. Using the case notes, write a referral to Dr Gaetano Manzoni, ENT Specialist, Balance Outpatient Clinic, Suite 4, 18 High Street, AB10 1AA. Request assessment and management of her recurrent positional vertigo, distinguishing the brief movement-triggered episodes from the documented absence of neurological warning features. 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 Donna Stradivari
- DOB: 12/02/1968 (58 yrs)
- Address: 24 Station Road, AB10 1AA
Social background
- Retired office administrator; lives with partner
- Independent mobility and self-care before symptoms began
- Does not drive; partner can accompany appointments
Medical history
- Remote appendicectomy; no ongoing complications
- Seasonal rhinitis; no current treatment
- No regular medicines; no known drug allergies
Initial assessment and progress
- 14/09/26: episodic spinning, approximately 20 seconds each
- Triggered by rolling R in bed or looking upwards
- Well between attacks; no continuous dizziness
- No associated palpitations or loss of consciousness
- Impression: possible BPPV; positional testing not performed
- Advice: careful head movements; rise slowly from bed
- 28/09 telephone review: symptoms settled; resumed usual activities without assistance
Current review
- 20/10: same positional episodes recurred; now daily
- 03/11: symptoms unchanged; no attacks without head movement
- No diplopia, visual loss, dysarthria, limb weakness or sensory change
- No severe headache, hearing loss or tinnitus
- No vomiting, fever or recent head injury
- Avoids stairs alone through fear of falling; no falls
- Today: cranial nerves, limb coordination and gait normal
- No spontaneous nystagmus; ears unremarkable
- No positional testing yet; no vestibular treatment trial
- Partner available to provide reliable transport and reassurance
- Pt upset by receptionist's manner during telephone booking
- Patient requests explanation before any examination provoking vertigo
Plan
- Refer ENT balance clinic: diagnostic positional testing; management advice
- Safety advice: new visual/neurological symptoms or sudden hearing loss → emergency care
Who is reading, and what do they need?
Dr Manzoni needs enough information from a new referral to assess the recurrent vertigo and arrange appropriate testing. Prioritise the current clinical pattern and assessment request. Name and age identify the patient; the address belongs in the heading. Medication and allergy status, baseline independence and earlier GP advice are optional context rather than the organising focus.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Approximately 20-second spinning episodes, triggered by rolling right in bed or looking upwards. | Duration and specific positional triggers define the episodes the specialist is being asked to assess. |
| Settled 28 September; daily recurrence from 20 October, unchanged on 3 November. | The relapse and current persistence explain the referral without implying progressive deterioration. |
| No diplopia, visual loss, dysarthria, limb weakness or sensory change. | These documented neurological negatives directly address the requested distinction between positional attacks and neurological warning features. |
| Normal cranial nerves, limb coordination and gait. | The current examination gives the specialist objective findings alongside the symptom history. |
| Possible BPPV; no positional testing or vestibular treatment; ENT testing and management requested. | This connects the provisional impression and assessment gap with the specific specialist request. |
| Well between attacks; no continuous dizziness or attacks without head movement. | This usefully clarifies the episodic pattern, although the duration and triggers already establish the central presentation. |
| Avoids stairs alone through fear of falling; no falls. | The functional restriction explains the practical impact without inventing falls or impaired gait. |
| Explanation requested before any examination provoking vertigo. | This preference can help the specialist prepare the patient for positional testing. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Remote appendicectomy without ongoing complications. | This resolved surgical history does not help assess the current vestibular presentation. |
| Seasonal rhinitis; no current treatment. | The notes provide no connection between this background condition and the current referral. |
| Retired office administrator; lives with partner. | Occupation and household description add little once any useful appointment support is stated separately. |
| Upset by receptionist's manner during telephone booking. | The booking complaint does not guide diagnosis, treatment or examination preparation. |
| Does not drive; partner can accompany appointments and provide transport. | Compress only if useful for attendance arrangements; these logistics should not displace the diagnostic request. |
A paragraph plan for this case
Open with the referral purpose and brief patient identification, requesting diagnostic positional testing and management advice. Follow with the initial attack duration and triggers, temporary resolution, daily recurrence, relevant documented neurological symptom negatives and current neurological examination. Close with the unperformed testing and treatment history, adding functional impact and examination preferences if useful; other associated-symptom negatives, ear findings and transport arrangements can be compressed or omitted.
Where candidates slip on this task
- Keep possible BPPV provisional: no positional testing has been performed, so the brief positional pattern and normal neurological examination support assessment rather than establish a confirmed diagnosis.
- Separate the approximately 20-second duration of each attack from daily recurrence since 20 October; unchanged symptoms on 3 November do not justify describing progressive deterioration.
- Select negative symptoms according to their relevance to the referral; using part of a note does not require repeating its entire list. Do not generalise selected negative findings or normal cranial nerves, coordination and gait into a claim that all neurological or serious causes are excluded.
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 negative symptom be included?
No. Prioritise documented neurological negatives that help Dr Manzoni distinguish the positional attacks from warning features. You may select relevant symptoms within a note without repeating its whole list; for example, mentioning no loss of consciousness does not require mentioning no palpitations. Other negatives are optional supporting context. Report selected findings accurately without claiming that they exclude all serious causes.
Should the receptionist complaint and examination preference receive equal attention?
Treat them differently. The receptionist complaint concerns an unrelated booking interaction and can be omitted. The request for an explanation before vertigo-provoking examination may help the specialist conduct positional testing, so it is useful optional information when space permits.
Sources
Last checked 22 Oct 2026. Rules and prices change: confirm on the official page before you book or apply.
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