The task
Assume that today's date is 22 October 2026. Ms Yilmaz was discharged from the Emergency Department this morning.
You are a doctor in the Emergency Department. Using the information in the case notes, write a letter to Dr Wiremu Tuhiwai, Consultant Neurologist, urgently referring Ms Yilmaz for specialist assessment and further investigation of a first witnessed tonic-clonic seizure. Address the letter to Dr Wiremu Tuhiwai, Consultant Neurologist, First Seizure Clinic, Department of Neurology, 40 Hospital Road. 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.
Case notes
Patient details
- Name: Ms Parisa Yilmaz
- DOB: 14/03/1995 (31 yrs)
- Address: Flat 3, 22 Park Road
- ED attendance: 21/10/26 (22:40); discharged 22/10/26 (09:00)
Social background
- Secondary school maths teacher; lives with partner
- Drives to work daily (25 min); no public transport near home
- Sings in community choir; planning overseas holiday with partner in 2/12
- Partner's mother told staff pt 'has always been highly strung'
- Alcohol ~6 std drinks/wk; non-smoker; denies recreational drugs
Medical history
- No previous recognised convulsive seizures or diagnosed epilepsy; nil febrile convulsions or head injury
- Appendicectomy age 12
- Childhood asthma — resolved, no inhalers since teens
- Medications: combined oral contraceptive pill
- Allergies: penicillin (rash)
- FHx: maternal cousin — epilepsy
Presentation
- Witnessed by partner at home 21/10 ~22:00: sudden LOC, no warning; stiffening → rhythmic jerking all 4 limbs ~2 min
- Cyanosed during episode; urinary incontinence; lateral tongue bite
- Post-ictal confusion ~20 min; then drowsy, headache, muscle aches
- Poor sleep past 1/52 (report writing, ~4 hrs/night); 2 glasses wine with dinner
- On questioning: occasional brief arm jerks in early morning × 6/12; once dropped a cup
- Complained about 3-hr wait for CT scan
Examination & investigations
- Review 01:00: GCS 15, alert, oriented; neuro exam normal; no injuries apart from tongue bite
- Obs: HR 82, BP 124/76, afebrile
- CT brain (non-contrast): normal
- FBC, UEC, glucose, Ca, Mg, LFTs: all normal; urine β-hCG negative
- ECG: sinus rhythm, normal intervals
Management & plan
- Observed overnight — no further events; antiseizure medication not started (for specialist decision)
- Driving: must not drive unless medically cleared and permitted under applicable national licensing standards (seizure-free period applies; neurology review alone does not lift restriction); advised to notify licensing authority — pt understands
- Safety advice: shower not bath, no swimming alone, avoid heights; partner given seizure first aid; call ambulance immediately if breathing difficulty, serious injury, seizure in water or not regaining responsiveness; also if seizure lasts 5 min or longer or repeated seizures without recovery between
- Advised regular sleep, limit alcohol
- Urgent referral neurology first seizure clinic: specialist assessment within 2/52; EEG ASAP (ideally within 72 hrs); MRI brain requested
- Discharge summary sent to GP; GP follow-up 1/52
- Medical certificate: 1/52 off work
Who is reading, and what do they need?
Dr Tuhiwai is a consultant in a first seizure clinic who will rely entirely on the letter. The event description, relevant history, results already available and the specific requests are what the clinic needs, so detail should be precise about the seizure and brief about everything else.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Witnessed ~22:00: sudden LOC without warning, stiffening then rhythmic jerking all limbs ~2 min | Core of the referral; a witness account of onset and motor features is the main evidence for the specialist. |
| Cyanosis, urinary incontinence, lateral tongue bite | Associated features of the event; report them as observed findings. |
| Post-ictal confusion ~20 min, then drowsy, headache, muscle aches | The recovery course helps the specialist characterise the event. |
| Past week ~4 hrs sleep/night; two glasses wine with dinner | Context recorded in the notes; state it as context without concluding it caused the seizure. |
| Brief early-morning arm jerks for 6/12; once dropped a cup | Emerged only on questioning; earlier events may matter to the specialist, so include them as reported. |
| No prior seizures; maternal cousin epilepsy; COCP; penicillin allergy | Relevant past and family history plus the only medicine and the allergy; the pill may matter if treatment is considered later. |
| Neuro exam normal; CT, bloods, β-hCG, ECG normal | Tells the clinic what is already done; report as normal findings, not as proof that other causes are excluded. |
| Must not drive; seizure-free period applies; advised to notify licensing authority | Practical safety consequence as she drives daily; neurology review alone does not lift the restriction, so clearance should not be implied. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Partner's mother: pt 'has always been highly strung' | Trap: a second-hand, non-clinical opinion that could bias interpretation and has no diagnostic value. |
| Complained about 3-hr wait for CT scan | A complaint; only the normal CT result matters to the neurologist. |
| Appendicectomy age 12; childhood asthma resolved | Remote, resolved history with no link to seizure assessment. |
| Sings in choir; planning overseas holiday in 2/12 | No action or advice on the card is attached to these, so they add nothing to the referral. |
| Home safety advice, partner's first-aid teaching, medical certificate, GP follow-up | Counselling content and admin the neurologist does not need; one brief statement that advice was given is enough. |
A paragraph plan for this case
Open with the urgent referral request and a one-line summary of the patient and event. Use the next paragraph for the event details, sleep and alcohol context, earlier jerks and relevant history, then the findings and normal results. Close with what has and has not been done (no medication, driving restriction) and the requests with their timeframes.
Where candidates slip on this task
- Make the antiseizure medication position explicit: none was started, deliberately left for the specialist. Silence could look like an oversight, and the contraceptive pill is her only medicine and may be useful to the specialist.
- Word the driving restriction carefully: she must not drive unless medically cleared and permitted under licensing standards, a seizure-free period applies, and neurology review alone does not lift it. Do not imply the clinic visit allows driving.
- Keep the timeframes distinct and accurate: specialist assessment within 2/52, EEG as soon as possible and ideally within 72 hours, MRI already requested. Present normal tests as results, not as ruling out epilepsy.
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 the early-morning arm jerks be included when the patient did not volunteer them?
Yes. They emerged on questioning, span 6/12 and include a dropped cup, so the specialist should have them. Report them as the patient described, without labelling a seizure type or implying a diagnosis.
How should sleep loss and wine be handled?
Give the facts: about 4 hours of sleep a night for a week and two glasses of wine with dinner. Do not state they caused the seizure; the notes only record them and the specialist judges their significance.
Sources
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