The task
Assume that today's date is 3 November 2026. You saw Jun and his mother today to discuss his blood test results.
You are Dr Kurt Gorringe, a general practitioner. Using the information in the case notes, write a letter to Dr Linh Bui, Consultant Paediatrician, referring Jun for confirmation of the diagnosis and further management. Address the letter to Dr Linh Bui, Consultant Paediatrician, Department of Paediatrics, 25 Park 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: Jun Luo (male)
- DOB: 14/06/2023 (3 yrs 4/12)
- Address: 8 Banksia Street
- Attended with mother
Social background
- Lives with mother and 6-yr-old sister; attends childcare 3 days/wk
- Mother works part-time as pharmacy assistant
- Parents separated 2025; mother says father 'lets him eat junk food' on access weekends
- Enjoys weekly swimming lessons
- Maternal grandmother convinced problem is 'too much fruit'
Medical history
- Born at term, BW 3.4 kg; uneventful neonatal period
- Immunisations up to date
- Tonsillitis 2025 — treated with amoxicillin, resolved
- Allergies: nil known
- FHx: maternal aunt — coeliac disease; mother — hypothyroidism
Presenting history
- 6/12 hx loose, pale, offensive stools 3–4×/day
- Abdominal distension, ↓ appetite, irritable
- Growth: wt 50th → 9th centile over 6/12; current wt 12.6 kg; ht 25th centile (stable)
- No blood in stools, no vomiting, no fever
- Lactose-free milk trialled by family 3/52 — no improvement
Examination
- Thin limbs, ↓ buttock fat, distended abdomen; no hepatosplenomegaly
- Mild pallor; well hydrated, alert and active
Investigations
- tTG-IgA > 10× ULN; total IgA normal
- FBC: Hb 101 g/L (↓), microcytic; ferritin 5 µg/L (↓)
- Stool MC&S and parasites: negative
- TFTs, LFTs, UEC: normal
Progress
- Mother anxious; has read online about gluten-free diet and wants to start immediately
- Advised to continue normal gluten-containing diet until specialist review — mother agreed
- Iron supplement not started — mother prefers to await specialist advice
- Mother complained about 4-hr wait in ED at another hospital earlier this year
Plan
- Refer paediatrician: confirm dx (further serology ± endoscopy and biopsy as appropriate) and manage
- Request advice re mgmt of iron deficiency
- Dietitian referral for gluten-free diet education once dx confirmed
- Discuss screening of first-degree relatives (sister)
- GP review 4/52 — weight check
- Mother given information about coeliac support organisation
Who is reading, and what do they need?
Dr Bui is a consultant paediatrician being asked to take over Jun's assessment and management. They need the growth trajectory, symptom history, key results and exactly what the GP has already advised, so detail should be objective and quantified while social information stays minimal.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| 6/12 loose, pale, offensive stools 3–4×/day; lactose-free milk 3/52 no improvement | Defines the main complaint and shows one dietary change was already tried without benefit. |
| Weight 50th to 9th centile over 6/12; now 12.6 kg; height 25th stable | Quantifies the faltering growth; stable height alongside falling weight is part of the picture. |
| Distension, reduced appetite, irritable; thin limbs, reduced buttock fat, mild pallor | Associated symptoms and signs; the negatives (no blood, vomiting, fever; well hydrated) are worth one brief clause. |
| tTG-IgA > 10× ULN with normal total IgA | The key result prompting referral; the normal total IgA is needed to interpret it. |
| Hb 101 g/L microcytic; ferritin 5 µg/L | Anaemia with low ferritin underpins the iron request; give values rather than a general word. |
| Stool MC&S and parasites negative; TFTs, LFTs, UEC normal | A one-line summary of tests already done; report as negative or normal, not as excluding other causes. |
| Continue gluten diet until review, mother agreed; iron not started, mother awaits advice | The paediatrician needs current diet and treatment status; the mother's wish to start gluten-free immediately explains why the advice was given. |
| Maternal aunt coeliac disease; mother hypothyroidism; screening of sister to discuss | Family history and the request about first-degree relative screening; the sister is a first-degree relative. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Father 'lets him eat junk food'; grandmother says 'too much fruit' | Trap: looks like dietary history but is unverified family opinion on cause with no objective data. |
| Mother complained about 4-hr ED wait at another hospital | A complaint about another service; irrelevant to this referral. |
| Tonsillitis 2025 treated with amoxicillin, resolved | Resolved and unrelated; 'allergies: nil known' is enough. |
| Childcare 3 days/wk, swimming lessons, mother's pharmacy job, parents separated | Social detail with no bearing on assessment; at most mention he lives with his mother and sister. |
| Coeliac support organisation information given; GP review 4/52 | Administrative follow-up; compress to a single brief reference to the weight-check review. |
A paragraph plan for this case
Open with the referral request and the reason for it, then give the symptom history, growth data and examination. Follow with investigation results, then what the GP has advised (diet, iron) and the specific requests, ending with family history and the screening question.
Where candidates slip on this task
- Present growth precisely: weight fell from the 50th to the 9th centile over six months, current weight is 12.6 kg, while height stayed at the 25th centile. Do not reverse these or omit the stable height.
- Do not state the diagnosis as confirmed; the referral is for confirmation. Report serology and family history as findings, and ask for further serology, endoscopy and biopsy only 'as appropriate'.
- Explain clearly that the gluten diet continues until specialist review and that iron was not started because the mother wished to await advice; avoid wording that suggests refusal or non-compliance.
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
More Medicine letter tasks
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- Urgent referral to a dermatologist: suspected melanoma referral letter
Your profession's guide: OET Medicine. Layout and structure: OET letter format.
Questions about this task
Is it appropriate to mention the mother's wish to start a gluten-free diet?
Yes, briefly. It tells the paediatrician what advice was given and that the mother agreed, which matters because the diagnosis is not yet confirmed. Do not describe her anxiety at length.
How should the dietitian and screening items be handled?
Both are plans, not actions needed now: dietitian referral follows confirmation of the diagnosis, and screening of the sister is something to discuss. Word them in that sequence, as intentions or questions, not as requests for immediate action.
Sources
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