The task
Original independent practice. Patient findings, dates and reported responses are fictional case facts, not general clinical recommendations. Allow 45 minutes: 5 minutes for reading and 40 minutes for writing. Assume that today is 3 November 2026. Mr Ngeno has returned for review, accompanied by his wife.
You are Mr Godfrey Ngeno's general practitioner. Using the case notes, write a referral letter to Dr Makena Yussuf, Consultant Respiratory and Sleep Physician, Specialist Sleep Clinic, 38 Clinic Road, SW1A 2AA, United Kingdom, requesting assessment and appropriate overnight testing for suspected obstructive sleep apnoea. 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?
Suspected obstructive sleep apnoea: referral
You are Mr Godfrey Ngeno's general practitioner. Using the case notes, write a referral letter to Dr Makena Yussuf, Consultant Respiratory and Sleep Physician, Specialist Sleep Clinic, 38 Clinic Road, SW1A 2AA, United Kingdom, requesting assessment and appropriate overnight testing for suspected obstructive sleep apnoea. 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: Mr Godfrey Ngeno
- DOB: 22/01/1975 (51 yrs)
- Lives with wife; shares bedroom; her sleep disrupted by snoring
Social and medical background
- Accounts clerk; regular weekday hours, no shift work; concentration important for work
- Does not drive or operate machinery; wife provides transport
- Brother claims own snoring is sleep apnoea; never medically assessed
- Brother's judgemental comment: patient naps because he is lazy
- Appendicectomy aged 19; no subsequent abdominal problems
Initial review: 12 October 2026
- 12/10/26: loud snoring most nights for 6/12
- Daytime tiredness and morning headaches on most days; no previous sleep consultation
- Evening course → late nights; allowing only 5–6 hrs for sleep
- Alcohol near bedtime on most nights
- No collateral sleep history available at initial consultation
- Discussed regular bedtimes and avoiding alcohol near bedtime
- Review arranged after course; asked to bring wife for collateral history
Current review: 3 November 2026
- 03/11/26: course finished 20/10; no ongoing evening study
- Now allows 7–8 hrs for sleep; reports stopping bedtime alcohol
- Morning headaches less frequent; still wakes unrefreshed
- Wife witnesses repeated breathing pauses → gasping; loud snoring persists
- Dozes during work meetings; concentration remains poor, with recent spreadsheet errors
- BMI 33 kg/m²; weight ↑ over preceding year after moving to desk-based role
- BP 138/86 mmHg; chest clear
- No previous sleep testing or treatment for sleep apnoea
- Wife attends current review; willing to describe night-time events to specialist
Plan
- Suspected obstructive sleep apnoea; diagnosis/severity not established
- Refer to sleep clinic: assessment and appropriate overnight testing
- Patient agrees to referral; chiefly concerned about daytime functioning and work performance
Who is reading, and what do they need?
Dr Yussuf needs an initial specialist account of Mr Ngeno, aged 51, rather than an assumed diagnosis. Persistent nocturnal symptoms, daytime impairment and changes to sleep opportunity deserve detail. His wife's shared-bedroom observations and disrupted sleep provide collateral context. His accounts work and regular weekday hours help interpret the functional impact; identifying details should remain brief.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Suspected obstructive sleep apnoea; diagnosis/severity unestablished; assessment and appropriate overnight testing requested. | Defines the referral question and preserves the specialist's responsibility to establish the diagnosis and severity. |
| Loud snoring most nights for six months. | Establishes the duration and frequency of the presenting nocturnal symptom. |
| Wife witnesses repeated breathing pauses followed by gasping; loud snoring persists. | Provides the key collateral finding supporting investigation beyond snoring alone. |
| Dozes during work meetings; poor concentration and recent spreadsheet errors. | Shows the daytime functional consequences that make specialist assessment important to this patient. |
| Course finished; sleep opportunity changed from 5–6 to 7–8 hours; bedtime alcohol reportedly stopped. | Helps the specialist interpret persistent symptoms after changes to previously restricted sleep opportunity and bedtime drinking. |
| Morning headaches less frequent; still wakes unrefreshed. | Distinguishes partial symptomatic improvement from continuing non-restorative waking. |
| BMI 33 kg/m²; weight gain over preceding year after moving to desk-based work. | Adds relevant physical and occupational context without making weight the sole explanation. |
| Does not drive or operate machinery; wife provides transport. | Clarifies the practical context of daytime dozing without inventing a driving exposure. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Brother claims his own snoring is sleep apnoea; never medically assessed. | Optional reported family context must not become a confirmed family history of sleep apnoea. |
| Brother says the patient naps because he is lazy. | An unsupported judgement contributes nothing to the specialist's diagnostic assessment. |
| Appendicectomy aged 19; no subsequent abdominal problems. | Remote resolved abdominal history does not help explain the current sleep referral. |
| No collateral sleep history available at the initial consultation. | The current witnessed history supplies the information previously missing; the earlier absence usually needs no separate explanation. |
| Review arranged after the course; asked to bring his wife. | Completed appointment arrangements do not require space in the current referral. |
| BP 138/86 mmHg; chest clear. | These findings may be compressed or omitted when the referral question and sleep history are clear. |
A paragraph plan for this case
Open with suspected obstructive sleep apnoea and the request for specialist assessment and appropriate overnight testing. Develop the six-month snoring history, current witnessed pauses and work impairment, then explain the previous late nights and bedtime alcohol, advice given, subsequent changes and residual symptoms. Finish with selected physical and practical context, optionally noting no previous sleep consultation, testing or treatment, the wife's willingness to provide collateral history, and the patient's agreement and concern about daytime functioning.
Where candidates slip on this task
- Distinguish the six-month snoring history from the October course-related sleep restriction; the course ended on 20 October, and 7–8 hours describes sleep opportunity, not measured sleep.
- Keep obstructive sleep apnoea provisional: witnessed pauses justify investigation, but neither snoring nor BMI establishes the diagnosis, its severity or a particular treatment requirement.
- Preserve the reported nature of alcohol cessation and the documented absence of driving or machinery use; do not invent alcohol dependence, driving incidents or additional occupational hazards.
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 examination finding and background detail appear?
No. The specialist principally needs the referral question, persistent snoring, witnessed breathing pauses and daytime impairment. BMI and the response to changed sleep habits add useful context. Blood pressure, a clear chest and other supporting details may be shortened or omitted without obscuring the purpose.
How should the brother's sleep-apnoea claim be handled?
It can usually be omitted because the brother has never been assessed. If retained, its unverified status must remain explicit. The brother's comment about laziness should be excluded entirely; it neither explains the patient's symptoms nor supports the requested overnight investigation.
Sources
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