The task
This is original independent practice material. Assume that today's date is 5 November 2026. Mr Schmidt has attended for assessment of walking-related calf pain.
You are a general practitioner. Using the information in the case notes, write a referral letter to Dr Delores Howell, Vascular Surgeon, Vascular Outpatient Clinic, 24 Station Road. Request assessment of Mr Jarrad Schmidt's suspected peripheral arterial disease, its functional impact and appropriate management. 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 peripheral arterial disease: referral
You are a general practitioner. Using the information in the case notes, write a referral letter to Dr Delores Howell, Vascular Surgeon, Vascular Outpatient Clinic, 24 Station Road. Request assessment of Mr Jarrad Schmidt's suspected peripheral arterial disease, its functional impact and appropriate management. 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 Jarrad Schmidt
- DOB: 17/03/1959 (67 yrs)
- Review: 05/11/26 — walking-related R calf pain
Social background
- Retired postal worker; enjoys collecting stamps
- Lives with wife; independent with personal care
- Smokes 12 cigarettes/day; smoking history approximately 35 yrs
- Wife now does most shopping because walking is difficult
- Complained receptionist was 'too slow and completely useless'
Medical history
- Type 2 diabetes: 8 yrs; no established neuropathy diagnosis
- Hypertension; hypercholesterolaemia
- Current medicines: metformin, perindopril, atorvastatin; reports taking regularly
- Appendicectomy aged 12; uncomplicated recovery
Current symptoms
- 4/12: reproducible R calf cramp on walking → resolves within 3 min standing still
- Previously walked 1 km continuously; now pain after approximately 150 m
- Occasional bilateral toe tingling for 2 yrs; unchanged
- Pt attributes new calf pain to 'diabetic nerve damage'
- No rest/night pain; no foot wounds reported
- No associated back pain or leg weakness
Assessment today
- R foot cooler than L
- R dorsalis pedis and posterior tibial pulses absent
- Both L pedal pulses palpable
- Doppler ankle brachial pressure index: R 0.64; L 1.02
- Skin intact; no ulceration or tissue loss
- Monofilament sensation preserved at all sites tested bilaterally
- BP 136/78 mmHg; pulse regular
Plan
- Working diagnosis: suspected PAD; do not assume neuropathic pain
- Smoking cessation support offered and accepted
- Refer vascular surgeon: assess walking limitation; advise investigations, management and suitability for supervised exercise programme
- GP review in 3/52: cardiovascular risk and diabetes management
- Foot care and daily skin checks discussed
Who is reading, and what do they need?
Dr Howell is a vascular surgeon receiving a new referral for suspected PAD and assessment of walking limitation. She needs the exertional pain pattern, reduced walking distance, vascular findings and specific management questions. Independent personal care and the wife taking over shopping can briefly illustrate function; current treatment and GP follow-up provide continuity without requiring a full social or medical history.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Vascular assessment: walking limitation, investigations, management and suitability for a supervised exercise programme | Defines the specialist’s requested decisions and keeps the referral focused on assessment and practical management. |
| Four months of reproducible right calf cramp walking; resolves within three minutes standing still | Establishes the presenting symptom’s duration, trigger and relief pattern, supporting the reason for vascular assessment. |
| Previously walked one kilometre continuously; now pain after approximately 150 metres | Quantifies the functional change that the surgeon is being asked to assess. |
| No rest or night pain; no foot wounds reported | Provides relevant information about the presentation’s severity while preserving the distinction between reported symptoms and examination findings. |
| Right dorsalis pedis and posterior tibial pulses absent | Supplies objective examination evidence supporting the suspected arterial explanation for the walking-related pain. |
| Doppler ankle brachial pressure index: right 0.64; left 1.02 | Gives the surgeon the measured vascular findings and comparison needed to assess the referral. |
| Type 2 diabetes: eight years; hypertension; hypercholesterolaemia; currently smokes 12 cigarettes/day; smoking history approximately 35 years | Provides useful cardiovascular risk context, which can be grouped briefly after the presenting problem and findings. |
| Monofilament sensation preserved bilaterally at all tested sites; no established neuropathy diagnosis | Helps distinguish documented findings from an assumed neuropathic explanation without claiming that neuropathy has been excluded. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Retired postal worker; enjoys collecting stamps | Occupation and hobby do not explain the current walking limitation or guide the requested vascular assessment. |
| Complaint that the receptionist was too slow and completely useless | The administrative complaint contributes nothing to the clinical question or continuity of care. |
| Appendicectomy aged 12 with uncomplicated recovery | This remote, resolved surgical history does not assist assessment of the current calf pain. |
| Occasional bilateral toe tingling for two years, unchanged | This apparent diagnostic clue is longstanding and separate from the new exertional complaint; omit or compress if explaining the distinction. |
| Patient attributes the new calf pain to diabetic nerve damage | This is an unconfirmed interpretation; omit or briefly contextualise it if discussing the diagnostic distinction. |
| Blood pressure 136/78 mmHg; regular pulse | These observations can be omitted or compressed because the limb findings and functional limitation more directly address the referral purpose. |
A paragraph plan for this case
Open with a brief patient identifier, the 5 November assessment and the request for vascular review. Group the exertional symptoms and walking limitation with the pulse and ABPI findings, adding the cooler right foot, palpable left pulses, absence of back pain or weakness, or intact skin without ulceration or tissue loss only if useful. Finish with concise cardiovascular background and current medicines, then the requested investigations, management and supervised exercise assessment; accepted smoking cessation support, the three-week GP review and foot care advice with daily skin checks can be compressed as ongoing care.
Where candidates slip on this task
- Retain suspected PAD as the working diagnosis. Preserved monofilament sensation and the absence of an established neuropathy diagnosis do not exclude neuropathy or establish another definitive diagnosis.
- Preserve both absent right pedal pulses and both ABPI values. Keep no rest or night pain and no reported wounds together without claiming that complications are excluded.
- Separate the four-month calf complaint from unchanged two-year toe tingling. Preserve approximate walking distances and three-minute relief; do not invent medicine doses or calculate an unsupported smoking exposure.
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 referral discuss diabetic neuropathy?
A brief distinction may help because the patient attributes the calf pain to nerve damage. Prioritise the exertional pattern and vascular findings. If sensory information is used, preserve the unchanged toe tingling and tested monofilament findings without treating either as proof for or against neuropathy.
How much functional and background information belongs in this referral?
The change from one kilometre to pain after approximately 150 metres directly addresses the requested assessment. The wife doing most shopping can add practical context. Cardiovascular conditions, smoking and current medicines are useful concise background; personal-care independence and ongoing GP measures can be shortened or omitted when space is limited.
Sources
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