The task
Original independent practice. Assume that it is 09:15 on 5 November 2026. Mr Hyatt has been assessed this morning, and urgent specialist assessment is already arranged for 11:00 today. Allow 45 minutes: 5 minutes for reading and 40 minutes for writing.
You are a general practitioner. Using the information in the case notes, write a referral letter to Dr Aditi Chakraborty, Consultant Neurologist, Urgent Neurovascular Clinic, Neurology Department, 18 Station Road, B15 2TT, United Kingdom. Request assessment and investigation of Mr Mathew Hyatt's suspected transient ischaemic attack through the urgent pathway already agreed by telephone, communicating the symptom timeline, current findings and interim 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 transient ischaemic attack: referral
You are a general practitioner. Using the information in the case notes, write a referral letter to Dr Aditi Chakraborty, Consultant Neurologist, Urgent Neurovascular Clinic, Neurology Department, 18 Station Road, B15 2TT, United Kingdom. Request assessment and investigation of Mr Mathew Hyatt's suspected transient ischaemic attack through the urgent pathway already agreed by telephone, communicating the symptom timeline, current findings and interim 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.
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One-page worksheet. Answers and reasons are on the linked webpage, so you can practise before checking.
Case notes
Patient details
- Name: Mr Mathew Hyatt
- DOB: 12/03/1961 (65 yrs)
- GP assessment: 05/11/26, 08:40
Social background
- Lives with wife; independent with daily activities; wife attended consultation
- Retired printer; enjoys crosswords
- Complained receptionist sounded unfriendly
- Wife discussed son's relationship breakdown
Medical history
- Hypertension 6 yrs; regular amlodipine; reports taking medication consistently
- Ex-smoker; stopped 8 yrs ago; previously 15 cigarettes/day
- No previous stroke/TIA or known AF
- No migraine or seizure history
- Appendicectomy 1985
- Allergies: nil known
- No peptic ulcer/GI bleeding history
- No antiplatelet or anticoagulant before today
Episode: 4 November 2026
- 20:10: sudden R-hand weakness + word-finding difficulty; dropped cup, could not name familiar objects; wife witnessed
- Both symptoms fully resolved 20:25; no recurrence
- No LOC, jerking, headache or visual disturbance
- Delayed seeking help: thought recovery meant harmless; did not contact emergency services overnight
Assessment: 5 November 2026
- Today: speech and neurological examination normal
- BP 154/88 mmHg; pulse 76, regular
- Capillary glucose 5.8 mmol/L
- ECG: sinus rhythm
- No brain or carotid imaging yet
Treatment and plan
- Clinic advised aspirin 300 mg orally; given 08:55 today
- No additional antithrombotic prescribed
- Working diagnosis: suspected TIA, not confirmed
- Dr Aditi Chakraborty accepted urgent assessment today, 11:00, Urgent Neurovascular Clinic, by telephone
- Wife accompanying directly to clinic; pt not driving
- Both advised: recurrent stroke symptoms → call 999 immediately, even if resolving
- Explained early stroke risk despite recovery; urgent review still necessary
- Request diagnostic assessment, appropriate investigations and secondary prevention advice
Who is reading, and what do they need?
Dr Chakraborty has accepted the 11:00 urgent review by telephone; the letter supplies a concise written handover. She needs the witnessed episode, resolution, examination and treatment before investigating suspected TIA. Keep Mr Hyatt's identity and 08:40 assessment time brief; include measurements and selected vascular history where they help immediate assessment.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Suspected TIA; diagnostic assessment, appropriate investigations and secondary prevention advice. | Frame the specialist's intended contribution while preserving diagnostic uncertainty; avoid repeating the request throughout the letter. |
| Dr Chakraborty accepted urgent assessment by telephone: 5 November, 11:00, Urgent Neurovascular Clinic. | Confirm the agreed pathway and appointment so the referral supports an existing arrangement rather than requesting routine scheduling. |
| 4 November 20:10: witnessed right-hand weakness, dropped cup, word-finding difficulty, inability to name objects. | Establish the focal symptoms and exact onset; the functional examples clarify the deficits, and the wife's observation supports the history. |
| Both symptoms fully resolved at 20:25; no recurrence. | Define the episode's duration and subsequent course without suggesting that recovery removes the need for urgent assessment. |
| Speech and neurological examination normal this morning. | Distinguish the current examination from the preceding focal deficits without treating normal findings as diagnostic exclusion. |
| Clinic-advised aspirin 300 mg orally, given 08:55 today; no additional antithrombotic. | Communicate the treatment already administered precisely; the additional prescribing detail can be compressed or omitted if medication status remains clear. |
| No brain/carotid imaging; hypertension on regular amlodipine; ex-smoker. | These selected findings and vascular risk factors orient investigation; treatment adherence, history duration and smoking quantities are optional supporting details. |
| Both advised: recurrent stroke symptoms require 999 immediately, even resolving; wife accompanying; not driving. | Preserve the documented emergency instruction and practical travel arrangements; distinguish recorded counselling from any additional general first-aid teaching. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Retired printer; enjoys crosswords. | Occupation and leisure interests do not help the neurologist assess this episode or continue the urgent pathway. |
| Complaint that the receptionist sounded unfriendly. | The service complaint has no bearing on the neurovascular handover. |
| Wife discussed their son's relationship breakdown. | This unrelated family information does not support the referral purpose. |
| Appendicectomy in 1985. | Remote surgery offers no stated connection to the presenting episode or immediate management. |
| Delayed seeking help, believing recovery meant harmless; no emergency contact overnight. | Potentially relevant to counselling, but optional once timing and urgency are clear; avoid blame or a lengthy explanation of delayed presentation. |
A paragraph plan for this case
Open with the referral purpose, provisional diagnosis, accepted 11:00 appointment and requested specialist input, keeping name and date of birth brief in the identification details. Use the middle paragraph for onset, resolution and current examination, followed by selected findings or background: no imaging yet, hypertension/amlodipine, smoking cessation, BP 154/88, regular pulse 76, glucose 5.8 mmol/L, sinus rhythm, baseline independence, and optional negatives concerning previous stroke/TIA/known AF, migraine/seizures, or loss of consciousness/jerking/headache/visual disturbance. Close with aspirin administration, any selected medication-safety background concerning allergies, peptic ulcer/GI bleeding and previous antiplatelet/anticoagulant use, then travel arrangements, documented emergency counselling and the explanation of early stroke risk despite recovery.
Where candidates slip on this task
- Keep 4 November's 20:10 onset and 20:25 recovery distinct from 5 November's assessment, aspirin and 11:00 appointment; the episode lasted 15 minutes.
- Do not use today's normal examination or sinus-rhythm ECG to rule out TIA or intermittent atrial fibrillation; keep diagnostic uncertainty clear.
- Specify the clinic-advised aspirin dose, oral route and 08:55 administration without inventing ongoing dosing; distinguish this treatment from emergency first aid during recurrent stroke symptoms.
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 relevant historical negative and measurement appear?
No. Prior stroke/TIA/AF history, migraine/seizure history, associated symptom negatives, vascular background and measurements can support assessment, but each is optional when the handover remains clear. Select details that help this neurologist interpret the episode or treatment; do not let background displace the timeline, current examination or agreed urgent review.
Beyond the documented counselling, what general first aid applies if stroke symptoms recur?
UK: 999; Australia: 000. Stroke signs: face/arm/leg weakness/numbness/paralysis, speech/comprehension problems, dizziness/imbalance/unexplained falls, vision loss/blurring, sudden/severe/changed headache, swallowing difficulty. Any sign, even resolving: ambulance immediately; no driving, food, drink or medication. Conscious: sideways, head supported/raised; loosen clothing; support weak limbs without pulling. Unresponsive: check breathing; normal—recovery position; absent/abnormal—CPR/AED; follow dispatcher. Signs, actions, UK.
Sources
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