The task
Assume that today's date is 5 November 2026. Ms Gifford has attended your general practice today. This is original independent practice material.
You are a general practitioner. Using the case notes, write a referral letter to Dr Liv Mende, Neurologist, Specialist Facial-Pain Clinic, 24 Queen Street, London SW1A 2AB, United Kingdom. Request diagnostic assessment and management advice for Ms Violeta Gifford's recurrent facial pain, distinguishing her symptoms from the completed dental assessment. 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 trigeminal neuralgia: referral
You are a general practitioner. Using the case notes, write a referral letter to Dr Liv Mende, Neurologist, Specialist Facial-Pain Clinic, 24 Queen Street, London SW1A 2AB, United Kingdom. Request diagnostic assessment and management advice for Ms Violeta Gifford's recurrent facial pain, distinguishing her symptoms from the completed dental assessment. 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: Ms Violeta Gifford
- DOB: 16/03/1968 (58 yrs)
- GP consultation today: 05/11/26; first medical assessment of pain
Social background
- Lives independently; works part-time as an accounts assistant
- Enjoys gardening; recently joined a local history group
- Discussed daughter's marital difficulties; daughter unaware of disclosure
Medical history
- No previous similar facial pain or facial shingles
- Appendicectomy aged 19; uncomplicated recovery
- Regular medicines: nil; no known drug allergies
Symptoms
- 6/52 severe electric-shock pain: R cheek → upper lip
- Attacks last 5–20 seconds; approximately 10/day
- Triggers: washing face, brushing teeth, light breeze
- Pain-free between attacks; no continuous background ache
- No attacks waking her from sleep
- Avoiding brushing affected side; ↓ social outings through fear
- Eating/drinking adequately; weight unchanged
- No persistent numbness, visual disturbance or limb weakness
Completed dental assessment
- 28/10/26 dentist: examination + dental radiographs; no dental cause identified
- No dental treatment recommended; written report available
- Old filling in left lower molar unchanged
Examination today
- Alert, comfortable between attacks; afebrile
- Cranial nerves normal, including facial sensation
- No facial swelling or visible oral lesion
- No temporomandibular joint tenderness or restricted opening
- Limb examination: no focal neurological deficit
Treatment/Progress
- Tried paracetamol; no relief
- No nerve-pain medicine started; patient prefers specialist review first
- Agreed to record attacks and triggers
Plan
- Suspected trigeminal neuralgia; diagnosis not established
- Refer neurologist: diagnostic review; advice on investigations and management
- GP review next week while awaiting appointment
- Enclose dentist's report with referral
Who is reading, and what do they need?
Dr Mende needs the attack pattern, relevant findings and completed dental assessment to advise on diagnosis and management after today’s first medical assessment. Brief identification of Ms Gifford, aged 58, establishes whose care is involved. Her lack of regular medicines or known drug allergies may support management advice, but the specialist does not need an extensive general history.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Suspected trigeminal neuralgia; diagnostic review and advice on investigations and management requested. | Establishes the referral’s purpose while preserving diagnostic uncertainty. |
| Six weeks of severe electric-shock pain from the right cheek to the upper lip. | Duration, quality and distribution provide the central symptom description for diagnostic assessment. |
| Attacks last 5–20 seconds and occur approximately ten times daily. | Attack duration and frequency distinguish the episodic presentation and convey its burden. |
| Triggers: washing her face, brushing her teeth and a light breeze. | Representative examples convey that light stimulation or routine activities provoke attacks; all three triggers need not be listed. |
| 28 October: dental examination and radiographs identified no dental cause; report to accompany referral. | Separates the completed dental investigation from the neurological assessment now requested and provides supporting documentation. |
| Pain-free between attacks, without continuous background ache or attacks waking her from sleep. | Useful supporting detail about the temporal pattern; it can be shortened if the main attack description is clear. |
| Normal cranial nerves, including facial sensation; no focal neurological deficit on limb examination. | Provides concise examination context without implying that normal findings establish or exclude a diagnosis. |
| Paracetamol ineffective; no nerve-pain medicine started because she prefers specialist review first. | Clarifies treatment exposure and the documented reason for awaiting specialist advice; useful management context if space permits. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Lives independently and works part-time as an accounts assistant. | Neither living arrangements nor employment changes the requested assessment; no associated care need or occupational impact is documented. |
| Enjoys gardening and recently joined a local history group. | Named leisure activities add no useful information beyond the documented reduction in social outings. |
| Daughter’s marital difficulties; daughter unaware of the disclosure. | This private third-party information has no documented connection to the facial pain or specialist request. |
| Appendicectomy at 19 with uncomplicated recovery. | Remote uncomplicated abdominal surgery does not inform this facial-pain assessment. |
| Unchanged old filling in the left lower molar. | Although superficially relevant to dental pain, this incidental finding does not explain the documented right-sided distribution. |
| Afebrile; no facial swelling, oral lesion, temporomandibular tenderness or restricted opening. | These supporting observations can be compressed or omitted when the core pain pattern and completed dental assessment are sufficiently clear. |
A paragraph plan for this case
Open with the diagnostic and management request and brief patient identification, then organise the pain pattern and its effect on brushing and social outings. Follow with the completed dental assessment, absence of recommended dental treatment and enclosed report, alongside selected examination findings; absence of persistent numbness, visual disturbance and limb weakness, and no previous similar facial pain or facial shingles, are optional supporting context. Close with treatment to date, the agreed attack-and-trigger diary and next week’s GP review, keeping any medicine and allergy background brief.
Where candidates slip on this task
- Keep trigeminal neuralgia provisional: normal cranial nerves and dental radiographs do not establish the diagnosis or exclude other causes; request the specialist’s assessment and investigation advice.
- Use 5 November 2026 for this first medical assessment and 28 October 2026 for the completed dental assessment; adequate intake and unchanged weight are optional context.
- Distinguish ineffective paracetamol from the unstarted nerve-pain medicine; her stated preference explains the latter, while reduced brushing and social outings describe impact without establishing any additional diagnosis.
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 normal finding and negative symptom appear?
The normal cranial nerves, including facial sensation, can concisely support the assessment. Other negatives may be selected or compressed according to space; the letter remains focused on the characteristic attacks, completed dental assessment and requested specialist review. Do not imply normal findings establish the diagnosis.
How much dental detail is useful in this referral?
Prioritise the 28 October examination and radiographs, the absence of an identified dental cause, and the planned report enclosure. The unchanged left lower molar filling adds no useful explanation for right cheek-to-upper-lip attacks. Avoid claiming that all dental or other causes have been excluded.
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