The task
Assume that today's date is 21 October 2026.
Using the information in the case notes, write a letter of referral to Dr Raj Menon, a rheumatologist, requesting urgent assessment and treatment. Address the letter to Dr Raj Menon, Rheumatologist, Westside Specialist Suites, Level 3, 210 Victoria Street, Westside. 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: Mrs Rania Haddad
- DOB: 17/08/1982 (44 yrs)
- Occupation: dental hygienist
Social background
- Married; one son aged 6
- Smokes approx. 5 cigarettes/day; alcohol 2–3 standard drinks/wk
- Attends gym 3x/wk — stopped 1 month ago
- Planning to try for a second pregnancy within the next year
- Pt upset that a locum GP in August told her the pain was 'just overuse'
Medical history
- Tonsillectomy age 9
- Seasonal allergic rhinitis
- No previous joint problems
- Medications: progestogen-only contraceptive pill
- Allergies: nil known
- Family Hx: maternal aunt — rheumatoid arthritis; mother — hypothyroidism
Presenting complaint (14/10/26)
- 11/52 pain and swelling both hands and wrists, symmetrical; now also both feet (balls of feet)
- Morning stiffness approx. 90 min
- Difficulty gripping dental instruments; 1 wk off work
- Fatigue; no rash, mouth ulcers, dry eyes or recent infection
- Read online about turmeric for joint pain — taking turmeric/curcumin capsules (500 mg daily, OTC) for 3/52
Examination
- Synovitis: bilateral MCP 2–3, PIP 2–3 and wrists; tender MTP joints bilaterally; positive MTP squeeze test
- No nodules, no rash; other systems NAD
- BMI 23; BP 122/78
Investigations (results 19/10/26)
- RF 85 IU/mL (positive); anti-CCP >300 U/mL (strongly positive)
- CRP 24 mg/L; ESR 42 mm/hr
- FBC, LFTs, U&E normal; hepatitis B and C serology negative; CXR normal
- X-ray hands and feet: periarticular osteopenia, no erosions
Management
- Naproxen 500 mg BD with esomeprazole 20 mg daily — partial relief
- Advised smoking cessation (smoking linked to worse RA); quit support offered
- Corticosteroids not started — to await specialist review
Plan
- Urgent referral to rheumatology for assessment and DMARD initiation
- GP review 2/52
Who is reading, and what do they need?
Dr Menon is a specialist who will triage the referral and decide on DMARD treatment. He does not know the patient. He needs the symptom pattern, examination, serology and imaging, baseline screening results, current treatment and factors that affect drug choice. Detail should be focused on those, with routine history kept minimal.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| 11/52 symmetrical pain and swelling of hands and wrists, now both feet | Duration and distribution with progression to the feet are the core of the inflammatory arthritis picture and the case for urgency. |
| Morning stiffness approx. 90 min; difficulty gripping dental instruments; 1 wk off work | Shows inflammatory features and functional and occupational impact, which support urgent assessment. |
| Synovitis MCP 2–3, PIP 2–3, wrists; tender MTPs; positive squeeze test | The examination findings confirm active synovitis in the small joints rather than simple overuse. |
| RF 85 positive; anti-CCP >300 strongly positive | The serology strongly supports the diagnosis and informs prognosis, so the specialist needs the values. |
| CRP 24, ESR 42; hand and foot X-ray: osteopenia, no erosions | Inflammatory markers and the absence of erosions on imaging give the specialist the baseline disease picture. |
| FBC, LFTs, U&E normal; hepatitis B and C negative; CXR normal | Baseline bloods and viral serology are relevant to starting DMARDs, so the specialist need not repeat them. |
| Planning a second pregnancy within the next year | Pregnancy plans affect the choice of DMARD, so this must be flagged to the specialist. |
| Naproxen with esomeprazole, partial relief; corticosteroids not started | Tells the specialist current treatment response and that steroids were withheld pending his review. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Locum GP in August said pain was 'just overuse'; pt upset | A complaint about earlier care does not help the specialist's assessment and could read as blame. |
| Attends gym 3x/wk — stopped 1 month ago | Lifestyle detail already reflected in functional impact, and it is not needed for diagnosis. |
| Tonsillectomy age 9; seasonal allergic rhinitis; married, son aged 6 | Unrelated history and family detail that does not affect the referral. |
| Maternal aunt with RA; mother with hypothyroidism | Looks relevant, but it adds little here. If mentioned at all it should be a few words only, and the mother's thyroid history can be omitted. |
| Turmeric/curcumin capsules 500 mg daily for 3/52 after reading online | The supplement can be listed with the medications, but her reasons for starting it are not needed. |
| Smoking approx. 5 cigarettes/day; BMI 23; BP 122/78; alcohol 2–3 drinks/wk | Routine lifestyle and observation details; at most a very brief mention of smoking, since the specialist can explore these. |
A paragraph plan for this case
State the request for urgent assessment and DMARD initiation, then the presentation and examination in one paragraph. Follow with the results and baseline screening, then current treatment, relevant factors such as pregnancy plans, and the GP follow-up.
Where candidates slip on this task
- Present results with the correct values and units from the card, and make clear which are abnormal and which are normal baseline screening for the specialist.
- Do not forget the pregnancy plan: it is easy to treat as social background, but it affects treatment choices and belongs in the letter.
- Keep the request clear and urgent, and avoid including the locum complaint or the patient's feelings about earlier advice.
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 family history be included?
It is optional and low priority. The aunt's rheumatoid arthritis is the only relevant item, and it would need only a few words. The mother's hypothyroidism is not relevant to this referral and can be omitted.
Do I need to mention the turmeric?
A brief mention in the medication list is reasonable, as it is an over-the-counter supplement the specialist may want to know about. Her reason for taking it and the online reading are not needed.
Sources
Last checked 22 Oct 2026. Rules and prices change: confirm on the official page before you book or apply.
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