The task
This is original independent practice material. Assume that today's date is 6 November 2026. Mr Keapock has returned to discuss his urine results.
You are the general practitioner reviewing Mr Jordon Keapock. Using the information in the case notes, write a referral letter to Dr Giulietta Pontecorvo, Consultant Urologist, requesting urgent investigation of his haematuria. Distinguish his account of the bleeding from the verified findings. Address the letter to Dr Giulietta Pontecorvo, Consultant Urologist, Urgent Urology Clinic, 24 Station Road, SW1V 1AA. 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.
Free · no sign-up · medicine
Which case notes belong in this letter?
Visible haematuria without proven infection: referral
You are the general practitioner reviewing Mr Jordon Keapock. Using the information in the case notes, write a referral letter to Dr Giulietta Pontecorvo, Consultant Urologist, requesting urgent investigation of his haematuria. Distinguish his account of the bleeding from the verified findings. Address the letter to Dr Giulietta Pontecorvo, Consultant Urologist, Urgent Urology Clinic, 24 Station Road, SW1V 1AA. 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 Jordon Keapock
- DOB: 14/03/1968 (58 yrs)
- Current review: 06/11/26
Social background
- Lives with partner; independent in daily activities
- Retired electrician; enjoys photography
- Complained receptionist was unfriendly when booking appointment
Medical history
- Former smoker: approximately 20 pack-years; stopped 2018
- External haemorrhoids; occasional blood on paper after straining
- Appendicectomy 1987; uncomplicated recovery
- No anticoagulants; no known drug allergies
Presenting history
- 02–05/11: reports 3 painless bleeding episodes after urination; source uncertain
- First episode: blood on toilet paper; pt assumed haemorrhoids
- Pt has not definitely seen blood mixed with stool; bowel habit unchanged
- No dysuria, frequency, fever or flank pain
Investigations
- 04/11: clean-catch MSU visibly pink in clinic; microscopy: numerous RBCs
- Urine dipstick: nitrites/leucocyte esterase negative
- 06/11: MSU culture no growth; sample collected before any antibiotics
- FBC: no anaemia; renal function within laboratory reference limits
- No antibiotics prescribed
Current assessment
- Today: no further visible blood since yesterday; denies clots
- Afebrile; haemodynamically stable; passing urine freely
- Abdomen soft, non-tender; no palpable mass
- Rectal examination: small external haemorrhoid, not bleeding; no palpable rectal mass
- No urinary tract imaging performed; no previous urological assessment
- Cause undetermined; infection not proven
- Haemorrhoid does not establish source of reported bleeding
Discussion and plan
- Explained need to investigate urine findings despite uncertainty
- Plan: urgent urology referral to investigate haematuria, including possible malignancy
- Pt agrees to referral; worried about cancer; understands diagnosis remains uncertain
- Previous shoulder strain resolved with physiotherapy
Who is reading, and what do they need?
Dr Giulietta Pontecorvo needs a focused account of Mr Jordon Keapock’s haematuria for urgent investigation. Identification can use his birth date, 14 March 1968, and review date, 6 November 2026. Assume no previous urological knowledge. Optional context includes the explained need for investigation, his agreement and cancer concern, and his understanding that the diagnosis remains uncertain.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Urgent urology investigation of haematuria, including possible malignancy. | Establishes the requested specialist action and its urgency while retaining diagnostic uncertainty. |
| 2–5 November: three reported painless bleeding episodes after urination; source uncertain. | Separates the patient’s account from verified urinary findings and preserves the uncertainty central to this referral. |
| 4 November: clean-catch MSU visibly pink in clinic; microscopy showed numerous RBCs. | Provides direct evidence of urinary bleeding despite uncertainty about the source of his reported episodes. |
| 6 November: MSU culture showed no growth; sample collected before any antibiotics. | Documents the microbiological result and sampling context without claiming that infection or other causes have been excluded. |
| Small external haemorrhoid, not bleeding; no palpable rectal mass. | Addresses the competing explanation for reported bleeding without establishing its source or dismissing the verified haematuria. |
| Former smoker: approximately 20 pack-years; stopped in 2018. | Adds relevant risk context for specialist investigation; useful background that may be omitted if space is limited. |
| No further visible blood since yesterday; no clots; stable, afebrile, passing urine freely. | Summarises current clinical condition without allowing symptom cessation to weaken the urgent investigation request. |
| No urinary tract imaging or previous urological assessment. | Clarifies the investigation already undertaken and helps the specialist plan the next assessment. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Lives with partner; independent in daily activities. | No support or functional problem is identified that would affect the requested investigation. |
| Retired electrician; enjoys photography. | The notes identify no relevant occupational exposure or practical consequence of these activities. |
| Complained receptionist was unfriendly when booking. | The administrative complaint does not inform haematuria assessment or the specialist’s requested action. |
| Appendicectomy in 1987 with uncomplicated recovery. | Although surgical history can appear relevant, this remote uncomplicated procedure adds no stated information needed for this referral. |
| Previous shoulder strain resolved with physiotherapy. | This resolved musculoskeletal problem has no stated bearing on the bleeding or urological investigation. |
A paragraph plan for this case
Open with patient identification and the urgent investigation request, then distinguish the reported bleeding from the witnessed pink urine and microscopy. Group the culture result, rectal examination and selected supporting context, such as smoking history, current stability and a soft, non-tender abdomen without a palpable mass. Close with the lack of urinary imaging or prior urological assessment and, if useful, his understanding and agreement; no anticoagulants and no known drug allergies merit only brief optional context.
Where candidates slip on this task
- Keep the 2–5 November episodes patient-reported and source-uncertain; haemorrhoid history and his initial assumption do not establish their source, while stool blood was not definitely seen and bowel habit was unchanged.
- Negative nitrites/leucocyte esterase, absent dysuria/frequency/fever/flank pain, no anaemia and renal function within reference limits remain supporting findings; no antibiotics were prescribed, and infection is unproven.
- Do not downgrade urgency because visible bleeding stopped yesterday or urine passes freely; retain possible malignancy as an investigation concern, without presenting cancer as diagnosed.
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
More Medicine letter tasks
- Urgent referral to a gastroenterologist: iron-deficiency anaemia and rectal bleeding referral letter
- Urgent referral to a rheumatologist: suspected rheumatoid arthritis referral letter
- Urgent referral to a dermatologist: suspected melanoma referral letter
Your profession's guide: OET Medicine. Layout and structure: OET letter format.
Questions about this task
Does the haemorrhoid explain the reported bleeding?
Its presence does not establish the source of the reported episodes. The examination found a small non-bleeding external haemorrhoid and no palpable rectal mass. Separately, the visibly pink urine and numerous urinary RBCs justify investigating haematuria regardless of his initial assumption.
Must every supporting negative finding appear?
No. Prioritise the urgent request, uncertain reported episodes, verified urine findings, culture result and rectal examination. Other supporting details can be selected or compressed according to space. Negative findings and renal function within reference limits must not be presented as excluding malignancy or establishing another diagnosis.
Sources
Last checked . Rules and prices change: confirm on the official page before you book or apply.
OETAce is an independent practice site. OET is a registered trademark of Cambridge Boxhill Language Assessment (CBLA); we are not affiliated with or endorsed by CBLA. All practice material here is original.