The task
Assume that today's date is 5 November 2026. It is 09:30. Ms Sarpong is being transferred immediately from the Emergency Department to the acute medical unit. This is original independent practice material. Allow 45 minutes: 5 minutes for reading and 40 minutes for writing.
You are the Emergency Department doctor. Using the case notes, write a transfer letter to Dr Ambrose Simpson, Acute Medical Registrar, Acute Medical Unit, Building 2, Level 1, 18 Hospital Road. Request immediate ongoing management of Ms Rosemary Sarpong's suspected adrenal crisis, clearly distinguishing prescribed treatment from documented administration and identifying the unverified administration time. The address given is the complete internal delivery address. 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: Transfer letter.
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Which case notes belong in this letter?
Suspected adrenal crisis: transfer
You are the Emergency Department doctor. Using the case notes, write a transfer letter to Dr Ambrose Simpson, Acute Medical Registrar, Acute Medical Unit, Building 2, Level 1, 18 Hospital Road. Request immediate ongoing management of Ms Rosemary Sarpong's suspected adrenal crisis, clearly distinguishing prescribed treatment from documented administration and identifying the unverified administration time. The address given is the complete internal delivery address. 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: Ms Rosemary Sarpong
- DOB: 12/03/1982 (44 yrs)
- ED arrival: 05/11/26, 09:00; transfer: 09:30
Social background
- Lives with partner; independent before current illness
- Librarian; works part-time
- Enjoys gardening and crosswords
- Partner mentioned private dispute with patient's sister
- Complained that receptionist was unfriendly
Medical history
- Addison's disease confirmed 2021; endocrine follow-up
- Usual oral replacement: hydrocortisone + fludrocortisone
- No known drug allergies
- Reports neither replacement medicine retained since vomiting began yesterday
- Ankle sprain 2019; fully recovered
- Non-smoker
Assessment
- Vomiting + watery diarrhoea since yesterday; poor fluid intake
- Suspected adrenal crisis; arrival BP 82/48 mmHg, pulse 118/min
- Today: profound weakness, dizziness, diffuse abdominal pain
- Dry mucous membranes; clinically dehydrated
- Abdomen: mild diffuse tenderness; no guarding
- Blood taken; electrolytes, renal function and laboratory glucose pending
- 09:25: BP 86/50 mmHg; remains alert
Treatment/Progress
- IV access secured; bedside monitoring ongoing
- Hydrocortisone 100 mg IV injection prescribed 09:05; prescription time only
- Hydrocortisone 100 mg IV injection: administration entry signed 'given'; time illegible/unverified
- Hydrocortisone 200 mg over 24 h continuous IV infusion prescribed; NOT commenced at transfer
- 0.9% sodium chloride 1 L IV over 30 min; commenced 09:12; still running at transfer
- No home emergency injection used
Plan
- Dr Ambrose Simpson accepted immediate acute medical transfer
- Direct transfer: monitored trolley, nurse escort
- Urgent review/implementation of ongoing steroid prescription; continue resuscitation, reassess fluid requirements; monitor BP, pulse, electrolytes/glucose
- Verify injection time; must not delay emergency care
- Original prescription and administration records accompany patient
Who is reading, and what do they need?
Dr Simpson, the acute medical registrar, has already accepted this immediate transfer. He needs patient identification, current instability, treatment doses and execution status, the running fluid prescription and actionable outstanding care. Allergy status, IV access and monitoring, baseline independence and the absence of a home emergency injection can be compressed or omitted when the essential handover remains clear. Employment, hobbies and interpersonal complaints do not help him continue care.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Dr Ambrose Simpson accepted immediate acute medical transfer | Establishes the agreed destination and urgency of the requested continuation of care. |
| Suspected adrenal crisis; arrival BP 82/48 mmHg, pulse 118/min | Communicates the working diagnosis and haemodynamic instability requiring immediate management. |
| Reports neither replacement medicine retained since vomiting began yesterday | Explains the interruption of oral replacement that directly informs emergency steroid management. |
| Addison's disease confirmed 2021; endocrine follow-up; usual oral replacement: hydrocortisone + fludrocortisone | Provides useful context for the suspected crisis and identifies the replacement medicines mentioned. |
| Hydrocortisone 100 mg IV injection prescribed 09:05; prescription time only. Hydrocortisone 100 mg IV injection: administration entry signed 'given'; time illegible/unverified | Communicates the documented injection dose while preventing prescription time being mistaken for administration time. |
| Hydrocortisone 200 mg over 24 h continuous IV infusion prescribed; NOT commenced at transfer | Identifies the prescribed ongoing steroid treatment and makes clear that it still requires urgent implementation. |
| 0.9% sodium chloride 1 L IV over 30 min; commenced 09:12; still running at transfer | Gives the receiving team the initial fluid prescription and confirms that this treatment is underway. |
| Urgent review/implementation of ongoing steroid prescription; continue resuscitation, reassess fluid requirements; monitor BP, pulse, electrolytes/glucose | Defines immediate ongoing care, including reassessment before deciding on further fluids. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Librarian; works part-time | Employment does not affect the immediate steroid, resuscitation or monitoring decisions. |
| Enjoys gardening and crosswords | Hobbies offer no useful information for this emergency transfer. |
| Partner mentioned private dispute with patient's sister | The private dispute has no documented connection to the acute presentation or required treatment. |
| Complained that receptionist was unfriendly | The reception complaint does not help the registrar continue acute medical care. |
| Ankle sprain 2019; fully recovered | Despite being medical history, the resolved injury has no bearing on this emergency. |
| Non-smoker | Routine risk-factor history can look relevant, but smoking status does not inform the immediate handover decisions. |
A paragraph plan for this case
Open with the accepted immediate transfer, suspected adrenal crisis and inability to retain replacement medicines. Follow with the haemodynamic findings and selected supporting symptoms or pending investigations. Then distinguish the documented hydrocortisone injection from the uncommenced steroid infusion and running saline, giving the supplied doses and fluid prescription. Close with the urgent ongoing management request, injection-time verification without delaying care, and selected transport or accompanying-record details.
Where candidates slip on this task
- Do not call 09:05 the injection time: it is prescription time. The 100 mg IV injection is signed as given, but its actual administration time remains unverified.
- Keep the hydrocortisone infusion of 200 mg over 24 hours separate from the saline prescription of 1 litre over 30 minutes: the steroid infusion has not commenced, whereas saline started at 09:12 and remains running. The notes do not state the volume already delivered.
- Verification of the injection time must not delay emergency care. Further fluids require reassessment; do not present the initial saline prescription as an indefinite rate. Accompanying records support reconciliation during the immediate monitored transfer.
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
How should the uncertain injection time be handled?
The distinction is between a known prescription time and an unverified administration time. The signed given entry documents administration of hydrocortisone 100 mg intravenously, but it does not establish when administration occurred. Identify both facts separately and request verification without delaying emergency care; do not infer the injection time from 09:05.
Must every assessment detail and background fact appear?
No. Prioritise the suspected crisis, arrival instability, failure to retain replacement medicines, treatment doses and execution status, running fluid prescription and immediate management request. Supporting symptoms, examination findings, pending tests and the latest observations can be selected or compressed according to their usefulness. Do not describe the small BP difference as recovery or laboratory results as available.
Sources
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