The task
Original independent practice. All patient findings and arrangements are fictional case facts, not general clinical recommendations. Allow 45 minutes: 5 minutes for reading and 40 minutes for writing. Assume that it is 10:25 on 3 November 2026. Emergency ambulance transfer has already been arranged for Ms Parisian.
You are the general practitioner assessing Ms Mell Parisian. Using the case notes, write a transfer letter to Dr Tuan Thai, Emergency Doctor, Emergency Department, 52 Clinic Road, SW1A 2AA, handing over her care for immediate assessment of suspected ectopic pregnancy with possible rupture. The letter will accompany her emergency ambulance transfer, which must proceed without waiting for the letter or outpatient investigations. 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 ectopic pregnancy: transfer
You are the general practitioner assessing Ms Mell Parisian. Using the case notes, write a transfer letter to Dr Tuan Thai, Emergency Doctor, Emergency Department, 52 Clinic Road, SW1A 2AA, handing over her care for immediate assessment of suspected ectopic pregnancy with possible rupture. The letter will accompany her emergency ambulance transfer, which must proceed without waiting for the letter or outpatient investigations. 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 Mell Parisian
- DOB: 08/04/1997 (29 yrs)
- GP assessment: 03/11/26; transfer letter prepared 10:25
Social background
- Lives with partner; partner present at practice
- Works in retail; enjoys baking at weekends
- Upset about a relative's inheritance dispute; unrelated to presentation
Medical and obstetric history
- One previous uncomplicated birth; no previous ectopic pregnancy
- No previous tubal surgery, fertility treatment or known PID
- No regular medication; no known drug allergies
- LMP 15/09/26; urine pregnancy test positive today
- Pregnancy location not established; no ultrasound performed
Current presentation
- R lower abdominal pain began yesterday evening
- Light vaginal bleeding since yesterday; no heavy external bleeding
- 10:00: sudden severe pain, shoulder-tip pain and marked dizziness
- Nauseated; no vomiting; no reported loss of consciousness
- No fever, dysuria or diarrhoea reported
Assessment and immediate care
- 10:15: pale, alert; BP 94/60 mmHg; pulse 112/min
- 10:25: BP ↓ 90/58 mmHg; pulse ↑ 118/min
- RR 22/min; oxygen saturation 98% on air at 10:25
- Abdomen: R lower tenderness with guarding
- Blood group unknown; no previous blood-group report available
- No serum hCG, FBC or ultrasound results available
- Last food/drink at 08:00; no further oral intake
- Concern explained: possible ectopic pregnancy and internal bleeding
- IV access obtained; direct observation and repeated observations pending paramedics
Transfer plan
- Working diagnosis: suspected ectopic pregnancy; possible rupture
- Emergency ambulance dispatched; Dr Tuan Thai accepted immediate ED transfer by telephone
- Urgent emergency/gynaecological assessment requested; no outpatient delay for tests
- Partner informed and will travel separately to emergency department
- Letter and available pregnancy-test result to accompany patient
Who is reading, and what do they need?
Dr Thai has accepted the emergency transfer by telephone and needs a rapid handover for Mell Parisian, born 8 April 1997. At 10:25 on 3 November, the priorities are pregnancy evidence, acute symptoms, timed haemodynamic deterioration, suspected rupture and immediate transfer without waiting for investigations or the letter. Select useful supporting history, findings and care details within the word guide; the receiving team does not need every relevant note repeated.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Suspected ectopic pregnancy, possible rupture; ambulance dispatched; Dr Thai accepted immediate ED transfer. | Establishes the emergency purpose, diagnostic uncertainty and transfer arrangement at the outset. |
| Positive pregnancy test today; LMP 15 September; pregnancy location unestablished. | The positive test and LMP provide essential pregnancy evidence. The unresolved location is useful supporting detail that may be compressed or omitted if the diagnosis remains explicitly suspected. |
| Right lower abdominal pain yesterday evening; light vaginal bleeding since yesterday, without heavy external bleeding. | Useful optional context for the acute deterioration. Select or compress it as space permits, and never use light external bleeding to dismiss possible internal bleeding. |
| 10:00: sudden severe pain, shoulder-tip pain and marked dizziness. | Identifies the essential acute symptom change that prompted emergency concern. |
| 10:15 BP 94/60, pulse 112; 10:25 BP 90/58, pulse 118, RR 22/min and oxygen saturation 98% on air. | The timed blood pressure and pulse measurements are essential evidence of deterioration. Respiratory rate and oxygen saturation are useful supporting observations that may be compressed or omitted. |
| Right lower abdominal tenderness and guarding; pale but alert. | Pallor and alertness belong with the essential 10:15 assessment. The abdominal findings are useful additional evidence and may be selected without making every examination detail compulsory. |
| IV access; direct observation and repeated observations; last intake 08:00, no further oral intake. | These are useful optional details about immediate care and intake. Include a concise selection where space permits, without implying unrecorded treatment. |
| Urgent emergency/gynaecological assessment; transfer must not wait for letter or outpatient tests. | Makes the essential immediate assessment request and prohibition on transfer delay explicit. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Retail work and weekend baking. | Employment and hobbies have no bearing on immediate emergency assessment. |
| Distress about an unrelated inheritance dispute. | The unrelated dispute does not explain or alter the documented physical emergency. |
| Lives with partner; partner present, informed and travelling separately. | Compress or omit partner logistics to prioritise the clinical emergency. |
| No fever, dysuria or diarrhoea reported. | Compress or omit this supporting negative symptom screen; the unstable observations and acute symptoms take priority. |
| Previous uncomplicated birth; no previous ectopic pregnancy. | This is optional obstetric context. Include briefly, compress or omit it to prioritise current deterioration; its absence from the letter does not contradict the notes, and its inclusion must not imply reassurance. |
| No previous tubal surgery, fertility treatment or known PID. | Compress or omit the complete risk-history negatives to prioritise current deterioration and emergency transfer. Omission does not imply that these risk factors are present; their documented absence must not be used to dismiss the suspected diagnosis. |
| Nausea; no vomiting; no reported loss of consciousness. | These supporting symptoms and negatives may be included briefly, compressed or omitted. The essential acute symptoms and timed observations already establish the emergency concern. |
A paragraph plan for this case
Identify Ms Parisian in the letter heading. Lead with the suspected ectopic pregnancy, possible rupture and accepted emergency ambulance transfer. Give the positive pregnancy test, LMP, 10:00 acute symptoms and distinct 10:15 and 10:25 blood pressure and pulse measurements. Close with urgent emergency/gynaecological assessment and explicit transfer without waiting for the letter or outpatient investigations. Fit a useful selection of supporting details around this core: earlier pain and bleeding, unconfirmed pregnancy location, abdominal findings, respiratory observations, medication and allergy status, IV access and monitoring, intake status or investigation gaps. These supporting details are optional, not a checklist. Previous birth and ectopic history, nausea and negative symptoms, partner logistics, the explanation already given and accompanying documents may all be omitted to prioritise the emergency.
Where candidates slip on this task
- If translating the LMP into gestation, 15 September to 3 November is seven weeks; neither a positive urine test nor gestation establishes pregnancy location.
- Keep the 10:15 and 10:25 observations distinct: falling blood pressure and rising pulse are documented here, while rupture and internal bleeding remain suspected.
- Do not let preparation of the letter or requests for serum hCG, FBC or ultrasound delay the dispatched ambulance; no test results or blood group are available.
- Do not treat every relevant note as compulsory. Supporting obstetric history, nausea and negative symptoms may be omitted without contradicting the notes; preserve the essential emergency information.
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 investigations be obtained before the ambulance leaves?
No. The task explicitly requires transfer without waiting for the letter or outpatient investigations. Investigation gaps and unknown blood group are useful optional handover details; if selected, report them accurately. The available positive urine pregnancy-test result can accompany her without delaying departure.
Does light vaginal bleeding reduce the importance of the emergency findings?
Do not use the light external bleeding to minimise the concern about possible internal bleeding. The notes also document sudden severe pain, shoulder-tip pain, dizziness, guarding and timed haemodynamic deterioration. These findings support the stated emergency concern without confirming rupture or the pregnancy's location.
Must I include the previous birth, absence of previous ectopic pregnancy, nausea and negative symptoms?
No. These are supporting details that may be included briefly, compressed or omitted to prioritise the current emergency. A suitable letter preserves pregnancy evidence, the acute symptoms, timed deterioration, suspected rupture, the accepted ambulance transfer and urgent assessment without waiting for the letter or outpatient tests.
Sources
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