The task
Assume that today's date is 22 October 2026. It is 10:30 and Ms Mehrotra is about to leave your practice for the hospital eye department.
You are an optometrist in a community optometry practice. Using the information in the case notes, write a letter to Dr Imogen Atherton, the on-call ophthalmology registrar, referring Ms Mehrotra for same-day assessment. Address the letter to Dr Imogen Atherton, On-call Ophthalmology Registrar, Eye Emergency Clinic, Hospital Eye Department. 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: Ms Orla Mehrotra
- DOB: 14/03/1995 (31 yrs)
- Seen: 22/10/26, 09:30 (same-day appt booked by pt this morning)
- GP: Dr Diarmuid Gunasekara
Social background
- Accountant, full-time; drives to work daily
- Lives with partner, who drove her to appt today
- Enjoys weekend pottery classes
- Non-smoker; alcohol 2–3 standard drinks/wk
- Says sister 'always overreacts about health' and told her headaches are just stress
Medical history
- Myopia R −2.50 / L −2.75 DS; monthly soft CL wearer
- Last routine eye exam 04/2025: optic discs normal; fundus photos + OCT on file
- Acne: oral doxycycline started by GP 2/12 ago
- Weight ↑ approx 8 kg over past 12/12
- Combined oral contraceptive pill; LMP 2/52 ago
- Tonsillectomy age 7
- Allergies: penicillin (rash)
Presenting complaint
- Headaches 3/52, gradually ↑; worse on waking and when lying down or bending
- Episodes of vision 'greying out' both eyes, lasting secs, several/day, esp on standing
- Intermittent whooshing noise in ears in time with heartbeat
- Denies diplopia, fever, neck stiffness, limb weakness or numbness
- Paracetamol PRN: minimal relief
- Annoyed GP receptionist could not offer appt until next wk
Examination
- VA (with CL): R 6/6, L 6/6; colour vision (Ishihara) normal both eyes
- Pupils equal and reactive, no RAPD; ocular motility full, no diplopia
- Dilated fundus: bilateral optic disc swelling, blurred margins; spontaneous venous pulsation absent both eyes; small peripapillary haemorrhage L
- OCT: RNFL thickness ↑ both eyes cf. 04/2025 baseline
- Visual fields (24-2): enlarged blind spots both eyes; otherwise full
- BP 126/80 (seated)
- Anterior segment: mild CL-related dry eye both eyes
Plan
- Phoned hospital eye dept 10:15: on-call ophthalmology registrar agreed to see pt today
- Doxycycline discussed with registrar on phone: advised pt to stop immediately pending assessment; pt informed and agrees
- Pt advised not to drive; partner to take her directly to eye dept
- Copies of fundus photos, OCT and fields to go with pt
- Lubricant drops PRN for dry eye
- Copy of letter to GP
Who is reading, and what do they need?
Dr Atherton is the on-call registrar who agreed by phone at 10:15 to see the patient today. She needs a fast, scannable account of symptoms, findings, relevant medicines and actions taken so she can start assessment. She does not need social background or routine optometric detail.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Headaches 3/52, gradually ↑; worse on waking, lying down, bending | The pattern and time course are central to the registrar's assessment. |
| Vision 'greying out' both eyes, secs, several/day, esp. on standing; whooshing noise with heartbeat | These associated visual and auditory symptoms are key to the picture and should be stated together. |
| Denies diplopia, fever, neck stiffness, limb weakness or numbness | These negatives help the registrar triage, and the full list should be kept. |
| Bilateral disc swelling, blurred margins, no spontaneous venous pulsation, small peripapillary haemorrhage L | This is the reason for referral. Describe the signs as recorded without naming a cause. |
| RNFL thickness ↑ both eyes vs 04/2025 baseline; enlarged blind spots | The comparison with the normal 04/2025 discs and the field result show change and its functional effect. |
| VA 6/6 both, colour normal, no RAPD, full motility; BP 126/80 seated | Preserved function and normal pupils help the registrar prioritise. Compress them to one statement. |
| Doxycycline for acne 2/12; weight ↑ about 8 kg; combined pill; LMP 2/52 ago | Medication, weight and menstrual details are relevant history for the registrar, stated without implying a link. |
| Doxycycline stopped on phone advice; penicillin allergy; no driving; copies going with her | This tells the registrar what has been done, the allergy risk and the safety advice. The patient agreed to stopping. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Says sister 'always overreacts about health' and told her headaches are just stress | Trap: it seems to bear on symptom history, but it is a family opinion and gives no clinical information. |
| Annoyed GP receptionist could not offer appt until next wk | A complaint about GP access does not help the registrar in an emergency referral. |
| Mild CL-related dry eye; lubricant drops PRN | It looks like an examination finding and treatment, but it is minor and unrelated to the urgent problem. |
| Accountant; pottery classes; alcohol 2–3 drinks/wk; non-smoker; tonsillectomy age 7 | Social and remote history does not affect urgent assessment. Drop it entirely or compress to a few words. |
| Myopia R −2.50 / L −2.75; monthly soft contact lenses; paracetamol PRN with minimal relief | Routine optical details are unnecessary for a registrar. Compress the contact lens and paracetamol mention at most. |
A paragraph plan for this case
Open with the purpose, same-day assessment, plus the 10:15 phone agreement and the key finding of bilateral disc swelling. Then give the symptoms and negatives, examination findings with baseline comparison, and relevant medicines and history, ending with actions taken, driving advice, enclosures and copy to the GP.
Where candidates slip on this task
- State the doxycycline action clearly: stopped on the registrar's phone advice pending assessment, with the patient informed and agreeing. Do not leave it as a mere mention of the medicine.
- Describe the disc swelling and other signs as recorded and do not name a diagnosis. The notes give no cause, and the registrar will draw the conclusions.
- Keep timing consistent with the card: appointment at 09:30, phone call at 10:15, patient leaving now. Do not drop the comparison with the normal 04/2025 discs or the advice not to drive.
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 Optometry letter tasks
- Routine referral for cataract assessment referral letter
- Diabetic eye check: early retinopathy found update letter
- Early dry age-related macular degeneration in a smoker update letter
Your profession's guide: OET Optometry. Layout and structure: OET letter format.
Questions about this task
Why include normal findings such as VA and colour vision?
They show current function and help the registrar triage. Keep them to one compact statement alongside pupils, motility and BP, so the abnormal findings stay prominent in a short letter.
Should I mention that the sister thinks it is stress?
No. It is a family opinion and not clinical information. The letter should focus on the recorded symptoms, findings, medicines and actions taken.
Sources
Last checked 22 Oct 2026. Rules and prices change: confirm on the official page before you book or apply.
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