The task
Assume that today's date is 22 October 2026. You received Dr Westerman's letter requesting information on 20 October 2026.
You are a senior radiographer in the Medical Imaging Department of a public hospital. Dr Jodie Westerman, a general practitioner, has written asking for details of a reaction her patient, Mrs Mele Uddin, had during a contrast-enhanced CT scan last week. Using the information in the case notes, write a letter to Dr Westerman describing the reaction, the treatment given in the department and recommendations for any future imaging involving contrast. Address the letter to Dr Jodie Westerman, General Practitioner, Family Medical Practice, 12 Main Street. 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: Response letter.
Case notes
Patient details
- Name: Mrs Mele Uddin
- DOB: 11/06/1979 (47 yrs)
- Referring GP: Dr Jodie Westerman
- Exam: CT abdomen/pelvis with IV contrast, 15/10/26, 10:40
- Indication: persistent R iliac fossa pain 3/52
Social background
- Lives with husband and 2 teenage children
- Primary school teacher
- Husband drove her to appt; complained to staff about cost of hospital parking
- Enjoys gardening; sings in community choir
Medical history
- Mild asthma: salbutamol PRN, last used 2/12 ago
- Seasonal hay fever
- Pre-scan screening: NKDA; reported allergy to prawns (hives)
- Contrast CT chest 2022 (another hospital): no reaction reported; agent unknown
- Laparoscopic cholecystectomy 2019
- eGFR > 90 (09/10/26)
Reaction (15/10/26)
- Contrast: iohexol (Omnipaque 350) IV via R antecubital cannula
- ~5 min post injection: itch, facial flushing, widespread urticaria (trunk, arms), bilateral eyelid swelling
- No wheeze, stridor, throat tightness or voice change; SpO2 98% RA; BP 128/80, HR 96
- Radiologist (Dr Nitin Wadhwa) attended; graded moderate allergic-like reaction
- Oral non-sedating antihistamine (cetirizine) given; IV access maintained; adrenaline not required
- Obs every 15 min: urticaria and eyelid swelling resolved by 1 hr 30 min
- D/C 13:00 with husband; advised to call 000 if breathing difficulty or lip/throat swelling
- Pt upset; told reception radiographer 'should have known' about her prawn allergy
- Images diagnostic; formal report sent to GP 15/10
- Reaction entered in hospital record and adverse event reporting system
Follow-up
- Phone call 16/10: rash fully resolved; no delayed reaction; no breathing problems
- GP letter 20/10: requests details of reaction, treatment, future contrast safety; pt asks if she must avoid seafood
Recommendations
- Record as allergic-like reaction to iohexol (iodinated contrast) in GP record/My Health Record
- All future imaging requests to state previous reaction + agent used
- Consider non-contrast alternatives (US, MRI) where clinically appropriate
- If iodinated contrast essential: radiologist review beforehand; different agent; perform at site with resuscitation facilities; premedication at radiologist discretion. Consider clinical immunology/allergy referral, particularly before elective repeat iodinated contrast
- No specific cross-reactivity between shellfish and iodinated contrast; this reaction requires no additional seafood restriction; existing prawn allergy still requires avoidance
- Hx asthma/atopy (incl. food allergy) → ↑ risk of further contrast reactions
- Pt given written contrast reaction card to carry
- Dr Wadhwa available to discuss if required
Who is reading, and what do they need?
Dr Westerman is the referring GP who asked three things: details of the reaction, treatment given, and safety of future contrast, and the patient asks about seafood. She needs clinical facts and actionable recommendations, with the record entry and who to contact. She does not need social or administrative detail.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| CT abdomen/pelvis 15/10/26; iohexol (Omnipaque 350) IV via R antecubital cannula | Identifies the examination and the specific agent, which the GP needs for the record and future requests. |
| About 5 min post injection: itch, flushing, urticaria, bilateral eyelid swelling | The description of the reaction is the first thing the GP requested. |
| No wheeze, stridor, throat tightness or voice change; SpO2 98% RA; BP 128/80, HR 96 | These negatives and observations show the severity picture and why it was graded as it was. |
| Graded moderate allergic-like by radiologist; cetirizine given; adrenaline not required | Covers the grading and treatment given in the department, which the task requires. |
| Obs every 15 min; resolved by 1 hr 30 min; discharged 13:00 with 000 advice | Shows the course and the safety advice given on discharge. Phone follow-up 16/10 confirmed full resolution. |
| Record as allergic-like reaction to iohexol; requests to state reaction and agent | Key recommendation for the GP's record and for any future referral. |
| If iodinated contrast essential: radiologist review, different agent, resuscitation facilities, premedication at discretion | The complete set of conditions for essential contrast, with non-contrast alternatives first and allergy referral considered, especially before elective repeat. |
| No cross-reactivity shellfish and contrast; no extra seafood restriction; prawn allergy still avoided | Answers the patient's question via the GP. Asthma and atopy raise risk, and she has a contrast reaction card. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Husband complained about cost of hospital parking | Unrelated to the clinical questions the GP asked. |
| Told reception radiographer 'should have known' about prawn allergy | Trap: emotive and not a clinical fact. The relevant point is the seafood advice, not the exchange. |
| Primary school teacher, choir, gardening, two teenagers | Social detail with no bearing on contrast safety. |
| Laparoscopic cholecystectomy 2019; eGFR > 90 | Not needed to describe or manage the reaction. The GP asked about the reaction, treatment and future contrast. |
| Entered in adverse event reporting system | Internal hospital process. The GP needs the recommended record entry in her own record instead. |
A paragraph plan for this case
Open by acknowledging the request and identifying the scan, then describe the reaction and department treatment with outcome and follow-up. Then give recommendations for future imaging, the seafood answer and the card, and end with the radiologist's availability.
Where candidates slip on this task
- Use the notes' term 'allergic-like reaction' and the radiologist's grading, and avoid stating an allergy diagnosis or a cause that the notes do not give.
- When covering essential future contrast, give all the listed conditions together and the allergy referral suggestion. A shortened list could drop a safeguard.
- Separate the two allergy points: no extra seafood restriction because of this reaction, while the existing prawn allergy still needs avoidance.
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 Radiography letter tasks
- Response to a mother's concern about radiation from repeated X-rays after her son's forearm fracture response letter
- Complaint about an older patient's wait in the department response letter
- Complaint from a residential aged care facility response letter
Your profession's guide: OET Radiography. Layout and structure: OET letter format.
Questions about this task
Should the letter mention the reaction happened without a prior contrast history?
Only if useful. The notes record a 2022 contrast CT chest elsewhere with no reaction reported and an unknown agent. It is minor context, so a brief mention at most, and it should not displace the reaction and recommendations.
Do I describe the discharge advice?
Yes, briefly. She was advised to call 000 for breathing difficulty or lip or throat swelling. If you quote it, keep it as written in the notes. The GP can then see what the patient was told.
Sources
Last checked 22 Oct 2026. Rules and prices change: confirm on the official page before you book or apply.
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