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    12th Letter

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    Bünyamin Emer
    - Mrs. Doreen Atkins, a 65-year-old widow with a sedentary lifestyle, has been experiencing chest pain that increases with physical activity and stress. - An exercise tolerance test showed reversible ischemia. - She has a history of hypertension, hyperlipidemia, smoking, and heavy drinking. - The doctor refers her to the cardiologist for further investigation including angiography and possible angioplasty given her symptoms and risk factors.

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    12th Letter

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    Bünyamin Emer
    761 views3 pages
    - Mrs. Doreen Atkins, a 65-year-old widow with a sedentary lifestyle, has been experiencing chest pain that increases with physical activity and stress. - An exercise tolerance test showed reversible ischemia. - She has a history of hypertension, hyperlipidemia, smoking, and heavy drinking. - The doctor refers her to the cardiologist for further investigation including angiography and possible angioplasty given her symptoms and risk factors.

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    - Mrs. Doreen Atkins, a 65-year-old widow with a sedentary lifestyle, has been experiencing chest pain that increases with physical activity and stress. - An exercise tolerance test showed reversible ischemia. - She has a history of hypertension, hyperlipidemia, smoking, and heavy drinking. - The doctor refers her to the cardiologist for further investigation including angiography and possible angioplasty given her symptoms and risk factors.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    761 views3 pages

    12th Letter

    Uploaded by

    Bünyamin Emer
    - Mrs. Doreen Atkins, a 65-year-old widow with a sedentary lifestyle, has been experiencing chest pain that increases with physical activity and stress. - An exercise tolerance test showed reversible ischemia. - She has a history of hypertension, hyperlipidemia, smoking, and heavy drinking. - The doctor refers her to the cardiologist for further investigation including angiography and possible angioplasty given her symptoms and risk factors.

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    Occupational English Test PPP MEDSAMPLE06

    WRITING SUB-TEST: MEDICINE


    TIME ALLOWED: READING TIME: 5 MINUTES
    WRITING TIME: 40 MINUTES

    Read the case notes and complete the writing task which follows.

    Notes:
    Assume that today's date is 23 March 2019
    You are a doctor at Eastham Hospital treating a woman admitted with chest pain.

    PATIENT DETAILS:

    Name: Doreen Atkins (Mrs)


    DOB: 12 Mar 1953 (65 y.o.)
    Residence: 29 Oldberry Road, Eastham

    Social Background:
    Widow (3 yrs), no children
    Retired office administrator
    Interests: reading, watching TV, socialising w. friends
    Sedentary lifestyle

    Family history: Mother – diabetes mellitus, hypothyroidism (dec. 70 y.o.)


    Father - lung cancer, heavy smoker, coronary artery disease (dec. 59 y.o.)
    Sister – hypothyroidism

    Medical history: 1997 R radius fracture → osteosynthesis


    2000 gall bladder removal
    2002 dyspepsia
    2014 hypertension
    2014 hyperlipidemia
    NSAIDs allergy
    Ex-smoker: quit 1 yr ago (20 cigs/day 18→64 y.o.)
    Excessive alcohol consumption (last 5 yrs: 30-35 units/wk)

    Current medications:
    Losartan 50mg PO 1x/day (hypertension)
    Atorvastatin 40mg PO 1x/day (hyperlipidemia)
    Aspirin 100mg PO 1x/day (hypertension)
    Omeprazole 20mg PO 1x/day (dyspepsia)

    ©Cambridge Boxhill Language Assessment Pty Ltd 2020


    PPP MEDSAMPLE06

    Presentation at Emergency Dept. 14 Mar 2019


    Presenting problem:
    Atypical chest pain (<10 min): 1st episode, diaphoresis, dizziness

    Treatment record:
    Oxygen, morphine, aspirin, nitroglycerin (sublingual) →pt. reports
    ↓pain/symptoms

    Test results: EKG: normal (monitored during admission)


    Troponin: negative (repeated pre-discharge: negative)
    Chest X-ray: normal
    Pt. discharged same day w. aspirin - follow-up with regular doctor 1 wk.

    21 Mar 2019 Re-presentation at ED: new episodes of chest pain reported (>2 to <10 min) regular doctor
    phone call advice →ED

    w. physical activity →need to rest to↓pain


    No pain at rest, no other symptoms
    Test results: CBC - total cholesterol 250mg/dl (↑), LDL 160 (↑), HDL 35 (↓), glycemia & renal
    function normal
    EKG monitoring

    Actions taken: ↑atorvastatin to 40mg/day, continue aspirin


    Pt given dietary advice to stop hypertension
    (DASH): ↓alcohol/salt consumption
    Exercise tolerance test ordered
    Pt. admitted for observation

    23 Mar 2019 Pt. still experiencing ↑chest pain w. stress/physical activity


    pain presents w. mild dyspnea (<10 min), no fainting
    Ex. tolerance test result: ↓ST on EKG in V1, V2 & V3 (reversible ischemia detected)

    Provisional diagnosis: Stable angina

    Plan: Refer to cardiologist for angiography/?angioplasty

    Writing Task:

    Using the information given in the case notes, write a letter of referral to Dr Gaffney, consultant cardiologist,
    requesting further investigation of Mrs Atkins’ chest pain. Address the letter to Dr Sarah Gaffney, Consultant
    Cardiologist, Eastham Hospital, Eccleston Lane, Eastham.
    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.

    ©Cambridge Boxhill Language Assessment Pty Ltd 2020


    23rd March 2019

    Dr Sarah Gaffney
    Consultant Cardiologist
    Eastham Hospital,
    Eccleston Lane,
    Eastham

    Dear Dr Gaffney,

    Re: Doreen Atkins, DOB: 12.03.1953

    I am writing regarding Mrs Atkins, who has signs and symptoms suggestive of stable angına. She
    now requires your further investigation of her condition.

    Today, Mrs Atkins reported experiencing chest pain, which increased during stress and physical
    activity, along with mild dyspnea. Her exercise tolerance test showed decreased ST levels in V1,
    V2, and V3, which indicates reversible ischemia.

    On 14th March, Mrs Atkins presented to the Emergency Department with an episode of chest
    pain, which lasted less 10 minutes, diaphoresis, and dizziness. As a result, she was treated with
    oxygen, morphine, aspirin and sublingual nitroglyserin, which helped her pain and symptoms. Due
    to having an normal EKG, chest X-ray, and negative troponin, she was discharged with aspirin.

    On 21st March, Mrs Atkins presented to the ED with new episodes of chest pain during physical
    activity, which decreased after resting. Her blood results revealed increased total cholesterol, 250
    mg/dl, LDL, 160 and decreased HDL, 35, levels, for which her atorvastatin doses were increased.
    Additionally, she was informed regarding her diet and recommended to decrease her alcohol and
    salt consumption. She was admitted to our facility for observation and EKG monitoring.

    Regarding her social background, she is a retired Office administer and has a sedentary lifestyle.
    Medically, she has hypertension and hyperlipidemia since 2014. She has a family history of
    diabetes, hypothyroidism and coronary artery disease. She ceased smoking last year but smoked
    20 cigarettes per day for 46 years and she has been drinking alcohol, 30-35 unites per week, in the
    last 5 years. In terms of her medications, she is taking losartan, aspirin, atorvastatin, and
    omeprazole.

    Given the above, it would be appreciated if you could provide further investigation of Mrs Atkins’
    chest pain and an angiography with possibility of an angioplasty.

    Should you require further information, please do not hesitate to contact me.

    Yours sincerely,
    Doctor

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