OET Writing practice · Medicine
Progressive headache with red flags – neurologist (urgent)
An original practice task written by LetterScore AI. Read the case notes in 5 minutes, then write your referral letter in 40 minutes, about 180–200 words in the body.
Write this letter and get feedback
Case notes
MEDICINE — WRITING TASK (practice) Time allowed: Reading time 5 minutes, Writing time 40 minutes Read the case notes below and complete the writing task which follows. Notes: Today's date: 10/09/2026 You are a GP at Riverbend Family Practice, 3 Ferry Lane, Calder Bridge. Patient: Mrs Naomi Hayashi, DOB 21/05/1972 (54 yrs) Social background: - Accountant; works from home 3 days/week - Married; husband (Paul) attends today. Two teenage sons - Non-smoker. Alcohol rarely - Family trip to Japan planned for October (son's 18th birthday) Family history: - Father: hypertension. Sister: migraine Medical history: - L breast cancer (2019): wide local excision + radiotherapy; anastrozole 1 mg daily (planned until 2029) - Episodic tension-type headaches in her 20s; none for >15 years - Osteopenia (DEXA 2024): calcium/vitamin D daily - Hand eczema: emollients PRN - NKDA Consultation notes: 28/07/2026 - Routine medication review. Feels well. Mammogram 06/2026: no abnormality - Mild eczema flare on hands (washing up); emollient advice - BP 126/80 27/08/2026 - c/o headache × 3 weeks: bifrontal, dull, 5/10 - Worse in mornings, eases over 1–2 hrs. Paracetamol gives partial relief - No visual symptoms, fever, scalp tenderness or jaw claudication - Long hours at screen (year-end accounts) - O/E: BP 130/82, T 36.8°C. Neurological exam normal. Fundoscopy: limited view (small pupils), no obvious abnormality - Imp: ?tension-type headache ?analgesic overuse. Headache diary; limit analgesia - Bloods: FBC, CRP, ESR, U&E, LFT, calcium 01/09/2026 (results) - FBC, U&E normal. CRP 3 mg/L, ESR 12 mm/hr (normal) - LFT: ALP 142 U/L (30–130); others normal. Corrected calcium 2.48 mmol/L (normal) 10/09/2026 - Headache worse, now 7/10; woken from sleep 3 nights this week - Worse with coughing and bending forward. Vomited ×2 this morning - Husband reports forgetfulness and difficulty finding words over the past 10 days - Diary: paracetamol on 9 of last 14 days - O/E: alert, orientated. Mild word-finding difficulty in conversation. Subtle R pronator drift. Reflexes symmetrical, plantars flexor. Gait normal - Optometrist letter received today (seen 08/09): bilateral early optic disc swelling - Imp: new progressive headache with features of raised ICP and focal neurology; ?intracranial metastasis Plan: - Discussed with on-call neurology registrar (Dr Hughes) 13:30: seen today at Acute Neurology Assessment Unit, 16:00, for urgent neuroimaging - Husband to drive her; letter to accompany pt - Advised not to drive - Attend ED immediately if drowsiness, seizure, worsening weakness or persistent vomiting - Continue anastrozole; trip to Japan to be reconsidered after assessment Writing Task: Using the information in the case notes, write a letter to Dr Owen Pritchard, Consultant Neurologist, Acute Neurology Assessment Unit, Calder Valley Hospital, 1 Infirmary Road, Calder Bridge, referring Mrs Hayashi for urgent assessment today. 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.
How to approach this referral letter
- The reader has never met the patient. State the reason for referral, and how urgent it is, in the first paragraph.
- Select the history, findings and investigation results that support the referral, and group them by topic rather than by date.
- End with what you are asking the reader to do, and any action you have already taken.
Members also get the model answer, the note-selection table and task-specific tips for this task.