OET Writing practice · Medicine
Suspected early rheumatoid arthritis – rheumatologist
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.
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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 Seaview Medical Group, 102 Promenade Road, Porthallow. Patient: Mrs Lucía Moreno, DOB 25/10/1984 (41 yrs) Social background: - Self-employed hairdresser; difficulty holding scissors, has cancelled clients - Married, 2 children (8 and 11) - Ex-smoker (stopped 2020; 10 pack-years). Alcohol approx. 8 units/week - Moved from Valencia, Spain, in 2012. Sister's wedding in Spain, November Family history: - Mother: osteoarthritis of knees. Maternal aunt: hypothyroidism Medical history: - Mild asthma: salbutamol PRN (uses <1×/month); no previous NSAID sensitivity - R carpal tunnel syndrome (2023): night splint - Contraception: levonorgestrel IUS (2022) - NKDA Consultation notes: 20/07/2026 - c/o pain and stiffness both hands × 6 weeks; morning stiffness approx. 90 min - Also both wrists and balls of feet. Fatigue - No rash, psoriasis, mouth ulcers, dry eyes, recent diarrhoea or infection - O/E: soft-tissue swelling and tenderness bilateral MCP 2–3 and R wrist. MCP squeeze test positive both hands; MTP squeeze test positive bilaterally. Knees normal. Skin and nails normal - Plan: FBC, CRP, ESR, RF, anti-CCP, U&E, LFT, urate; X-ray hands and feet - Naproxen 500 mg BD + omeprazole 20 mg daily 29/07/2026 (results) - CRP 31 mg/L (<5), ESR 44 mm/hr (<20) - RF 58 IU/mL (positive), anti-CCP >340 U/mL (strongly positive) - Hb 118 g/L, platelets 452 × 10⁹/L. U&E, LFT normal. Urate 290 µmol/L (normal) - X-ray hands/feet: periarticular osteopenia at MCP joints; no erosions 12/08/2026 - Partial response to naproxen; morning stiffness 60 min - Tingling R thumb/index finger at night (known carpal tunnel) - Worried about "ending up in a wheelchair" 10/09/2026 - Symptoms worse; morning stiffness 2 hrs - O/E: synovitis bilateral MCP 2–4, both wrists; R knee effusion - Working 2 days/week only; financial concerns - Rheumatology advice line (08/09): do not start corticosteroids before assessment - Pre-DMARD screening sent: hepatitis B and C, HIV serology (pending). CXR booked 15/09 - Flu vaccine due Plan: - Urgent referral to early inflammatory arthritis clinic - Continue naproxen + omeprazole - Occupational health/hand therapy advice once diagnosis confirmed Writing Task: Using the information in the case notes, write a letter to Dr Fiona Gallagher, Consultant Rheumatologist, Early Inflammatory Arthritis Clinic, Porthallow District Hospital, 6 Hospital Hill, Porthallow, referring Mrs Moreno for urgent assessment. 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.