OET Writing practice · Medicine
Toddler with faltering growth and raised tTG – paediatrician
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 Meadowbank Health Centre, 45 Tannery Lane, Stoneleigh. Patient: Zainab Rahimi, DOB 02/01/2025 (20 months) Social background: - Lives with parents and brother (Omid, 5) in 2-bedroom flat - Father (Farid): delivery driver, works nights; fluent in English - Mother (Parisa): full-time carer; first language Dari; prefers an interpreter - Family arrived from Afghanistan 2023 - Attends weekly toddler group. Health visitor involved since 06/2026 - Brother: asthma, well controlled Birth and development: - Born 38 weeks, normal delivery. Birth weight 3.1 kg (50th centile). No neonatal problems - Breastfed to 12 months; solids from 6 months - Walked at 14 months; approx. 10 words. 12-month developmental review normal - Immunisations up to date Growth (weight): - 9 months: 8.6 kg (50th centile) - 12 months: 9.2 kg (25th–50th) - 15 months: 9.3 kg (9th–25th) - 18 months: 9.1 kg (2nd–9th) - 20 months: 8.9 kg (<2nd). Length 81 cm (9th–25th) Medical history: - Bronchiolitis (01/2026), managed at home - Candida nappy rash (04/2026), resolved - No regular medications. NKDA Consultation notes: 22/07/2026 (health visitor referral; mother with interpreter) - Mother concerned: eating less, "big tummy", irritable - Stools 3–4/day: loose, pale, very offensive, difficult to flush × 4 months (since more bread, pasta and naan) - No vomiting, no blood in stools. No recurrent chest infections - Food diary (health visitor): offered 3 meals + 2 snacks; eats approx. half; cow's milk approx. 800 mL/day - O/E: thin limbs, reduced buttock muscle bulk, distended soft abdomen, no organomegaly. Pale. Chest clear. No bruising; interacts well with mother - Plan: FBC, ferritin, U&E, LFT, TFT, coeliac serology (tTG IgA + total IgA), stool culture. Reduce milk to 400 mL/day 05/08/2026 (results) - Hb 96 g/L (105–135), MCV 68 fL (low), ferritin 7 µg/L (low) - tTG IgA 94 U/mL (<7); total IgA normal - U&E, TFT normal. Albumin 33 g/L (35–50); LFT otherwise normal - Stool culture: no pathogens - Plan: iron supplement (sodium feredetate) started. Continue gluten until specialist review 10/09/2026 - Wt 8.9 kg. Stools unchanged. More clingy; poor sleep - Milk reduced to approx. 450 mL/day - Mother has read online about gluten-free diets; wants to stop bread now. Explained need to continue gluten until assessed - Mild eczema on cheeks: emollient - Father unable to attend weekday morning appointments (night shifts) Plan: - Referral to paediatrics: faltering growth, ?coeliac disease; confirmation of diagnosis and dietetic input - Dari interpreter required - Continue iron and gluten-containing diet until seen Writing Task: Using the information in the case notes, write a letter to Dr Catherine Moyo, Consultant Paediatrician, Children's Outpatient Department, Stoneleigh Royal Hospital, 19 Beacon Road, Stoneleigh, referring Zainab for 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.