OET Writing practice · Medicine
Urgent referral: suspected appendicitis from rural clinic – ED
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: 06/09/2026 Time: 14:30 You are a doctor at Coldwater Rural Health Clinic, 3 Main Street, Coldwater (120 km from nearest hospital). Patient: Ms Mele Tupou, DOB 14/02/2007 (19 yrs) Social background: - From Tonga; seasonal fruit picker on working visa since 06/2026 - Lives in farm workers' hostel. Cousin (Sione) accompanying her; no family in country - Non-smoker, no alcohol - Speaks good English Medical history: - Mild asthma, salbutamol 100 mcg inhaler PRN (used twice this year) - L wrist fracture 2019, healed - Acne, benzoyl peroxide gel - Allergy/intolerance: codeine (severe vomiting) Clinical notes: 06/09/2026 14:30 - Presenting complaint: abdominal pain × 18 hrs. Started around umbilicus last night (20:00), moved to R lower abdomen this morning. Constant, worse with walking and coughing - Anorexia since last night; nausea, vomited × 2 this morning. No diarrhoea. Last BO yesterday, normal - No dysuria or frequency. No vaginal discharge or bleeding - LMP 20/08/2026, regular 28-day cycle. Sexually active, uses condoms - Last ate 07:00 (small piece of toast); sips of water until 12:00 O/E: - Looks unwell, lying still. T 38.1°C, HR 104, BP 118/72, RR 18, SpO2 99% on air - Abdomen: tenderness and guarding in R iliac fossa (McBurney's point), rebound tenderness, Rovsing's sign positive. No masses. Bowel sounds reduced - Chest clear Investigations (point of care): - Urine dipstick: leucocytes trace, nitrites negative, blood negative - Urine β-hCG: negative - Capillary glucose 5.8 mmol/L - CRP 64 mg/L - Alvarado score 9 - No ultrasound or laboratory facilities at clinic Treatment: - 13:50 IV cannula (R forearm, 18G). Hartmann's solution 1 L commenced - 13:50 IV paracetamol 1 g - 13:55 IV ondansetron 4 mg - 14:00 IV morphine 2.5 mg – pain score 8/10 → 4/10 - Nil by mouth since 12:00 Other: - Pt very anxious about cost of hospital care and missing work; confirmed she has travel insurance (policy details with cousin) - Employer (Hillcrest Orchards) informed by cousin - Requests medical certificate for work Plan: - Diagnosis: acute appendicitis most likely - Urgent transfer by road ambulance to Bellhaven Base Hospital ED; ambulance ETA at clinic 15:00, arrival at ED approx. 16:30 - Continue IV fluids and NBM during transfer - Medical certificate provided Writing Task: Using the information in the case notes, write a letter to Dr Callum Reid, Emergency Department Registrar, Bellhaven Base Hospital, 1 Hospital Drive, Bellhaven, referring Ms Tupou for urgent assessment and management. 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.