Write a letter of referral to Dr Lisa Smith, Endocrinologist, City Hospital, Newtown, for further management of Mrs Sharma's blood sugar levels.

Dr Lisa Smith Endocrinologist City Hospital Newtown 10 February 2019 Dear Dr Smith, Re: Mrs Priya Sharma, DOB: 08/05/58 Thank you for seeing Mrs Priya Sharma, a type 2 diabetic, for further management of her blood sugar levels. Mrs Sharma was diagnosed with NIDDM in 1999. She has been monitoring her BP and sugar levels at home since then. She has a strong family history of diabetes and is allergic to penicillin. Her weight is steady (BMI of 24) and an eye examination in October 2017 indicated no issues. She initially presented on 29/12/18 concerned that her blood sugar levels were no longer well controlled. Her BP that day was 155/100 and her recent sugar levels were ranging between 6 and 18mmol/L. Her medication included metformin 500mg twice a day and glipizide 5mg twice in the morning. I instituted Atacand 4mg once in the morning. A pathology report received on 05/01/2019 showed HbA1c levels of 10% and GFR greater than 60ml/min. Her cholesterol was high (6.2). On 12/01/19, I prescribed Lipitor 20mg in the morning. I also increased her metformin regime to 750mg twice daily. Since then, her home-monitored BP has been within range and her cholesterol has fallen to 3.2. Her non-fasting blood sugars are 7-8mmol/L, but her fasting blood sugar levels are usually in the 16+ range, which is high. Therefore, I am referring her to you for your specialist advice. Yours sincerely, Doctor

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Write a letter of referral to Dr Lisa Smith, Endocrinologist, City Hospital, Newtown, for further management of Mrs Sharma's blood sugar levels.

Dr Lisa Smith Endocrinologist City Hospital Newtown 10 February 2019 Dear Dr Smith, Re: Mrs Priya Sharma, DOB: 08/05/58 Thank you for seeing Mrs Priya Sharma, a type 2 diabetic, for further management of her blood sugar levels. Mrs Sharma was diagnosed with NIDDM in 1999. She has been monitoring her BP and sugar levels at home since then. She has a strong family history of diabetes and is allergic to penicillin. Her weight is steady (BMI of 24) and an eye examination in October 2017 indicated no issues. She initially presented on 29/12/18 concerned that her blood sugar levels were no longer well controlled. Her BP that day was 155/100 and her recent sugar levels were ranging between 6 and 18mmol/L. Her medication included metformin 500mg twice a day and glipizide 5mg twice in the morning. I instituted Atacand 4mg once in the morning. A pathology report received on 05/01/2019 showed HbA1c levels of 10% and GFR greater than 60ml/min. Her cholesterol was high (6.2). On 12/01/19, I prescribed Lipitor 20mg in the morning. I also increased her metformin regime to 750mg twice daily. Since then, her home-monitored BP has been within range and her cholesterol has fallen to 3.2. Her non-fasting blood sugars are 7-8mmol/L, but her fasting blood sugar levels are usually in the 16+ range, which is high. Therefore, I am referring her to you for your specialist advice. Yours sincerely, Doctor

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141 Cases Available

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Showing 20 of 141 cases from our expanding collection.

Case Title	Specialty	Task Type	Level	Clinical Focus	Action
Case 01: Ms. Eleanor BennetTraining	Cardio	Referral	Intermediate	Post-MI / Captopril Side Effects	View Case
Case 02: Mr. Adam KnowlesOET sample	GI	Urgent	Advanced	Obstructive Jaundice / ?Pancreatic Malignancy	View Case
Case 03: Mr. Barry JonesOET sample	Orthopedic	Referral	Intermediate	Lower Back Strain / Return to Work	View Case
Case 04: Mrs. Priya SharmaOET sample	Endocrine	Referral	Intermediate	Type 2 Diabetes / Poor Glycaemic Control	View Case
Case 05: Ms. Anne HallOET sample	GI	Referral	Intermediate	GORD / Dysphagia	View Case
Case 06: Mr. Allen Mathis	Cardio	Urgent	Advanced	Biventricular Heart Failure / Silent Ischaemia	View Case
Case 07: Mr. Derek Romano	Cardio	Urgent	Intermediate	Acute Myocardial Infarction	View Case
Case 08: Mr. John Elvin	Cardio	Urgent	Advanced	Anterior MI / Acute Asthma Exacerbation	View Case
Case 09: Mrs. Lucy Clarke	Cardio	Urgent	Intermediate	Unstable Angina	View Case
Case 10: Mr. Robert Martin	Cardio	Urgent	Intermediate	Hypertension / ?Unstable Angina	View Case
Case 11: Brendan Cross	Cardio	Urgent	Advanced	Acute Rheumatic Fever	View Case
Case 12: Mr. Dave Cochrane	Cardio	Urgent	Advanced	Acute Left Ventricular Failure	View Case
Case 13: Emma Johnson	Respiratory	Urgent	Intermediate	Acute Asthma Exacerbation	View Case
Case 14: Mrs. May Hong	Respiratory	Urgent	Advanced	Right Lower Lobar Pneumonia	View Case
Case 15: Ms. Sally McConville	Respiratory	Urgent	Intermediate	Acute Asthma / ?Pneumonia	View Case
Case 16: Mr. Ammar Moustafawy	GI	Urgent	Advanced	Liver Abscess	View Case
Case 17: Mrs. Ann Howard	GI	Urgent	Intermediate	Early Bowel Obstruction / ?Carcinoma	View Case
Case 18: Mr. Brian Morgan	GI	Urgent	Intermediate	Acute Appendicitis	View Case
Case 19: Mr. Fred Davies	GI	Urgent	Advanced	Acute Colonic Pseudo-obstruction	View Case
Case 20: Mrs. Jenny Perkins	GI	Urgent	Intermediate	Large Bowel Obstruction (Sigmoid Volvulus)	View Case

Case 04: Mrs. Priya Sharma

Type 2 Diabetes / Poor Glycaemic Control

Occupational English Test

Writing sub-test: Medicine

Reading time: 5 minutes · Writing time: 40 minutes

NOTES

Assume that today's date is 10 February 2019

Mrs Priya Sharma is a patient in your general practice who is concerned about her glucose level control.

PATIENT DETAILS:

Name:

Mrs Priya Sharma

DOB:

08 May 1958 (Age 60)

Address:

71 Seaside Street, Newtown

Social background:

Married 40 years – 3 adult children, 5 grandchildren (overseas).

Retired (clerical worker).

Family history:

Many relatives with type 2 diabetes

Nil else significant

Medical history:

1999 – type 2 diabetes

Nil significant, no operations

Allergic to penicillin Menopause 12 yrs

Never smoked, nil alcohol

No formal exercise

Current Drugs:

Metformin 500mg 2x /day

Glipizide 5mg 2x/morning

No other prescribed, OTC, or recreational

29 Dec 2018

Discussion:

Concerned that her glucose levels are not well enough controlled – checks levels often (worried?)

Attends health centre – feels not taking her concerns seriously

Recent blood sugar levels (BSL) 6-18

Checks BP at home

Last eye check October 2017 – OK Wt steady, BMI 24

App good, good diet

Bowels normal, micturition normal

O/E:

Full physical exam:

NAD

BP 155/100

No peripheral neuropathy; pelvic exam not performed

Pathology requested:

FBE, U&Es, creatinine, LFTs, full lipid profile, HbA1c

Medication added:

candesartan (Atacand) tab 4mg 1x/morning

Review 2 weeks

05 Jan 2019

Pathology report received:

FBE, U&Es, creatinine, LFTs in normal range

GFR > 60ml/min

HbA1c 10% (very poor control)

Lipids:

Chol 6.2 (high), Trig 2.4, LDLC 3.7

12 Jan 2019

Review of pathology results with Pt – changes in medication recommended

Metformin regime changed from 500mg x2/day to 750mg 2x/day

Atorvastatin (Lipitor) 20mg 1x/morning added

Glipizide 5mg 2x/morning

Review 2 weeks

30 Jan 2019

Home BP in range; sugars improved

Pathology requested:

fasting lipids, full profile

06 Feb 2019

Pathology report received:

Chol 3.2, Trig 1.7, LDLC 1.1

10 Feb 2019

Pathology report reviewed with Mrs Sharma

Fasting sugar usually in 16+ (high) range

Other blood sugars 7-8

Refer to specialist at Diabetes Unit for further management of sugar levels

WRITING TASK

Using the information in the case notes, write a letter of referral to Dr Smith, an endocrinologist at City Hospital, for further management of Mrs Sharma's sugar levels. Address the letter to Dr Lisa Smith, Endocrinologist, City Hospital, Newtown.

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.