writing sub-test - موسسه زبان دایِلو · her dental history is unremarkable, except...

Writing sub-testDentistrySample Test

Please print in BLOCK LETTERS

Candidate number

Family name

Other name(s)

City

Date of test

Candidate’s signature

YOU MUST NOT REMOVE OET MATERIAL FROM THE TEST ROOM

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© Cambridge Boxhill Language Assessment – Sample Test (2014)

The OET CentreGPO Box 372Melbourne VIC 3001 Australia

Telephone: +613 8656 4000Facsimile: +613 8656 4020www.occupationalenglishtest.org

ABN 51 988 559 414

TURN OVER 2

OCCUPATIONAL ENGLISH TESTWRITING SUB-TEST: DENTISTRY

TIME ALLOWED: READING TIME: 5 MINUTES WRITING TIME: 40 MINUTES

Read the case notes below and complete the writing task which follows.

Notes:

Patient: Ms Taylor Hawking (DOB: 24.03.95)112 High StreetGreenville

Reason for Presenting: Dissatisfied with appearance Rotation of 13 and 23Left drifting of lower midline

Medical History: Allergic to penicillin, allergic to peanuts, asthma

Current Medication: Ventolin inhaler p.r.n. Carries EpiPen

Family and Social History: University studentLives at home with parents, 2 siblings

Examination: All teeth present in both arches DO composite 23MO amalgams 16, 17Occ amalgam 25

Treatment Record:

31.03.11 Exam: L & R bite-wing (BW) radiographs & OPG. Digital photographs. Occlusal decay detected on BW 26, 27, 36, 37, 46 & 47. Calculus lower anterior teeth. Treatment required: restoration of teeth 26, 27, 36, 37, 46 & 47 and prophylaxis.Appointments scheduled.

08.04.11 LA right mandibular block lignocaine with adrenaline 2% 2ml. 47 Occ and 46 Occ very deep decay.Fuji VII base & composite Heliomolar shade A3.

15.04.11 LA left mandibular block lignocaine with adrenaline 2% 2ml. 36 Occ and 37 Occ deep cavities.Fuji VII base & composite Heliomolar shade A3.

22.04.11 LA buccal infiltration lignocaine with adrenaline 2% 3ml. 26 Occ and 27 Occ cavity within enamel bonded composite A3 & scale with ultrasonic and hand scalers lower ant teeth.

09.12.11 Exam: no obvious decay. Soft tissue exam OK. Minimal recession. Small amount lingual anterior calculus.Treatment: scale, clean, floss & polish.

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05.07.12 Exam: no obvious decay. Soft tissue exam OK. Minimal recession. Small amount lingual anterior calculus.Treatment: scale, clean, floss & polish.

27.07.12 Emergency exam: 38, erupting pericoronitis. Irrigate hydrogen peroxide.Refer for OPG.Prescribed Doxycycline tab 100mg daily and Metronidazole tab 200mg t.i.d.Chlorhexidine mouth wash (antibacterial mouthwash). Review condition in 2 weeks.Reassess status of wisdom teeth as to whether they require extraction.

09.08.12 Reviewed 38, pericoronitis resolved. Arrange convenient time to have wisdom teeth extracted.

01.05.13 Recall examination.

No obvious decay. Wisdom teeth settled no further problems.

Soft tissue exam OK.

Minimal recession detected. Calculus lower ant lingually.

Treatment: oral hygiene instruction and showed how to effectively use floss. Scale, (ultra sonic and hand), floss and prophy.

10.02.14 Recall examination.

Patient concerned about “ugly appearance” of smile.

O/E: teeth 13 and 23 rotated. Upper and lower crowding.

Lower midline displaced to left 5mm.

Refer for OPG.

Treatment: possible extraction of teeth in both arches, refer to orthodontic assessment before definitive treatment (inc. fixed appliance therapy).

To write referral letter to orthodontist. Patient to take OPG.

Writing Task:

Using the information given in the case notes, write a letter of referral to the orthodontist, Dr Peter Rosenberg, 48 Crown Avenue, Stillwater.

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.

4

OCCUPATIONAL ENGLISH TESTWRITING SUB-TEST: DENTISTRY

SAMPLE RESPONSE: LETTER OF REFERRAL

Dr Peter RosenbergOrthodontist48 Crown AvenueStillwater

10 February, 2014

Dear Dr Rosenberg,

Re: Ms Taylor Hawking, DOB 24/03/95.

Thank you for seeing 19-year-old Ms Taylor Hawking.

I saw her for a recall examination on 10 February 2014 and she was concerned about the “ugly appearance” of her smile and would like to explore possible treatment options.

Ms Hawking has her entire permanent dentition with all teeth present in both arches. She has upper and lower crowding and the rotated upper canine teeth are of particular concern.

Her dental history is unremarkable, except that 38, when erupting, had pericoronitis and required emergency treatment with antibiotic therapy and antibacterial mouthwash on 27/07/12.

Ms Hawking has allergies to penicillin and peanuts, for which she carries an EpiPen. She is also asthmatic, which is controlled with Ventolin inhaler as required. She does not take preventative medication for her asthma.

I would be most grateful if you could assess Ms Hawking and explore the orthodontic treatment options with her. An OPG has been sent with the patient.

Please do not hesitate to contact me if you require any further information.

Yours sincerely,

Dentist

Writing sub-testDieteticsSample Test


Candidate number

Family name

Other name(s)

City

Date of test



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ABN 51 988 559 414

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Notes:

Name: Dean Jones

DOB: 30/12/71

Medical History: Hypercholesterolaemia

Social History: Job: airline industry – catering dept. Shift work – 5am some days/7pm other days. Varies week-week, little notice given. Lives alone – prepares own meals, does not enjoy cooking, ltd cooking skills. Not interested in food, had difficulty recalling recent diet.

12/01/14 Referred by Dr Barnstaple; nutritional assessment & mgt of Wt and hypercholesterolaemia.

Examination: Wt: 86.8kgHt: 168cm BMI: 30.8 (RR 20-25) Waist: 102cm (Target < 95cm) Lipids: Cholesterol 6.1mmol/L (RR: < 5.5mmol/L) Lipid fractions N/A

Exercise: V. active in past – gym and jogging.Nil exercise in last few months – no motivation. Now has 1 month off work – plans to rtn to gym + mates from work.

Dietary Intake: Usually nil for breakfast.When arrives at work (early shift) – toasted sandwich (white bread), ham & cheese. Drinks 3-4 coffees, 2 sugars + full cream milk during morning.

Lunch From staff cafeteria – food choices include:

Hot chips Pies/pasties Pasta dishes (with cream sauce) Soft drink with lunch

OCCUPATIONAL ENGLISH TESTWRITING SUB-TEST: DIETETICS



3 3

Afternoon Biscuits & cheese/nothing

Dinner Take-away/very simple meals: e.g., fried eggs (2), toast (white bread)/instant noodles/

burger (1/4-pounder + cheese) and fries/fied rice/beef noodle dish (local Chinese restaurant)

After dinner Chips (plain or corn chips), soft drink can

Assessment: Dietary intake pattern irregular, often skips meals (esp b/fast). Dietary quality poor, ltd fresh fruit/veg, ltd intake wholegrain cereals. Fat, sugar & sodium intake excessive.

Management: Advised regular meals & snacks, fresh fruit, veg & salads daily, wholegrains, unsweetened drinks/water. Sample menu provided. Exercise to be resumed.

R/V 1/12

10/2/14 Lost 1.5kg, 2cm at waist. Enjoying regular gym. Meals more reg, esp b/fast. Eating fruit daily, cooking in evenings, e.g., frozen meals, veg 3/7 at least. Mood, energy levels improved.

R/V 2/12 after next blood tests. Continue with improvements.

Writing Task:

Using the information in the case notes, write a letter back to the referring doctor describing the situation. Address your letter to Dr Eva Barnstaple, 45 Cameron Street, Newtown.

In your answer:





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Dr Eva Barnstaple 45 Cameron St Newtown

10 February 2014

Dear Dr Barnstaple,

Re: Dean Jones, DOB 30/12/71

Thank you for referring this patient for nutritional assessment and management of weight and hypercholesterolaemia.

At his first visit on 12/01/14, Mr Jones was slightly over-weight, with a Body Mass Index of 30.8 and waist 7cm above the ideal. His total cholesterol levels were high at 6.1 mmol/L (reference range less than 5.5mmol/L).

Mr Jones’ dietary pattern was irregular, especially regarding breakfast. His diet was high in sugar, fat and sodium. He consumed limited fresh fruit and vegetables. His level of exercise had recently been low.

He was advised to eat more regularly, especially breakfast, and to increase fresh fruit, vegetables, whole grains and unsweetened drinks or water. He was given a sample menu. He agreed to start exercising again.

On review today, his diet has improved considerably. He is eating fruit daily and fresh vegetables at least three times a week. He is cooking for himself or heating frozen meals in the evenings. He is again enjoying regular exercise at the gym. He has lost 1.5kg and 2cm around the waist. His mood and energy levels have also improved. I have scheduled another review for two months time and I would expect to see continued improvements.

Please do not hesitate to contact me should you need further information.

Yours sincerely,

Dietitian

OCCUPATIONAL ENGLISH TESTWRITING SUB-TEST: DIETETICS

SAMPLE RESPONSE: LETTER

Writing sub-testMedicineSample Test


Candidate number

Family name

Other name(s)

City

Date of test



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ABN 51 988 559 414

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OCCUPATIONAL ENGLISH TESTWRITING SUB-TEST: MEDICINE



Notes:

Patient: Mrs Priya Sharma DOB: 08.05.53 (Age 60)Residence: 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 (NIDDM) Nil else significant

Medical History: 1994 – NIDDM Nil significant, no operations Allergic to penicillin Menopause 12 yrs Never smoked, nil alcohol No formal exercise

Current Drugs: Metformin 500mg 2 nocte Glipizide 5mg 2 mane No other prescribed, OTC, or recreational

29/12/13 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 2012 – 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 1 mane

Review 2 weeks

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05/01/14 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

12/01/14 Review of pathology results with Pt Changes in medication recommended Metformin regime changed from 2 nocte to 1 b.d. Atorvastatin (Lipitor) 20mg 1 mane added Glipizide 5mg 2 mane Review 2 weeks

30/01/14 Home BP in range Sugars improved Pathology requested: fasting lipids, full profile

06/02/14 Pathology report received: Chol 3.2, Trig 1.7, LDLC 1.1

10/02/14 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:





4

Dr Lisa SmithEndocrinologistCity HospitalNewtown

10 February 2014

Dear Dr Smith,

Re: Mrs Priya Sharma 71 Seaside Street, Newtown DOB 08.05.53

Thank you for seeing Mrs Priya Sharma, a type 2 diabetic. I would be grateful if you would assist with her blood sugar control.

Mrs Sharma is 60 years old and has a strong family history of diabetes. She was diagnosed with NIDDM in 1994 and has been successfully monitoring her BP and sugar levels at home since then. She first attended my surgery on 29/12/13 as she was concerned that her blood sugar levels were no longer well controlled.

On initial presentation her BP was 155/100 and she said that her blood sugars were running between 6 and 18. Her medication at that time was metformin 500mg x2 nocte and glipizide 5mg x2 mane.

Mrs Sharma is allergic to penicillin. A pathology report on 05/01/2014 showed HbA1c levels of 10% and GFR greater than 60ml/min. Her cholesterol was high (6.2).

On 29/12/13, I instituted Atacand 4mg, 1 tablet each morning. Since then her home-monitored BP has been within range. On 12/01/14, I also prescribed Lipitor 20mg daily, and her lipids have improved, with cholesterol falling from 6.2 to 3.2.

Mrs Sharma reports that her fasting BSL is in the 16+ range (other blood sugars are 7-8). I am concerned about her fasting blood sugars, which remain high, and would appreciate your advice.

Yours sincerely,

Doctor

OCCUPATIONAL ENGLISH TESTWRITING SUB-TEST: MEDICINE


Ms Georgine Ponsford, Resident Community Nurse, Community Retirement Home 103 Light Street, Newtown (Today’s date) Dear Ms Ponsford, RE: Mr Lionel Ramamurthy, aged 63 years Mr Ramamurthy will be discharged tomorrow (11/2) from Newtown Public Hospital back into your care following a bout of pneumonia. He was admitted with acute SOB, wheezing, painful coughing, fever, sleeplessness and general aches, and was hospitalised for seven days. You’ll be glad to know that Mr Ramamurthy has made good progress overall and is no longer feverish with his inflammatory markers having normalised. He does, however, still have a dry cough. In addition, his mobility has improved; he can now walk short distances without his walking frame as well as use the shower and toilet independently. Please make sure Mr Ramamurthy sits up as much as possible to ensure postural drainage. In addition, he will need to continue his deep breathing and coughing exercises (he may also need paracetamol for his chest and abdominal pain). Mr Ramamurthy will also need to be kept warm and encouraged to drink plenty of fluids during his recovery period. His diet will also need to be monitored as he did gain some weight during his stay. If you have any questions, please do not hesitate to contact me. Yours sincerely, Charge Nurse

Writing sub-testNursingSample Test


Candidate number

Family name

Other name(s)

City

Date of test



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ABN 51 988 559 414

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Notes:

Mr Lionel Ramamurthy, a 63-year-old, is a patient in the medical ward of which you are Charge Nurse.

Hospital: Newtown Public Hospital, 41 Main Street, Newtown

Patient details

Name: Lionel Ramamurthy (Mr)

Marital status: Widowed – spouse dec. 6 mths

Residence: Community Retirement Home, Newtown

Next of kin: Jake, engineer (37, married, 3 children <10) Sean, teacher (30, married, working overseas, 1 infant)

Admission date: 04 February 2014

Discharge date: 11 February 2014

Diagnosis: Pneumonia

Past medical history: Osteoarthritis (mainly fingers) – VoltarenEyesight due to cataracts removed 16 mths ago – needs check-up

Social background: Retired school teacher (history, maths). Financially independent. Lonely since wife died. Weight loss – associated with poor diet.

Medical background: Admitted with pneumonia – acute shortness of breath (SOB), inspiratory and expiratory wheezing, persistent cough ( chest & abdominal pain), fever, rigors, sleeplessness, generalised ache. On admission – mobilising with pick-up frame, assist with ADLs (e.g., showering, dressing, etc.), very weak, ambulating only short distances with increasing shortness of breath on exertion (SOBOE).

OCCUPATIONAL ENGLISH TESTWRITING SUB-TEST: NURSING



3

Medical progress: Afebrile. Inflammatory markers back to normal. Slow but independent walk & shower/toilet. Dry cough, some chest & abdom. pain. Weight gain post r/v by dietitian.

Nursing management: Encourage oral fluids, proper nutrition. Ambulant as per physio r/v. Encourage chest physio (deep breathing & coughing exercises). Sitting preferred to lying down to ensure postural drainage.

Assessment: Good progress overall

Discharge plan: Paracetamol if necessary for chest/abdom. pain. Keep warm. Good nutrition – fluids, eggs, fruit, veg (needs help monitoring diet).

Writing Task:

Using the information given in the case notes, write a discharge letter to Ms Georgine Ponsford, Resident Community Nurse at the Community Retirement Home, 103 Light Street, Newtown. This letter will accompany Mr Ramamurthy back to the retirement home upon his discharge tomorrow.

In your answer:





4

Ms Georgine Ponsford Resident Community Nurse Community Retirement Home 103 Light Street Newtown

10 February 2014

Dear Ms Ponsford,

Re: Lionel Ramamurthy (aged 63), for discharge from Newtown Public Hospital on 11 February 2014

Mr Lionel Ramamurthy was admitted on 4 February 2014 having contracted pneumonia. He is now ready for discharge back into your care.

On admission, he was experiencing fevers and rigors. He suffered dyspnoea, wheezing and sleeplessness. He had chest and abdominal pain due to prolonged persistent coughing.

After a week in hospital, he has stabilised and his breathing problems are now resolved. However, he still experiences some chest and abdominal pain, with a dry cough. His nursing management in hospital initially consisted of a walking frame and assistance with showering and dressing. Mr Ramamurthy is now more independent. He is also able to walk about slowly without assistance, and shower and use the toilet independently.

Mr Ramamurthy is on Voltaren for osteoarthritis. Paracetamol may be administered as needed if chest and abdominal pain persists and he should be kept warm. Please encourage oral fluids, and ensure that he sits up, rather than lies down, whenever possible to ensure postural drainage. He should ambulate regularly, and continue with deep breathing and coughing exercises.

Mr Ramamurthy was very weak on admission to hospital, but has gained weight with dietitian input. He will need ongoing monitoring of his diet to maintain a healthy BMI.

If you have any queries, please contact me.

Yours sincerely,

Charge Nurse

OCCUPATIONAL ENGLISH TESTWRITING SUB-TEST: NURSING

SAMPLE RESPONSE: LETTER OF DISCHARGE

Writing sub-testOccupational TherapySample Test


Candidate number

Family name

Other name(s)

City

Date of test



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ABN 51 988 559 414

TURN OVER 2

OCCUPATIONAL ENGLISH TESTWRITING SUB-TEST: OCCUPATIONAL THERAPY



Notes:

You are an occupational therapist working on an orthopaedic ward in an acute hospital. The following client, who was admitted five weeks ago, is due to be discharged to a rehabilitation centre tomorrow.

Patient Details: Jack Spencer (Mr)

234 High Street Oldmeadows

DOB: 10/10/51

Medical Presentation: Presented at casualty w. neighbour 5 weeks ago:

Admitted to hospital with L fractured humerus & olecranon process following fall at home. Surgery completed on olecranon process, screw inserted 4 wks ago. Plaster fitted.

Past Medical History: Rheumatoid arthritis bilaterally in hands

Fractured femur 2004

Tonsillectomy 1960

Social History: Resides in own home alone

Wife died 4 yrs ago

4 independent children (live in other states)

8 grandchildren

Retired carpenter

Receives pension from superannuation

Hobbies and Interests: Plays bowls 2x wkly

Involved in local community club

Enjoys outings w. friends

Gardening

Enjoys radio, TV

3

Therapy: Under surgeon’s recommendation: Pt was not to mobilise L arm until last wk when plaster removed.

Daily therapy approx. 20 mins to mobilise arm within pain limits, over past wk.

Motivated to be independent again.

Activities of Daily Living:

Dressing: independent except buttons. Previously independent.

Showering: minimal assistance w. bathing & drying. Previously independent. Has bath only.

Grooming: independent.

Cooking: yet to be assessed. Previously cooked all meals.

Cleaning: not assessed. Previously received home help for all cleaning.

Banking: not assessed. Previously independent. Writes and signs banking slips w. L hand.

Shopping: not assessed. Previously independent.

Driving: has driver’s licence. Previously drove manual transmission car.

Writing Task:

Using the information given in the case notes, write a letter to the Occupational Therapist at the Oldmeadows Extended Care Centre, 13 River Street, Oldmeadows, where Mr Spencer is to be discharged, detailing his treatment to date and other information the therapist may need.

In your answer:





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Occupational TherapistOldmeadows Extended Care Centre13 River StreetOldmeadows

10 February 2014

Dear Occupational Therapist,

Please accept the following discharge summary for:

Jack Spencer234 High StreetOldmeadowsDOB: 10/10/51

Mr Spencer has been a patient at this hospital for the past five weeks and will be discharged tomorrow. He had a fall at home and sustained a fracture to the left humerus and olecranon process. Surgery was completed four weeks ago; screws were inserted to strengthen the olecranon process and plaster was fitted. Under the surgeon’s instructions, Mr Spencer had had to keep his limb immobile until the plaster was removed last week. Since then, upper limb therapy has involved mobilisation of the limb within pain limits for approximately twenty minutes every day.

Mr Spencer is 62 years old and lives alone in his own home. He is a retired carpenter who is involved in various community activities including bowling and the local community club. Prior to this injury, he was independent in all personal care and community tasks. He received home help for all house cleaning tasks and independently completed all cooking.

Currently Mr Spencer is having difficulty managing buttons, but otherwise dresses independently. He requires minimal assistance with bathing and drying. His ability to continue to complete cooking, cleaning, banking and shopping has not been assessed. He writes with his left hand and drives a manual car. Mr Spencer is keen to return home and maintain his independence.

Thank you for accepting this gentleman for rehabilitation. If you require further information, please do not hesitate to contact me.

Yours faithfully,

Occupational Therapist

OCCUPATIONAL ENGLISH TESTWRITING SUB-TEST: OCCUPATIONAL THERAPY

SAMPLE RESPONSE: LETTER OF DISCHARGE

Writing sub-testOptometrySample Test


Candidate number

Family name

Other name(s)

City

Date of test



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ABN 51 988 559 414

TURN OVER 2

OCCUPATIONAL ENGLISH TESTWRITING SUB-TEST: OPTOMETRY



Notes:

Name: (Mr) Mark Wilkinson (D.O.B. 09/07/1968)

First visit: 27/02/13 (referred by GP, Dr Heather Meredith)

General health: Type 2 diabetes – diagnosed June 2012 Overweight (Wt: 110kg, Ht: 178cm). BP – 163/92 Smoker since age 18 (1986) Cholesterol: total cholesterol – 8.3mmol/L Asthma since 1987 Medications – statins (for cholesterol lowering), bronchodilator (ventolin) (for asthma)

Current refractive condition: Astigmatism, presbyopia

External examination: Nothing abnormal found

Visual acuity: R and L 6/6

Refraction: R: plano/-1.50 x 165, L: +0.25/-1.00 x 180, Add +1.00. The patient’s current glasses are accurate for distance but have no near addition.

Amsler: Nothing abnormal described R or L

IOP: R and L 16mmHg (Goldmann)

Slit lamp biomicroscopy: Nothing abnormal in anterior segment, R or L

Dilated fundus examination: 2 microaneurysms and one intra-retinal (blot) haemorrhage noted in right eye superior temporal quadrant, more than two disc diameters from fovea. Three microaneurysms noted 2-3 disc diameters inferior and temporal to left optic nerve head. Maculae appear uncompromised and optic nerve heads are flat and pink.

Diagnosis: 1 Bilateral astigmatism with a new finding of (age-appropriate) presbyopia 2 Bilateral mild/moderate non-proliferative diabetic retinopathy (NPDR)

Management: 1 Multifocals prescribed (first pair) 2 Counselled patient regarding ocular findings and the importance of good glycaemic control 3 Review recommended for 12 months 4 Report sent to patient’s general medical practitioner

3

Second visit: 10/02/14 Patient reports that current glasses are blurred at distance but adequate for near. R vision worse than L at all distances. Admits to very poor blood-glucose control over previous 12 months.

Visual acuity: R 6/9- and L 6/6-

Refraction: R: 1.00/-1.75 x 165, L: 1.25/-1.00 x 180, Add +1.75

Amsler: Minor metamorphopsia described within central 2 degrees on R (temporal to fixation), nothing abnormal described on L

IOP: R and L 18mmHg (Goldmann)

Slit lamp biomicroscopy: Trace, but generalised cortical lens opacities R and L. Nothing abnormal found other than this.

Dilated fundus examination: Microaneurysms and intraretinal haemorrhages noted in all quadrants of both eyes. Retinal vessel irregularities evident in both eyes. Small neovascular frond noted in right superior temporal quadrant. R macula appears mildly oedematous. Hard exudates are present within one disc diameter of fovea. L macula appears uncompromised.

Diagnosis: 1 Bilateral myopic shift and increase in presbyopia 2 R proliferative, L severe NPDR

Management: 1 Discussion of findings with patient 2 Referral to ophthalmologist (semi-urgent) – diabetic status treatment plan 3 No alteration of spectacles at this stage

Writing Task:

Using the information in the case notes, write a letter to request a review of the patient’s diabetic status and a treatment plan. Write to the Ophthalmologist (Dr Milson Werrall, Ophthalmologist, Benbow General Hospital, 32-40 Main Street, Benbow West).

In your answer:





4

Dr Milson WerrallOphthalmologistBenbow General Hospital32-40 Main StreetBenbow West

10 February 2014

Dear Dr Werrall,

Re: Mr Mark Wilkinson

Mr Mark Wilkinson has been a patient at this clinic since 2013. He was diagnosed with Type 2 Diabetes in June 2012. Mr Wilkinson has visited our clinic twice, most recently complaining of blurred distance vision. On examination, his bilateral mild non-proliferative diabetic retinopathy (NPDR) has progressed to proliferative diabetic retinopathy (PDR) in the right eye and severe NPDR in the left eye.

Visual acuity tests show significant deterioration of vision in the right eye over the past 12 months, and Amsler test results over the same period show development of minor metamorphosia in the right eye (temporal to fixation). IOP has increased from 16 to 18 mmHg (Goldmann) on both sides.

Dilated fundus examinations show signs of developing macula oedema in the right eye, although the left remains uncompromised. Significantly increased numbers of microaneurysms and intraretinal haemorrhages are evident in all quadrants of both eyes, as are retinal vessel irregularities.

Management to date has involved counselling regarding the significance of ocular findings, and about the importance of good glycaemic control (which Mr Wilkinson has been unable to maintain), and recommendation of an annual review, which the most recent consultation comprised.

Please examine Mr Wilkinson to assess his condition, and recommend an appropriate treatment and management plan.

Yours sincerely,

Optometrist

OCCUPATIONAL ENGLISH TESTWRITING SUB-TEST: OPTOMETRY


Writing sub-testPharmacySample Test


Candidate number

Family name

Other name(s)

City

Date of test



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ABN 51 988 559 414

TURNOVER 2

OCCUPATIONAL ENGLISH TESTWRITING SUB-TEST: PHARMACY



Notes:

Personal Details:

Name: Alexia Rollinson (Ms) Address: 15 Fine St, Newtown DOB: 12/11/1973Age: 40 yearsDate: 10 February 2014

Social/Family Background: Single. Works full time as an accountant

Diagnosis: Hypertension, hypercholesterolaemia, low vitamin D since 2011

Medication: Betaloc (metoprolol), 100mg b.d. Lipitor (atorvastatin), 20mg mane Ostevit-D 1000IU mane

Current Status: BP 147/100mmHg (taken in pharmacy) Lipid profile: LDL – 131, HDL – 64, Triglycerides – 269mg/dl Vitamin D < 54 (60-160nmol/L) (print out with customer) Ht 153cm, Wt 65kg, BMI 27.8 (verbal from customer) Does no regular exercise – drives to work, no sport or recreational activity Low mood Overweight

Discussions in Pharmacy: New to area, moved 1 month ago, and has no GP yet. Medications required today and repeats are filled. Came in for advice and explained current needs. Monitoring diet to decrease Wt – target 58kg, BMI <25.

• Exercise – Started own exercise program (e.g., walk 30 min 4 times/wk). Says ‘never sticks to it’. Has tried all types of exercise aids advertised on TV, video programs, getting desperate & upset. Wants some help due to lack of progress.

• Diet – Discussed fruit & vegetables, low fat milk, low GI foods & low saturated fats. Bought two electronic scales last week, one for kitchen (food) & one for bathroom (self). Discussed fruit & nut snacks, not chocolate bars (admitted to loving them). Always browsing for Wt loss products. Tried several tablets, drinks, powders, etc. Getting desperate & upset. Wants help due to no progress with Wt loss or change in exercise & daily activities.

Offered to write to local GP for support. Also mentioned a dietitian – customer liked idea.

Pharmacy Management:

• Provided free booklets - Healthy eating and exercise - Council brochure on walking tracks, walking groups, etc. - Local gymnasiums & sports groups

• Letter to GP – suggested referral to dietitian

Writing Task:

Using the information in the case notes, write a letter of referral to Dr Sally Windwood, 9 Blewston St, Newtown, to explain your discussion and advice including a suggestion of consulting a dietitian.

In your answer:





3

Dr Sally Windwood9 Blewston StNewtown

10 February 2014

Dear Dr Windwood,

Re: Ms Alexia Rollinson (DOB: 12/11/73)

I am writing to you out of concern for a customer in our pharmacy today. Mrs Rollinson has been diagnosed and treated for hypertension, hypercholesterolaemia and low vitamin D since 2011. Her current medication is metoprolol 100mg b.d., atorvastatin 20mg mane and Ostevit-D 1000IU mane. She moved to this area one month ago and has not contacted a doctor yet, as she has adequate medication and repeats.

Mrs Rollinson is a 40-year-old accountant who drives to work, does no exercise and does not participate in any recreational or sporting activities. She is overweight (BMI 27.8) and has a long history of browsing for dietary products and purchasing exercise aids.

We had a brief discussion about her lifestyle, exercise and diet which made it clear that she requires some guidance. I provided her with some brochures on diet and exercise programs as well as booklets on local organisations. Her mood was somewhat low.

Following our discussions, I offered to write to you as I know that you have access to dietitians in your consulting rooms. Mrs Rollinson agreed and would benefit from making contact with a new doctor in the local area.

Please do not hesitate to contact me with any questions.

Yours sincerely,

Pharmacist

OCCUPATIONAL ENGLISH TESTWRITING SUB-TEST: PHARMACY


4

Writing sub-testPhysiotherapySample Test


Candidate number

Family name

Other name(s)

City

Date of test



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ABN 51 988 559 414

TURN OVER 2

OCCUPATIONAL ENGLISH TESTWRITING SUB-TEST: PHYSIOTHERAPY



Notes:

You have been treating a patient, Sharyn Royale, who has right lateral epicondylitis. You are writing a letter back to her doctor, Dr Jones.

Name: Sharyn Royale (F), DOB: 25/03/1981Occupation: Personal assistantG.H.: Good, allergic to antibiotics, smoker (10 cigs/day), sedentarySocial: Single, lives with sister. Leisure: computer games; internet. Seems shy/nervous.

23.01.2014 Patient referred by Dr Jones – suspected lateral epicondylitis

Complaint: 1/12 ago developed pain in R elbow when typing as pre-holiday workload on computer.

Moderate pain lateral elbow (6/10) with some radiation into forearm with prolonged typing and home-related tasks (e.g., turning on tap).

Patient perceives loss of strength in R forearm, gradual onset over 2/52.

Typing: Painful after <15mins typing, elbow pain + (8/10).

Handwriting: Painful after <15mins, elbow pain (5/10).

R shoulder – occ dull ache, does not appear related to elbow pain. Dr advised 1 week off aggravated duties.

Physical examination: R shoulder: No apparent distress (NAD), cervical spine: NAD Tender on palpation (palp), R lateral epicondyle (6/10) Wrist extenstion (Ext): G4 with pain (5/10) Stretch ECRB/ECRL (forearm) pain (4/10)

Diagnosis: R lateral epicondylitis

Treatment: Ultrasound (US) 0.8 w/cm 2 int. x7 mins to lateral epicondyle Deep frictions x4 mins Eccentric exercise program 2x 10 repetitions Advice re: icing, stretching and avoiding aggravated activities25.01.2014

Complaint: No change in symptoms, and has not been typing

Examination: Reduced tender on palp (5/10). Less pain on resisted extension (4/10).

Treatment: US, massage, increased exercises Can restart duties: writing – 5 min; computer – avoid

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27.01.2014

Complaint: Symptoms improved. Less pain turning on taps. 5 min writing OK.

Examination: Pain on palp (4/10). Ext stretch increase range, pain 2/10.

Treatment: US, frictions, add weight 0.25kg to exercises

Patient instructed to use weight with home exercises

To try 5 min on computer every 2 hours

Patient on holidays for a week03.02.2014

Complaint: Feeling better after holiday break. Can turn on taps with pain 1/10. Only used computer twice, but no pain.

Examination: Pain on palp 1/10. Wrist Ext 4+, pain 1/10.

Treatment: Repeat US, frictions Exercises increased weight to 0.5kg Instructed to use raise for wrist position for mouse work. To return to work on light duties. Max 5 min typing/hr for first day. No heavy lifting. If

no change in symptoms, can increase by 5 min every second hour on Day 2. Day 3 can increase 10 min each hour if no pain.

10.02.2014

Complaint: Symptoms better. No pain on turning on taps. Has increased computer time, sometimes to half an hour. Slight discomfort then. Employer is supportive of light duties.

Examination: Slight tenderness on palp (1/10), slight pain on resisted wrist Ext (1/10)

Treatment: US, frictions, reviewed exercise regime. Patient advised to restrict duties. Asked to go back to Dr for review, seeking

extension on light duties.

Writing Task:

Using the information in the case notes, write a letter back to the referring doctor, Dr Jones, for assesment of her case and return to full duties at work. Address the letter to: Dr Felicia Jones, Fit Families Practice, 25 North Road, Newtown.

In your answer:





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Dr Felicia JonesFit Families Practice25 North RoadNewtown

10 February 2014

Dear Dr Jones,

Re: Ms Sharyn Royale. D.O.B 25/03/1981

Thank you for referring the above patient who presented with symptoms consistent with right lateral epicondylitis, aggravated when typing at work.

She was complaining of moderate (6/10) pain on the lateral aspect of the elbow, with some radiation into the forearm and loss of strength in the right forearm. On examination, the right lateral epicondyle was tender on palpation. Pain was aggravated by resisted wrist extension and stretching of extensors.

Ms Royale was initially treated with ultrasound, frictions and given an eccentric exercise program. I advised her about icing and stretching, and recommended rest from the aggravating activities. Over the past three weeks, her exercise regime has been gradually increased, and she has commenced short periods of activity, including typing, without setback.

On re-assessment today, her presenting symptoms have significantly reduced. However, I believe she could benefit from an extension to her light duties at work, maintaining gradual increase to her duties.

I refer Ms Royale back to you for re-assessment of her management regarding return to full duties at work.

Please do not hesitate to contact me if you require any further information.

Regards,

Physiotherapist

OCCUPATIONAL ENGLISH TESTWRITING SUB-TEST: PHYSIOTHERAPY


Writing sub-testPodiatrySample Test


Candidate number

Family name

Other name(s)

City

Date of test



– –




ABN 51 988 559 414

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OCCUPATIONAL ENGLISH TESTWRITING SUB-TEST: PODIATRY



Notes:

You are attending to a five-year-old girl with mild cerebral palsy (CP) who exhibits toe walking. The patient was referred to you by her paediatrician, Dr Robyn Black.

Patient: Felicity Brown

Residence: 1 Power Street, Princetown

Date of Birth: May 16, 2009

Examination date: February 10, 2014

Diagnosis: Toe walking (equinus gait)

Past medical history: Mild L hemiplegic (one arm/one leg affected) CP since September 2009

Mild asthma – salbutamol inhaler, occasionally, mostly nocte

Spent wks on & off in children’s hospital – 1st few yrs of life

Sees paediatrician 6 mthly

Assessment by educational psychologist – should integrate well into school

Above average intelligence

Chest infections annually – Rx: antibiotics √

No known allergies

Social background: Lives with parents, 1 brother (7yrs), 1 sister (9yrs)

Parents (especially mother) very overprotective. Attended preschool fairly successfully. Preparing for school next year. Enjoys music and is learning the piano.

Treatment record: Felicity always walks on toes. Late walker ~22mths. Mother worried – paediatrician doing nothing about problem, recommended mother to see podiatrist for 2nd opinion. Gait reasonable. Managing well but mother comments that she seems to trip a lot. Plays table tennis with siblings – doesn’t have to move far/fast to compete. Normal childhood games, playing, etc. Likes running – slowly but enjoys it. Mother seems to want an orthotic.

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On examination: Shoe wear slightly uneven L side but reasonable

Range of foot movement in the R foot – NAD

L foot – Varus position with equinus. Assessment of movement through L ankle ?spastic and reveals a ‘clasp knife’ quality. Overly strong calf muscles compared to weak dorsiflexors (tibialis anterior)

No pain in feet/legs

Suggested paediatric physio to ankle movement

Suggested the need for assessment by a prosthetic and orthotic (P&O) professional for AFO (ankle foot orthoses)

Letter to paediatrician to explain findings and recommendations

Writing Task: Using the information given in the case notes, write a letter to the paediatrician, Dr Robyn Black, 9 Fenton St, Newtown, outlining your findings and reinforcing that Felicity’s mobility and gait are acceptable and that you provided reassurance to the parents.

In your answer:





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Dr Robyn Black Paediatrician9 Fenton StNewtown

10 February 2014

Dear Dr Black,

Re: Felicity Brown, 5 years old, cerebral palsy

Thank you for recommending Felicity for assessment of her toe walking. It is more of a concern to her mother than for her mobility and enjoyment of life as a five-year-old with mild cerebral palsy. The mother reported an increase in incidents of tripping.

On examination, I identified the left foot to be in a varus position with equinus. There is an overpowering of the calf muscles. The anterior leg muscles (mainly tibialis anterior) are unable to provide enough dorsiflexion resulting in tripping. The equinus appears to be spastic in nature and has a ‘clasp knife’ feel. The right foot was normal. Felicity copes very well with this problem.

I have provided the name of a paediatric physiotherapist to assist with exercises for Felicity’s left foot and the name of a P&O professional who will be able to prescribe an AFO (ankle foot orthosis) if necessary. With a combined approach, we should be able to see some improvements in the range of motion at the left ankle joint.

Please do not hesitate to contact me with any queries.

Sincerely,

Podiatrist

OCCUPATIONAL ENGLISH TESTWRITING SUB-TEST: PODIATRY


Writing sub-testRadiographySample Test


Candidate number

Family name

Other name(s)

City

Date of test



– –




ABN 51 988 559 414

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OCCUPATIONAL ENGLISH TESTWRITING SUB-TEST: RADIOGRAPHY



Notes: You are the chief radiographer in a city hospital. The Director of Radiology has asked you to write a response to the following memo, using the information on the documents below.

MEMO

TO: Dr Fred Quirk, Director of Radiology FROM: Dr Ian Page, Director of Intensive Care DATE: 07 February 2014 SUBJECT: Response delay for ICU

Dear Fred,

I have been made aware of a delay in getting an urgent chest X-ray in I.C.U. last Saturday. The patient, Mr Rouse, was to have a post central line insertion check X-ray, as there was some question as to whether the patient had a pneumothorax. The patient had to wait for over 50 minutes for the X-ray and I believe this to be an unacceptable time delay for intensive care dependent patients. Could you please look into this as I would be concerned if such delays continued to occur.

Regards,

Ian Page

1. RADIOGRAPHY DEPT PATIENT LOG: Saturday, 01/02/2014 (extracts)

Radiographers on duty: Steve Jones, Kate Brown (sick, not replaced)

Time Referral Location Pt. Name Exam Comments12.05 ED SIMON CXR ?SOB

12.15 WD 4 LEE CXR PAIN

12.25 ED KOSKO AXR RENAL

12.40 ICU BAY 3 RAMSON CXR TUBE REM.

1.00 WD 7 HIGGINS R.HIP POST OP

1.15 ED JONES SKULL LOC

1.25 ICU BAY 6 AHMED CXR R.CRACKLES

1.35 ED LAMB CXR PNEUMONIA

1.45 ED SMYTH L.KNEE TWISTED

2.30 THEATRE ALLAN GAMP R.WRIST

2.40 ICU BAY 7 ROUSE CXR POST C.V.C

2.55 ED JOHNSTON R. FOOT ?GOUT

3.05 WD 9 WU CXR POST OP

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2. RADIOGRAPHY DEPT PHONE/MESSAGES LOG: Saturday, 01/02/2014 (extracts)

TIME MESSAGE11.30 CXR for Pt Lee on Wd 412.00 Send films for Pt Brown to ED12.10 Dr Smith will be on pager from now on12.35 CXR in ICU Bay 3, Pt Ramson12.50 G.A.M.P. in theatre at approx 1.45pmPager (12.50) CXR for Pt on Wd 91.10 Films needed in theatre for Pt Higgins1.20 CXR in ICU Bay 6, Pt Ahmed1.40 Theatre ready in 5 minutes for G.A.M.P.1.42 CXR in ICU Bay 7, Pt Rouse Told have to go to theatre – will go ASAP to do CXRPager (2.00) ED – need to contact Dr on callPager (2.10) ICU – Bay 7 still waiting, how long? – Delayed in theatre, will be there ASAPPager (2.25) ED – need to do a C.T. later this evening2.45 ICU – is film on Bay 7 ready? – Already sent3.00 Dr Smith – What time for C.T.?3.15 Brian (Dr on call) will be in 10 minutes late

3. DEPARTMENTAL POLICY DOCUMENT

DEPARTMENT OF RADIOLOGY

Policy on the Recall of Radiographic Staff

1) Recall of Radiographer staff is the responsibility of the radiographer on duty only. It is the decision of the radiographer on duty as to whether additional staff is required.

2) Replacing staff absent through illness is not, in itself, considered grounds for recalling staff.

3) Staff recalled are to be given 45 minutes’ warning prior to the time they are required in the hospital.

Writing Task:

Using the information given above, write a letter responding to Dr Page’s memo. Address the letter to: Dr Ian Page, Director, Intesive Care.

In your answer:





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Dr Ian Page Director, Intensive Care

10 February 2014

Dear Dr Page,

Re: Delays in response to ICU request

Dr Quirk has asked me to look into the circumstances surrounding the delay in responding to an ICU request for Mr Rouse on Saturday, 01 February.

Responding to ICU requests is a top priority and we always attempt to respond to such requests as quickly as possible. On the day in question, one of our radiographers rang in sick, so we were operating at half our normal staff level. Further complicating this was the fact that just prior to receiving notification for the request for a CXR on ICU, we received notice that a theatre case would be ready for us in five minutes. As the theatre case was a G.A.M.P. and they normally do not take long, calling in the on-call radiographer was not considered. It takes at least 45 minutes for the on-call radiographer to start work. Unfortunately, the theatre case was delayed until 2.30 and the radiographer was not able to leave the theatre to attend to the ICU case until 2.40.

It would appear that on this occasion circumstances were against us. Normally, we supply prompt, reliable service and we anticipate that this will continue in the future. Fortunately, it is rare that such circumstances arise.

I hope this has been of help.

Regards,

Chief Radiographer

OCCUPATIONAL ENGLISH TESTWRITING SUB-TEST: RADIOGRAPHY


Writing sub-testSpeech PathologySample Test


Candidate number

Family name

Other name(s)

City

Date of test



– –




ABN 51 988 559 414

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Notes:

You are assessing a 6-year-old male who has childhood apraxia of speech (CAS).

Name: Connor MillsD.O.B.: 4/03/07Social history: Lives with parents and one sister (born 2003)

Medical history: Birth uneventful Childhood coughs & colds Full vaccinations

Onset: Noticeable since 2010

General background: Verbal skills – always fairly good, but erratic according to mother. Primary school staff recommended assessment by Speech Pathologist, as difficulties more evident. Sometimes manages difficult words but later cannot manage same words. Talking slow to begin. No issues with family understanding him. During preschool years dyspraxia become more evident. Preschool teacher found him hard to understand, requested hearing/vision tests. Parents ignored due to overzealous preschool teacher. Reluctantly had hearing tested 2011.

Physical: Normal healthy, active, bright boy. Getting on well with peers at school. Participating in all activities. Coordination poor. Described by family as clumsy. Oral capabilities – no eating, chewing or swallowing difficulties.

Hearing tests: 2011 NAD

Sight tests: Nil

OCCUPATIONAL ENGLISH TESTWRITING SUB-TEST: SPEECH PATHOLOGY



3

10 February 2014

On examination Speech: Decreased overall intelligibility Inconsistent articulation errors, esp with blends. Oral groping evident Increased errors with longer words: 3+ syllables No dysarthria

Receptive language: Comprehension – above average No problems socialising at school or with reading or maths Mild delay with spelling & writing

Expressive language: Nil evident Vocabulary – average Syntax – good Narrative – reasonable to good

Cognitive: NAD

Speech pathology therapy Recommendations: Regular sessions – wkly to spend 1:1 time with Connor. Reassured parent & child regular sessions very likely to help with disorder. Reinforced Connor’s condition is milder end of spectrum. Suggested family, school support & encouragement. Discussed speech pathology sessions wkly for 3/12 ?referral to Occupational Therapist

Writing Task: Using the information given in the case notes, write a letter to the referring doctor, Dr M. Walton, 10 North Road, Newtown. Give your assessment of the patient’s issues and your recommendations.

In your answer:





10 February 2014

Dr M. Walton10 North RoadNewtown

Dear Dr Walton,

Re: Connor Mills DOB 04/03/07

Thank you for seeing six-year-old Connor who has presented with his parent today. He exhibits signs of childhood apraxia of speech with no obvious cause. His preschool teacher identified intelligibility issues in 2011 and hearing tests were conducted with no abnormality detected. No sight tests have been done.

Speech evaluation showed decreased intelligibility characterised by inconsistent articulation errors and increasing errors with words longer than 3 syllables. Oral groping was also evident. Receptive and expressive language were within normal limits, however he is having some milder difficulties with writing and spelling at school.

There is no evidence of dysarthria or a motor disorder but he is described as clumsy by his family. Connor is developing very well socially and academically. I plan to provide some weekly one-on-one sessions with Connor for 3 weeks in order to further assess him and provide therapy. I have reassured his parent that overall Connor presents with a milder form of dyspraxia and is likely to respond well to therapy.

I was wondering if an Occupational Therapy assessment might be warranted, given his coordination and writing difficulties.

If you require any further information or have any queries, please do not hesitate to contact me.

Yours sincerely,

Speech Pathologist

OCCUPATIONAL ENGLISH TESTWRITING SUB-TEST: SPEECH PATHOLOGY


4

Writing sub-testVeterinary ScienceSample Test


Candidate number

Family name

Other name(s)

City

Date of test



– –




ABN 51 988 559 414

TURN OVER 2

OCCUPATIONAL ENGLISH TESTWRITING SUB-TEST: VETERINARY SCIENCE



Notes:

You are a veterinarian at a private veterinary clinic that is open on Saturdays. Mrs Stella Alma has brought her dog, ‘Grainger’, to you for treatment because it is Saturday and her normal veterinary clinic is closed.

Patient: ‘Grainger’Owner: Mrs Stella AlmaBreed: DachshundSex: FemaleDOB: 22/05/06Weight: 5.5kg

History: Dry dog-food in morning, canned at night1 other dog in household (female dachshund)WormingSpay 23/03/10No known allergies/conditions

Vaccinations: Canine Adenovirus-2Canine ParvovirusDistemperKennel cough

10/02/14Reason for presenting:

Dog seems depressedAnorexia 5 daysDrinking and urinating a lotVomiting+++Diarrhoea++LethargyWeakness

On presentation: Very depressedApprox 10% dehydratedSlow deep respirationAcetone breathLung sounds normalHeart rate 110/minAbdominal palpation negative

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Clinical Pathology: Available blood chemistry and urinalyses

Results: PCV(%) 58 (37-55%)Urea nitrogen 28mg/dL (10-28dL)Glucose 360mg/dL (65-118mg/dL) Protein 9.5g/dL (5.4-7.1g/dL)

Urinalysis: SpG: 1.035; Protein ++++ Glucose ++++ Ketones +++

Diagnosis: Diabetic ketoacidosisPossibility of electrolyte abnormalities Possibility of hypokalaemia

Treatment: To stabilise prior to move to another hospital for intensive care.IV cephalic catheter. IV Fluids – sodium chloride 500ml in 1 hour.Regular insulin 2.5 units, subcutaneously (SC) at 10.30am.

Discussed with owner re:• long-term daily insulin treatment• management requirements• cost (owner says price not an issue)

Referral: • Refer the animal for intensive care• Request further blood electrolyte and blood gas analysis• Attach blood chemistry and urinalysis results to referral

Writing Task:

Using the information in the case notes, write a letter of referral to Dr Barron at the Emergency Centre for intensive care. Address the letter to Dr Barron, Animal Emergency Centre, Newtown.

In your answer:





4

Dr BarronAnimal Emergency CentreNewtown

10 February 2014

Dear Dr Barron,

Re: ‘Grainger’, female dachshund

Mrs Alma’s dachshund Grainger, a 7-year-old female (5.5kg) presented today at my clinic. She was severely depressed, had slow deep respiration, was approximately 10% dehydrated and had acetone breath. Her symptoms are consistent with diabetic ketoacidosis.

Grainger has a history of depression, anorexia (5 days), vomiting, diarrhoea, lethargy and weakness. She has also been drinking and urinating excessively. I have attached the urinalyses and available blood chemistry tests to this letter. Blood chemistry shows abnormally high PCV, glucose and protein levels and urinalysis shows elevated protein (4+), glucose (4+) and ketones (3+).

In order to stabilise Grainger, I placed an IV cephalic catheter and began rapid administration of sodium chloride an hour later. In addition, 2.5 units of regular insulin were administered subcutaneously at 10:30am today.

I am sending Grainger onto the Emergency Centre for intensive care of her diabetic ketoacidosis. I discussed with the owner the requirement for long-term daily insulin treatment of the dog, the management requirements and the costs she can expect. Mrs Alma does not believe price to be an issue. Grainger also requires further blood electrolyte and blood gas analysis. I suspect electrolyte abnormalities and possible hypokalaemia.

Thank you for accepting this case.

Yours sincerely,

Veterinarian

OCCUPATIONAL ENGLISH TESTWRITING SUB-TEST: VETERINARY SCIENCE

SAMPLE RESPONSE: REFERRAL LETTER

writing sub-test - موسسه زبان دایِلو · her dental history is unremarkable, except...

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