Oet Writing Letters

MATERIALS

Writing Test – Physiotherapists Time allowed: 40 minutes Read the case notes below and complete the writing task which follows. The patient is to be discharged from the orthopaedic ward to a rehabilitation centre where he will attend as an outpatient. Patient history Surname: Browning Given Names: John Louis Birthdate: 30.10.39 Occupation: Credit Manager Social: Lives with his wife. Children have moved out. Diagnosis: Elective total knee replacement on 16.12.96 X-ray Report (19.12.96): L Total Knee Replacement position appears satisfactory Past history L Knee trouble for many years – osteoarthritis, instability, intermittent locking. Painful most of the time. Uses a walking stick. Was an A-grade soccer player. Years of knee pain L > R Keen sportsman in the past. Previously independent.

17.12.96 Resting in bed with a zimmer knee splint. Treatment Deep breathing and coughing exercises Bed exercises: static quads, straight-leg raise, foot and ankle Plan Continue bed exercises, mobilise when able, aim for home 18.12.96 Complaining of pain Treatment Continue bed exercises Poor static quadriceps contraction – unable to lift leg Plan To commence ambulating on Friday 20.12.96 Pain decreased Treatment Bed exercises as previously – still not able to straight leg raise Quad exercises ++ Commence active knee fl exion = 30º Commence partial weight bearing with crutches and Zimmer splint – walked 10 metres with diffi culty

24.12.96 No change in range of motion or quads strength Continue bed exercises and walking Encourage ++ 4.1.97 No change. For manipulation under anaesthetic tomorrow. 6.1.97 Having intensive physiotherapy Knee fl exion = 60º Quads lag – 10º Walking independently between crutches Refer to rehabilitation centre for out-patient physiotherapy Review in out-patient clinic: 6.2.97

PHYSIOTHERAPISTS – WRITING SUBTEST

Writing Task Using the information in the case notes, write a letter of referral to Ms Barbara Blunt, Physiotherapy Department, St Stephen’s Rehabilitation Centre, Bond Street, Burwood, 3125. In your answer: • Expand the relevant case notes into complete sentences. • Do not use note form. • The body of the letter should be approximately 200 words.

Task 4 Case Notes: Margaret Robinson Time allowed: 40 minutes Read the cases notes below and complete the writing task which follows: Date 8 July 2012 Patient History Surname: Robinson Given Names: Margaret Emma Birth date: 23/05/63 Occupation: Office Manager Social: Widow 3 teenage children -works full time Diagnosis: adhesive capsulitis X-ray Report: (06/05/12) Shoulder joint shows no abnormality Past History Left shoulder movement severely restricted Constant arm and shoulder aches worse at night Pain severe if lies on left side Difficulty with routine activities - combing hair, fastening bra Family bread winner - concerned about impact on her work - mainly desk & computer based 09/05/12 Assessment Uniform impairment of all left shoulder movements restricted flexion, extension, abduction, circumdiction Treatment Heat therapy Passive mobilisation at various points of shoulder movement Ultra sound NSAIDS for joint pain Plan Regular stretching exercises Use of therapeutic putty to maintain grip strength & dexterity Review 2 weeks 23/05/12 Subjective no change, patient tired and dispirited Treatment Passive mobilisation - little improvement Heat therapy Ultra sound

04/07/12 6 weeks later: After 12 treatment sessions Subjective Patient still reporting severe pain at night causing sleeplessness Unable to lift left arm above level of shoulder No identifiable improvement Plan Referral to orthopaedic consultant for assessment - arthrography and possible corticosteroid injections.

WRITING TASK Using the information in the case notes write a letter of referral to Dr. Ian Hanson, Consultant Orthopaedic Surgeon, Riverlea Public Hospital, 115 Graham Street, Riverlea In your answer

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Expand the relevant case notes into complete sentences Do not use note form Use correct letter format The body of your letter should be approximately 180 - 200 words

Task 5 Case Notes: Alice Denham Time allowed: 40 minutes Read the cases notes below and complete the writing task which follows: Today's Date 25/05/12 Patient History Surname: Denham Given Names: Alice Mary Birth Date: 14/11/67 Occupation: Primary school teacher Social: Stressful divorce 2011, 3 teenage children Moved interstate for current teaching position - January 2012 No family support network Medical History Diagnosis: coronary artery disease Admitted

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10/05/12 St Edwards Hospital, West End 11/05/12 Triple coronary bypass surgery

No family history of heart disease Persistent insomnia Hypertension Increasing chest tightness and breathlessness last 3 months Admitted after severe angina attack Medication - anginine 1 tab sublingually as required propranolol 40mg tds 13/05/12 Admitted with severe chest pain and transferred to the intensive care unit. Now recovering in Intensive Care Unit Deep breathing and coughing exercises Foot and ankle bed exercise and calf exercises (to prevent DVT) Reluctant to participate because of nausea and pain – very anxious 14/05/12 Transferred to ward Anxious about recovery - reluctant to move or exercise Needs ++ +support and encouragement Deep breathing and coughing Continued bed exercises Patient advised to walk around bed & go to toilet independently 20/05/12 Encouraged to use Triflo incentive deep breathing exerciser Walked with assistance to shower 13/05/12 Improved use of Triflo Walking without assistance Wants to return to teaching work by 2nd semester (17/07/12) 25/05/12 Continued improvement – able to ascend and descend without distress Wants to attend Rehabilitation Centre to maintain motivation and gain confidence before returning to full time work Discharge Plan Refer to St Edwards Cardiac Rehabilitation Centre for continuing outpatient physiotherapy. Review at Outpatients Clinic by Dr. O’Connor scheduled for 10am . Writing Task Using the information in the case notes write a letter of referral to Ms. Jenny Chong, Senior Physiotherapist, St Edwards Cardiac Prevention & Rehabilitation

Centre, 22 Thompson Street, West End, 4101. In your letter:

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Expand the relevant case notes into complete sentences Do not use note form Use correct letter format The body of your letter should be approximately 180 - 200 words

Writing Task Sample – Physiotherapy Time allowed: 40 minutes Read the cases notes below and complete the writing task which follows: Today’s Date 12 February 2010 Patient History:

Surname Stewart

Given Names Anthony Birth date 23.10.64 Occupation National Park Ranger Social Married with 2 teenage children -works full time Diagnosis Talar dome cartilage deficit in right ankle CT Report (27.1.10) no abnormality detected in bones

Past History: Jumping off from a 1.5metre height of fence at work, twisted ankle badly on 03.11.09Referred by GP Dr. David Robertson for physiotherapy Occupational activities: walks in rough terrain every day Sports: surfing, soccer –social game every Saturday, coaching his teenage son. Recurrent ankle sprain bilaterally when played in local club 10 years ago

17. 11.09 Assessment Walking with a pair of crutches Moderate swelling and bruise around right ankle and dorsum of foot Restricted movement: DF: -5 degrees, PF: 10 degrees, inversion:

eversion = 6:1 (limited eversion). Foot to wall: -2cm (right) vs 10 cm (left) (normal:12-14 cm) Anterior draw and Talar tilt: unable to test due to pain

Treatment Ultrasound Taping A home based exercise program: stretches with towel, ankle pumps Plan Review in 3 days

20.11.09 Improved Assessment Mild swelling and bruise DF: 0 degree Foot to wall: 0cm (right) Treatment Ultrasound Taping Taught to walk with one crutch Stretches of gastrocnemius and soleus Plan Review in 3 days

22.12.09 (4 weeks later after 8 treatment sessions) No new complaint Assessment DF: 8cm (right) vs 10cm (left) Treatment Ankle guard Functional exercises: lunges, jogging, step ups Will go away for Christmas holidays for 4 weeks Provided a home exercise program include stretches, strengthening, balance training and functional tolerances training Plan Review after his holiday

24.01.10 Pain after surfing, pain was aggravated after walking even wore the ankle guard Assessment Mild intra-articular effusion DF: 0 degree PF: 5 degrees Foot to wall: 2cm (right) vs 10cm TOP (tenderness on palpation): medial joint line and talar dome Anterior draw: no laxity in ATFL Treatment Taping Stretches

Grade I joint mobilisation Plan Refer to see GP

12.02.10 Pain after joint mobilisation CT result was back Plan Referral to his GP: Dr David Robertson for orthopaedic opinion – MRI to rule out a cartilage deficit of talocrual joint or talar dome fracture, or arthroscopy.

WRITING TASK Using the information in the case notes write a letter of referral to Dr David Robertson, General Practitioner, 115 King Street, Warners Bay, 2284 In your answer 1 Expand the relevant case notes into complete sentences 2 Do not use note form 3 Use correct letter format. The body of your letter should be approximately 180 - 200 words

Task 2 Case Notes: Thomas Smith Time allowed: 40 minutes

Read the cases notes below and complete the writing task which follows: Today's Date 15 October 2012 Patient Thomas Smith Date of Birth: 20/03/2007 Social History Mother- house wife Father- Factory shift worker, has a brother and a sister aged 10 and 4 Ante-natal History Normal Birth History Prolonged labour, forceps delivery and at birth agars score was 5 after 5 minutes of birth Post-natal History At the age of 8 months, child diagnosed with cerebral palsy and started physiotherapy. He had uncontrolled fits and he is on Sodium evaporates. 12/08/12 Both upper limbs - hypertonic and difficult to extend completely. Both lower limbs - hypertonic, contractions in both Achilles tendons. Management plan Increase the duration of exercise at home and physiotherapy. 25/08/12 Brian was admitted to Mater Children Hospital due to high temperature and a bad cough and investigation revealed features of pneumonia. Treatment: Started deep breathing exercise, coughing exercise, continued stretching exercise for both upper and lower limbs. 28/08/12 Mild cough, no high temperature, no SOB Patient was discharged Management Plan Review at clinic after one week.

05/09/12 No breathing difficulties Still both Achilles tendons contracted Continued intense stretching exercise frequently 10/10/12 Right side Achilles tendon was released surgically at Spirit Children Hospital Started bed exercises Stretching exercise for quadriceps muscles and both upper limbs Gradual stretching exercise to right ankle joint 15/10/12 Patient was discharged and needs to be given physiotherapy at a local hospital.

Writing Task

You are a physiotherapist Catherine Ure at Mater Children Hospital. Using the information in the case notes write a letter of referral to Maxwell Smart, Physiotherapist at Sunshine Hospital 64 Nicklin Way, Caloundra, 4356. In your answer:

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Expand the relevant case notes into complete sentences Do not use note form Use correct letter format The body of your letter should be approximately 180 - 200 words.