OET Stuff

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Dr Fransiska Hutahaean

NEWNHAM, TAS 7248

24-08-1992

Dr G Brian

Emergency Department Medical Officer

Alfred

Hospital

Commercial Road

PRAHRAN, VIC

Dear Dr Brian,

I am referring Mr. William Johnson, 23 years old, of

, Frankston, who has been complaining of abdominal pain for 2 days.

He first presented yesterday with a 24 hour history of crampy central abdominal pain, nausea and several loose bowel motions. There was a generalized central abdominal tenderness. I assessed him as having the possibility of viral gastroenteritis. I advised him to take more fluid and rest. I prescribed an analgesia[i] and sent him home.

Today he came back again due to worsening abdominal pain. He had vomited several times overnight and could not eat or drink. On examination I found a rise in temperature. He was flushed and restless. There was tenderness with mild guarding in his right abdomen. The bowel sounds were slightly diminished. I started to consider the possibility of early appendicitis. I prescribed Maxolon 10 mg tablet to be taken four hourly while maintaining his fluid balance.

Further investigation has shown that his blood pressure had increased (140/90 mmHg) as well as his temperature ( 38,8°C ). There was localized tenderness in his right iliac fossa with guarding and rebound tenderness. The bowel sounds had diminished. His blood test showed leukocytosis ( white blood cell count was 18.000 cells/mm ) which confirmed my diagnosis:acute appendicitis.

I would be grateful if you could arrange an admission for surgical assessment and urgent appendectomy.

Yours sincerely,

Dr Fransiska Hutahaean

General Practitioner

Probable Grade: A

Dr Fransiska Hutahaean

02/07/2002

Dr C Burt

Respiratory Specialist

Launceston General Hospital

LAUNCESTON, TAS 7250

Dear Dr Burt,

I am referring Mr. George Kent, a 30-year-old teacher, who presented today. He has been complaining of a productive cough for 3 days. The cough, which developed after swimming in a cold lake, was accompanied by thick and rusty sputum.

On examination, he looked very ill. He had a high temperature and his respiratory rate was 30 times per minute. He had difficulty in breathing that was confirmed by his use of respiratory accessory muscles and flaring of his nostrils. His other vital signs were normal. I assessed him as having severe respiratory failure associated with an infection.

I would appreciate your assessment and further treatment of this patient’s condition.

Yours sincerely,

Dr Fransiska Hutahaean

General Practitioner

Correction by Andrea

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Dr Fransiska Hutahaean

08-02-1990

Dr Lee

Gynaecologist

Launceston General Hospital

LAUNCESTON, TAS 7250

Re    : Mrs. Lidia Markovich, Suspect dysfunctional uterine bleeding

DOB: 18 -02- 1955

Thanks for seeing Mrs. Markovich, a 35-year-old teacher. She has been complaining of heavy continuous vaginal bleeding for 10 days. The bleeding was accompanied by various pains in the lower part of her abdomen. She also has had irregular painful and heavy periods over the last six months. Otherwise, examination was normal. Blood test at this time showed anemia. I diagnosed her as having dysfunctional uterine bleeding and prescribed an analgesic, transquiliser tablets and Mycrogynon tablets.

Her menarche, which was at 14 years old, was regular. She has had 5 pregnancies which had resulted in 2 children and 3 artificial abortions. Her children are 12 years of age and 7 years of age. Her father is 75 years old and still healthy. Her mother died 10 years ago because of carcinoma of the uterus. The patient has had a stressful life.

I would appreciate your further investigation to make a more precise diagnosis and treatment.

Yours sincerely,

Dr Fransiska Hutahaean

General Practitioner.

Probable grade: B

Correction by Kay, the corrections are in the bold.

Dr Fransiska Hutahaean

08-02-1990

Dr Lee

Gynaecologist

Launceston General Hospital

LAUNCESTON, TAS 7250

I am referring Mrs. Lidia Markovich, a 35-year-old teacher, who has been complaining of heavy continuous vaginal bleeding and various pains in the lower part of her abdomen for 10 days. She also has had irregular painful and heavy periods over the last six months.

On examination, her blood pressure was slightly high ( 140/80  mmHg ) while the rest of her vital signs were within normal range. She was anemic but the results for all her other tests were normal. I assessed her as having dysfunctional uterine bleeding and prescribed an analgesic, transquiliser tablets and Mycrogynon tablets.

Her menarche, which was at aged 14, was regular. She has had 5 pregnancies which had resulted in 2 children and 3 artificial abortions. Her children are 12 years old and 7 years old. She had measles when she was 3 years of age and an appendectomy at aged 12.  Her father is 75 years old and still healthy. Her mother died 10 years ago due to uterine carcinoma. The patient has had a stressful life.

I would appreciate your further investigation to make a more precise diagnosis and treatment.

Yours sincerely,

Dr Fransiska Hutahaean

General Practitioner.

Probable grade: B

Correction by Kay, the corrections are in the bold.

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Dr Fransiska Hutahaean

22/02/2008

Dr Saut Gurning

Neurologist

Launceston General Hospital

LAUNCESTON, TAS 7250

Dear Dr Gurning,

I am referring Mrs. Jane Pryor, a 44-year-old mature student, who initially presented 2 weeks ago. She had been complaining of headaches and nausea for 3 weeks. The headaches, which were centered at the front of her head just above her right eye, lasted for several hours. Her partner reported that she has been showing a slight impediment in her speech over the last twelve months. Beside this, I found no abnormalities in her physical examinations. I recommended her to take some rest, increase the amount of exercise she does and take analgesics if the headache recurred.

She had neither a significant history of headaches nor head trauma. She had a hysterectomy 12 years ago. There was no obvious current psychological or emotional stress. Her daughter died of Hodgkinson’s lymphoma at aged 13 while her mother has had a carcinoma but currently is in remission.

Today she came to see me again due to her condition worsening. The headaches have become more severe and lasted longer. They were accompanied by nausea, clamminess of the skin and dizziness. The speech impediment occurred more frequently. On examination, she was tense, worried and slightly confused but still no obvious clinical signs. She appeared to be dragging her left foot very slightly. I suspect there is a space occupying lesion in her brain.

I would appreciate your further assessment and treatment of this patient’s condition.

Yours sincerely,

Dr Fransiska Hutahaean

General Practitioner

Correction by Andrea

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Dr Fransiska Hutahaean

16/12/2007

The Registrar

Ophthalmology Department

Sir Charles Gairdner Hospital

NEDLANDS    WA 6151

Dear Sir/ Madam,

I am referring Mrs. Elizabeth Evans, 40 years old, who first came to see me on 10/12/2006 with the major complaint of redness and soreness in her left eye. I prescribed Flucloxacillin capsules 250 mg four times daily and Chlorsig ointment applied every 4 to 6 hours.

Four days later she came back with no improvement. On examination I found the swelling in the upper lid was increasing and her lymph glands were also swollen and tender. I prescribed Doxycycline Hydrochloride 100 mg which were taken once a day for seven days.

She came back again today with no improvement at all and she was evasive when asked about medication. I diagnosed her as having a severe eye infection which is not responding to treatment and I am concerned at the possibility of cellulitis. I suspected that she might not be taking her medication correctly.

I am referring her to you for further treatment as she may require hospitalization in order to better monitor medication and intravenous antibiotics.

Yours sincerely

Dr Fransiska Hutahaean

General Practitioner

Probable grade: B

Correction by Kay, the bold ones are the correct ones.

Dr Fransiska Hutahaean

16-12-2007

The Registrar

Ophthalmology Department

Sir Charles Gaidner Hospital

NEDLANDS, WA 6151

Dear Sir/ Madam,

I am referring Mrs. Elizabeth Evans, 40 years old, who initially presented on 10/12/2007 with the major complaint of redness and soreness in her left eye. It was accompanied by the swelling of her upper lid. I prescribed Flucloxacillin capsules 250 mg to be taken four times daily and Chlorsig ointment to be applied 4 to 6 hourly everyday.

Two days later, she presented again due to a worsening of her condition. The swelling of her upper lid had become severe. On palpation, I found tenderness in her swollen glands. I changed the antibiotics to Doxycyclin Hydrochloride 100 mg to be taken once daily for seven days.

The patient’s condition has not improved with treatment therefore she came to see me again today. She was evasive when she was asked about her medication. I diagnosed that she had a severe eye infection which is not responding to treatment although I suspected that she might not be taking her medication properly. I recommend that she is admitted to hospital to enable her medication regime to be strictly adhered to. She may need intravenous antibiotics because of the possibility of cellulites.

Your assistance in this matter is appreciated.

Yours faithfully,

Dr Fransiska Hutahaean

General Practitioner

Correction by Andrea

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Dr Fransiska Hutahaean

30-04-1991

The Registrar

Emergency Department

Launceston General Hospital

LAUNCESTON, TAS 7250

Dear Sir/ Madam,

I am referring Mr. Derek Romano, a 46-year-old insurance clerk, with acute myocardial infarction. The patient initially presented on 20-03-1991 for a general medical check up. On examination, he was overweight and had a high blood pressure. I advised him to lose weight and stop smoking that I would review him in a month.

Two weeks later he came to see me again. He was still smoking and had no improvement in exercise. I assessed him as having hypertension and commenced him on Nifedipin 20 mg daily.

Eleven days later he presented again with the major complaint of epigastric pain. The pain was radiating retrosternally and occurred after eating and walking. I assessed him as having gastric reflux and added Mylanta 30 mls four times daily. I also increased Nifedipin to 20 mg twice daily.

His father died of acute myocardial infarction at aged 48. He had no allergies.

Today he presented again with the major complaint of crushing retrosternal chest pain which lasted for an hour. On examination, he was in obvious distress. His blood pressure was 160/100 mmHg and there were few crepitations at his lung bases. Electrocardigram confirmed acute myocardial infarction. I administered Oxygen, Morphine 2,5 mg and Maxolon 10 mg intravenously immediately.I also gave him Anginine sublingually.

I would appreciate your assessment and further treatment of this patient’s condition.

Yours faithfully,

Dr Fransiska Hutahaean

General Practitioner

Correction by Ruth

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Dr Fransiska Hutahaean

29-01-1989

Dr B Aritonang

Surgeon

Launceston General Hospital

LAUNCESTON, TAS 7250

Dear Dr Aritonang

I am referring Mrs. Trudy Mchugh, 38 years old, who first came to see me on 27/01/1989 with the major complaint of abdominal pain in the left lower quadrant of her abdomen. The pain was sharp, constant and worsened while sitting up, walking or bending.

Examination has shown that she was not distressed. The blood pressure was 140/80 mmHg. The heart rate was normal and regular. There was tenderness on light palpation of her left lower abdomen and a vague mass as well.

She has had a spontaneous abortion in January 1989[i] and previous history of ovarian cystectomy and appendectomy. Her last period was in November 1988 and she is still breastfeeding her 3 year old child. Therefore I ordered a B-hCG test to exclude another pregnancy.

Further investigation has shown that she was moderately distressed. The pain worsened after eating tonight. She still had no bowel action or flatus for 3 days. The blood test has revealed that she had anemia. There was a tension in her abdomen and no bowel sounds. I diagnose her as having an Early bowel obstruction due to diverticulitis or carcinoma.

I would appreciate your assessment and further treatment of this patient’s condition.

Yours sincerely

Dr Fransiska Hutahaean

General Practitioner