10 Letter Practice Questions with Answers | OET

Today's date: 21 July 2026 PATIENT DETAILS Name: Ms Iris Grant DOB: 08 November 1944 (81 years) Address: 7 Willow Crescent, Ashcombe Lives alone; daughter visits twice weekly. Retired librarian; enjoys radio gardening programmes. DENTAL / MEDICAL HISTORY Hypertension controlled with amlodipine 5 mg daily. Osteoarthritis of hands. No known allergies. Non-smoker. Cataract surgery in 2023. Attends routine dental reviews. ORAL STATUS Remaining teeth: 13, 23, 33, 34, 43 and 44. All clinically stable. Upper arch edentulous. Lower posterior teeth extracted gradually because of caries and periodontal disease. Existing acrylic partial dentures no longer fit after recent extractions and are not being worn. New complete upper and partial lower dentures planned; impressions scheduled for 04 August 2026. Expected completion: approximately eight weeks. CURRENT CONCERNS 15 July 2026: Reports increasing difficulty chewing meat, raw vegetables, apples and crusty bread. Now relies on soup, mashed potato, porridge, yoghurt and tea. Often skips lunch because preparing suitable meals feels troublesome. No oral pain, ulcers, swallowing difficulty, nausea or bowel changes. Appetite remains good. Weight: 58.4 kg, down from 61.1 kg in March 2026. BMI 21.4 kg/m². Daughter concerned about reduced food variety and energy. MANAGEMENT Discussed softer high-protein foods, moist cooking methods and avoiding unnecessarily restrictive diets. Provided oral-hygiene advice. Ms Grant agrees to dietetic referral for interim nutrition support while dentures are made.

Ms Naomi Chen
Senior Dietitian
Ashcombe Community Nutrition Service
26 Hawthorn Avenue, Ashcombe

21 July 2026

Dear Ms Chen,

Re: Ms Iris Grant, DOB 08 November 1944

I am referring Ms Grant, an 81-year-old patient, for interim nutritional assessment and support while her new dentures are being prepared. Your guidance would help her maintain adequate and varied nutrition during this period.

Ms Grant's upper jaw has no teeth, and several lower back teeth have recently been removed because of decay and gum disease. Her current partial dentures no longer fit and are not being worn. New dentures are planned, with impressions scheduled for 04 August 2026 and completion expected in about eight weeks.

Since 15 July, she has had increasing difficulty chewing meat, raw vegetables, apples and crusty bread, and now relies on soft foods such as soup, mashed potato and yoghurt. As she lives alone, preparing suitable meals has become troublesome, and she often skips lunch. Her weight has fallen from 61.1 kg to 58.4 kg since March 2026 (BMI 21.4), and her daughter is concerned about her reduced food variety and energy.

I have advised softer high-protein foods, moist cooking methods and avoiding overly restrictive diets. I would be grateful if you could provide practical dietary support to maintain adequate nutrition until her denture treatment is complete.

Yours sincerely,

General Dentist

Today's date: 21 July 2026 PATIENT DETAILS Name: Mr Owen Hart DOB: 06 February 1983 (43 years) Address: 27 Rowan Close, Westbridge Occupation: Accountant Regular patient since 2019. MEDICAL / DENTAL HISTORY Medically fit. No known allergies. Takes no regular medication. Non-smoker. Attends six-monthly examinations. Moderate dental anxiety but manages treatment with reassurance. Composite restorations 16 and 26 (2022). PRESENTING COMPLAINT 02 July 2026: Intermittent throbbing pain from lower right first molar (46) for two weeks, worse at night and with hot drinks. Pain disturbed sleep twice. No swelling, fever or difficulty swallowing. EXAMINATION / INVESTIGATIONS 46: Large occlusal composite; tender to percussion. No mobility or periodontal pocketing. Cold test produced prolonged severe pain. Adjacent teeth responded normally. Periapical radiograph showed deep restoration close to pulp and slight widening of apical periodontal ligament space. Roots appeared unusually curved, particularly the mesial root. TREATMENT AND REVIEW 02 July 2026: Diagnosis discussed as symptomatic irreversible pulpitis with symptomatic apical periodontitis. Local anaesthetic administered. Emergency access completed; inflamed coronal pulp removed. Canals irrigated, calcium hydroxide dressing placed and tooth sealed temporarily. Paracetamol and ibuprofen advice given. No antibiotics prescribed. 09 July 2026: Pain resolved; 46 comfortable to percussion and temporary seal intact. Limited-field CBCT suggested marked curvature and possible additional mesial canal. 21 July 2026: Remains asymptomatic. Patient wishes to retain tooth and consents to specialist assessment. REFERRAL REASON Endodontic assessment and definitive root-canal treatment of 46 due to complex canal anatomy.

Dr Celia Monroe
Endodontist
Westbridge Endodontic Centre
14 Alder Street, Westbridge WB4 2LN

21 July 2026

Dear Dr Monroe,

Re: Mr Owen Hart, DOB 06 February 1983

I am referring Mr Owen Hart, a 43-year-old patient, for specialist assessment and definitive root-canal treatment of tooth 46, given complex canal anatomy.

On 2 July 2026, he presented with two weeks of intermittent throbbing pain from 46, worse at night and with hot drinks, disturbing sleep twice. No swelling, fever or difficulty swallowing. Tooth 46 has a large occlusal composite and was tender to percussion, with no mobility or periodontal pocketing. Cold testing produced prolonged severe pain, while adjacent teeth responded normally.

The periapical radiograph showed a deep restoration close to the pulp and slight widening of the apical periodontal ligament space, with unusually curved roots, particularly the mesial root. Limited-field CBCT confirmed marked curvature and a possible additional mesial canal.

I diagnosed symptomatic irreversible pulpitis with symptomatic apical periodontitis. Under local anaesthetic, emergency access was completed, the inflamed coronal pulp removed, the canals irrigated, a calcium hydroxide dressing placed and the tooth temporarily sealed. By 9 July, the pain had resolved and 46 was comfortable to percussion, and it remains asymptomatic today. Mr Hart wishes to retain the tooth and consents to specialist assessment. I would be grateful if you could undertake definitive root-canal treatment of 46.

Yours sincerely,

General Dentist

Today's date: 21 July 2026 Patient: Ms Rosa Kent, 74 years old Living circumstances: - Widowed; lives alone in a ground-floor flat - Son, Daniel, lives nearby and visits twice weekly - Usually independent with personal care and meals Admission: 17 July 2026 Discharge: 21 July 2026 Presenting concerns: - Three days of poor oral intake during hot weather - Dizziness on standing, weakness and reduced urine output - Initial observations: BP 98/62 mmHg, pulse 104 bpm, dry oral mucosa Hospital course: 17 July: Intravenous fluids commenced after medical review; amlodipine withheld. 20 July: Drinking independently when fluids placed within reach; postural dizziness resolved. 21 July: BP 126/74 mmHg, pulse 78 bpm, urine pale; mobilising safely with walking stick. Nursing observations: - Prefers chilled water, weak tea and diluted apple juice - Finds large jugs difficult to lift because of hand stiffness - Drank approximately 1.6 L yesterday using a lightweight bottle and small cup - Sometimes forgets to drink when knitting Discharge plan: - Encourage regular drinks, aiming for 1.5-2 L daily as advised by medical team - Keep filled lightweight bottles in kitchen and sitting room - Record intake and urine colour for seven days - Community nurse to review hydration, standing BP and dizziness twice this week - Amlodipine restarted at usual dose; GP review booked for 28 July

Ms Leona Briggs
Community Health Nurse
Riverbank Community Nursing Service
18 Alder Close, Westhaven WH4 2PL

21 July 2026

Dear Ms Briggs,

Re: Ms Rosa Kent, aged 74

I am writing to hand over Ms Kent's care, following her admission on 17 July 2026 with signs of dehydration after three days of poor oral intake. She is discharged today for short-term home follow-up.

On admission, she reported dizziness on standing, weakness and reduced urine output. Her blood pressure was 98/62 mmHg, pulse 104 bpm, with dry oral mucosa. Intravenous fluids were commenced after medical review, and amlodipine was withheld. She responded well, with postural dizziness resolving by 20 July.

At discharge, her blood pressure is 126/74 mmHg, pulse 78 bpm, and urine pale. She is mobilising safely with a walking stick and independent with personal care and meals. Amlodipine has been restarted at the usual dose; a GP review is booked for 28 July.

Ms Kent prefers chilled water, weak tea and diluted apple juice, but finds large jugs difficult to lift due to hand stiffness. Lightweight filled bottles are kept in the kitchen and sitting room, and she drank 1.6 L yesterday. Please encourage 1.5 to 2 L daily, and record intake and urine colour for seven days. I would be grateful if you could review her hydration, standing blood pressure and dizziness twice this week.

Yours sincerely,

Ward Nurse

Today's date: 21/07/2026 PATIENT Ms Lena Cole, 32 years (DOB 09/11/1993) First pregnancy; 29 weeks' gestation Occupation: hospital laboratory technician; rotating shifts, including two overnight shifts weekly Lives with partner REFERRAL (30/06/2026) Referred by midwife Ms Naomi Kerr following gestational diabetes diagnosis. Oral glucose tolerance test (27/06/2026): fasting 5.4 mmol/L; 2-hour 8.7 mmol/L. No medication commenced. Obstetric review otherwise reassuring; fetal growth appropriate. INITIAL DIETETIC ASSESSMENT (04/07/2026) Usual intake: frequently missed breakfast after night duty; large evening meal; fruit juice with lunch; biscuits and sweetened coffee overnight. Limited meal preparation on working days. Education provided: distribute carbohydrate across three meals and planned snacks; combine carbohydrate with protein; replace juice and sweetened drinks with water; check food labels. Agreed goals: eat breakfast daily; prepare work meals in advance; record meals alongside glucose readings. REVIEW (19/07/2026) Breakfast now eaten 6 days/week; juice ceased; taking prepared lunches on day shifts. Home glucose log: fasting readings mostly 4.6-5.1 mmol/L; post-meal readings generally within maternity-team targets. Three raised readings occurred after unplanned overnight snacks from vending machine. Lena feels hungry at 03:00 and finds available choices unsuitable. Discussed portable snacks: wholegrain crackers with cheese, plain yoghurt, or nuts with fruit. Lena will trial packing two options per night shift. Weight: 74.2 kg; pre-pregnancy weight 70.8 kg. Plan: continue meal and glucose record; dietetic review in two weeks; contact maternity team if readings repeatedly exceed agreed targets.

Ms Naomi Kerr
Midwife
Bramble Maternity Centre
24 Orchard Way, Westbridge

21 July 2026

Dear Ms Kerr,

Re: Ms Lena Cole, DOB 09/11/1993

I am writing to update you on the progress of Ms Lena Cole, whom you referred on 30 June 2026, regarding the nutritional management of her gestational diabetes. She is now at 29 weeks' gestation, and no medication has been commenced.

Since her initial assessment on 4 July, Ms Cole has made several dietary changes. She now eats breakfast six days weekly, has stopped drinking fruit juice, and takes prepared lunches on day shifts. Her weight is 74.2 kg, compared with a pre-pregnancy weight of 70.8 kg.

Her home glucose log shows fasting readings mostly between 4.6 and 5.1 mmol/L, with post-meal readings generally within the maternity team's targets. However, three raised readings followed unplanned overnight snacks from a vending machine.

Ms Cole reports feeling hungry at approximately 03:00 during her overnight shifts and finds the available choices unsuitable. We discussed portable options, including wholegrain crackers with cheese, plain yoghurt, or nuts with fruit, and she will trial packing two per shift. She will continue recording her meals alongside glucose readings, and I will review her in two weeks. She has been advised to contact the maternity team should her readings repeatedly exceed the agreed targets.

Yours sincerely,

Dietitian

Today's date: 21 July 2026 Patient: Ms Nina Cole, 67, retired florist. Right-handed. Lives alone in ground-floor flat; sister visits on Sundays. Medical background: Bilateral hand osteoarthritis diagnosed 2022. Increasing thumb-base pain and morning stiffness for six months. Paracetamol as required. No recent falls. Referred to Elmbridge Outpatient Occupational Therapy by GP. Initial assessment, 24 June 2026: - Difficulty opening jars, ring-pull tins and milk bottles - Pain 6/10 during prolonged food preparation; grip weak, left worse than right - Independent with dressing, bathing, shopping and medication - Frequently skips cooked evening meal when hands are painful - Kitchen has good lighting; commonly used pans stored in low cupboard Interventions and trial outcomes: - Rubber jar grip alone: inconsistent success - Mounted jar opener: opened three jar sizes independently with minimal discomfort - Easy-grip bottle opener and ring-pull aid: effective after one demonstration - Lightweight saucepan: safely lifted when half-filled - Pacing plan: sit for chopping, prepare ingredients in short stages, alternate heavy and light tasks, rest before pain increases Review, 18 July 2026: Pain during meal preparation reduced to 3/10. Preparing hot evening meals five days weekly. Uses aids correctly but forgets planned rests when cooking for visitors. Declined meal-delivery information. Equipment supplied: mounted jar opener, bottle opener, ring-pull aid and lightweight saucepan. Transfer needs: Review equipment placement at home; reinforce pacing; assess low-cupboard access and consider storage reorganisation. Patient hopes to resume weekly batch cooking.

Ms Leila Morgan
Community Occupational Therapist
Harborview Community OT
18 Seaforth Avenue, Harborview, HV4 2PL

21 July 2026

Dear Ms Morgan,

Re: Ms Nina Cole, aged 67

I am writing to transfer the care of Ms Nina Cole, a 67-year-old woman with bilateral hand osteoarthritis, who has completed outpatient occupational therapy for kitchen difficulties.

Ms Cole lives alone in a ground-floor flat, with her sister visiting on Sundays. At initial assessment on 24 June 2026, she reported difficulty opening jars, ring-pull tins and milk bottles, with pain rated 6/10 during prolonged food preparation and grip weakness, worse on the left. She skipped cooked evening meals when her hands were painful. She remained independent with dressing, bathing, shopping and medication.

A mounted jar opener enabled her to open three jar sizes independently, and an easy-grip bottle opener and ring-pull aid were effective after one demonstration. She safely lifted a lightweight saucepan when half-filled. A pacing plan of seated chopping, staged preparation and alternating heavy and light tasks was introduced. At review on 18 July 2026, pain had reduced to 3/10 and she was preparing hot evening meals five days weekly.

I would be grateful if you could arrange a home visit to review equipment placement, reinforce pacing when she cooks for visitors, and assess low-cupboard access with storage reorganisation. Ms Cole hopes to resume weekly batch cooking.

Yours sincerely,

Occupational Therapist
Elmbridge Outpatient Occupational Therapy

Today's date: 21 July 2026 Patient: Mr Joel Moss, aged 21. University architecture student. Presenting concerns • Increasing blur in left eye over 12 months • Frequent spectacle adjustments • Reports glare and ghost images around lights at night Ocular examination • Unaided visual acuity: R 6/18, L 6/60 • Best corrected acuity: R 6/6, L 6/12 • Current refraction: R -1.25/-1.00 x 175; L -3.00/-4.25 x 20 • Previous refraction (August 2025): R -1.00/-0.75 x 180; L -2.25/-2.75 x 15 • Retinoscopy: clear reflex R; scissoring reflex L • Keratometry: R 43.50/44.50 D; L 45.25/49.75 D, irregular mires • Corneal topography: asymmetric inferior steepening L; mild inferior asymmetry R • Central corneal thickness: R 505 µm, L 462 µm • Slit-lamp examination: subtle inferior corneal thinning L; no scarring or oedema; anterior chambers quiet • Intraocular pressure: R 14 mmHg, L 13 mmHg • Dilated fundus examination normal both eyes Relevant history • Seasonal allergic conjunctivitis; rubs eyes frequently during spring • No regular medicines; no known drug allergies • Maternal cousin reportedly wears rigid contact lenses for an unspecified corneal condition Assessment and plan • Findings raise suspicion of keratoconus, more marked in left eye • Explained need to avoid eye rubbing • Refer for corneal assessment, diagnostic confirmation and management advice

Dr Evelyn Hart
Consultant Ophthalmologist
Wycliff Corneal Centre
18 Linden Avenue, Westbridge

21 July 2026

Dear Dr Hart,

Re: Mr Joel Moss, aged 21

I am referring Mr Moss, a 21-year-old man, for corneal assessment and diagnostic confirmation of suspected keratoconus, which appears more advanced in the left eye.

Over the past twelve months, he has reported increasing blur in the left eye, frequent spectacle adjustments, and glare with ghost images around lights at night. His refraction has progressed, with left cylinder increasing from -2.75 x 15 in August 2025 to -4.25 x 20 currently.

Unaided visual acuity is R 6/18 and L 6/60, with best corrected acuity of R 6/6 and L 6/12. Retinoscopy showed a scissoring reflex in the left eye. Keratometry recorded L 45.25/49.75 D with irregular mires, and topography demonstrated asymmetric inferior steepening on the left. Central corneal thickness measured 505 µm right and 462 µm left, and slit-lamp examination revealed subtle inferior corneal thinning on the left, without scarring or oedema.

I have advised him to avoid eye rubbing, which is relevant given his seasonal allergic conjunctivitis and a family history of a corneal condition. Intraocular pressures and dilated fundus examination were normal. I would be grateful if you could confirm the diagnosis and advise on appropriate management.

Yours sincerely,

Optometrist

Today's date: 21 July 2026 Patient: Mira Lane, aged 8; Year 3 pupil. Lives with parents and younger brother. Background: - Referred by school SENCO on 4 June 2026 due to difficulty understanding spoken instructions and learning new vocabulary - Hearing screening normal, May 2026 - Enjoys science, drawing and cooperative games; confident when discussing familiar topics Speech and language assessment (12 July 2026): - Receptive language below age expectations, particularly multi-step directions and time/order concepts - Needs extra processing time before responding - Expressive language: clear speech; uses well-formed simple sentences but has limited descriptive vocabulary - Narrative: recalls main events when pictures are provided; may omit sequence words and supporting details - Findings consistent with developmental language disorder Parent discussion (15 July 2026): - Parents report homework takes longer when instructions are lengthy - Mira responds well to written checklists and enjoys reading comics - Family planning seaside holiday in August Trial classroom strategies (16-20 July 2026): - Teacher used short instructions, one or two steps at a time, and asked Mira to repeat key points - Visual timetable and illustrated vocabulary cards introduced - Mira completed tasks more independently and contributed during group science work Plan: - Continue weekly speech pathology sessions for eight weeks - Pre-teach key topic vocabulary using pictures, definitions and examples - Allow five seconds' processing time; check understanding privately - Review with school and parents on 30 September 2026

Ms Eliza Hart
Year 3 Teacher
Cedar Primary School
14 Rowan Avenue, Westbridge

21 July 2026

Dear Ms Hart,

Re: Mira Lane, aged 8

I am writing to update you on the communication needs of Mira Lane, a Year 3 pupil in your class, and to share a classroom support plan following her recent speech and language assessment.

Assessment on 12 July 2026 showed that Mira's understanding of spoken language is below age expectations, particularly with multi-step directions and time or order concepts, and she needs extra time to process before responding. Her speech is clear and she uses well-formed simple sentences, although her descriptive vocabulary is limited. She is confident when discussing familiar topics and enjoys science, drawing and cooperative games. These findings are consistent with a developmental language disorder.

Recently, short instructions of one or two steps, asking Mira to repeat key points, a visual timetable and illustrated vocabulary cards have helped her. With this support she completed tasks more independently and contributed during group science work.

I recommend pre-teaching key topic vocabulary using pictures, definitions and examples, allowing about five seconds of processing time, and checking her understanding privately. Mira will attend weekly speech pathology sessions for eight weeks, and I would be grateful if we could review her progress together with her parents on 30 September 2026.

Yours sincerely,

Speech Pathologist

Today's date: 21 July 2026 Patient: Ms Mira Lane, 72-year-old retired librarian. Lives alone; daughter visits twice weekly. Referrer: Dr Joel Moss, General Practitioner Reason for imaging: - CT chest requested for persistent dry cough and reduced appetite for six weeks - No haemoptysis, fever or recent chest injury - Former smoker; stopped 18 years ago - Previous chest X-ray report available in imaging system Appointment: 20 July 2026, Briarfield Diagnostic Centre Pre-examination: - Identity and referral details confirmed - Patient ambulant and independent - Explained breath-hold instructions; practised successfully before positioning - No contrast requested - Patient anxious about results but agreed to proceed Examination: - Non-contrast CT chest performed supine - Initial acquisition completed - Sudden coughing during lower chest images despite repeat breath-hold coaching - One limited repeat acquisition attempted after rest and water - Cough recurred; no further repeats undertaken to avoid unnecessary radiation - Upper and mid-chest images technically satisfactory - Respiratory motion reduced image quality at both lung bases - Patient remained comfortable; no dizziness or breathlessness - Discharged independently after examination Actions and follow-up: - Technical limitation documented on imaging record - Images sent to reporting radiologist, Dr Leena Ford - No image interpretation discussed with patient - Patient advised report would go to referrer - Radiologist to determine whether available images are sufficient or whether alternative/further imaging is required - Patient prefers morning appointments; daughter can accompany her on Tuesdays

Dr Joel Moss
General Practitioner
Rowanbank Medical Practice
24 Linton Road, Westbridge WB3 7HT

21 July 2026

Dear Dr Moss,

Re: Ms Mira Lane, aged 72

I am writing to update you on the CT chest examination performed on Ms Lane on 20 July 2026, which you requested for her persistent dry cough and reduced appetite. The examination was completed, though image quality at the lung bases was limited.

Ms Lane attended Briarfield Diagnostic Centre for the examination. Breath-hold instructions were explained and practised successfully beforehand. A non-contrast CT chest was performed supine, and the initial acquisition was completed. However, sudden coughing during the lower chest images, despite repeated breath-hold coaching, reduced image quality at both lung bases.

After a period of rest and some water, one limited repeat acquisition was attempted. The cough recurred, so no further repeats were undertaken to avoid unnecessary radiation. The upper and mid-chest images were technically satisfactory. Ms Lane remained comfortable throughout, with no dizziness or breathlessness, and was discharged independently.

The technical limitation has been documented, and the images have been sent to the reporting radiologist, Dr Leena Ford. Ms Lane was advised that the report would be sent to you. I would be grateful if you could be guided by Dr Ford's assessment as to whether the available images are sufficient or whether further imaging is required.

Yours sincerely,

Radiographer

Today's date: 21 July 2026 Patient: Poppy, 6-year-old female (spayed) English Cocker Spaniel, 14.8 kg Owner: Ms Leila Morgan, 8 Bramble Close, Eastmere Background: - No known drug allergies - Eats commercial salmon-based dry food - Enjoys swimming weekly 12 February 2026: - Presented with head shaking and scratching both ears - Otoscopy: erythematous canals, moderate brown discharge; tympanic membranes visible and intact - Cytology: numerous Malassezia organisms, occasional cocci - Ears cleaned; prescribed miconazole/polymyxin B/prednisolone drops twice daily for 14 days - Clinical signs resolved by review on 28 February 19 April 2026: - Right-ear recurrence following swimming - Similar cytology; no foreign body detected - Same topical treatment for 14 days; advised ear drying after swimming - Good response, but mild canal thickening remained 30 June 2026: - Bilateral pruritus and odour recurred - Cytology: Malassezia and cocci; culture showed methicillin-sensitive Staphylococcus pseudintermedius - Treated with gentamicin/betamethasone/clotrimazole drops twice daily for 10 days Review, 18 July 2026: - Discharge reduced, but head shaking returned three days after treatment ended - Otoscopy: narrowed, inflamed canals; tympanic membranes not fully visualised - No skin lesions elsewhere; flea prevention current - Poppy bright and eating normally Reason for referral: - Recurrent bilateral otitis despite appropriate local therapy - Request dermatological assessment, investigation of underlying causes and long-term management plan - Owner willing to pursue allergy testing if recommended

Dr Imogen Farley
Veterinary Dermatologist
Alderbrook Veterinary Referral Centre
46 Hawthorn Avenue, Northbridge

21 July 2026

Dear Dr Farley,

Re: Poppy, English Cocker Spaniel, owner Ms Leila Morgan

I am referring Poppy, a 6-year-old spayed female English Cocker Spaniel, for specialist assessment and long-term management of recurrent bilateral otitis externa that has persisted despite appropriate topical therapy.

Poppy first presented on 12 February 2026 with head shaking and scratching of both ears. Otoscopy showed erythematous canals with moderate brown discharge, and intact tympanic membranes. Cytology revealed numerous Malassezia organisms and occasional cocci. She responded well to cleaning and miconazole/polymyxin B/prednisolone drops, with signs resolving by 28 February. A right-ear recurrence followed swimming on 19 April, again resolving with the same treatment, although mild canal thickening remained.

On 30 June, bilateral pruritus and odour recurred. Cytology showed Malassezia and cocci, and culture grew methicillin-sensitive Staphylococcus pseudintermedius. She was treated with gentamicin/betamethasone/clotrimazole drops. At review on 18 July, discharge had reduced, but head shaking returned three days after treatment ended. Otoscopy showed narrowed, inflamed canals with tympanic membranes not fully visualised. No other skin lesions were present, and flea prevention is current.

I would be grateful if you could investigate underlying causes and formulate a long-term management plan. The owner, Ms Leila Morgan, is willing to pursue allergy testing if recommended.

Yours sincerely,

Veterinarian
Eastmere Veterinary Practice

Today's date: 21 July 2026 Patient: Mr Alan Webb, 40-year-old delivery coordinator. Referrer: Dr Lena Hart, General Practitioner, Brookfield Health Clinic. Appointment: 21 July 2026, 09:30, Westmere Diagnostic Centre. Clinical indication: Intermittent right upper abdominal discomfort and nausea after rich meals for six weeks. No fever or jaundice reported. Preparation instructions: - Appointment letter advised fasting for six hours; clear water permitted - Mr Webb ate toast and yoghurt at 07:15 because he believed fasting applied only to blood tests - Misunderstanding discussed without blame; rebooking offered Examination: - Identity, referral and consent confirmed - Liver, kidneys, spleen and visualised pancreas assessed - Gallbladder contracted following recent food intake; lumen and wall not adequately demonstrated - Common bile duct partly seen and not visibly dilated - No focal liver abnormality identified - Mr Webb remained comfortable throughout Sonographer's actions: - Explained that eating stimulates gallbladder contraction, preventing reliable assessment for stones or wall changes - Technical limitation recorded on imaging system - No contrast or medication administered - Mr Webb returned to work Follow-up needs: - Repeat targeted gallbladder ultrasound with correct fasting preparation - Morning appointment preferred due to afternoon shifts - Provide verbal and written fasting instructions when rebooking - Current images available; formal report will note incomplete gallbladder assessment Other history: - Seasonal hay fever - Enjoys weekend cycling - No previous abdominal surgery

Dr Lena Hart
General Practitioner
Brookfield Health Clinic
24 Mariner Road, Westbridge

21 July 2026

Dear Dr Hart,

Re: Mr Alan Webb, aged 40

I am writing to update you on the abdominal ultrasound performed for Mr Alan Webb on 21 July 2026, following your referral for intermittent right upper abdominal discomfort and nausea after rich meals over six weeks. The gallbladder could not be adequately assessed, and a repeat examination is required.

The liver, kidneys, spleen and visualised pancreas were assessed. No focal liver abnormality was identified, and the common bile duct was partly seen and not dilated.

The gallbladder was contracted following recent food intake, so its lumen and wall could not be adequately demonstrated. Mr Webb had eaten toast and yoghurt at 07:15, having understood that fasting applied only to blood tests. As eating stimulates gallbladder contraction, reliable assessment for stones or wall changes was not possible. He remained comfortable throughout, and no contrast or medication was administered.

I would be grateful if you could arrange a repeat targeted gallbladder ultrasound with correct fasting preparation. A morning appointment is preferred, as Mr Webb works afternoon shifts, and clear verbal and written fasting instructions should be provided when rebooking. The current images are available, and the formal report will note the incomplete gallbladder assessment.

Yours sincerely,

Sonographer