Just a follow up letter regarding Mrs. Jane Smith who recently had a Colposcopy with me on 15/05/2023. Please find a summary of the results and management plan below. Referred for abnormal cervical screening test (CST) showing high-grade squamous intraepithelial lesion (HSIL). Colposcopy revealed an acetowhite lesion at 12 o'clock position extending into the endocervical canal; punch biopsies were taken from the lesion and endocervical curettage (ECC) was performed. Histopathology confirmed cervical intraepithelial neoplasia grade 3 (CIN3) in the punch biopsies and ECC. Management plan includes large loop excision of the transformation zone (LLETZ) scheduled for 30/06/2023 at City General Hospital. Please keep me updated regarding any new changes with her CST/CST co test results that may warrant an earlier review or follow up. Should you have any further concerns, please do not hesitate to contact me. I will keep you informed if Mrs. Smith returns with any issues.

Thank you for referring this 42-year-old lady, Zoe Adams, who works as a high school teacher. She is a non-smoker and drinks alcohol socially (2-3 glasses of wine per week). Family history significant for rheumatoid arthritis in her mother and osteoarthritis in her father. Summary: Zoe presents with a 6-month history of progressive joint pain and stiffness, primarily affecting her hands, wrists, and knees. Morning stiffness lasts approximately 2 hours. She reports fatigue and occasional low-grade fever. Previous treatment with over-the-counter NSAIDs provided minimal relief. Symptoms have begun to interfere with her daily activities and work performance. Examination reveals bilateral swelling and tenderness of the MCP and PIP joints of both hands. Wrists show reduced range of motion and synovial thickening. Knees demonstrate mild effusion bilaterally. No rheumatoid nodules observed. Cardiovascular and respiratory examinations unremarkable. Investigations: 15/05/2023: Blood tests show elevated inflammatory markers: CRP 28 mg/L, ESR 40 mm/hr. RF positive at 75 IU/mL, anti-CCP antibodies strongly positive at 120 U/mL. CBC reveals mild anemia with Hb 11.2 g/dL. Liver and kidney function tests within normal limits. 22/05/2023: X-rays of hands and wrists demonstrate early erosive changes in MCP joints bilaterally, consistent with early rheumatoid arthritis. Management: Working diagnosis is rheumatoid arthritis based on clinical presentation, positive serology, and radiographic findings. Differential diagnoses include psoriatic arthritis and systemic lupus erythematosus, but less likely given the absence of skin involvement and negative ANA. Initiating treatment with methotrexate 15 mg weekly, folic acid 5 mg daily (except on methotrexate day), and prednisolone 10 mg daily for 4 weeks, tapering by 2.5 mg every 2 weeks. Advised on potential side effects and importance of regular monitoring. Educated patient on RA course and importance of early aggressive treatment. Follow-up in 6 weeks to assess treatment response, monitor for side effects, and consider addition of hydroxychloroquine if inadequate improvement. Will repeat blood tests including CBC, liver function, and inflammatory markers prior to next visit.

It was great to see you today in clinic. Your ongoing progress with managing your chronic lower back pain is encouraging, and I'm pleased to see you've been diligent with your home exercises. Summary of Consultation: Today's session focused on assessing your current pain levels and mobility. You reported a decrease in pain intensity from 7/10 to 5/10 over the past two weeks. Range of motion tests showed improvement in lumbar flexion and extension. Diagnosis: Chronic lower back pain (lumbago) - persistent pain in the lower back region, likely due to muscle strain and poor posture. Management Plan: • Continue current medication regimen (Ibuprofen 400mg as needed) • Increase daily walking to 30 minutes, focusing on maintaining proper posture • Apply heat therapy to lower back for 15-20 minutes before bed • Schedule follow-up appointment with physiotherapist for hands-on treatment Home Exercise Program: 1. Cat-Cow Stretch: 2x10 repetitions, hold each position for 5 seconds 2. Pelvic Tilts: 3x15 repetitions 3. Supine Bridge: 3x10 repetitions, hold for 5 seconds at the top 4. Bird-Dog Exercise: 2x8 repetitions on each side, hold for 3 seconds Next Review: Your next appointment is scheduled for 4 weeks from today. We will reassess your pain levels, review your progress with the home exercise program, and adjust the management plan as necessary. Please let me know if any of the above causes any exacerbation of symptoms; it's always preferable that you get in touch as soon as possible so we can sort this out between appointments to maximise the benefit of each session. Kind regards,