| Course | PA 503 Essential Foundations in Clinical Medicine |
|---|---|
| Week | 6 |
| Paper type | Assessment and plan draft |
| Length | About 950 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | Master of Physician Assistant Studies (MPAS) |
| Updated | October 2026 |
Free sample paper for PA 503 Week 6
Assessment and Plan Draft: Coughed-Up Blood in a Former Heavy Smoker of 58 With a Normal Chest Radiograph, Where Bronchitis Leads but Cancer Is Not Excluded
Student Name
Chamberlain University
PA 503: Essential Foundations in Clinical Medicine
Instructor Name
Month Day, Year
Assessment and Plan Draft: Coughed-Up Blood in a Former Heavy Smoker of 58 With a Normal Chest Radiograph, Where Bronchitis Leads but Cancer Is Not Excluded
Summary Line
A 58-year-old former heavy smoker, about 36 pack-years, quit six years ago, with three weeks of streaked hemoptysis that began with an upper respiratory infection, no fever, weight loss or dyspnea, a normal examination apart from rhonchi that clear with coughing and a normal chest radiograph today.
Assessment
Leading diagnosis: acute bronchitis with airway bleeding. The history supports it: the cough and blood streaking began with a cold, the volume is small, there is no fever and the only examination finding is rhonchi that clear with coughing, consistent with airway secretions. The chest radiograph shows no consolidation, effusion or mass. Acute respiratory infections are among the most common causes of hemoptysis in adults (Earwood & Thompson, 2015).
Against it: three weeks is at the outer edge of an uncomplicated bronchitis, and the patient's age and smoking history raise the probability of malignancy beyond that of most adults with this complaint.
Alternatives and what would close them. Pneumonia is unlikely without fever, focal findings or radiographic consolidation; the normal radiograph largely closes it. Pulmonary embolism is unlikely without breathlessness, pleuritic pain, tachycardia or low oxygen saturation; no further testing is needed unless those appear. Bronchiectasis is unlikely without a history of daily sputum production over years; computed tomography, if done, would also show it. Pseudohemoptysis from the nose or gut was excluded by history and a normal nose and throat examination. Tuberculosis is unlikely without risk factors such as recent travel, homelessness or known exposure, and the radiograph shows no upper-lobe disease.
Must not miss: lung cancer. A normal chest radiograph does not exclude it. In symptomatic patients, chest radiography detected only about 77% to 80% of lung cancers in the best primary care studies (Bradley et al., 2019), and in a primary care cohort about 7.5% of men with a first episode of hemoptysis were diagnosed with respiratory tract cancer within three years (Jones et al., 2007). After a normal radiograph, the patient's probability of cancer remains roughly 2% or higher, which is too high to stop.
Plan
1. Computed tomography of the chest with contrast, ordered today, to look for a lesion the radiograph missed, because risk factors for malignancy warrant further imaging despite a normal radiograph (Earwood & Thompson, 2015). Parent: the must-not-miss diagnosis.
2. Complete blood count and coagulation studies. Parent: the volume and persistence of bleeding, and the need to exclude a bleeding tendency before any procedure.
3. If the computed tomography shows a mass, nodule or suspicious airway finding, referral to pulmonology for bronchoscopy within two weeks. Parent: the must-not-miss diagnosis.
4. If the computed tomography is normal, return in four weeks; if hemoptysis persists or recurs, referral to pulmonology for bronchoscopy, since central airway tumors can be missed on imaging. Parent: the leading diagnosis, which should have resolved by then.
5. Lung cancer screening eligibility. At 58, with roughly 36 pack-years and six years since the last cigarette, the patient also meets the criteria for annual low-dose computed tomography screening (Krist et al., 2021); if today's scan is normal, annual screening should begin next year. Parent: long-term risk.
6. Return precautions: seek same-day care for more than a few teaspoons of blood, breathlessness, chest pain or fever. Parent: the alternatives that would change the plan.
What I Would Tell the Patient
"Your X-ray looks normal, and the most likely cause is the irritation left by your cold. Because you smoked for many years, an X-ray isn't enough to be sure there's nothing else, so I'd like you to have a CT scan this week. Most scans like this are normal, but it's the right next step, and I'll call you with the result as soon as I have it. If the bleeding gets heavier or you feel short of breath before then, come in the same day."
Why Not Simply Wait and See
A reasonable alternative plan would treat the hemoptysis as bronchitis, ask the patient to return in two to four weeks and order computed tomography only if it persisted. That plan saves a scan, radiation and cost for the many patients whose bleeding resolves. It was not chosen here for three reasons. The bleeding has already lasted three weeks. The patient's risk, as a former heavy smoker aged 58, is well above that of the average adult with hemoptysis. And the radiograph, which might have justified waiting if it were a highly sensitive test, misses about one in five lung cancers in symptomatic patients. If the patient were 35 and had never smoked, waiting would be the better plan.
Findings That Would Redirect the Plan
Some findings would send the plan in another direction. Hemoptysis of more than a small volume, breathlessness or a fall in oxygen saturation would call for same-day emergency evaluation. A fever with new focal crackles would raise pneumonia and call for a repeat examination and possibly antibiotics. A platelet count or clotting result outside the normal range would need to be investigated before any biopsy. And a computed tomography finding of a small, smooth nodule rather than a mass would lead to a nodule follow-up schedule rather than immediate referral. Each of these possibilities is written into the return precautions so the patient knows which changes should bring them back sooner.
References
Bradley, S. H., Abraham, S., Callister, M. E., Grice, A., Hamilton, W. T., Lopez, R. R., Shinkins, B., & Neal, R. D. (2019). Sensitivity of chest X-ray for detecting lung cancer in people presenting with symptoms: A systematic review. British Journal of General Practice, 69(689), e827-e835. https://doi.org/10.3399/bjgp19X706853
Earwood, J. S., & Thompson, T. D. (2015). Hemoptysis: Evaluation and management. American Family Physician, 91(4), 243-249.
Jones, R., Latinovic, R., Charlton, J., & Gulliford, M. C. (2007). Alarm symptoms in early diagnosis of cancer in primary care: Cohort study using General Practice Research Database. BMJ, 334(7602), 1040. https://doi.org/10.1136/bmj.39171.637106.AE
Krist, A. H., Davidson, K. W., Mangione, C. M., Barry, M. J., Cabana, M., Caughey, A. B., Davis, E. M., Donahue, K. E., Doubeni, C. A., Kubik, M., Landefeld, C. S., Li, L., Ogedegbe, G., Owens, D. K., Pbert, L., Silverstein, M., Stevermer, J., Tseng, C.-W., & Wong, J. B. (2021). Screening for lung cancer: US Preventive Services Task Force recommendation statement. JAMA, 325(10), 962-970. https://doi.org/10.1001/jama.2021.1117
What the PA 503 Week 6 assignment asks for
Week six asks you to draft the assessment and plan for a case. Open the assessment with a compressed summary line. Name a leading diagnosis and argue for it using findings from the case, including those that argue against it. Address the main alternatives and what closes or keeps each open. State the must-not-miss diagnosis and how the plan addresses it. In the plan, give each test or action a parent: the part of the assessment it answers. Include follow-up and return precautions. Explain any reasonable alternative plan you did not choose. Keep the assessment longer than the plan, since the reasoning is what is being graded, and avoid listing every finding without weighing it.
Inside the PA 503 Week 6 example
The summary line captures the course's patient, three weeks into streaked hemoptysis after a cold, a normal examination apart from clearing rhonchi and a normal radiograph today. Bronchitis leads, supported by the history and examination, with the three-week duration and risk profile against it. Pneumonia, embolism, bronchiectasis, pseudohemoptysis and tuberculosis are each closed with a reason. Lung cancer is the must-not-miss diagnosis, kept open because radiography misses about a fifth of cancers. Six plan items each name a parent, from chest computed tomography to screening eligibility and return precautions. Sections explain why waiting was rejected and which findings would redirect the plan.
PA 503 Week 6 rubric: what full points look like
An assessment that carries findings it never uses is the common failure: everything from the case appears, nothing is weighed and the paragraph reads as copying. Almost as expensive is a plan with orphaned items, tests ordered with no line above that they would answer. Assessments that state a diagnosis without arguing against it, that omit the must-not-miss condition or that present the plan without follow-up also lose points. Strong drafts open with a summary line, argue the leading diagnosis both ways, close alternatives with reasons, name and address the must-not-miss diagnosis, give each plan item a parent and explain the alternative plan not chosen. A short script for the patient conversation is a useful finishing touch.
PA 503 Week 6 help: mistakes that cost points
Assessment and plan drafts reward reasoning more than completeness, and most students write too much plan and too little assessment. If you share the case, we can help you write a summary line, argue the leading diagnosis with evidence for and against and make sure each plan item answers something in the assessment. Deciding on the must-not-miss diagnosis, and making sure the plan addresses it, is a step we can reason through together. The plan and its reasoning are yours. Section-supplied headings are followed in the custom sample in the order given. We can also check that no plan item lacks a parent in the assessment.
Get a PA-503 Week 6 example written to your instructions
Send the case, the headings your section publishes and the weighting your rubric gives the two halves, and a custom example is written to them and returned inside 24 to 48 hours, the first one free. If a template file is supplied in your classroom, attach it, and the example arrives already built inside that file.
More PA 503 papers and MPAS samples
- PA 503 Week 1: First Question Post
- PA 503 Week 2: Illness Scripts
- PA 503 Week 3: Problem Representation
- PA 503 Week 4: Diagnostic Schema
- PA 503 Week 5: Test Characteristics Problem Set
- PA 503 Week 7: Verbal Case Summary
- PA 503 Week 8: Diagnostic Error Analysis
- PA 502 Week 6: Guideline Comparison
- PA 501 Week 6: Care Team Map
PA 503 Week 6 questions, answered
How should the two halves be balanced?
In most sections the assessment is the longer one, sometimes by a wide margin, which surprises people used to a plan-heavy format. The argument is what is being marked and the plan is its consequence. Send your section's headings and word limits and the example is balanced the way your own rubric weights them.
Does the draft need a full problem list?
Where a case carries several active problems, most sections want them listed and ranked, with the full argument written for the leading one and short entries for the rest. A single-problem case needs none of that apparatus. Send the case and the instructions together so the example handles the number your section expects.
Can the plan include things the course has not covered?
It can, and usually should where the assessment implies them, provided each item is tied to an uncertainty already on the page. Marks go missing when a plan is assembled from what sounds thorough rather than from what the argument requires. The example is written to the case in front of it, never to a checklist.
Where can I find a free PA 503 Week 6 sample paper?
You can read the full PA 503 Week 6 assessment and plan for hemoptysis with a normal chest radiograph on this page.
Why does the PA 503 Week 6 sample order computed tomography?
Because a normal radiograph misses about a fifth of lung cancers and the patient's risk as a former heavy smoker is too high to stop.