| Course | PA 504 Medical Interviewing and Documentation |
|---|---|
| Week | 4 |
| Paper type | Review of systems draft |
| Length | About 630 words, 4 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | Master of Physician Assistant Studies (MPAS) |
| Updated | October 2026 |
Free sample paper for PA 504 Week 4
Review of Systems Draft: What Was Asked and What Came Back for a 56-Year-Old With Exertional Chest Burning, With Scope Stated
Student Name
Chamberlain University
PA 504: Medical Interviewing and Documentation
Instructor Name
Month Day, Year
Review of Systems Draft: What Was Asked and What Came Back for a 56-Year-Old With Exertional Chest Burning, With Scope Stated
Scope
This review of systems was taken at the follow-up visit for the 56-year-old school custodian with six weeks of exertional chest burning, in Spanish through an in-person interpreter. It covers the systems relevant to the present complaint and to a first comprehensive visit, and it does not repeat what is already in the history of present illness. Every "denies" below records a question that was asked and answered no. Systems not asked about are listed as not reviewed rather than left to look normal.
The Review
Constitutional: Questions covered fever, shaking chills, sweating at night and any change in weight. None reported; weight is unchanged by the patient's estimate and by the clinic scale over the past year.
Eyes: Not reviewed.
Ears, nose, throat: Asked about sore throat and trouble swallowing. Denies both.
Cardiovascular: Asked about palpitations, leg swelling, waking at night short of breath and needing more pillows. Denies all four. Exertional chest burning described in the history of present illness.
Respiratory: Asked about cough, wheeze and coughing up blood. Denies all three. Shortness of breath only with the chest burning.
Gastrointestinal: Asked about burning after meals, sour taste in the mouth, trouble swallowing, nausea, vomiting, black stools and abdominal pain. Denies all; reports none of these with or without the chest burning.
Genitourinary: Asked about urinary symptoms. Denies.
Musculoskeletal: Reports bilateral knee pain at work for about a year, worse on stairs. Denies joint swelling or redness.
Neurologic: Asked about fainting, near-fainting, weakness on one side and numbness. Denies all.
Psychiatric: Asked about mood and sleep. Reports worry about the chest symptoms and about missing work; sleeping well.
Endocrine: Asked about increased thirst and urination. Denies.
Hematologic: Not reviewed.
Skin: Not reviewed.
Notes on the Choices
Denies means you asked. Each negative is written as a question asked and answered, such as "asked about black stools; denies." A templated list of negatives that were never asked would put words in the patient's mouth, a serious documentation error.
Symptoms, not conditions. Entries name symptoms, such as "burning after meals," rather than conditions such as "no reflux," because the patient can report a symptom but not a diagnosis.
The history is not repeated. The exertional burning is pointed to rather than restated. Repeating it here would invite two versions to drift apart.
Scope, stated. Eyes, hematologic and skin were not reviewed, and the note says so. A blank would read as normal; "not reviewed" tells the next clinician exactly what is unknown.
Positives beside negatives. The gastrointestinal entry matters as much for what it rules out as for what it finds: no burning after meals, no sour taste and no black stools, alongside a failed antacid, argue against reflux as the cause of the chest symptoms.
An order that never moves. Systems appear in the same order in every note so a reader can find any system in the same place.
What This Adds
The review adds evidence against the alternative explanation the intake form assumed, acid reflux, and finds no symptoms of heart failure or arrhythmia. It also records knee pain on stairs, which matters for any exercise stress test, since a patient who cannot walk on a treadmill may need a different kind of test. Many women with heart disease do not describe classic chest pain (Canto et al., 2012), so a careful negative review of digestive symptoms helps a reader weigh the chest burning correctly.
References
Canto, J. G., Rogers, W. J., Goldberg, R. J., Peterson, E. D., Wenger, N. K., Vaccarino, V., Kiefe, C. I., Frederick, P. D., Sopko, G., & Zheng, Z.-J. (2012). Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality. JAMA, 307(8), 813-822. https://doi.org/10.1001/jama.2012.199
Reading the PA 504 Week 4 instructions
The fourth week asks for a review of systems drawn from an encounter, written so that every entry reflects a question actually asked. State the scope first: which systems were covered and why, and that the history of present illness is not repeated. Then go system by system in a fixed order. Write each negative as what was asked and what the patient said, and name symptoms rather than conditions, since a patient can report a symptom but not a diagnosis. Mark any system not asked about as not reviewed instead of leaving it blank or calling it negative. Include positives that sit outside the main complaint. After the review, explain the choices behind how entries are worded and what the review adds to the reasoning about the patient, using a source where one helps.
How the PA 504 Week 4 example is put together
The scope paragraph places the review at the follow-up visit, in Spanish through a staff interpreter, and says the chest burning is covered in the history and only pointed to here. Thirteen systems follow in a set order. The constitutional entry lists the questions on fever, chills, sweating at night and weight; the cardiovascular entry asks about palpitations, swollen legs, waking breathless and extra pillows; the digestive entry asks about burning after meals, a sour taste, trouble swallowing, nausea and black stools, all answered no. Knee pain on stairs for a year is recorded. Eyes, blood and skin are listed as not reviewed. The notes explain that a "denies" means a question was asked, that symptoms are named instead of conditions and that a stated scope tells the next clinician what is unknown. The closing section shows how the digestive negatives argue against reflux and why the knees matter for choosing a stress test.
Where the points sit in the PA 504 Week 4 rubric
The largest share of points is lost to a templated block, "negative times twelve systems," or to a list of negatives that the encounter never asked about; markers treat that as words put in the patient's mouth. Nearly as costly is a review that repeats the history of present illness at length, which creates two versions that can drift apart. Other deductions come from conditions written in place of symptoms, from blank systems that read as normal, from an order that changes partway down and from positives buried or left out because they do not fit the main complaint. Full credit goes to a stated scope, a fixed order, negatives written as asked, "not reviewed" where nothing was asked and positives recorded wherever they fall. The explanation earns its points by showing what the review adds to the reasoning, such as evidence against the explanation first assumed.
Common PA 504 Week 4 mistakes, and how to avoid them
The review of systems looks simple, which is why templated versions are so common and so heavily marked down. If you share the encounter material your instructor gave, we can help you separate what was actually asked from what a template would assume, and write each entry as a question and its answer. We can also help decide which systems the visit really covered and how to say plainly that others were not reviewed. Showing what the review contributes to the reasoning, rather than listing it, is the part students most often leave out, and we can help you write that closing paragraph around your own case. The clinical content remains yours. If your program uses a particular system order or format, the custom sample follows it exactly.
Get a PA-504 Week 4 example written to your instructions
Send the assignment, the rubric and the systems list your program uses, and a custom PA-504 Week 4 review of systems draft comes back written to it inside 24-48h, the first one free. If your program states a required number of systems or a fixed order, say so and the draft is built to that count.
More PA 504 papers and MPAS samples
- PA 504 Week 1: Interview-Only Fact Post
- PA 504 Week 2: Encounter Opening Script
- PA 504 Week 3: HPI Draft
- PA 504 Week 5: Interpreted Encounter Analysis
- PA 504 Week 6: Collateral History Brief
- PA 504 Week 7: Note Revision Exercise
- PA 504 Week 8: Consultant Letter
- PA 503 Week 4: Diagnostic Schema
- PA 502 Week 4: Surrogate Outcome Critique
- PA 501 Week 4: Role Delineation Memo
PA 504 Week 4 questions, answered
How many systems does the draft have to cover?
Whatever your assignment sets, and the counts published by programs differ considerably. Where nothing is stated, a review scoped to the complaint and the systems next to it is defensible and easier to defend than a full sweep nobody asked for. Say in the scope note which ones you covered, so a marker can see the choice was made rather than missed.
Can a system be left out?
Yes, and doing it openly costs nothing. Write that a system was not reviewed and give the reason in a clause. What loses points is a blank space, because a reader cannot distinguish a deliberate limit from a forgotten one, and an entry invented to fill the space is worse than either.
What if the material shows only a handful of systems being asked about?
Then the draft carries those and marks the rest as not covered. Building a full review out of a short encounter is the single defect this assignment exists to catch, and the version reporting a narrow review honestly usually scores above the one that looks complete. Note the limit and move on.
Where can I find a free PA 504 Week 4 sample paper?
The complete PA 504 Week 4 review of systems for exertional chest burning, with every negative written as a question asked, is on this page.
Why does the PA 504 Week 4 sample list some systems as not reviewed?
Because a blank would read as normal, while "not reviewed" tells the next clinician exactly what is still unknown about the patient.