| Course | PA 510 Comprehensive Clinical Module Dermatology |
|---|---|
| Week | 7 |
| Paper type | Biopsy site justification |
| Length | About 870 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 510 Week 7
Biopsy Site Justification: Which Papule to Punch When the Question Is Lichen Planus Versus a Reaction to Hydrochlorothiazide, and Why Not the Shin Plaque
Student Name
Chamberlain University
PA 510: Comprehensive Clinical Module Dermatology
Instructor Name
Month Day, Year
Biopsy Site Justification: Which Papule to Punch When the Question Is Lichen Planus Versus a Reaction to Hydrochlorothiazide, and Why Not the Shin Plaque
The Question the Sample Must Answer
Is D.O.'s eruption idiopathic lichen planus, or a lichenoid reaction to hydrochlorothiazide, started for blood pressure about four months before the rash appeared? The answer matters because a drug reaction usually resolves after the drug is stopped, often slowly, while lichen planus does not depend on the drug. Clinically, the two can look nearly identical; histology can sometimes help, since lichenoid drug eruptions may show features such as eosinophils or parakeratosis that are less typical of idiopathic disease (Halevy & Shai, 1993). The biopsy will not always settle the question, but it should be taken so that it has the best chance.
Which Lesion, and Why Not the Others
Chosen: a fully developed, unscratched papule on the left flexor forearm, about 8 centimeters above the wrist, 4 millimeters across, with the flat top and fine surface lines seen elsewhere.
Not the shin plaques. They are the largest lesions, but thick, long-standing plaques on the shins can show marked thickening of the epidermis that complicates interpretation, and the lower leg heals slowly. Not the scratched papules, because excoriation adds injury changes that obscure the pattern. Not the linear group along the old scratch, because those lesions are newer and may not be fully developed. Not the mouth, because the question can be answered from skin, and an oral biopsy is less comfortable. Not the wrist crease itself, where tendons and nerves sit close to the surface.
Which Part of It
The center of the papule, which shows the established pattern. An inflammatory eruption like this one is sampled in a developed lesion rather than at an edge, unlike a lesion where the border with normal skin is the question.
Depth Follows the Question
A 4-millimeter punch biopsy, taken through the full dermis into the fat. The question depends on the pattern of inflammation along the junction between the epidermis and dermis and in the upper dermis, and on cells such as eosinophils deeper in the dermis. A shave biopsy would remove the top and might miss the deeper features. A punch includes the full depth and leaves a small wound that can be closed with one stitch.
The Words That Travel With the Sample
Requisition description, as it will be sent: "Skin, left flexor forearm, 4 mm punch. Flat-topped, polygonal, violet-gray papules with fine white surface lines, on flexor wrists and forearms, shins (with thick scaled plaques), lower back; lacy white network on both buccal mucosae; linear lesions along a scratch on the left forearm. Severe itch. Onset six weeks ago. Hydrochlorothiazide started about four months ago; no other new medicines. Question: lichen planus versus lichenoid drug eruption. Please comment on eosinophils and parakeratosis."
The requisition describes findings and states the question. It does not write "lichen planus" as the clinical diagnosis, which would hand the reader a conclusion instead of the evidence.
The Medicine History Behind the Question
The question is only as good as the medication history behind it. D.O. was asked to bring every bottle from home, and the list was checked against the pharmacy record: hydrochlorothiazide 25 milligrams each morning since four months ago, a daily low-dose aspirin started by D.O. without a prescription, and ibuprofen a few times a month for back pain. No other new medicines, supplements or injections were reported. Hydrochlorothiazide is the medicine most clearly timed with the eruption and is among the drugs reported to cause lichenoid reactions (Halevy & Shai, 1993), so it is named on the requisition; the others are listed so the pathologist has the whole picture.
Consent and Aftercare, in Brief
The biopsy was explained to D.O. in plain words: a small round sample about the width of a pencil eraser, numbing medicine first, one stitch, a small scar that may be lighter or darker than the surrounding skin. The risk of a raised or thickened scar on darker skin was raised specifically, and D.O. accepted it for a forearm site. D.O. asked whether the result would say which treatment to use; the answer given was that it would help answer whether the medicine was the cause, which would guide the next step. Wound care and the date for stitch removal were given in writing.
What It Will Not Settle
Histology may be typical of either condition, and in that case the answer will come from what happens after the drug is stopped: an improvement over weeks to months supports a drug reaction (Halevy & Shai, 1993). The plan for stopping hydrochlorothiazide and choosing another blood pressure medicine is being made with the supervising PA and is recorded in the visit note. Lichen planus has also been associated with hepatitis C infection in some populations (Le Cleach & Chosidow, 2012); a screening test is ordered separately and is not a reason for the biopsy.
References
Halevy, S., & Shai, A. (1993). Lichenoid drug eruptions. Journal of the American Academy of Dermatology, 29(2), 249-255. https://doi.org/10.1016/0190-9622(93)70176-T
Le Cleach, L., & Chosidow, O. (2012). Lichen planus. New England Journal of Medicine, 366(8), 723-732. https://doi.org/10.1056/NEJMcp1103641
PA 510 Week 7 instructions, in plain terms
The seventh week asks you to justify a biopsy decision in writing. State the clinical question the specimen must answer before anything else. Choose a lesion from those available and defend it, explaining why each of the others was passed over. Say which part of the lesion you would sample, edge, center or untouched area, and why. Choose a technique and depth that follow from the question, such as a punch for features deep in the dermis, rather than from habit. Write the description that will travel with the specimen, giving findings and the question rather than a condition name. Mention consent points that matter for this patient. Close by saying what the biopsy will not settle and which other step will. Support your reasoning with sources.
How this PA 510 Week 7 example is built
The justification frames the question as idiopathic lichen planus against a lichenoid reaction to hydrochlorothiazide started four months before the rash, and cites a review describing histologic features that may favor a drug cause. It chooses a fully developed, unscratched papule on the left flexor forearm and gives a reason for passing over the shin plaques, the scratched papules, the newer linear group along the old scratch, the mouth and the wrist crease. The center of the papule is chosen because the established pattern is the question. A 4-millimeter punch into fat is tied to the inflammation along the junction and to eosinophils deeper in the dermis. A section checks the full medicine list against the pharmacy record. The requisition text is quoted in full, with findings and the question. Consent covers scarring risk on darker skin, and the close names the drug withdrawal course and a separate hepatitis C screen.
PA 510 Week 7 rubric: what full points look like
Naming a technique and never tying it back to the question loses the largest share here, because the depth then rests on preference. Choosing a lesion with no sentence about those passed over gives up the comparison rows. The specimen description reduced to a condition name is the point markers comment on most, since it hands the pathologist a conclusion instead of findings. Further deductions follow for a justification that repeats the full history, for a site chosen without regard to healing or anatomy, for no mention of what the biopsy cannot answer and for missing consent points that matter for the patient, such as scarring on darker skin. Strong justifications state the question first, compare candidate lesions, choose the part and depth to fit the question, write a requisition that describes and asks, and say which other step will settle what histology cannot.
PA 510 Week 7 help from the desk
Biopsy justifications are short but tightly argued, and most drafts name a technique without connecting it to a question. Bring your case and we will work out with you the question the specimen must answer, compare the candidate lesions and explain why each was or was not chosen. We can also help you tie the technique and depth to the features the pathologist needs, and write a requisition that describes findings and asks a clear question. Many drafts never say what the biopsy cannot settle; that last section, built on your own case, is one we can shape together. The decision and its reasoning are yours. If your assignment asks for a diagram of the site or a set requisition form, the custom sample includes both with the prose carrying the reasoning.
Get a PA-510 Week 7 example written to your instructions
Send the case your section supplied, the rubric, and the diagram or form if one is issued. A custom justification built to those fields returns inside 24-48h and the first request is free. Tell us which techniques your classroom has covered and the sample argues inside that range rather than outside it.
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PA 510 Week 7 questions, answered
Do we have to name a technique?
Most sections want one named and defended in the same passage. What carries the marks is the link between the depth a technique reaches and the thing the question needs to see, so the name by itself is worth very little. Where your instructions restrict the options, argue inside that set rather than proposing something the course has not covered.
The case already names a condition. Does that shorten the justification?
It changes the question rather than removing it. With a condition supplied, a specimen is usually being asked to confirm, to grade, or to establish margins, and the document says which of those it is doing. A justification treating a named condition as the end of the argument loses the reasoning rows that make up most of the rubric.
Our assignment wants a diagram of the site. Does the prose still carry the marks?
Usually the larger half of them. Diagrams fix a location and nothing else; the reasons live in the text, and markers read the two separately. Label the diagram so every mark on it matches a paragraph, then check that the prose stands alone, because a reader working from the words should arrive at the same site.
Where can I find a free PA 510 Week 7 sample paper?
This page holds the full PA 510 Week 7 biopsy site justification for lichen planus versus a hydrochlorothiazide reaction, with the requisition text quoted.
Why does the PA 510 Week 7 sample avoid the shin plaques?
Thick long-standing shin plaques can show epidermal changes that complicate reading the slide, and the lower leg heals slowly, so a forearm papule answers the question better.