| Course | PA 516 Comprehensive Clinical Module HEENT (Head, Ears, Eyes, Nose, Throat) |
|---|---|
| Week | 4 |
| Paper type | Fundoscopic exam limits write-up |
| Length | About 750 words, 6 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | Master of Physician Assistant Studies (MPAS) |
| Updated | October 2026 |
Free sample paper for PA 516 Week 4
Fundoscopic Examination Limits in an Undilated 3 mm Pupil: A Sharp Disc and a Red Reflex in Both Eyes for T.M., and the Diabetic Retina This View Could Not Clear
Student Name
Chamberlain University
PA 516: Comprehensive Clinical Module HEENT (Head, Ears, Eyes, Nose, Throat)
Instructor Name
Month Day, Year
Fundoscopic Examination Limits in an Undilated 3 mm Pupil: A Sharp Disc and a Red Reflex in Both Eyes for T.M., and the Diabetic Retina This View Could Not Clear
Conditions Are Findings
Visit: the same day as the tuning fork tests, as part of T.M.'s yearly diabetes review. Room: overhead lights off, window blind closed. Pupils: about 3 mm in both eyes in the dimmed room; no dilating drops were used because the clinic does not stock them and T.M. was driving afterward. Instrument: direct ophthalmoscope, examiner's correction set at minus 1, right eye examined with the examiner's right eye and left with the left. T.M. fixed on a light switch across the room.
Red Reflex First
Red reflex present and symmetric in both eyes at arm's length, with no dark spots or opacities moving across it. This is the one finding that covers the whole path of light from cornea to retina, so it is recorded before the narrower views.
The Disc in Parts
Right eye: margins sharp all the way around; color pink-orange; cup-to-disc ratio estimated at about 0.3. Left eye: margins sharp; color pink-orange; cup-to-disc ratio estimated at about 0.3. No swelling, no hemorrhages at the margins. The cup-to-disc figures are estimates from a small, undilated view and are given to one decimal place for that reason.
Vessels
Followed from the disc for about one disc diameter in each of the four directions in each eye. Arteries narrower than veins in the usual proportion. No nicking seen at the crossings within that range. No hemorrhages, no cotton wool spots and no new vessels seen in the parts reached.
Say Which Quadrants
The macula was glimpsed only briefly in each eye before T.M. looked toward the light and the pupil constricted. The periphery of the retina was not seen in any quadrant of either eye. In practical terms, the exam reached the disc and a ring of retina around it, perhaps a tenth of the fundus.
What This View Supports
It supports two statements: the red reflexes are present and equal, and the optic discs appear flat with sharp margins. The second matters in this case because T.M. has had headaches and a one-sided ear problem, and disc swelling would have raised a concern about pressure inside the skull. It does not support a statement that the retina is free of diabetic changes. Early diabetic retinopathy often appears as small hemorrhages and microaneurysms away from the disc, exactly where this exam did not reach. The diabetes standards recommend that adults with type 2 diabetes have a dilated eye examination or retinal photographs, read by an eye care professional or a validated program, at diagnosis and at intervals afterward (ElSayed et al., 2025). T.M.'s last dilated exam was more than two years ago, so a referral was placed for retinal photographs at the optometry office in town.
Why the Limits Are Written Down
A note that says "fundi normal" will be read by the next clinician, by an insurer and perhaps by a motor carrier's medical examiner as a full diabetic eye exam. Bickley et al. (2021) caution that a small undilated pupil limits the direct ophthalmoscope to the posterior pole. Writing the limits protects T.M. from a missed screening and protects the note from a claim it cannot support.
What Would Have Changed the Plan
Had the discs shown blurred margins or a loss of the small venous pulsations near them, the headaches would have become a more urgent question and the referral would have been to the emergency department or neurology the same day, not to optometry. Had the red reflex been dull or absent in one eye, the concern would have shifted to a cataract or a bleed in the eye, and the acuity test would have been read in that light. Had the clinic been able to dilate the pupils, the macula and the near periphery could have been examined, but even then a direct ophthalmoscope would not replace retinal photographs for a diabetic screen. None of these occurred, so the plan stayed at a routine referral with a date: retinal photographs within four weeks, booked the same day as the visit.
References
Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bates' guide to physical examination and history taking (13th ed.). Wolters Kluwer.
ElSayed, N. A., McCoy, R. G., Aleppo, G., Balapattabi, K., Beverly, E. A., Briggs Early, K., Bruemmer, D., Callaghan, B. C., Echouffo-Tcheugui, J. B., Ekhlaspour, L., Frykberg, R. G., Garg, R., Garg, S. J., Giurini, J. M., Khunti, K., Lal, R., Lingvay, I., Matfin, G., Pandya, N., . . . Bannuru, R. R. (2025). 12. Retinopathy, neuropathy, and foot care: Standards of care in diabetes-2025. Diabetes Care, 48(Suppl. 1), S252-S265. https://doi.org/10.2337/dc25-S012
The Chamberlain PA 516 Week 4 instructions
The fourth week asks you to document a fundoscopic exam with its limits made explicit. List the conditions first: room light, pupil size, whether drops were used, which eye was examined with which of your eyes and the lens setting. Record the red reflex before anything else. Describe the optic disc in parts, margins, color and cup-to-disc ratio, and present the ratio as an estimate. Report the vessels and how far you followed them. Then say which parts of the retina you reached and which you did not, quadrant by quadrant if possible. Explain what the view supports and what it does not, especially for any screening purpose such as diabetes. Close with what would have changed the plan and the referral or test that fills the gap.
Inside the PA 516 Week 4 example
The write-up begins with a darkened room, 3 mm pupils, no drops because T.M. had to drive and a direct ophthalmoscope set at minus 1. Equal red reflexes are recorded first. Each disc is described with sharp margins, pink-orange color and an estimated ratio of 0.3. Vessels are followed one disc diameter in four directions with no nicking or hemorrhages. A quadrant section admits only a brief glimpse of the macula and no periphery, roughly a tenth of the fundus. The supports section says the discs are flat, which matters given T.M.'s headaches, but not that diabetic changes are absent, and cites the ADA standards for dilated exams or retinal photographs. Further sections explain who could misread a bare normal and which findings would have triggered a same-day referral.
Reading the PA 516 Week 4 grading rubric
Most marks on this write-up follow how honestly the limits are recorded. A clean sweep describing disc, vessels, macula and periphery through a small undilated pupil is read as a copied normal and loses the largest share. Missing conditions at the top cost the next most, because a grader cannot judge the findings without knowing the pupil size and lighting. Credit goes to a red reflex recorded first and a disc described in parts with an estimated ratio. Faculty deduct when a normal disc is treated as a normal eye or when a limited view is used to clear a diabetic screen. The plan section is graded on whether the referral matches the gap, and references should include a current diabetes or ophthalmology standard.
PA 516 Week 4 help from the desk
The most common mistake in this assignment is describing a complete fundus that a small pupil could never have shown. If you send your exam conditions, findings and the reason for the exam, the custom sample will write the conditions first, record the red reflex and disc in parts and then state exactly which areas were not seen. Where your case involves diabetes, hypertension or headache, the sample explains what the limited view can and cannot answer for that problem. It adds a referral or follow-up test that fits the gap and cites the standard your course uses. If you examined only one eye, the sample shows how to record that. Use the model to check structure and wording, and keep your own findings as the source for anything you hand in.
Get a PA-516 Week 4 example written to your instructions
Send the Week 4 instructions along with any case images or findings your section issues, and a custom PA-516 fundoscopic write-up is returned inside 24 to 48 hours, the first one free. Tell us whether your classroom expects a labeled drawing alongside the description, since some sections give that its own row.
More PA 516 papers and MPAS samples
- PA 516 Week 1: Hidden Eardrum Discussion Post
- PA 516 Week 2: Tympanic Membrane Documentation
- PA 516 Week 3: Tuning Fork Interpretation
- PA 516 Week 5: Visual Acuity Documentation
- PA 516 Week 6: Referred Pain Mapping
- PA 516 Week 7: Sinus Imaging Rationale
- PA 516 Week 8: ENT Referral Letter
- PA 514 Week 4: Empiric Coverage Rationale
- PA 512 Week 4: Anemia Indices Worksheet
- PA 510 Week 4: Clinical Photograph Critique
- PA 505 Week 4: Criteria Application Exercise
PA 516 Week 4 questions, answered
Is it a problem that the pupil was not dilated?
Not for the assignment, which is generally written around that restriction on purpose. The graded move is recording the restriction and then holding every later claim inside it. What does cost points is a description reading as though a wide view had been obtained, since the conditions line and the findings then contradict each other and a grader only has to compare two paragraphs.
How precise should the cup-to-disc estimate be?
A fraction in ordinary steps, given as an estimate and labeled as one. Finished examples write it that way because a handheld view through a small pupil does not support more precision, and a figure carrying two decimals tells a grader the number came from somewhere other than the examination. Where a section supplies images, the estimate is read off those instead.
What belongs in the impression?
One or two sentences at most, tied to the structures actually described. In the finished versions the impression names what the visible portion is consistent with and states that the unexamined portion remains unaddressed. An impression covering the whole eye after a partial view is the pairing faculty mark down, because the document then claims more than its own conditions line allows.
Where can I find a free PA 516 Week 4 sample paper?
The full PA 516 Week 4 fundoscopic limits write-up is on this page, recording an undilated view of both discs and the retina it could not reach.
Why does the PA 516 Week 4 sample refuse to call the retina normal?
Through 3 mm undilated pupils only the discs and a small ring around them were seen, and diabetic changes often appear farther out, so retinal photographs were ordered.