| Course | PA 516 Comprehensive Clinical Module HEENT (Head, Ears, Eyes, Nose, Throat) |
|---|---|
| Week | 8 |
| Paper type | ENT referral letter |
| Length | About 720 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 516 Week 8
ENT Referral Letter Asking for a Look at T.M.'s Right Nasopharynx: Findings by Structure With Their Instrument, the Unvisualized List and Laterality on Every Line
Student Name
Chamberlain University
PA 516: Comprehensive Clinical Module HEENT (Head, Ears, Eyes, Nose, Throat)
Instructor Name
Month Day, Year
ENT Referral Letter Asking for a Look at T.M.'s Right Nasopharynx: Findings by Structure With Their Instrument, the Unvisualized List and Laterality on Every Line
Letter Heading
To: Otolaryngology clinic, regional medical center. From: PA student, rural family medicine clinic, under the supervising physician. Date: the day after the ear pain visit. Re: T.M., 54-year-old commercial truck driver. Urgent request for nasal endoscopy and examination of the right nasopharynx.
A Request for a Look
Thank you for seeing T.M. We are asking for an urgent look at the right nasopharynx because of a persistent right middle ear effusion in an adult, right-sided nasal stuffiness with blood-streaked mucus, referred right ear pain and a firm right upper neck node. We do not have an endoscope, and we have not ordered imaging, so that the choice of study can follow your examination.
Findings Carry Their Instrument
Right ear (otoscope with pneumatic bulb, after irrigation): drum intact, amber, retracted, with an air-fluid line and reduced mobility; unchanged across two visits three weeks apart.
Left ear (otoscope with pneumatic bulb): normal.
Hearing (512 Hz tuning fork): Weber to the right; on the right, bone conduction longer than air; on the left, air longer than bone. Audiometry and tympanometry booked, results not yet available.
Nose (otoscope with wide speculum, front third only): pale right inferior turbinate; no polyp, crusting or bleeding point seen.
Oropharynx (penlight with a wooden blade): both tonsils small and equal in size; no ulcer or mass.
Neck (palpation): one firm, painless node in the right upper jugular chain, roughly 15 mm across and fixed to the deeper tissue. No other nodes felt.
Cranial nerves (bedside exam): facial movement symmetric; tongue and palate move normally; voice clear.
The Unvisualized List
Not seen: the nasopharynx and both eustachian tube openings; the posterior two thirds of the nasal cavity; the tongue base, larynx and hypopharynx; the right middle ear contents behind the intact drum. These are the structures we are asking you to see.
Laterality Throughout
Every abnormal finding is on the right. The left ear and the left side of the neck are normal. The nasal findings are right-sided at the level we could reach.
Relevant History
Symptoms began about ten weeks ago with a head cold: right ear fullness, then right nasal stuffiness, then blood-streaked mucus twice in three weeks, then right ear pain for ten days. Type 2 diabetes managed with metformin; last A1C 7.2%. Former smoker, about twenty pack-years, stopped eight years ago. Born in the United States; no travel to southern China or Southeast Asia. No weight loss or night sweats reported. A one-sided effusion in an adult with a neck node is a recognized presentation of nasopharyngeal carcinoma, which is why we are asking for endoscopy rather than treating as sinusitis (Chen et al., 2019).
What a Second Look Would Settle
Endoscopy would settle whether there is a lesion at the right eustachian tube opening or elsewhere in the nasopharynx, and whether the larynx and hypopharynx are clear. If a lesion is seen, a biopsy would settle what it is, and you may wish to sample the neck node as well. If the nasopharynx is normal, we would welcome your advice on the effusion, including whether ventilation tubes are appropriate given T.M.'s driving schedule.
Contact
T.M. has been told why the referral is urgent and agreed to it. T.M. drives interstate routes and has asked for an appointment on a Monday or Friday if possible. Please send your findings to the clinic; we will continue to follow T.M.'s diabetes and the vision referral already in place. Earwax management followed the cerumen guideline (Schwartz et al., 2017).
Enclosures
Copies of the two ear examinations, the tuning fork results, the fundoscopy note and the acuity record are attached. The audiometry and tympanometry reports will be forwarded when they are available, probably before T.M. is seen. A medication list is attached: metformin 1,000 mg twice daily and atorvastatin 20 mg at night, with no blood thinners, which may matter if a biopsy is taken.
References
Chen, Y.-P., Chan, A. T. C., Le, Q.-T., Blanchard, P., Sun, Y., & Ma, J. (2019). Nasopharyngeal carcinoma. The Lancet, 394(10192), 64-80. https://doi.org/10.1016/S0140-6736(19)30956-0
Schwartz, S. R., Magit, A. E., Rosenfeld, R. M., Ballachanda, B. B., Hackell, J. M., Krouse, H. J., Lawlor, C. M., Lin, K., Parham, K., Stutz, D. R., Walsh, S., Woodson, E. A., Yanagisawa, K., & Cunningham, E. R. (2017). Clinical practice guideline (update): Earwax (cerumen impaction). Otolaryngology-Head and Neck Surgery, 156(1 Suppl.), S1-S29. https://doi.org/10.1177/0194599816671491
The Chamberlain PA 516 Week 8 instructions
The final week asks for a referral letter to an ear, nose and throat specialist. Address and date it, and put your request in the first lines so the reader knows what you want before the details. Arrange findings by structure rather than in narrative paragraphs, and attach the instrument to each finding so the specialist knows what equipment produced it. List the structures that were not examined as a separate item, since those are often the reason for referral. Give the side of every finding. Add a brief history with timeline, risk factors and medicines that matter for procedures. Say what the specialist's examination would settle and what you will continue to manage. Close with what the patient has been told, how to reach them and any enclosures. Cite only what supports the urgency.
Inside the PA 516 Week 8 example
The letter is addressed from a PA student in a rural family practice to a regional otolaryngology clinic, dated the day after the ear pain visit. Its first paragraph asks for urgent nasal endoscopy and a look at the right nasopharynx and explains why imaging was not ordered. Findings follow by structure, from the pneumatic otoscope views of both ears through tuning fork results, the front third of the nose, the oropharynx under a penlight, a firm upper jugular node and cranial nerves. A separate list names the nasopharynx, tube openings, back of the nose, larynx and middle ear as unseen. A laterality line notes that every abnormality is right-sided. A short history cites Chen and colleagues, then sections cover what endoscopy would settle, what T.M. knows, scheduling needs and enclosures including medicines.
Where the points sit in the PA 516 Week 8 rubric
Points on this letter go first to whether the specialist can see the request and its urgency immediately; a request buried at the end costs the most. Next comes organization: findings in narrative form, or without the instrument that produced them, lose substantial credit because the reader cannot judge them. A separate list of unexamined structures earns marks, since it tells the consultant exactly where to look. Laterality must be stated for every finding, and any slip between sides is a serious deduction. Faculty also reward a brief, relevant history and medication list, and a clear statement of what the referral should settle. Tone and format matter: the letter should be one page, addressed and dated. Citations should be few and directly relevant.
Common PA 516 Week 8 mistakes, and how to avoid them
Students often lose marks on referral letters by copying the whole chart and hiding the request. Send your case and the specialty you are referring to, and the custom sample will open with the request and its urgency, then list your findings by structure with the instrument named for each. Structures you did not examine get their own list, which helps the specialist plan. Laterality is checked on every line. A short history and the medicines relevant to procedures are pulled from your scenario. Where your program uses a set referral template or e-consult form, the sample follows it. Read the model for structure and order, then write your letter from your own findings and confirm every side and value before sending it in.
Get a PA-516 Week 8 example written to your instructions
Send the Week 8 case and whatever letter format your classroom posted, including salutation and any copy line it requires, and a custom PA-516 referral letter is returned inside 24 to 48 hours, the first at no charge. Say which specialty the letter is addressed to and the example is written to that reader.
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 4: Fundoscopic Exam Limits Write-Up
- PA 516 Week 5: Visual Acuity Documentation
- PA 516 Week 6: Referred Ear Pain Map
- PA 516 Week 7: Sinus Imaging Rationale
- PA 514 Week 8: Reportable Condition Brief
- PA 512 Week 8: Treatment Response Summary
- PA 510 Week 8: Teledermatology Referral Brief
- PA 505 Week 8: Capacity Determination Note
PA 516 Week 8 questions, answered
What goes in if the examination was entirely normal?
A normal examination is the reason many of these letters exist, and finished versions say so directly, listing what was checked, with what, and on which side. The letter then rests on the structures no instrument reached and asks for those. A normal record summarized in one adjective gives the reader nothing to work from and usually costs the findings row outright.
Should the letter name a suspected diagnosis?
Most rubrics want the working impression stated and stated briefly, so the reader knows what has already been considered. Finished examples give it in a sentence, mark how firmly it is held, and keep it separate from the request. What the week penalizes is an impression written as a conclusion when the structures confirming or excluding it were never visible.
How much of the chart belongs in it?
Very little. Finished letters reference results by date and enclose them rather than retyping them, keeping the page short enough that the request stays visible. Sections publishing a template usually specify headings and a copy line, and the example follows those. Send the format your classroom posted along with the case material.
Where can I find a free PA 516 Week 8 sample paper?
The full PA 516 Week 8 ENT referral letter is on this page, with findings by structure and instrument, a list of unexamined areas and laterality on every line.
Why does the PA 516 Week 8 letter not order imaging first?
The writer wants the specialist to examine the nasopharynx with an endoscope and choose any imaging afterward, so the study fits what the endoscopy shows.