| Course | PA 518 Comp Clin Mod Cardiovascular |
|---|---|
| Week | 3 |
| Paper type | Pretest probability worksheet |
| Length | About 760 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 518 Week 3
Pretest Probability Worksheet at the Clinic Visit: Eleven Rows for A.K., Three Absences Counted as Evidence, and an Intermediate Band of 35 to 50 Percent Written at 10:40 a.m.
Student Name
Chamberlain University
PA 518: Comp Clin Mod Cardiovascular
Instructor Name
Month Day, Year
Pretest Probability Worksheet at the Clinic Visit: Eleven Rows for A.K., Three Absences Counted as Evidence, and an Intermediate Band of 35 to 50 Percent Written at 10:40 a.m.
The Case, as Supplied
A 64-year-old with type 2 diabetes, hypertension and treated high cholesterol reports three weeks of pressure behind the breastbone brought on by climbing stairs or carrying loads and relieved by rest within five minutes. One episode followed a large meal at rest. Former smoker, 30 pack-years, quit twelve years ago. Known left bundle branch block. Examination today: blood pressure 146/84, pulse 88, no murmur, lungs clear, no leg edema. Kidney function last month: eGFR of 52; LDL cholesterol 92 mg/dL on atorvastatin.
Rows Before the Figure
Table 1
Features Bearing on the Likelihood of Obstructive Coronary Disease
| Feature | Present or absent | Direction | Rough size |
|---|---|---|---|
| Age 64, male | Present | Up | Sets the starting band |
| Substernal pressure | Present | Up | Moderate |
| Brought on by exertion | Present | Up | Large |
| Relieved by rest within minutes | Present | Up | Moderate |
| One episode at rest after a meal | Present | Down | Small |
| Type 2 diabetes, 11 years | Present | Up | Moderate |
| Hypertension | Present | Up | Small |
| Former smoker, quit 12 years ago | Present | Up | Small |
| Chronic kidney disease, stage 3a | Present | Up | Small |
| Pain reproduced by chest wall pressure | Absent | Up | Small |
| Pain with breathing or position | Absent | Up | Small |
| Known coronary or other vascular disease | Absent | Down | Moderate |
Note. Note. Sizes are in words, as the assignment asks for no numeric weights.
Absences Are Rows
Three features are recorded because A.K. does not have them. Pain that can be reproduced by pressing on the chest, or that changes with breathing or position, would point away from the heart; their absence keeps the cardiac explanation in front. No prior heart attack, stent, stroke or leg artery disease is known, which keeps A.K. out of the group in whom disease is already established. Leaving these rows out would make the grid look as if nobody asked.
Direction Before Size
The table gives direction first and size second, because the direction is firm and the size is a judgment. Effort-related pressure that settles with rest is the strongest single item, and it is the one the pretest tables are built on. Diabetes is the largest risk factor in the list; the chest pain guideline names it among the features that raise clinical likelihood above the table's age and symptom value (Gulati et al., 2021). The kidney disease, the old smoking history and the hypertension each add a little. The one reflux-like episode takes a little away.
A Band, Not a Decimal
The tables give about 44 percent for a male patient aged 60 to 69 with typical angina (Knuuti et al., 2019). The risk factors argue for the upper part of the band; the single atypical episode argues for leaving room below. The estimate is written as intermediate, 35 to 50 percent. A figure such as 46.3 percent would suggest a precision that the tables, built from large populations, do not have for one person.
Defending the Band
Two rows argue hardest against the figure. The first is the post-meal episode with a sour taste, which could mean that some or all of the pain is from the esophagus. It was kept as a downward row rather than dismissed, but it stands against five episodes on effort, each relieved by rest. The second is the absence of known vascular disease; if A.K. had a prior stent, the question would not be whether disease exists. Neither is strong enough to move the band below 35 percent.
What the Band Is For
An intermediate band means testing is likely to change management. In the chest pain guideline, patients with stable symptoms and an intermediate to high likelihood are candidates for either anatomic or functional testing, and the choice depends on the patient's ability to exercise, the resting ECG and local expertise (Gulati et al., 2021). Here the left bundle branch block and the knees will both shape that choice later in the course.
The Hour It Was Written
Estimate recorded at 10:40 a.m. in the exam room, before any test was ordered. It will be revised if the pain pattern changes, if A.K. develops pain at rest, or once a test result is available.
References
Gulati, M., Levy, P. D., Mukherjee, D., Amsterdam, E., Bhatt, D. L., Birtcher, K. K., Blankstein, R., Boyd, J., Bullock-Palmer, R. P., Conejo, T., Diercks, D. B., Gentile, F., Greenwood, J. P., Hess, E. P., Hollenberg, S. M., Jaber, W. A., Jneid, H., Joglar, J. A., Morrow, D. A., . . . Shaw, L. J. (2021). 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 144(22), e368-e454. https://doi.org/10.1161/CIR.0000000000001029
Knuuti, J., Wijns, W., Saraste, A., Capodanno, D., Barbato, E., Funck-Brentano, C., Prescott, E., Storey, R. F., Deaton, C., Cuisset, T., Agewall, S., Dickstein, K., Edvardsen, T., Escaned, J., Gersh, B. J., Svitil, P., Gilard, M., Hasdai, D., Hatala, R., . . . Clapp, B. (2019). 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes. European Heart Journal, 41(3), 407-477. https://doi.org/10.1093/eurheartj/ehz425
Reading the PA 518 Week 3 instructions
The third week asks for a worksheet that turns a case into a pretest probability. Put the case at the top in the words supplied. Below it, list each feature in its own row with whether it raises or lowers the estimate and roughly how much, in words if your template asks for no weights. Give absent features their own rows, since a missing finding is evidence. Write the figure once, at the bottom, as a band rather than a precise decimal. Beneath the grid, defend the figure against the two rows that argue most strongly against it. Explain what the band means for the next step, such as whether testing is likely to change management. Record the time the estimate was made and what would cause you to revise it. Cite the table and the guideline you used.
Inside the PA 518 Week 3 example
The case block lists A.K.'s age, three risk factors, three weeks of effort pressure, one post-meal episode, a 30 pack-year smoking history ended twelve years ago and today's exam. Table 1 gives twelve rows with presence, direction and rough size, from age and sex setting the starting band to known vascular disease absent and pulling down. A section explains why the absence of chest wall tenderness and of positional pain are recorded. Direction is separated from size, with diabetes named as the largest risk factor and cited to the chest pain guideline. The band of 35 to 50 percent is drawn from the ESC table's 44 percent. A defense addresses the reflux-like episode and the lack of known disease. A section on what the band means cites the guideline on testing choices, and the close time-stamps the estimate.
Reading the PA 518 Week 3 grading rubric
The grade on this worksheet mostly rests on the grid. A figure given without rows beneath it, or rows without direction, loses the most because the estimate cannot be followed. Faculty next look for absent features entered as rows; skipping them is a frequent deduction. Points go to a band rather than a decimal and to a source for the starting value. The defense paragraph is graded on whether it takes on the strongest counter-evidence rather than restating the supporting rows. Credit is also given for explaining what the band means for testing. A time stamp and a trigger for revision earn a smaller share. Using words for size when weights are not requested follows the template, and a numbered APA table with a note completes the format.
Common PA 518 Week 3 mistakes, and how to avoid them
Worksheets often lose marks when students jump to a figure and then list a few supporting facts. Send your case and the table your course uses, and the custom sample will put every feature in a row with its direction and size, including findings the patient does not have. The figure appears once, as a band, with its starting point named. The defense section takes on the two rows that argue hardest against the estimate, drawn from your case. If your template uses likelihood ratios or numeric weights, the sample follows that instead of words. A closing line records the time and what would trigger a revision. Compare the grid with your own case notes before you use any part of the model in your worksheet.
Get a PA-518 Week 3 example written to your instructions
Send the case your section supplied and its worksheet file, including any weighting column it carries, and a custom example is completed to them and returned within 24 to 48 hours, the first one free. If your section fixed the condition the estimate has to address, name it in the request; every row in the grid is written against that condition.
More PA 518 papers and MPAS samples
- PA 518 Week 1: Pretest Likelihood Discussion Post
- PA 518 Week 2: ECG Interpretation Drill
- PA 518 Week 4: Chest Pain Risk Stratification
- PA 518 Week 5: Troponin Trend Reasoning
- PA 518 Week 6: Stress Test Selection Rationale
- PA 518 Week 7: Stroke Risk Scoring Memo
- PA 518 Week 8: Reperfusion Timing Brief
- PA 516 Week 3: Tuning Fork Interpretation
- PA 514 Week 3: Incubation Window Analysis
- PA 512 Week 3: Peripheral Smear Correlation
- PA 510 Week 3: Distribution Pattern Analysis
PA 518 Week 3 questions, answered
How exact does the estimate need to be?
A band is normally enough and it is easier to defend than a single figure. Sections publishing categories want the category name and the rows behind it. What gets queried is precision with nothing supporting it, so a sheet claiming a specific shift for one feature should point at where that number came from, or state it plainly as a judgment.
Do we use the published values from the reading?
Where your section names a source, yes, and the row cites it. Where it does not, the defensible move is words rather than borrowed numbers, since a value carried across from a different group of patients is harder to justify than an honest judgment. Send the reading list with the assignment and the example uses whichever your classroom expects.
Is this the same as the Week 4 assignment?
They sit next to each other and are marked differently. The worksheet is your own reasoning about one case, built row by row from its features. Week 4 applies a published tool with fixed variables and leaves you no say in which features count. Sections often place them a week apart precisely so the difference shows up in the writing.
Where can I find a free PA 518 Week 3 sample paper?
This page carries the full PA 518 Week 3 worksheet, twelve rows with absent findings included and a band of 35 to 50 percent stamped with its time.
Why does the PA 518 Week 3 sample give a band instead of an exact percentage?
Pretest tables come from large populations, so a precise decimal such as 46.3 percent would claim accuracy that a single patient's estimate does not have.