| Course | PA 520 Comprehensive Clinical Module Pulmonology |
|---|---|
| Week | 3 |
| Paper type | Obstructive versus restrictive memo |
| Length | About 620 words, 4 pages |
| Format | Memo with APA 7 citations |
| School | Chamberlain University |
| Program | Master of Physician Assistant Studies (MPAS) |
| Updated | October 2026 |
Free sample paper for PA 520 Week 3
Memorandum
To: Dr. Okafor, supervising physician, rural family clinic
From: PA student
Date: Two weeks after the first visit
Re: L.B. spirometry: restrictive pattern suspected, not confirmed; lung volumes and DLCO requested
Finding First
L.B.'s spirometry shows a reduced forced vital capacity with a normal FEV1/FVC ratio, a pattern that points toward restriction rather than obstruction but cannot confirm it.
The Figures, in the Order They Were Used
Ratio first, because it decides between the two families: FEV1/FVC 0.79, above the lower limit of normal of 0.66. Obstruction is defined by a ratio below the lower limit, so obstruction is not shown (Stanojevic et al., 2022).
Then the volume: FVC 2.71 L, 64 percent predicted, z-score minus 2.6, below the lower limit.
Then the flow: FEV1 2.14 L, 68 percent predicted, reduced in proportion to the FVC.
Bronchodilator response: FEV1 up 60 mL, FVC up 50 mL, not significant.
Predicted values come from the GLI race-neutral set, and every effort counted met the acceptability and repeatability rules.
The Loop, Described
The flow-volume loop is narrow along the volume axis, reflecting the small vital capacity. The expiratory limb rises steeply to a peak flow of 6.9 L per second, which is 88 percent of predicted, and then falls in a nearly straight line to residual volume. There is no scooping, the inward curve of the falling limb that appears when small airways close early in obstruction. The inspiratory limb is a smooth, rounded curve with no flattening, which argues against a narrowing in the upper airway. Overall the loop looks like a small version of a normal loop, tall for its width, which is the shape usually seen with a restrictive process.
What Spirometry Cannot Demonstrate
Spirometry measures how much air can be blown out and how fast, not how much air the lungs hold. Restriction is defined by a reduced total lung capacity, which needs body plethysmography or a gas dilution method. A low FVC with a normal ratio can also come from air trapping in obstructive disease, from incomplete effort, from obesity or from weak breathing muscles. In large studies, a sizable share of people with this spirometry pattern turn out to have a normal total lung capacity when it is measured (Stanojevic et al., 2022). That is why this memo says suspected rather than shown.
Family, Not Name
If restriction is confirmed, the causes fall into families: scarring or inflammation within the lung's own walls, the interstitial diseases; disease of the pleura; stiffness or deformity of the chest wall, including obesity; and weakness of the breathing muscles. L.B.'s body mass index is 27, there is no kyphosis, and strength is normal on examination, which makes the chest wall and muscle families less likely. The history points toward the lung tissue family: nine months of breathlessness and dry cough in a farmer who forks moldy hay from a loft into the barn every winter morning. Hypersensitivity pneumonitis is one disease in that family, and its guideline stresses that the diagnosis rests on exposure history, chest imaging and sometimes bronchoscopy, not on lung function alone (Raghu et al., 2020). The memo therefore names the family and not the disease.
The Next Measurement, Named
Requested: full lung volumes by body plethysmography and a single-breath diffusing capacity for carbon monoxide, at the hospital laboratory 40 miles away. A low total lung capacity would confirm restriction; a low diffusing capacity would support disease of the lung tissue. A high-resolution chest CT is likely to follow, and a walk test with oximetry is being booked in the meantime.
Action Requested
Please co-sign the orders for lung volumes and diffusing capacity and review whether a chest CT should be ordered now or after those results.
References
Raghu, G., Remy-Jardin, M., Ryerson, C. J., Myers, J. L., Kreuter, M., Vasakova, M., Bargagli, E., Chung, J. H., Collins, B. F., Bendstrup, E., Chami, H. A., Chua, A. T., Corte, T. J., Dalphin, J.-C., Danoff, S. K., Diaz-Mendoza, J., Duggal, A., Egashira, R., Ewing, T., . . . Wilson, K. C. (2020). Diagnosis of hypersensitivity pneumonitis in adults: An official ATS/JRS/ALAT clinical practice guideline. American Journal of Respiratory and Critical Care Medicine, 202(3), e36-e69. https://doi.org/10.1164/rccm.202005-2032ST
Stanojevic, S., Kaminsky, D. A., Miller, M. R., Thompson, B., Aliverti, A., Barjaktarevic, I., Cooper, B. G., Culver, B., Derom, E., Hall, G. L., Hallstrand, T. S., Leuppi, J. D., MacIntyre, N., McCormack, M., Rosenfeld, M., & Swenson, E. R. (2022). ERS/ATS technical standard on interpretive strategies for routine lung function tests. European Respiratory Journal, 60(1), Article 2101499. https://doi.org/10.1183/13993003.01499-2021
Reading the PA 520 Week 3 instructions
The third week asks for a one-page memo deciding whether a spirometry result points toward obstruction or restriction. Use the header block your template prints and write a subject line that identifies the record without opening it. Put the finding first in one sentence that can stand alone. Then present the figures with units in the order you used them, so the reader follows your reasoning, usually beginning with the FEV1 to FVC ratio. Describe the flow-volume loop in words, limb by limb, since a picture is often supplied and the description is what gets marked. Add a short paragraph on what spirometry cannot show. Name the family of causes rather than a single disease, and say which family the history favors. Close with the next measurement and what you need from the reader.
How the PA 520 Week 3 example is put together
The memo is addressed to the supervising physician with a subject line naming the suspected pattern and the tests requested. Its first sentence gives the finding. The figures follow in order: ratio 0.79 above the lower limit, FVC 64 percent of predicted, FEV1 reduced in proportion and a non-significant bronchodilator change, citing the 2022 interpretive standard. The loop section describes a narrow loop, a steep rise to a peak flow of 6.9 L per second, a straight descending limb with no scooping and a rounded inspiratory limb. The limits paragraph explains why many people with this pattern turn out to have normal total lung capacity. A families section rules down chest wall and muscle causes, names the lung tissue family and cites the hypersensitivity pneumonitis guideline. Requests for volumes, diffusing capacity and a co-signature close it.
PA 520 Week 3 rubric: what full points look like
The marks on this memo go first to the logic of separating the families. Starting from anything other than the ratio, or calling a pattern obstructive or restrictive without the defining value, costs the most. Next in weight is the loop description: a picture referred to but not described in words loses substantial credit. Faculty reward a limits paragraph that explains why spirometry cannot confirm restriction. Naming a single disease where only a family is justified is a common and heavy deduction. A memo that states the next measurement and why earns credit, and so does a clear request to the reader. The header block, a usable subject line and a finding that stands alone make up the format marks, along with cited standards.
PA 520 Week 3 help from the desk
The usual problem with this memo is naming a specific lung disease from a spirometry report. Share your values plus the loop image or its description, and your sample would write the finding in one sentence, list the figures starting from the ratio and describe each limb of the loop in plain words. A limits paragraph explains what your spirometry cannot confirm, and the causes are grouped into families with the one your history favors identified. The next measurement is named with the reason it would settle the question. If your template prints a different header or asks for an impression line, the sample follows it. Check your own values against the reference set before you rely on any of the reasoning.
Get a PA-520 Week 3 example written to your instructions
Send the memo assignment, the template your section posted and the figures you were given, and an example written to that template lands inside 24-48h, free the first time. Where your classroom supplies a picture of the trace rather than numbers, send that too and the description is written from it.
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- PA 520 Week 6: Dyspnea Scale Documentation
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PA 520 Week 3 questions, answered
Can restriction be confirmed from spirometry alone?
No, and saying so is worth points. A reduced capacity with a preserved ratio is consistent with restriction and also with an effort that ended early or with air trapped behind obstruction. The finished memo records the pattern as suggestive, names lung volume measurement as the thing that would confirm it, and leaves the claim where the evidence leaves it.
How formal does the header block need to be?
Formal enough to be filed and found again: addressee, author, the date, and a subject line carrying the record and the question, in whatever format your section's template gives. Where no template is posted, a four-line block is standard and takes seconds to write; markers tend to check that it exists rather than grade its typography.
The figures look like both families. What then?
Write that. A combined picture is a legitimate finding, and the memo states which features point each way, notes that spirometry cannot separate them, and names the measurement that would. Forcing an ambiguous set into one family to produce a tidy finding is the commonest way this record loses its reasoning row.
Where can I find a free PA 520 Week 3 sample paper?
This page carries the full PA 520 Week 3 memo describing a narrow loop without scooping and a preserved ratio as suspected, not confirmed, restriction.
What does the PA 520 Week 3 memo request next?
Lung volumes by body plethysmography and a diffusing capacity for carbon monoxide, which would confirm restriction and show whether gas transfer is reduced.