| Course | PA 520 Comprehensive Clinical Module Pulmonology |
|---|---|
| Week | 8 |
| Paper type | Symptom to number mismatch case |
| 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 520 Week 8
Symptom to Number Mismatch: A Farmer Who Cannot Reach the Calf Hutches Against an FVC of 64 Percent, Four Explanations Each With a Test and a Diffusing Capacity Ordered Before Any New Treatment
Student Name
Chamberlain University
PA 520: Comprehensive Clinical Module Pulmonology
Instructor Name
Month Day, Year
Symptom to Number Mismatch: A Farmer Who Cannot Reach the Calf Hutches Against an FVC of 64 Percent, Four Explanations Each With a Test and a Diffusing Capacity Ordered Before Any New Treatment
Two Records, Laid Out First
Table 1
The Measured Record Beside the Reported Record
| The figures and their circumstances | The account and its instrument |
|---|---|
| FVC 2.71 L, 64 percent predicted, ratio 0.79, acceptable and repeatable spirometry, seated | mMRC grade 2 of 4 over the past month, read aloud and chosen by L.B. |
| PaO2 68 mm Hg on room air at rest, A-a gradient 35 mm Hg | Borg 6 of 10 after a 60-yard bucket climb on the clinic ramp |
| SpO2 95 percent at rest, 86 percent at minute 4 of a 6-minute walk | "The breath won't fill up. I can't get a full one in." |
| 6-minute walk distance 348 meters, one 25-second stand | Stops halfway up the 80-yard calf hutch slope twice a day; gave up hay forking in March |
| Hemoglobin 14.6 g/dL | Says the barn work now takes twice as long as last year |
Note. Note. Each row pairs a measurement with the closest part of L.B.'s own account.
One Sentence Naming the Gap
L.B.'s breathlessness and loss of function are greater than a moderately reduced vital capacity alone would usually explain.
Explanations With a Test Attached
Explanation 1: anemia or another cause of low oxygen delivery. Supported if hemoglobin is low or falling; defeated by a normal hemoglobin. The same arterial draw gave 14.6 g/dL, which defeats this explanation.
Explanation 2: impaired gas transfer across thickened lung tissue, out of proportion to the volume loss. Supported by a reduced diffusing capacity for carbon monoxide; defeated by a normal one. The widened gradient and the exercise drop already lean this way, but the diffusing capacity has not been measured.
Explanation 3: pulmonary hypertension, either from the lung disease or from another cause. Supported by an echocardiogram showing a raised estimated pulmonary artery pressure and right heart strain; defeated by a normal echocardiogram. The heart rate rose more than expected for the distance walked, which leaves this open.
Explanation 4: deconditioning or a cardiac limit unrelated to the lungs. Supported by a cardiopulmonary exercise test showing a low heart rate reserve or early anaerobic threshold with preserved breathing reserve; defeated if the test shows a ventilatory limit with oxygen drop. Leg fatigue was low on the walk test, which argues against deconditioning.
Ordered by What Is Cheapest to Check
First, already done: the hemoglobin, which excluded anemia. Second, diffusing capacity, which can be measured in the same visit as lung volumes, takes 20 minutes and is already ordered. Third, an echocardiogram, which needs a separate appointment in the regional hospital. Fourth, a cardiopulmonary exercise test, which needs a specialist referral and is the most demanding for L.B. If the diffusing capacity is markedly reduced and the echocardiogram is normal, the fourth test may not be needed.
A Measurement, Not a Treatment
The recommendation is to measure the diffusing capacity, with lung volumes, before starting any new treatment. An inhaler would not address a stiff lung, and steroids should not be started before the diagnosis is clearer, since hypersensitivity pneumonitis is diagnosed by combining exposure history, high-resolution CT and, in some cases, bronchoscopy, and the guideline treats removal from the exposure as the first step (Raghu et al., 2020). The one non-test action recommended now is to reduce L.B.'s exposure to moldy hay dust: wearing a fitted respirator when forking hay, and having someone else do it where possible.
What Stays Open
Even if the diffusing capacity is low and the CT shows changes typical of hypersensitivity pneumonitis, it will remain open how much of the damage is fibrotic and permanent, whether L.B. can continue dairy farming, and whether the exercise drop will require oxygen. Those questions depend on the course of the disease after exposure is reduced, and they will need the same walk test, done the same way, repeated over months (Holland et al., 2014).
References
Holland, A. E., Spruit, M. A., Troosters, T., Puhan, M. A., Pepin, V., Saey, D., McCormack, M. C., Carlin, B. W., Sciurba, F. C., Pitta, F., Wanger, J., MacIntyre, N., Kaminsky, D. A., Culver, B. H., Revill, S. M., Hernandes, N. A., Andrianopoulos, V., Camillo, C. A., Mitchell, K. E., . . . Singh, S. J. (2014). An official European Respiratory Society/American Thoracic Society technical standard: Field walking tests in chronic respiratory disease. European Respiratory Journal, 44(6), 1428-1446. https://doi.org/10.1183/09031936.00150314
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
PA 520 Week 8 instructions, in plain terms
The final week asks you to explain a mismatch between what a patient reports and what the measurements show. Begin by laying out both records in parallel: the figures with their circumstances on one side, and the patient's account with its instrument and wording on the other. State the gap in a single sentence a marker can find quickly. Then give the candidate explanations, usually around four, each written as a claim with the observation that would support it and the one that would defeat it. Put the explanations in the order of how cheap and easy they are to check. Recommend a measurement rather than a treatment, and explain why treatment should wait. Close with what will remain uncertain even after the recommended test. Cite sources that support the diagnostic approach.
How the PA 520 Week 8 example is put together
Table 1 places five measured findings beside five parts of L.B.'s account, from FVC and the arterial gas to the patient's own words and the abandoned hay forking. The gap is stated in one sentence. Four explanations follow: anemia, already defeated by a hemoglobin of 14.6; impaired gas transfer, to be tested by diffusing capacity; pulmonary hypertension, to be tested by echocardiogram; and deconditioning or a cardiac limit, to be tested by a cardiopulmonary exercise test. Each carries its supporting and defeating observation. The order section ranks them by cost and notes the last may prove unnecessary. The recommendation is a diffusing capacity with lung volumes, plus a fitted respirator for hay work, citing the hypersensitivity pneumonitis guideline. The close lists fibrosis, farming and oxygen needs as open questions.
Reading the PA 520 Week 8 grading rubric
The rubric on this case rewards structure and testability. Arguing explanations before both records are laid out loses the most, because the reader cannot see the gap being explained. A clearly stated gap in one sentence earns its own marks. Faculty give the largest share to explanations written as claims with supporting and defeating observations; a list of possible causes without tests attached scores poorly. Ordering by cost or ease is expected and graded. Recommending a treatment instead of a measurement is a significant deduction, since the week tests diagnostic reasoning. The closing paragraph on what stays open earns marks for honesty about limits. Sources should back the diagnostic approach, and a numbered, titled table with a note is expected.
PA 520 Week 8 help from the desk
This final case often goes wrong when students jump to a treatment for the symptoms instead of explaining the gap. Send your case's measurements and the patient's account, and the custom sample will set them out side by side, state the gap in one sentence and build about four explanations, each with the observation that would support or defeat it. The explanations are ordered by what is cheapest to check in your setting. The recommendation is a measurement, with the reason treatment should wait, and any safe interim step is named. A closing paragraph says what will remain open. If your course expects a different number of explanations, the sample adjusts. Review each explanation against your own case details before using the reasoning.
Get a PA-520 Week 8 example written to your instructions
Send the case your section published, the rubric rows and any scale or values it supplied, and a written example returns inside 24-48h, free on a first request. Where your classroom gives an open case with figures you choose yourself, say so and the example is built to make the choosing visible rather than hidden.
More PA 520 papers and MPAS samples
- PA 520 Week 1: Exertional Oxygen Claim Post
- PA 520 Week 2: Spirometry Interpretation
- PA 520 Week 3: Obstructive Versus Restrictive Memo
- PA 520 Week 4: ABG Analysis Worksheet
- PA 520 Week 5: Pulse Oximetry Limits Brief
- PA 520 Week 6: Dyspnea Scale Documentation
- PA 520 Week 7: 6-Minute Walk Test Report
- PA 518 Week 8: Reperfusion Timing Brief
- PA 516 Week 8: ENT Referral Letter
- PA 514 Week 8: Reportable Condition Brief
- PA 512 Week 8: Treatment Response Summary
PA 520 Week 8 questions, answered
Does the case have to reach a diagnosis?
Usually not, and reaching for one early is what costs the reasoning row. The assignment is built around holding two records that point different ways and stating what would separate them, so a piece closing on a named condition has answered a question the case did not ask. Where a rubric row wants a leading possibility, give it with the evidence still outstanding.
How many candidate explanations are enough?
Enough to cover the different kinds of gap rather than a target count. One where the figure was taken under circumstances that exclude the moment the symptom appears, one where the device reports something narrower than the writer assumed, one where the account was recorded in a form that will not compare, and one where both records are correct and describing different things.
Can the recommended measurement be something the classroom has not covered?
Yes, provided the piece says what it would show and under what circumstances it would be taken. Markers are checking whether the recommendation follows from the gap, not whether the test appeared in the assigned reading. A test named without stating which result would change the picture tends to read as a guess.
Where can I find a free PA 520 Week 8 sample paper?
The full PA 520 Week 8 mismatch case is on this page, with both records in one table, four testable explanations and a diffusing capacity recommended first.
Which explanation does the PA 520 Week 8 sample rule out first?
Anemia, because the hemoglobin from the arterial draw was 14.6 g/dL, which defeats the claim that low oxygen carrying explains the breathlessness.