| Course | PA 528 Comprehensive Clinical Module Neurology |
|---|---|
| Week | 1 |
| Paper type | Discussion post with two replies |
| Length | About 560 words |
| Format | Discussion post with APA 7 citations |
| School | Chamberlain University |
| Program | Master of Physician Assistant Studies (MPAS) |
| Updated | October 2026 |
Free sample paper for PA 528 Week 1
Week 1 Discussion: Initial Post
The Right Hemisphere, Above the Brainstem and Reaching the Cortex: Localizing B.T.'s Left-Sided Weakness From a Forehead That Still Wrinkles, a Neglected Left Hand and an Absent Crossed Sign
Initial Post
The lesion is in the right cerebral hemisphere, above the brainstem, and it involves the cortex. That is my claim for B.T., a 67-year-old right-handed retired bus driver brought in two hours after a spouse noticed the left side of B.T.'s mouth drooping at lunch. Each finding I use is doing two jobs: supporting this level and excluding another.
The left lower face is weak, but B.T. can still wrinkle the forehead on both sides. The forehead receives input from both hemispheres, so a weak lower face with a spared forehead points to a lesion above the facial nucleus. It excludes a facial nerve palsy, which would weaken the whole left face, forehead included.
The left arm drifts down and turns inward within ten seconds, and the left leg is only slightly weak. Face and arm worse than leg fits the lateral surface of the hemisphere, where face and arm are represented, and argues against a lesion near the midline, where the leg area sits.
The Findings That Are Absent
There is no weakness of the right face, no double vision and no trouble moving the eyes outward on either side. A brainstem lesion often produces crossed findings, a cranial nerve problem on one side and limb weakness on the other. Their absence pushes the lesion above the brainstem. B.T. speaks clearly enough to be understood, with slurring but no word-finding trouble, and repeats and names objects correctly. In a right-handed person, language usually sits in the left hemisphere, so intact language is consistent with a right-sided lesion.
Why the Cortex
B.T. ignores the left side: when touched on both hands at once, B.T. reports only the right; asked to bisect a line, B.T. marks it well to the right of center; B.T.'s gaze rests toward the right. Neglect of this kind points to the right parietal cortex rather than deep white matter alone. The NIH Stroke Scale, which scores these findings, gave B.T. a 9, with points for facial palsy, arm drift, sensory loss, extinction and dysarthria (Brott et al., 1989).
Hedges That Survive Marking
I am confident about the side and about the level above the brainstem. I am less certain whether a deep component, such as the internal capsule, is involved as well, because the leg is mildly weak. Imaging will settle that; the guideline recommends brain imaging before any treatment decision, and CT is enough to exclude bleeding (Powers et al., 2019).
Reply to Grace
Grace, your post places your patient's lesion in the left pons because of right arm weakness. Which finding excludes the left internal capsule? A crossed sign, such as a left facial palsy that includes the forehead or a left sixth nerve palsy, would make your case; without it, the arm weakness could come from anywhere along the tract.
Reply to Dev
Dev, you localized to the spinal cord at C5. What did the face show? A normal face and normal cranial nerves would support you, and a sensory level on the trunk would set the ceiling. If either is missing from your case, adding it would make the level hard to argue with.
References
Brott, T., Adams, H. P., Jr., Olinger, C. P., Marler, J. R., Barsan, W. G., Biller, J., Spilker, J., Holleran, R., Eberle, R., & Hertzberg, V. (1989). Measurements of acute cerebral infarction: A clinical examination scale. Stroke, 20(7), 864-870. https://doi.org/10.1161/01.STR.20.7.864
Powers, W. J., Rabinstein, A. A., Ackerson, T., Adeoye, O. M., Bambakidis, N. C., Becker, K., Biller, J., Brown, M., Demaerschalk, B. M., Hoh, B., Jauch, E. C., Kidwell, C. S., Leslie-Mazwi, T. M., Ovbiagele, B., Scott, P. A., Sheth, K. N., Southerland, A. M., Summers, D. V., & Tirschwell, D. L. (2019). Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 50(12), e344-e418. https://doi.org/10.1161/STR.0000000000000211
Reading the PA 528 Week 1 instructions
Week one's post asks for a localization claim in continuous prose, roughly three to four hundred words. Open with the place: side, level and, where possible, a named structure, before any mention of disease. Then present the findings as evidence, pairing each one with the level it supports and the level it rules out. Include findings that are absent, since a missing crossed sign or an intact language function can be as informative as a deficit. Explain any feature that points to the cortex rather than deep structures. Keep hedges for the parts of the claim the examination genuinely cannot settle, and say what will settle them. Cite your sources. Reply to two classmates by asking for the one finding that would make their localization hard to dispute.
How this PA 528 Week 1 example is built
The post claims the right hemisphere above the brainstem, involving cortex, for B.T., a right-handed retired bus driver whose spouse noticed a drooping mouth at lunch. The spared forehead is used to exclude a facial nerve palsy, and face and arm weakness worse than leg to favor the lateral surface. Absent double vision and crossed signs push the lesion above the brainstem, and intact language fits the right side. A cortex section describes extinction, line bisection and gaze preference and cites the NIH Stroke Scale's derivation for a score of 9. The hedge concerns a possible deep component, to be settled by CT as the acute stroke guideline recommends. Replies ask Grace for a crossed sign supporting her pontine level and Dev for facial findings and a sensory level supporting C5.
Reading the PA 528 Week 1 grading rubric
Credit in this discussion rests first on where the post begins. Opening with a disease, or with a recap of the case, costs the most because the localization never becomes a claim. Faculty then look for findings doing two jobs, supporting one level and excluding another; findings that only support lose part of their value. Absent findings must be used as evidence, and a post that ignores them misses a major marking row. Credit goes to cortical signs correctly identified. Hedges are rewarded when they are specific and tied to a test, and penalized when they blur the whole claim. Sources should support specific points. Replies earn marks only if they ask for a decisive finding, not if they restate agreement.
PA 528 Week 1 help from the desk
Students tend to lose points here by opening with a diagnosis and listing deficits afterward. If you pass along the case your section posted, the model post would start with the side and level, then use each finding to support one level and exclude another, including the findings your patient does not have. Cortical signs are identified where present. Hedges are kept to the parts of the claim the exam cannot decide, with the test that will. Replies target the single finding that would strengthen each classmate's localization. The length and citation count follow your section. Draw every finding in your own post from your case notes, keeping the model as a guide to order and reasoning.
Get a PA-528 Week 1 example written to your instructions
Send the week's discussion instructions and the rubric your classroom posts, and a custom example comes back inside 24-48h, written to your findings rather than to a generic case. The first one is free. Attach the reply requirements too, since what counts as a substantive response is set locally and changes what the example has to do.
More PA 528 papers and MPAS samples
- PA 528 Week 2: Lesion Localization Exercise
- PA 528 Week 3: Cranial Nerve Deficit Map
- PA 528 Week 4: Motor Neuron Brief
- PA 528 Week 5: Seizure Semiology Write-up
- PA 528 Week 6: Episodic Symptom Timeline
- PA 528 Week 7: Stroke Syndrome Correlation
- PA 528 Week 8: Neuroimaging Request Brief
- PA 526 Week 1: Abdominal Region Discussion Post
- PA 524 Week 1: Filtration Stand-In Discussion Post
- PA 522 Week 1: Hormone Pair Discussion Post
- PA 520 Week 1: Exertional Oxygen Claim Post
PA 528 Week 1 questions, answered
Do I have to name a diagnosis in a Week 1 post?
Often not, and where the instructions do ask for one it usually arrives last. The work being marked is the localization, so an example puts the level and side first and treats a named condition as something the place makes available. Check what your classroom asks, because a few sections want a single most likely condition stated outright.
The vignette gives no examination findings. What then?
Then the example argues from what the history can settle on its own and says where it stops. Pace, laterality and the pattern of symptoms narrow a list before any examination begins, and an example that reaches those limits and names the two or three examination findings it would want next is doing exactly what the marking wants.
Will the example work if my section grades the replies separately?
Yes. Where replies carry their own points, the example supplies them as separate pieces with their own evidence rather than as sign-offs, because a reply in this module is a second localization attempt on somebody else's case. Send the reply count and the deadline pattern your classroom uses and the example is built to match it.
Where can I find a free PA 528 Week 1 sample paper?
This page holds a full PA 528 Week 1 post localizing left-sided weakness to the right hemisphere above the brainstem, with replies to two classmates.
Why does a wrinkling forehead matter in the PA 528 Week 1 sample?
The forehead gets input from both hemispheres, so weakness of the lower face with a spared forehead points above the facial nucleus and excludes a facial nerve palsy.