PA 531 Week 4 Worst-First Differential Table Example

Course	PA 531 Emergency Medicine
Week	4
Paper type	Worst-first differential
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 531 Week 4

Worst-First Differential for A.N. at 02:15: Six Entries That End Badly and Quickly, Each With What Would Make It the Answer, What Would Close It and How Long the Closing Takes Here

Student Name

Chamberlain University

PA 531: Emergency Medicine

Instructor Name

Month Day, Year

What this page is doingThe title narrows the list to fast killers and adds the time to close each, which is the field that makes this differential usable in a small hospital.

Worst-First Differential for A.N. at 02:15: Six Entries That End Badly and Quickly, Each With What Would Make It the Answer, What Would Close It and How Long the Closing Takes Here

The Entries, Ordered by How Fast

Table 1

Worst-First Differential With an Exit and a Clock for Each Entry

Entry	What would make it the answer	What would close it	Time to close here
Aneurysmal subarachnoid hemorrhage	Blood on CT; xanthochromia in spinal fluid	CT within 6 hours of onset read as normal	About 40 minutes
Intracerebral hemorrhage	Blood in brain tissue on CT	Normal CT	About 40 minutes
Pituitary apoplexy	Visual loss, eye palsy, a bleed into a pituitary mass	Normal visual fields and eye movements, and a normal pituitary on imaging	Fields now; MRI not available until 08:00
Cervical artery dissection	Neck pain, a narrowed vessel on CT angiography	Normal CT angiography of the neck	About 60 minutes
Cerebral venous thrombosis	Risk factors and a filling defect on CT venography	Normal CT venography	About 60 minutes, if requested with the angiogram
Bacterial meningitis	Fever, stiff neck, typical spinal fluid	No fever, a supple neck, and a clear explanation elsewhere	Clinical now; spinal fluid if needed

Note. Note. Times assume the overnight CT technologist is on site; MRI is a daytime service in this hospital.

What this page is doingGiving every entry an exit and the time that exit takes here turns the differential into a workup that can be scheduled.

The Entries Dropped Since Week 2

Hypertensive encephalopathy, carbon monoxide poisoning, angle-closure glaucoma and reversible vasoconstriction syndrome have been dropped or deferred. A.N.'s blood pressure, 182/98, is high but A.N. is alert with normal vision. A carboxyhemoglobin measured on the venous gas was 1.2 percent. The eyes are white and not painful. Vasoconstriction syndrome usually recurs over days and remains for later if the first workup is normal. Migraine stays off this list because it does not end badly and quickly.

An Exit for Every Entry

Each entry has a finding that would close it. For subarachnoid hemorrhage, the exit is a CT done within six hours of the onset of headache and read as normal by a qualified radiologist, which in a large prospective study had a sensitivity of 100 percent (Perry et al., 2011). A.N.'s onset was 00:45, so a CT before 06:45 can close it without a lumbar puncture.

Exits This Place Lacks

Two exits are not available tonight. MRI, the best test for pituitary apoplexy and for a small dissection, cannot be done until 08:00. Neurosurgical opinion is not on site. If the CT and angiography are normal but A.N.'s visual fields become abnormal, the lack of MRI would mean transfer or waiting, and that decision is written down now rather than made under pressure.

What this page is doingNaming the exits this hospital lacks, and what will be done if they are needed, prevents an unavailable test from silently leaving an entry open.

Blank Is Not Open

An entry with no exit performed is not "probably fine." Until its exit is complete, the entry stays open in the note. For meningitis, the clinical exit has been met: no fever, a supple neck at 02:10 and a clear alternative explanation in the timing. That is recorded, not assumed.

Still Standing at the Close

At 02:15, with the CT ordered and visual fields normal, the entries still standing are subarachnoid hemorrhage, intracerebral hemorrhage, dissection and venous thrombosis. All four are addressed by the CT and angiography requested together. The order of the list does not change when the tests come back; the tests close entries one at a time.

Why CT Angiography Was Added

The aneurysmal hemorrhage guideline supports CT angiography in patients with confirmed hemorrhage to locate an aneurysm, and it also screens for dissection and, with a venous phase, for venous thrombosis (Hoh et al., 2023). Requesting it at the same time as the plain CT saves a second trip to the scanner.

What Happens After the Scan

If the CT shows blood, the plan moves straight to transfer and the remaining entries become the receiving team's work. If the CT and angiogram are both normal within six hours, subarachnoid hemorrhage and the vascular entries close, and the list returns to the Week 2 column for a second look at the less urgent causes.

What this page is doingStating in advance what each scan result will do to the list keeps the differential from being rebuilt from scratch once results arrive.

References

Hoh, B. L., Ko, N. U., Amin-Hanjani, S., Chou, S. H.-Y., Cruz-Flores, S., Dangayach, N. S., Derdeyn, C. P., Du, R., Hanggi, D., Hetts, S. W., Ifejika, N. L., Johnson, R., Keigher, K. M., Leslie-Mazwi, T. M., Lucke-Wold, B., Rabinstein, A. A., Robicsek, S. A., Stapleton, C. J., Suarez, J. I., . . . Welch, B. G. (2023). 2023 guideline for the management of patients with aneurysmal subarachnoid hemorrhage: A guideline from the American Heart Association/American Stroke Association. Stroke, 54(7), e314-e370. https://doi.org/10.1161/STR.0000000000000436

Perry, J. J., Stiell, I. G., Sivilotti, M. L. A., Bullard, M. J., Emond, M., Symington, C., Sutherland, J., Worster, A., Hohl, C., Lee, J. S., Eisenhauer, M. A., Mortensen, M., Mackey, D., Pauls, M., Lesiuk, H., & Wells, G. A. (2011). Sensitivity of computed tomography performed within six hours of onset of headache for diagnosis of subarachnoid haemorrhage: Prospective cohort study. BMJ, 343, Article d4277. https://doi.org/10.1136/bmj.d4277

Reading the PA 531 Week 4 instructions

The fourth week narrows the earlier differential to the four to six conditions that end badly and quickly, usually in a table with prose beneath. Order the entries by how fast each can cause harm. For each, give three fields: what would make it the answer, what would close it, and how long closing it takes in your setting. Explain which entries from the earlier list were dropped and why. Name any exit your setting lacks, such as a scanner or specialist unavailable overnight, and say what you will do if it is needed. Treat entries with no exit performed as still open. State which entries remain standing at the time of writing. Cite the evidence behind any exit you rely on.

Inside the PA 531 Week 4 example

Table 1 lists subarachnoid hemorrhage, intracerebral hemorrhage, pituitary apoplexy, cervical dissection, venous thrombosis and meningitis, each with a defining finding, an exit and the local time to reach it, with a note about the overnight CT technologist and daytime MRI. A section explains dropping hypertensive encephalopathy, carbon monoxide after a normal carboxyhemoglobin, glaucoma and vasoconstriction syndrome. The exit for subarachnoid hemorrhage is a CT within six hours of a 00:45 onset, citing Perry. A section names the missing overnight MRI and neurosurgery and the plan if visual fields change. Meningitis is closed clinically and recorded. Four entries remain at 02:15. A section cites the 2023 guideline for adding CT angiography, and a final section says what each scan result will do to the list.

Reading the PA 531 Week 4 grading rubric

Faculty grade this table on its three fields. An entry without an exit, or without the time the exit takes, loses the largest share because the differential cannot be scheduled. The order must reflect speed of harm. Credit is given for explaining dropped entries with reasons rather than silently deleting them. Naming exits the setting lacks, with a contingency, is weighted heavily in this course. Treating unexamined entries as cleared is a significant deduction. The section on what remains standing should be specific to the time. Evidence for each exit, such as CT sensitivity within six hours, must be cited correctly. Prose beneath the table should argue, not repeat the rows.

PA 531 Week 4 help from the desk

Worst-first differentials usually go wrong when entries have no exit or the exit cannot be done where the patient is. Tell us your case, setting and earlier differential, and the table built from them would keep only the fast killers, give each a defining finding, an exit and the time it takes in your setting, and explain the entries you dropped. Exits your setting lacks are named with a plan. Open entries stay open until their exit is done. The entries still standing at your time of writing are listed. If your complaint is chest pain or abdominal pain, the entries change but the fields stay. Fill the time column from the services actually available to your patient.

Get a PA-531 Week 4 example written to your instructions

Send the case and the list your classroom supplies, plus anything your section says about what the department in the scenario can and cannot do, and a custom PA-531 Week 4 differential comes back inside 24 to 48 hours with every exit named. The first one is free.

More PA 531 papers and MPAS samples

PA 531 Week 4 questions, answered

Does every dangerous entry need a test to close it?

No, and assuming it does produces the longest and weakest versions of this assignment. Some entries close on a finding, some on history the case already contains, and some on an interval passing without change. What the rubric wants is the mechanism written down, whatever it is. Entries closed by sending everything are marked no better than entries closed on nothing at all.

How is this different from the Week 2 brief?

Week 2 opens a complaint out as wide as it goes; this one narrows the dangerous end of that column and closes it. The brief is a map and this is a set of decisions about the worst part of the map, so the entries are fewer, the reasoning per entry is longer, and every line ends in something done rather than something considered.

Can an entry be closed on history alone?

Often yes, and sections reward it when the history is quoted rather than summarized. The requirement is that a reader can see which sentence in the case did the work, so a row closing on history names it. What loses marks is the closure asserted in general terms, where nothing in the material supplied would let a marker check the claim.

Where can I find a free PA 531 Week 4 sample paper?

The full PA 531 Week 4 worst-first table is on this page, six fast-killing causes of sudden headache with an exit and a local closing time for each.

What exit does the PA 531 Week 4 sample use for subarachnoid hemorrhage?

A CT done within six hours of onset and read as normal by a qualified radiologist, which Perry and colleagues found to be highly sensitive.