| Course | PA 612 Clinical Clerkship - Internal Medicine |
|---|---|
| Week | 2 |
| Paper type | Admission H&P |
| Length | About 690 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 612 Week 2
Admission History and Physical for W.H.: A One-Liner That Carries Three Weeks of Fever, Two Positive Blood Cultures for Streptococcus gallolyticus and Iron-Deficiency Anemia, Written to Be Amended With Pending Items Listed
Student Name
Chamberlain University
PA 612: Clinical Clerkship - Internal Medicine
Instructor Name
Month Day, Year
Admission History and Physical for W.H.: A One-Liner That Carries Three Weeks of Fever, Two Positive Blood Cultures for Streptococcus gallolyticus and Iron-Deficiency Anemia, Written to Be Amended With Pending Items Listed
One-Liner
W.H. is a 74-year-old retired carpenter with hypertension and a mitral valve repair 9 years ago, admitted on March 2, 2026, with three weeks of fevers, fatigue and 4 kg of weight loss, two of two blood cultures from the clinic growing Streptococcus gallolyticus, and new iron-deficiency anemia.
History of Present Illness
Evening fevers to 38.6 °C for three weeks, night sweats, reduced appetite, fatigue climbing stairs. No chest pain, cough, urinary symptoms or rash. No dental work in the past year. Bowel habits unchanged; no visible blood in stool. Primary care drew blood cultures on February 27; both bottles grew gram-positive cocci in chains by March 1, identified as S. gallolyticus on March 2, prompting direct admission.
W.H. had no prior episodes of fever like this, no recent hospital stays and no intravenous drug use. A dentist visit 14 months ago included a cleaning only. The spouse reports that W.H. has looked pale for about two months and has been sleeping in the afternoon, which is new.
Past History, Medications and Social History
Mitral valve repair with annuloplasty ring in 2017 for degenerative regurgitation. Hypertension. No prior colonoscopy. Medications: amlodipine 5 mg daily, aspirin 81 mg daily. No known drug allergies. Lives with spouse; former smoker, 20 pack-years, quit 2005; two beers a week.
Family history: father died of a stroke at 79; no family history of colorectal cancer known. Allergies confirmed with W.H. and the pharmacy record. No over-the-counter pain medicines.
Findings, Not Normals
Temperature 38.2 °C, pulse 96, blood pressure 128/72, oxygen saturation 97 percent on room air. At the apex, a new soft (2/6) murmur through all of systole that last year's visit did not record. Conjunctival pallor. No splinter hemorrhages, Janeway lesions or Osler nodes. Abdomen soft, nontender, no palpable mass. Neurologic examination without focal deficit.
Laboratory: hemoglobin 9.8 g/dL, mean corpuscular volume 74 fL, ferritin 9 ng/mL; white cell count 11.4 × 10^9/L; creatinine 1.0 mg/dL; alkaline phosphatase 168 U/L, other liver tests normal; C-reactive protein 86 mg/L.
Pending Is a Category
Pending at admission: repeat blood cultures (two sets drawn 18:00); transthoracic echocardiogram, requested; colonoscopy, to be requested once cardiac evaluation is complete; susceptibility testing for the organism; cause of the raised alkaline phosphatase.
Each pending item has an expected time: cultures read at 24 and 48 hours, echocardiogram tomorrow morning, susceptibilities in 24 to 48 hours. The night team knows what will change overnight and what will not.
Assessment and Plan, by Problem
1. S. gallolyticus bacteremia with a new murmur and a prior mitral repair: infective endocarditis is likely until proven otherwise. Duke criteria to be applied once echocardiography is available (Fowler et al., 2023). Start ceftriaxone 2 g intravenously daily pending susceptibilities. Repeat cultures daily until negative.
2. S. gallolyticus is strongly associated with colorectal neoplasia; in a meta-analysis, infection with this organism carried a much higher risk of colorectal cancer than with related strains (Boleij et al., 2011). Colonoscopy this admission.
3. Iron-deficiency anemia, likely gastrointestinal blood loss; hold aspirin; colonoscopy as above.
4. Raised alkaline phosphatase: fractionate; imaging if colonoscopy shows a lesion.
5. Hypertension: continue amlodipine.
Written to Be Amended
Each problem has its own number so later notes can add to it. The note is signed with the time; results that return later are added in dated addenda, not by editing the original text.
The structure also anticipates the likely amendments: problem 1 will gain the echocardiogram result and the Duke classification, problem 2 the colonoscopy findings and problem 4 the fractionation. Each will be added as a dated line under its number rather than as a new free-text paragraph.
References
Boleij, A., van Gelder, M. M. H. J., Swinkels, D. W., & Tjalsma, H. (2011). Clinical importance of Streptococcus gallolyticus infection among colorectal cancer patients: Systematic review and meta-analysis. Clinical Infectious Diseases, 53(9), 870-878. https://doi.org/10.1093/cid/cir609
Fowler, V. G., Durack, D. T., Selton-Suty, C., Athan, E., Bayer, A. S., Chamis, A. L., Dahl, A., DiBernardo, L., Durante-Mangoni, E., Duval, X., Fortes, C. Q., Fosbøl, E., Hannan, M. M., Hasse, B., Hoen, B., Karchmer, A. W., Mestres, C. A., Petti, C. A., Pizzi, M. N., . . . Miro, J. M. (2023). The 2023 Duke-International Society for Cardiovascular Infectious Diseases criteria for infective endocarditis: Updating the modified Duke criteria. Clinical Infectious Diseases, 77(4), 518-526. https://doi.org/10.1093/cid/ciad271
Reading the PA 612 Week 2 instructions
The second week asks for an admission history and physical that is long and openly sectioned, since someone arriving on the fourth hospital day will look things up by heading. Start with a one-liner: age, the background that matters and the reason for the hospital bed, in one sentence. Record abnormal findings and pertinent negatives rather than lists of normal results. Treat pending items as their own category so nothing waiting is forgotten. Write the assessment and plan by problem, with the plan for each problem beside it. Write the note so it can be amended by dated addenda rather than edited. On day one the diagnosis may still be open; say what is likely and what will settle it. Cite the criteria or evidence behind key decisions.
How this PA 612 Week 2 example is built
The one-liner names W.H. as a 74-year-old retired carpenter with hypertension and a mitral repair, admitted March 2, 2026, with three weeks of fevers, 4 kg weight loss, two positive cultures and iron-deficiency anemia. The history covers evening fevers, no dental work and cultures drawn February 27. Background lists the annuloplasty ring, amlodipine and aspirin. Findings give a temperature of 38.2, a new 2/6 apical murmur, pallor, no peripheral stigmata and laboratory results including hemoglobin 9.8, ferritin 9 and alkaline phosphatase 168. Pending items list repeat cultures, an echocardiogram, a colonoscopy, susceptibilities and the alkaline phosphatase. Five numbered problems follow, citing Fowler et al. (2023) for applying the Duke criteria and Boleij et al. (2011) for colonoscopy. A final section explains numbering and dated addenda.
Reading the PA 612 Week 2 grading rubric
The admission note loses the most when it lacks a one-liner or buries the reason for admission in paragraph three, since later readers rely on that sentence. Next comes a plan written as a list of orders detached from the problems they address. Graders deduct for exhaustive normals that hide the abnormal findings. Faculty reward pending items listed as a category, problems numbered for later amendment and an assessment that states what is likely and what will settle it. Citation of the criteria or evidence behind decisions earns credit. A note designed for dated addenda rather than editing shows understanding of the record. APA form completes the rubric.
Common PA 612 Week 2 mistakes, and how to avoid them
Admission notes most often fall short by reproducing a full review of systems and normal examination findings, so the new murmur is lost among them. Another common problem is a plan that lists orders without saying which problem each one serves. Some notes also forget what is still pending. If your patient was admitted for something else, send the history, examination and initial results; a note prepared for you would open with a one-liner, record findings rather than normals, list pending items, number the problems with a plan beside each and leave room for addenda. A site template changes only where each part sits; the content above stays the same.
Get a PA-612 Week 2 example written to your instructions
Send the assignment, the rubric and your site's admission template, and a custom PA-612 history and physical is written to them and back inside 24-48h, first one free. Examples here are built on constructed cases: the people you meet on rotation, the hours you record and anything a supervisor puts a signature to remain entirely your own work to write and submit.
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PA 612 Week 2 questions, answered
What does the assessment say when the diagnosis is still open on day one?
It says so, in those terms. Admission documents are written before most of the information exists, and a strong example names the working explanation, the alternatives still standing, and what each one is waiting on. Faculty mark the document on whether the weeks after it have something firm to work from, and false confidence written on the first day makes every amendment look like a correction.
How much history is too much?
The usable test is whether a sentence would change a decision. Detail that no problem on the list depends on reads as volume rather than as assessment, and volume is the first thing trimmed. Services publishing a required history template want every field attempted, so the answer is completeness inside the fields you were given and restraint everywhere the template leaves open.
The template my site uses looks nothing like the examples online.
Expect that. Inpatient services publish their own orders, headings and rules about where the plan sits, so an example built to somebody else's reads as though it belongs to another hospital. Attach the blank template with the assignment and the finished version arrives in your service's order, field by field, rather than in a shape lifted from a textbook.
Where can I find a free PA 612 Week 2 sample paper?
The complete PA 612 Week 2 admission history and physical for Streptococcus gallolyticus bacteremia with suspected endocarditis is on this page.
Why does the PA 612 Week 2 sample plan a colonoscopy?
Streptococcus gallolyticus is strongly associated with colorectal neoplasia, and the patient also has iron-deficiency anemia, so colon evaluation is planned during the admission.