| Course | PA 612 Clinical Clerkship - Internal Medicine |
|---|---|
| Week | 5 |
| Paper type | Problem list memo |
| Length | About 500 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 612 Week 5
Memorandum
To: Medicine team, ward 5
From: PA student
Date: March 8, 2026, hospital day 7
Re: Problem list for W.H. rebuilt: two dates per problem, one promotion, two closures, one merge and one item left unexplained
The List
Table 1
W.H. Problem List, Hospital Day 7
| Problem | Began | Recognized | Status | Carried by |
|---|---|---|---|---|
| Streptococcus gallolyticus endocarditis, mitral valve with annuloplasty ring | Before admission | Hospital day 2 (echocardiogram) | Active; antibiotic day 6 of 42 | Medicine, infectious disease |
| Sigmoid mass, biopsy pending | Before admission | Hospital day 6 (colonoscopy) | Active | Medicine, gastroenterology, surgery |
| Iron-deficiency anemia | Before admission | Hospital day 1 | Active; likely from the mass | Medicine |
| Raised alkaline phosphatase, 168 U/L | Before admission | Hospital day 1 | Active, unexplained | Medicine |
| Hypertension | Years | Known | Stable | Medicine |
| Hypokalemia during bowel preparation | Hospital day 5 | Hospital day 5 | Closed day 6 | None |
| Orthostatic hypotension during bowel preparation | Hospital day 5 | Hospital day 5 | Closed day 6 | None |
Note. Note. "Began" is the best estimate of onset; "Recognized" is the day the team identified it.
Two Dates, Not One
Most of W.H.'s problems began before admission and were recognized during it. Keeping both dates shows that the sigmoid mass is not a hospital complication; it is the probable source of the bacteremia and the anemia, present for months.
Promotion Needs Evidence
"Sigmoid mass" replaces "colorectal neoplasm, to be evaluated" from the admission list. The promotion rests on the colonoscopy on day 6, which found a 3.5-centimeter fungating sigmoid mass, biopsied, and two small polyps, removed. The association of this organism with colorectal neoplasia was the reason for the colonoscopy (Boleij et al., 2011). The entry will become "sigmoid adenocarcinoma" only when pathology reports it.
The CT on day 7 was ordered because of the mass; it showed no spread to the liver or lungs, which is recorded under the mass problem rather than as a separate item.
Closing Is Not Deleting
Hypokalemia and orthostatic hypotension are closed, not removed. They stay on the list marked "closed day 6," with the cause, so a reader planning another bowel preparation will see them.
The same rule applies to the anemia once it is treated: it will stay on the list as "iron-deficiency anemia from the sigmoid tumor, treated with intravenous iron," not disappear, because it explains the hemoglobin a reader will see for months.
A Merge Gets a Sentence
"Fever" and "bacteremia" from the admission list are merged into "Streptococcus gallolyticus endocarditis," because both are fully explained by it under the 2023 Duke criteria (Fowler et al., 2023).
Leave the Unexplained Visible
The alkaline phosphatase of 168 is not explained. Day 7 imaging of the abdomen found the liver clear. Fractionation is pending; bone or liver origin is still possible. It stays on the list as "unexplained" rather than being folded into the mass.
Leaving it visible also protects the patient: if the fractionation shows a bone origin, a bone scan may be needed before surgery, and that decision depends on someone remembering the result is still outstanding.
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
What the PA 612 Week 5 assignment asks for
The fifth week asks for two things on one page: the problem list itself and the argument beneath it. The list is usually a table with columns for the problem, the day it began, the day it was recognized, its status and the service carrying it. The first two dates often differ, and that difference matters. Promoting a problem from a symptom or suspicion to a diagnosis needs evidence, and so does each merge. Closing a problem is not deleting it; closed problems stay visible with their cause. Anything unexplained should stay on the list as unexplained rather than being folded into a convenient diagnosis. The memo explains each change. Cite the criteria or evidence behind promotions and merges.
Inside the PA 612 Week 5 example
The memo is addressed to the ward team on March 8, hospital day 7. A seven-row table lists endocarditis, the sigmoid mass, anemia, the alkaline phosphatase, hypertension and two closed bowel preparation problems, each with began, recognized, status and service. A section explains that most problems predated admission. The promotion section moves "colorectal neoplasm, to be evaluated" to "sigmoid mass" on colonoscopy evidence, citing Boleij et al. (2011), and holds the word adenocarcinoma for pathology. The closing section keeps hypokalemia and orthostatic hypotension marked closed with their cause. The merge section folds fever and bacteremia into endocarditis under Fowler et al. (2023). The final section keeps the alkaline phosphatase unexplained after a clear CT, with fractionation pending.
Reading the PA 612 Week 5 grading rubric
The memo loses the most when the list has one date per problem, which hides how much of the illness predated admission. Next comes a promotion without evidence, such as naming a cancer before pathology. Graders deduct when closed problems are deleted rather than marked closed with a cause. Faculty reward merges explained in a sentence and unexplained findings left visible. A table with status and owning service earns credit for usability. The argument beneath the list should account for every change. Citation of the evidence behind promotions and merges, in APA form, completes the rubric. A status column that shows whether each problem is active, stable or closed, and which service carries it, also earns marks because the list is read by consultants as well as the primary team.
PA 612 Week 5 help: mistakes that cost points
A weak problem list memo lists diagnoses without dates or by copying the admission list with a few additions. Another common problem is folding an unexplained abnormality into the main diagnosis to tidy the list. Some memos also drop resolved problems that would matter later. If your patient's list looks different, send the problems with when each started and when it was found; a memo written for you would give two dates per problem, promote and merge only with evidence, keep closed items visible and leave the unexplained on the list. If the chart and memo disagree, the memo would say which is being corrected and why.
Get a PA-612 Week 5 example written to your instructions
Send the assignment, the rubric and the problem list template your service uses, and a custom PA-612 expansion memo is written to them and returned inside 24-48h, first one free. Where the assignment supplies the case and the list it started from, the example is built on that list rather than on one invented for the purpose.
More PA 612 papers and MPAS samples
- PA 612 Week 1: Inpatient Day Count Post
- PA 612 Week 2: Admission History and Physical
- PA 612 Week 3: Attending Rounds Presentation
- PA 612 Week 4: Overnight Event Summary
- PA 612 Week 6: Goals of Care Summary
- PA 612 Week 7: Hospital Course Summary
- PA 612 Week 8: Day of Discharge Checklist
- PA 610 Week 5: Preventive Care Opportunity Brief
- PA 608 Week 5: Error Pattern Write-Up
- PA 604 Week 5: Productivity Expectation Review
- PA 603 Week 5: Employment Gap Explanation
PA 612 Week 5 questions, answered
Should symptoms be on the list or only diagnoses?
Services differ and the template usually says. Where symptoms are allowed, they carry the same requirements as anything else: a date, a status, and a reason for standing on their own. Where the list takes diagnoses only, an unexplained finding still needs somewhere to live, normally a short open questions block underneath. Either convention works provided the memo states which one it uses.
How far back does the list go? My patient has decades of history.
The working boundary is relevance to this admission, plus anything a covering clinician would need in the middle of the night. Chronic conditions that change management stay; conditions inactive for years usually move to a past history block instead of the active list. Where a section requires the full list it says so, and the safe version follows your template and explains the cut it made.
The memo and the chart disagree. Which one do I write to?
Write to the chart and say where the memo departs from it. An expansion memo that silently corrects a list leaves a reader unable to tell an error from an update. Naming the disagreement, the day it was noticed, and what the writer believes is correct turns a discrepancy into the kind of reasoning this week is marked on.
Where can I find a free PA 612 Week 5 sample paper?
A complete PA 612 Week 5 problem list expansion memo, with two dates per problem and reasons for every change, is on this page.
Why is the sigmoid mass not called cancer in the PA 612 Week 5 sample?
Pathology had not reported yet, so the problem is promoted to "sigmoid mass" on colonoscopy evidence and renamed only when the biopsy confirms it.