| Course | PA 626 Clinical Clerkship: Elective I |
|---|---|
| Week | 6 |
| Paper type | Consult reply |
| Length | About 440 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 626 Week 6
Consult Question Brief Answering a Primary Care Clinician's Question About Metformin at an eGFR of 28: The Question Restated in the Referrer's Words, a Short Answer, Who Does What Next and the Uncertainty in One Place
Student Name
Chamberlain University
PA 626: Clinical Clerkship: Elective I
Instructor Name
Month Day, Year
Consult Question Brief Answering a Primary Care Clinician's Question About Metformin at an eGFR of 28: The Question Restated in the Referrer's Words, a Short Answer, Who Does What Next and the Uncertainty in One Place
The Question, Restated
"My patient's eGFR has dropped to 28. Should I stop metformin, and what should I use instead?" from the primary care clinician, about B.S., 61, with type 2 diabetes, A1C 7.4 percent.
B.S.'s last three eGFR values were 34 in March, 29 in June and 28 in September; albuminuria has stayed in the moderately increased range.
The Answer
Yes, stop metformin now. Guidance advises reducing the dose when eGFR falls to 30 to 44 and stopping it below 30 (Rossing et al., 2022). B.S. has been below 30 on two readings three months apart.
What to Use Instead
Continue the SGLT2 inhibitor B.S. already takes; it still protects the kidney at this level. For glucose, add a GLP-1 receptor agonist if covered; if not, a DPP-4 inhibitor with the dose adjusted for kidney function. Avoid sulfonylureas that accumulate in kidney disease.
Doses for any replacement depend on the eGFR at the time of prescribing, and the clinic pharmacist can confirm them. A GLP-1 receptor agonist also lowers albuminuria and cardiovascular risk, which matters for a patient at this stage, but its price may decide the choice if B.S. has a high deductible.
Who Does What Next
Primary care: stop metformin today, choose the replacement and recheck A1C in 3 months. Nephrology: see B.S. in 6 weeks for stage 4 planning, including a discussion of kidney replacement options. Clinic pharmacist: review all other medications for kidney dosing, sending a list to both clinicians by Friday.
Uncertainty in One Place
The one uncertainty: whether the fall from 34 to 28 is stable decline or partly a temporary drop from a recent dehydration episode. A repeat eGFR in 4 weeks will tell; the metformin decision does not wait for it.
Length Set by the Reader
The reply is short because the referrer asked a specific question and has a patient in front of them; the full nephrology assessment will follow the visit.
Everything the referrer did not ask for, such as a full review of the patient's bone and mineral results, waits for the visit note, where it can be explained properly.
References
Rossing, P., Caramori, M. L., Chan, J. C. N., Heerspink, H. J. L., Hurst, C., Khunti, K., Liew, A., Michos, E. D., Navaneethan, S. D., Olowu, W. A., Sadusky, T., Tandon, N., Tuttle, K. R., Wanner, C., Wilkens, K. G., Zoungas, S., & de Boer, I. H. (2022). KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease. Kidney International, 102(5S), S1-S127. https://doi.org/10.1016/j.kint.2022.06.008
What the PA 626 Week 6 assignment asks for
The sixth week asks for a brief reply to a consult question. The first line is the question, restated in the referrer's own terms so they can see it was heard. Then answer it, briefly, for one reader who has a patient in front of them. Say who does what next, naming each clinician. Keep uncertainty in one place rather than scattering hedges through the reply. The length is set by the reader's need, not by how much you know. If the referral barely asks anything, restate the question you inferred and say so. Repeat findings only where the answer depends on them. A recommendation is expected, but this is not a full treatment plan. Cite the guidance behind the answer.
How the PA 626 Week 6 example is put together
The brief quotes the primary care question about stopping metformin at an eGFR of 28 for B.S., 61, with an A1C of 7.4. The answer stops metformin now, citing Rossing et al. (2022) for reducing at 30 to 44 and stopping below 30, and notes two readings below 30. The replacement section keeps the SGLT2 inhibitor, adds a GLP-1 agonist if covered or a kidney-adjusted DPP-4 inhibitor if not, and avoids accumulating sulfonylureas. The next steps assign primary care, nephrology in six weeks for stage 4 planning and the pharmacist's review by Friday. The uncertainty section isolates whether the drop reflects recent dehydration, settled by a repeat in four weeks. A final line explains the brevity.
Where the points sit in the PA 626 Week 6 rubric
Consult replies are judged first on whether the referrer's question is answered in the first lines. A reply that opens with history or a full assessment, leaving the answer for the end, falls short. Next, faculty look for next steps assigned to named clinicians, since unassigned steps are the usual failure of consultation. Uncertainty kept in one place is credited; hedges scattered throughout are not. Brevity matched to the reader's need is weighed. Accuracy of the recommendation against guidance is checked closely, and the guidance should be cited in APA form.
Common PA 626 Week 6 mistakes, and how to avoid them
Consult replies commonly bury the answer under a review of the case that the referrer already knows. Another frequent gap is a recommendation with no owner, so each clinician waits for the other. Some replies also hedge every sentence. If your consult question differs, send the referral as written and the key findings; we would restate the question, answer it first, assign next steps by name, place the uncertainty in one spot and keep the length to what the referrer needs. If the referral barely asks anything, the brief would state the inferred question. A reply of this kind usually fits in under a page, and length is set by the referrer's question.
Get a PA-626 Week 6 example written to your instructions
Send the referral your section supplies together with the assignment as your classroom words it, plus the rubric rows if you have them, and a custom PA-626 Week 6 consult brief is written to that question and returned inside 24-48h, the first one free. Tell us the reply format your service uses and the example matches it.
More PA 626 papers and MPAS samples
- PA 626 Week 1: Elective Gap Post
- PA 626 Week 2: Elective Rationale Memo
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- PA 626 Week 7: Directed Reading Brief
- PA 626 Week 8: Unmet Objective Memo
- PA 624 Week 6: Safety Net Referral Memo
- PA 648 Week 6: Evidence of Closure Memo
- PA 622 Week 6: Collateral Contact Note
- PA 650 Week 6: Harm and Benefit Balance
PA 626 Week 6 questions, answered
The referral I was given barely asks anything. What does the brief answer?
Vague referrals are common and the assignment usually expects the writer to name the question the referrer seems to be asking, say so plainly, and answer that. A brief opening with the question as it was received and then the question as this service reads it scores better than one silently substituting the second. Send the referral text with the instructions and the example does that in your service's form.
How much of the findings should the brief repeat?
Only what bears on the question. A referrer who sent the patient already has their own record, so repeating it fills the page with material the reader supplied. The example keeps findings this service produced and that change the answer, and leaves the rest out. Where the rubric asks for a fuller account, that section goes underneath the answer rather than in front of it.
My rubric wants a recommendation. Does that make it a treatment plan?
The rubric decides, and on this week the graded object is usually the reply rather than the management behind it. A sample sets out the document: what the answer commits this service to, what it asks of the referrer, and where the uncertainty sits. Clinical decisions stay with the people holding the patient, and nothing here is written as guidance for anyone's care.
Where can I find a free PA 626 Week 6 sample paper?
A complete PA 626 Week 6 consult question brief on metformin at an eGFR of 28 is on this page.
What is the one uncertainty in the PA 626 Week 6 sample?
Whether the fall in eGFR is stable decline or partly a temporary drop after dehydration, which a repeat test in four weeks will settle.