| Course | PA 532 Surgical and Clinical Skills |
|---|---|
| Week | 2 |
| Paper type | Surgical indication brief |
| Length | About 640 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 532 Week 2
Memorandum
To: Dr. Marsh, general surgery
From: PA student, surgical clinic
Date: Clinic day, October
Re: Indication for repair of right inguinal hernia in R.V.
The Patient, in Four Lines
R.V., 68, retired carpenter who still works in a home woodshop most days. Reducible right inguinal hernia for 18 months, now aching by mid-afternoon and after lifting lumber. Atrial fibrillation on apixaban, mild COPD, enlarged prostate on tamsulosin. Wants to keep working in the shop.
The Future Where Nothing Happens
Without repair, the hernia will probably keep causing discomfort and may grow. In a randomized trial of men with minimally symptomatic inguinal hernias, about a quarter of those assigned to watchful waiting crossed over to surgery within two years, mostly because of increasing pain, and the rate of acute incarceration was low, under 2 per 1,000 patient-years (Fitzgibbons et al., 2006). R.V. is not minimally symptomatic: the pain limits work every day. For R.V., the future without surgery most likely means continued pain, a growing hernia and eventual repair under less favorable conditions, older and possibly as an emergency.
Alternatives Need a Course Too
Watchful waiting with a truss: a truss can reduce discomfort but is poorly tolerated during physical work and does not change the course. Open repair with mesh under local anesthesia and sedation: returns most patients to light work within one to two weeks and avoids general anesthesia, useful with COPD. Laparoscopic repair: less early pain and faster return in many series but requires general anesthesia. The international guidelines suggest that men with symptomatic inguinal hernias be offered repair, and that the technique be chosen according to the surgeon's expertise and the patient's factors (HerniaSurge Group, 2018).
One Currency for Both Sides
Days in the shop. With repair: an expected two weeks of light activity, then four weeks before heavy lifting, about six weeks of reduced shop work once. Without repair: R.V. currently stops shop work most afternoons, roughly half a working day lost five days a week, ongoing, with a risk of emergency surgery that would cost far more. Counting both sides in the same currency shows repair costs about six weeks once against a loss that continues indefinitely.
A Threshold This Person Clears
The threshold for offering repair in a man with a reducible hernia is symptoms that matter to the patient. R.V. clears it: daily pain that stops valued work. Anticoagulation and COPD raise the stakes but do not change the indication; they shape the timing and the technique.
What Would Reverse It
A new cardiac event, an ejection fraction found to be very low, or R.V. deciding the pain is tolerable would each move the recommendation back toward waiting. A hernia that became irreducible or tender would move it toward urgent repair.
What R.V. Values
R.V. said the shop is "what keeps me going" since retiring, and would rather lose six weeks once than keep stopping every afternoon. That preference is the reason the threshold is cleared; a man with the same hernia who did not mind the ache could reasonably choose to wait.
Timing Within the Year
R.V. asked for a date in late October, after a commissioned set of cabinets is finished. Elective repair can wait that long safely, since the hernia is reducible and has not changed in size over the past three months. If it became painful and firm in the meantime, R.V. was told to come to the emergency department the same day.
Who Else Is Involved
The cardiologist manages the atrial fibrillation and will be asked about holding apixaban. R.V.'s primary care clinician will be told the plan. R.V.'s daughter will drive R.V. home and stay the first night.
Recommendation
Offer elective open repair with mesh under local anesthesia with sedation, after a preoperative risk review and a plan for apixaban.
References
Fitzgibbons, R. J., Jr., Giobbie-Hurder, A., Gibbs, J. O., Dunlop, D. D., Reda, D. J., McCarthy, M., Jr., Neumayer, L. A., Barkun, J. S. T., Hoehn, J. L., Murphy, J. T., Sarosi, G. A., Jr., Syme, W. C., Thompson, J. S., Wang, J., & Jonasson, O. (2006). Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: A randomized clinical trial. JAMA, 295(3), 285-292. https://doi.org/10.1001/jama.295.3.285
HerniaSurge Group. (2018). International guidelines for groin hernia management. Hernia, 22(1), 1-165. https://doi.org/10.1007/s10029-017-1668-x
What the PA 532 Week 2 assignment asks for
The second week calls for a memo of two pages at most deciding whether a surgical indication is met. Keep the patient to three or four lines with only the facts that bear on the question. Spend your longest paragraph on what the problem does over the coming months if nobody operates, with evidence. Give the alternatives, including waiting, their own course. Choose one currency, such as days of work, pain or risk, and measure both sides in it. State the threshold for surgery and show whether this patient clears it, including the patient's own values. Name what would reverse the recommendation. Close with the recommendation and any timing considerations. Cite trials and guidelines.
How the PA 532 Week 2 example is put together
The memo addresses the surgeon and compresses R.V. to an 18-month reducible hernia that now aches each afternoon, apixaban for atrial fibrillation, mild COPD and BPH. The longest section describes the future without surgery using the Fitzgibbons trial's crossover and incarceration rates and explains why R.V., who is not minimally symptomatic, would likely need repair anyway. Truss, open repair under local anesthesia and laparoscopic repair are given courses, citing the HerniaSurge guidelines. Both sides are counted in days of shop work: about six weeks once against half a day lost five days a week. The threshold section ties clearance to symptoms that matter to R.V. Reversal conditions are listed, and further sections cover R.V.'s values, a late-October date and the others involved.
PA 532 Week 2 rubric: what full points look like
The memo is graded first on the future without surgery. A brief that describes the operation but never what happens if nobody operates loses the largest share. Next comes the treatment of alternatives: waiting and other techniques need a course of their own, not a single dismissive line. Credit grows with a single currency used for both sides, since mixed measures cannot be compared. The threshold must be stated and applied to this patient, including the patient's values. Faculty reward stated reversal conditions. Memo format with headings and a two-page limit is expected. Evidence from trials and guidelines should support the natural history and the recommendation.
PA 532 Week 2 help: mistakes that cost points
The most common problem with indication briefs is describing how the operation is done instead of whether it should be. Pass along your patient's details and the condition, and the memo prepared from them would compress the patient, spend its longest paragraph on the course without surgery, give alternatives their own course and measure both sides in one currency. The threshold is applied to your patient, including their own priorities, and reversal conditions are listed. If your case is a gallbladder, a joint or a skin lesion, the same structure applies. Keep the memo within two pages, and draw the patient facts from your own case.
Get a PA-532 Week 2 example written to your instructions
Whatever your classroom published for this week, send it over as it stands, together with the rubric if one came with it. A custom PA-532 indication brief is written to that material, not to a general version of the week, and it comes back inside 24-48h. The first one is free, revisions included.
More PA 532 papers and MPAS samples
- PA 532 Week 1: Procedure Limits Discussion Post
- PA 532 Week 3: Preoperative Risk Summary
- PA 532 Week 4: Informed Consent Script
- PA 532 Week 5: Procedure Step Sequence
- PA 532 Week 6: Wound Closure Rationale
- PA 532 Week 7: Postoperative Day Plan
- PA 532 Week 8: Complication Timeline Analysis
- PA 531 Week 2: Chief Complaint Brief
- PA 530 Week 2: Knee Mechanism of Injury Brief
- PA 528 Week 2: Lesion Localization Exercise
- PA 526 Week 2: Abdominal Quadrant Brief
PA 532 Week 2 questions, answered
What if the patient in my scenario obviously needs the operation?
Then the brief argues that, and the marks come from how the case is built rather than from a surprise ending. An obvious indication still has to beat the alternatives on the page, and the untreated course still has to be described, because that is the evidence. A recommendation nobody could disagree with is fine when the reasoning behind it is visible.
How much of the patient history belongs in a brief this short?
Only what moves the decision. A brief carrying three paragraphs of background reads as a case write-up that lost its way, and length spent there is length not spent on the comparison. A usable test: delete any fact that would not change the recommendation if it were different, and see whether the brief still holds together.
Does a brief have to recommend the procedure?
No, and sections often reward the well-argued negative more than the positive, because it is harder to write. If the answer is that this person should not have the operation, the brief still has to say what happens instead, over what span, and who reviews it. Declining to operate is a plan, not the absence of one.
Where can I find a free PA 532 Week 2 sample paper?
The full PA 532 Week 2 indication memo is on this page, weighing hernia repair against waiting in days of shop work lost.
What threshold does the patient clear in the PA 532 Week 2 sample?
Symptoms that matter to the patient, here daily groin pain that stops valued woodshop work most afternoons.