| Course | PA 616 Clinical Clerkship - Surgery |
|---|---|
| Week | 4 |
| Paper type | Case preparation card |
| Length | About 540 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 616 Week 4
Case Preparation Card for C.N.'s Laparoscopic Heller Myotomy With Dor Fundoplication: One Page in Compartments, Ordered by Who Will Ask, a Source in Brackets After Every Line and a Box for What I Do Not Know
Student Name
Chamberlain University
PA 616: Clinical Clerkship - Surgery
Instructor Name
Month Day, Year
Case Preparation Card for C.N.'s Laparoscopic Heller Myotomy With Dor Fundoplication: One Page in Compartments, Ordered by Who Will Ask, a Source in Brackets After Every Line and a Box for What I Do Not Know
Compartment 1: The Patient (the intern asks first)
C.N., 44, music teacher. Dysphagia to solids and liquids for 2 years, regurgitation at night, 6 kg weight loss. Eckardt symptom score 9 [clinic note]. High-resolution manometry: type II achalasia, panesophageal pressurization, raised integrated relaxation pressure [manometry report]. Timed barium esophagram: 5-centimeter column at 5 minutes [radiology report]. Endoscopy: no tumor at the gastroesophageal junction [endoscopy report].
Compartment 2: Why This Operation (the resident asks)
For type II achalasia, laparoscopic Heller myotomy, pneumatic dilation and peroral endoscopic myotomy are all effective first treatments; myotomy is usually paired with a partial fundoplication to limit reflux (Vaezi et al., 2020). C.N. chose surgery after discussing all three [consent note].
The resident may also ask why not peroral endoscopic myotomy. The answer on the card: both are effective for type II achalasia; the endoscopic approach does not add a wrap and carries more reflux, while the laparoscopic approach adds an anti-reflux wrap at the cost of abdominal incisions (Vaezi et al., 2020) [consent note].
Compartment 3: Anatomy and Steps (the attending asks)
Gastroesophageal junction exposed by dividing the phrenoesophageal ligament; anterior vagus nerve identified and preserved [operative atlas]. Myotomy about 6 centimeters on the esophagus and 2 to 3 centimeters onto the stomach, dividing longitudinal then circular muscle down to mucosa (Vaezi et al., 2020). Intraoperative endoscopy to check completeness and test for leak [attending's preference card]. Dor fundoplication: anterior partial wrap sutured to the myotomy edges [operative atlas].
Compartment 4: What Can Go Wrong
Mucosal perforation during myotomy, usually repaired at once (Vaezi et al., 2020). Pneumothorax from pleural entry. Incomplete myotomy on the gastric side, the usual cause of persistent dysphagia. Postoperative reflux.
For each, the card notes how it would show: a perforation as bubbles under saline during endoscopy, a pneumothorax as rising airway pressures or falling oxygen saturation, and an incomplete myotomy as a tight junction on endoscopy before the wrap is placed. Knowing the sign lets me watch the right screen during the case.
Compartment 5: Recovery Plan (the nurse asks)
Contrast esophagram on postoperative day 1, then clear liquids; soft diet for 2 weeks; discharge usually day 1 or 2 [service protocol]. Enhanced recovery principles of early feeding and multimodal analgesia apply (Gustafsson et al., 2019).
Compartment 6: What I Do Not Know
Whether the attending uses a bougie during the myotomy. Exact port positions this attending prefers. How the anesthesiologist handles aspiration risk at induction given a dilated esophagus. I will ask the resident before 07:00.
Built for This Case, Not the Category
Everything on the card is specific to C.N.'s manometry, imaging and operation. It does not cover other foregut operations.
References
Gustafsson, U. O., Scott, M. J., Hubner, M., Nygren, J., Demartines, N., Francis, N., Rockall, T. A., Young-Fadok, T. M., Hill, A. G., Soop, M., de Boer, H. D., Urman, R. D., Chang, G. J., Fichera, A., Kessler, H., Grass, F., Whang, E. E., Fawcett, W. J., Carli, F., . . . Ljungqvist, O. (2019). Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations: 2018. World Journal of Surgery, 43(3), 659-695. https://doi.org/10.1007/s00268-018-4844-y
Vaezi, M. F., Pandolfino, J. E., Yadlapati, R. H., Greer, K. B., & Kavitt, R. T. (2020). ACG clinical guidelines: Diagnosis and management of achalasia. American Journal of Gastroenterology, 115(9), 1393-1411. https://doi.org/10.14309/ajg.0000000000000731
What the PA 616 Week 4 assignment asks for
The fourth week asks for a case preparation card on one side of one page, divided into headed compartments rather than a running list, since you will look for a compartment under pressure. Order the compartments by who on the team is likely to ask about them. Put the source in brackets after every line, whether a chart document, a guideline or an atlas, so you know what each fact rests on. Include a box for what you do not know and how you will find out before the case. Build the card for this patient and this operation, not for the category in general. The card may or may not be graded at your site, but the discipline of fitting it on one page is the point. Cite the guidance used.
Inside the PA 616 Week 4 example
Compartment 1 covers C.N., 44, with two years of dysphagia, an Eckardt score of 9, type II achalasia on manometry, a 5-centimeter barium column at 5 minutes and no tumor on endoscopy, each line bracketed to its report. Compartment 2 explains choosing myotomy among three effective options and pairing it with a partial wrap (Vaezi et al., 2020). Compartment 3 sets out exposure, vagus preservation, a 6-centimeter esophageal and 2 to 3-centimeter gastric myotomy, endoscopic leak testing and the Dor wrap. Compartment 4 lists perforation, pneumothorax, incomplete myotomy and reflux. Compartment 5 covers the day 1 esophagram, diet and recovery principles (Gustafsson et al., 2019). Compartment 6 lists three unknowns to ask about before 07:00. A closing line limits the card to this case.
PA 616 Week 4 rubric: what full points look like
Case cards lose the most when they exceed a page or run as an undifferentiated list, which defeats their use in the operating room. Next comes a card without sources, so the student cannot tell which facts are from the chart and which from memory. Graders deduct for generic content about the procedure category rather than this patient. Faculty reward compartments ordered by who asks, a source after every line and an honest box for unknowns with a plan. Accuracy of anatomy and steps is checked closely. Citation of guidelines in APA form completes the rubric.
PA 616 Week 4 help: mistakes that cost points
Case cards most often fall short by copying a textbook chapter on the operation in small type. Another common problem is leaving out the patient's own data, so the card would fit any case. Some cards also omit what the student does not know. If your assigned case is different, such as a cholecystectomy, a colectomy or a thyroidectomy, send the patient's key data and the operation; a card prepared for you would fit one page, order compartments by who asks, put a source after every line, keep a box for unknowns and stay specific to the case. If your site assigns reading, those sources would be the ones bracketed.
Get a PA-616 Week 4 example written to your instructions
Send the case your site assigned along with the week's instructions and whatever reading list came with them, and a custom PA-616 card is built from those sources and no others, then returned inside 24-48h with nothing charged for the first. If the assignment sets a page limit or a required compartment, name it and the card is built to fit.
More PA 616 papers and MPAS samples
- PA 616 Week 1: Surgical Service Chain Post
- PA 616 Week 2: Pre-Rounding Data Sheet
- PA 616 Week 3: Service Census Update
- PA 616 Week 5: Operative Note Draft
- PA 616 Week 6: Postoperative Check Note
- PA 616 Week 7: Procedure Log Summary
- PA 616 Week 8: Chief Resident Feedback Reply
- PA 614 Week 4: Medical Decision Making Paragraph
- PA 612 Week 4: Overnight Event Summary
- PA 610 Week 4: Medication Reconciliation Memo
- PA 608 Week 4: Missed Item Review
PA 616 Week 4 questions, answered
Is the card marked, or is it just something I carry?
On this clerkship it is usually both, and the collected version is marked on whether it could have been used. Faculty look at the page limit, the sourcing, and whether the compartments answer questions somebody would actually put. A card written to look thorough on submission, with paragraphs and no brackets, tends to score below a scruffy one that obviously went into a pocket.
What if my site does not assign anything to read?
Then say so on the card and name what you used instead, which most sections accept. A course text, a society document or the hospital's own material all work as sources provided each one is named where it is used. What loses marks is an unattributed card, because the assignment is partly about where surgical knowledge on a service actually comes from.
Should the card say what I would do in the case?
Keep that off it unless the instructions ask. A preparation card is a reference the writer reads from, and a plan asserted on it reaches into territory this clerkship gives to somebody with a signature. Where a section does want a proposed course of action, it says so explicitly, and then it belongs in its own compartment, marked as proposed rather than stated.
Where can I find a free PA 616 Week 4 sample paper?
The complete PA 616 Week 4 case preparation card for a laparoscopic Heller myotomy, one page with sources in brackets, is on this page.
What is in the unknowns box in the PA 616 Week 4 sample?
Whether the attending uses a bougie, the preferred port positions and how anesthesia handles aspiration risk with a dilated esophagus.