Absite Exam Test Bank
ABSITE Exam 4 Questions and Correct
Answers 2025 A+.
A healthy 40-year-old man is consulting with you for evaluation of intermittent left groin
discomfort (4 out of 10 on pain scale) which has been present for the past three weeks. These
symptoms have caused him to miss work on occasion. He denies any constitutional symptoms,
and has no other complaints at this time. On physical examination, you cannot detect a hernia,
even with provocative maneuvers (i.e., Valsalva, cough). Your recommendation at this time
would be:
A. Computed tomography (CT) of the abdomen and pelvis with oral and intravenous contrast for
further evaluation
B. Diagnostic laparoscopy
C. Contrast herniography (peritoneography)
D. Left groin exploration with possible inguinal hernia repair
A+ TEST BANK 1
E. trasonography of the left groin
- Correct Answer :Ultrasonography of the left groin
Correct.
This patient may have an occult inguinal hernia which is not detectable on physical examination.
Ultrasonography, herniography and CT are all useful diagnostic studies, with ultrasound being
the least invasive, less costly, and with high sensitivity and specificity. In this patient with minimal
symptoms, there is no indication for immediate laparoscopy or groin exploration.
A 60-year-old male presents with persistent pain over his right lower abdomen six months after a
bilateral TEPP laparoscopic inguinal hernia repair. There is no evidence of hernia recurrence,
seroma or infection on physical examination. As part of your investigation, you obtain a plain
abdominal radiograph, which reveals multiple bilateral spiral tacks across the lower abdomen.
You obtain the operative report, and confirm your suspicion that the surgeon used permanent
spiral tacks for mesh fixation. Injury to which of the following nerves is the most likely cause for
his persistent pain?
A. Ilioinguinal nerve
B. Iliohypogastric nerve
,C. Genital branch of the genitofemoral nerve
D. Lateral femoral cutaneous nerve
E. Femoral nerve
- Correct Answer :Iliohypogastric nerve
Correct.
Post-herniorrhaphy neuralgia has been reported to occur in up to 20% of cases. Injury to any of
the nerves mentioned can result in post-herniorrhaphy neuralgia. Given the location of the
patient's symptoms and the method used for mesh fixation, the iliohypogastric nerve is the most
vulnerable to injury during laparoscopic mesh fixation.
A 67-year-old man presents with vomiting and abdominal distension. An abdominal x-ray reveals
air/fluid levels suggesting small bowel obstruction. On exam, her abdomen is distended with
diffuse tenderness and there is a tender mass in the right groin. At operation, you resect a
strangulated 6-cm segment of small intestine and there is moderate contamination with bowel
contents. What should you do for the hernia?
A. Complete the operation and plan a subsequent hernia repair.
B. Perform a repair using polypropylene mesh.
C. Perform a repair using biologic mesh.
D. Perform a tissue-based repair.
- Correct Answer :Perform a tissue-based repair.
Correct.
It is important to repair the hernia defect at operation to avoid the risks of early recurrent
intestinal obstruction. With contamination during the bowel resection, the safest option is to
A+ TEST BANK 2
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perform a tissue-based repair. Permanent mesh should be avoided in this situation because of
the risk of infection. Use of biologic mesh is associated with almost certain hernia recurrence. It
may be necessary to perform the hernia repair through a separate groin incision.
A 33-year-old man has a symptomatic recurrent inguinal hernia following a totally
extraperitoneal (TEP) repair two years ago. Which of the following is the best approach for
reoperation?
A. TEP repair
B. Trans-abdominal pre-peritoneal (TAPP) repair
C. Open inguinal repair
D. Open trans-abdominal repair
- Correct Answer :Open inguinal repair
Correct.
Most experts would recommend an open repair in this circumstance. It is important to avoid
using the same approach as previously done to minimize the risk of nerve injury or other
complications due to scarring. The open inguinal approach is the best answer. Open trans-
abdominal repairs are associated with a higher recurrence rate and a repeat TEP or TAPP repair
is likely to be more difficult due to scarring.
A vibrant 78-year-old male is referred for management of a right inguinal hernia diagnosed by his
primary care physician during his annual evaluation one year ago. He denies symptoms
attributable to the hernia, which is easily reducible. Which of the following is appropriate to
consider when recommending watchful waiting rather than repair?
A. Pain which limits his physical activity is more likely within the next year if the hernia is not
repaired.
B. The risk of incarceration or strangulation is less than 1% within 2 years.
C. Less than 10% of patients will have a hernia repair within 2 years.
D. Wearing a supportive truss will decrease the risk of complications.
E. Men are at a higher risk of developing hernia complications, compared to women.
- Correct Answer :The risk of incarceration or strangulation is less than 1% within 2 years.
Correct.
Results of a large prospective study comparing watchful waiting with operative repair in men
aged 40-65 with minimal to no symptoms of a reducible hernia showed no difference in pain or
physical health scores, or rate of post-operative complications in patients who crossed over from
watchful waiting to surgery. At 11.5 years of follow-up, up to 68% of patients crossed from the
watchful waiting cohort to surgical repair. The rate of significant hernia complications in patients
being watched is low, reported at 0.0018 per patient year, in this study. Although women were
not included in the watchful waiting study, women are at higher risk for hernia complications in
general, and should therefore be offered surgical repair when a diagnosis is made.
A+ TEST BANK 3
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A 68-year-old male undergoes a laparoscopic repair for an incarcerated inguinal hernia. You are
unable to reduce the omentum in the incarcerated sac with traction. Which of the following
should be considered?
A. Amputate the incarcerated omentum, leaving the distal portion in situ.
B. Incise the iliopubic tract.
C. Incise the lacunar ligament.
D. Open the femoral space into the internal ring.
E. Perform an incision in the involved groin to reduce the omentum
. - Correct Answer :Incise the iliopubic tract.
Correct.
The incarcerated hernia contents can usually be reduced with gentle dissection. If not, then
incising the iliopubic tract anteriorly avoiding the epigastric vessels is the best option. The
epigastric vessels, testicular vessels and the femoral vessels are at risk if opening the femoral
space into the internal ring, and the lacunar ligament cannot be cut. A counterincision is only
necessary if opening the iliopubic tract is unsuccessful.
What are the boundaries of Hesselbach's triangle?
A. External oblique, inguinal ligament, femoral vein
B. Rectus sheath, inferior epigastric vessels, and inguinal ligament
C. Rectus sheath, iliopubic tract, and femoral vein
D. Cooper's ligament, Transversalis fascia, and lacunar ligament
E. Cooper's ligament, internal oblique, and femoral vein
- Correct Answer :Rectus sheath, inferior epigastric vessels, and inguinal ligament
Correct.
Hesselbach's triangle forms the floor of the inguinal canal and is bounded by the rectus sheath,
inferior epigastric vessels, and inguinal ligament. Direct hernias arise within Hesselbach's
triangle.
During a laparoscopic repair of an inguinal hernia, dissection below the iliopubic tract is more
likely to result in injury to:
A. Femoral nerve
B. Genital branch of genitofemoral nerve
C. Vas deferens
D. Cremasteric vessels
E. Femoral artery
- Correct Answer :Genital branch of genitofemoral nerve
Correct.
The preperitoneal space contains adipose tissue, lymphatics, blood vessels, and nerves. The
nerves of the preperitoneal space of specific concern to the surgeon include the lateral femoral
cutaneous nerve and genitofemoral nerve (see Sabiston Textbook of Surgery, Fig. 46-4). The
A+ TEST BANK 4
ABSITE Exam 4 Questions and Correct
Answers 2025 A+.
A healthy 40-year-old man is consulting with you for evaluation of intermittent left groin
discomfort (4 out of 10 on pain scale) which has been present for the past three weeks. These
symptoms have caused him to miss work on occasion. He denies any constitutional symptoms,
and has no other complaints at this time. On physical examination, you cannot detect a hernia,
even with provocative maneuvers (i.e., Valsalva, cough). Your recommendation at this time
would be:
A. Computed tomography (CT) of the abdomen and pelvis with oral and intravenous contrast for
further evaluation
B. Diagnostic laparoscopy
C. Contrast herniography (peritoneography)
D. Left groin exploration with possible inguinal hernia repair
A+ TEST BANK 1
E. trasonography of the left groin
- Correct Answer :Ultrasonography of the left groin
Correct.
This patient may have an occult inguinal hernia which is not detectable on physical examination.
Ultrasonography, herniography and CT are all useful diagnostic studies, with ultrasound being
the least invasive, less costly, and with high sensitivity and specificity. In this patient with minimal
symptoms, there is no indication for immediate laparoscopy or groin exploration.
A 60-year-old male presents with persistent pain over his right lower abdomen six months after a
bilateral TEPP laparoscopic inguinal hernia repair. There is no evidence of hernia recurrence,
seroma or infection on physical examination. As part of your investigation, you obtain a plain
abdominal radiograph, which reveals multiple bilateral spiral tacks across the lower abdomen.
You obtain the operative report, and confirm your suspicion that the surgeon used permanent
spiral tacks for mesh fixation. Injury to which of the following nerves is the most likely cause for
his persistent pain?
A. Ilioinguinal nerve
B. Iliohypogastric nerve
,C. Genital branch of the genitofemoral nerve
D. Lateral femoral cutaneous nerve
E. Femoral nerve
- Correct Answer :Iliohypogastric nerve
Correct.
Post-herniorrhaphy neuralgia has been reported to occur in up to 20% of cases. Injury to any of
the nerves mentioned can result in post-herniorrhaphy neuralgia. Given the location of the
patient's symptoms and the method used for mesh fixation, the iliohypogastric nerve is the most
vulnerable to injury during laparoscopic mesh fixation.
A 67-year-old man presents with vomiting and abdominal distension. An abdominal x-ray reveals
air/fluid levels suggesting small bowel obstruction. On exam, her abdomen is distended with
diffuse tenderness and there is a tender mass in the right groin. At operation, you resect a
strangulated 6-cm segment of small intestine and there is moderate contamination with bowel
contents. What should you do for the hernia?
A. Complete the operation and plan a subsequent hernia repair.
B. Perform a repair using polypropylene mesh.
C. Perform a repair using biologic mesh.
D. Perform a tissue-based repair.
- Correct Answer :Perform a tissue-based repair.
Correct.
It is important to repair the hernia defect at operation to avoid the risks of early recurrent
intestinal obstruction. With contamination during the bowel resection, the safest option is to
A+ TEST BANK 2
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perform a tissue-based repair. Permanent mesh should be avoided in this situation because of
the risk of infection. Use of biologic mesh is associated with almost certain hernia recurrence. It
may be necessary to perform the hernia repair through a separate groin incision.
A 33-year-old man has a symptomatic recurrent inguinal hernia following a totally
extraperitoneal (TEP) repair two years ago. Which of the following is the best approach for
reoperation?
A. TEP repair
B. Trans-abdominal pre-peritoneal (TAPP) repair
C. Open inguinal repair
D. Open trans-abdominal repair
- Correct Answer :Open inguinal repair
Correct.
Most experts would recommend an open repair in this circumstance. It is important to avoid
using the same approach as previously done to minimize the risk of nerve injury or other
complications due to scarring. The open inguinal approach is the best answer. Open trans-
abdominal repairs are associated with a higher recurrence rate and a repeat TEP or TAPP repair
is likely to be more difficult due to scarring.
A vibrant 78-year-old male is referred for management of a right inguinal hernia diagnosed by his
primary care physician during his annual evaluation one year ago. He denies symptoms
attributable to the hernia, which is easily reducible. Which of the following is appropriate to
consider when recommending watchful waiting rather than repair?
A. Pain which limits his physical activity is more likely within the next year if the hernia is not
repaired.
B. The risk of incarceration or strangulation is less than 1% within 2 years.
C. Less than 10% of patients will have a hernia repair within 2 years.
D. Wearing a supportive truss will decrease the risk of complications.
E. Men are at a higher risk of developing hernia complications, compared to women.
- Correct Answer :The risk of incarceration or strangulation is less than 1% within 2 years.
Correct.
Results of a large prospective study comparing watchful waiting with operative repair in men
aged 40-65 with minimal to no symptoms of a reducible hernia showed no difference in pain or
physical health scores, or rate of post-operative complications in patients who crossed over from
watchful waiting to surgery. At 11.5 years of follow-up, up to 68% of patients crossed from the
watchful waiting cohort to surgical repair. The rate of significant hernia complications in patients
being watched is low, reported at 0.0018 per patient year, in this study. Although women were
not included in the watchful waiting study, women are at higher risk for hernia complications in
general, and should therefore be offered surgical repair when a diagnosis is made.
A+ TEST BANK 3
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A 68-year-old male undergoes a laparoscopic repair for an incarcerated inguinal hernia. You are
unable to reduce the omentum in the incarcerated sac with traction. Which of the following
should be considered?
A. Amputate the incarcerated omentum, leaving the distal portion in situ.
B. Incise the iliopubic tract.
C. Incise the lacunar ligament.
D. Open the femoral space into the internal ring.
E. Perform an incision in the involved groin to reduce the omentum
. - Correct Answer :Incise the iliopubic tract.
Correct.
The incarcerated hernia contents can usually be reduced with gentle dissection. If not, then
incising the iliopubic tract anteriorly avoiding the epigastric vessels is the best option. The
epigastric vessels, testicular vessels and the femoral vessels are at risk if opening the femoral
space into the internal ring, and the lacunar ligament cannot be cut. A counterincision is only
necessary if opening the iliopubic tract is unsuccessful.
What are the boundaries of Hesselbach's triangle?
A. External oblique, inguinal ligament, femoral vein
B. Rectus sheath, inferior epigastric vessels, and inguinal ligament
C. Rectus sheath, iliopubic tract, and femoral vein
D. Cooper's ligament, Transversalis fascia, and lacunar ligament
E. Cooper's ligament, internal oblique, and femoral vein
- Correct Answer :Rectus sheath, inferior epigastric vessels, and inguinal ligament
Correct.
Hesselbach's triangle forms the floor of the inguinal canal and is bounded by the rectus sheath,
inferior epigastric vessels, and inguinal ligament. Direct hernias arise within Hesselbach's
triangle.
During a laparoscopic repair of an inguinal hernia, dissection below the iliopubic tract is more
likely to result in injury to:
A. Femoral nerve
B. Genital branch of genitofemoral nerve
C. Vas deferens
D. Cremasteric vessels
E. Femoral artery
- Correct Answer :Genital branch of genitofemoral nerve
Correct.
The preperitoneal space contains adipose tissue, lymphatics, blood vessels, and nerves. The
nerves of the preperitoneal space of specific concern to the surgeon include the lateral femoral
cutaneous nerve and genitofemoral nerve (see Sabiston Textbook of Surgery, Fig. 46-4). The
A+ TEST BANK 4
