Wise MD
Study online at https://quizlet.com/_i0otix
1. A 49-year-old man is referred for evaluation of a left groin mass found during
a routine screening physical. He has well-controlled hypertension but no other
chronic disease or history of prior surgery. He is 70 in (178 cm) tall and weighs
160 lb (73 kg). On physical examination, blood pressure is 132/80 mm Hg,
pulse is 75/min, and respirations are 16/min and unlabored. With the patient in
supine position, the abdomen is soft and nontender; there is no organomegaly,
and no masses are palpated. No groin or scrotal masses are appreciated, and
there is no tenderness to palpation.
Which of the following is the most appropriate next step in management?
a. Reassure the patient that no hernia is present
b. Order computed tomography of the pelvis
c. Have the patient stand up and perform the Valsalva maneuver
d. Advise the patient to return to clinic when the mass is protruding
e. Obtain an ultrasound of the groin: c. Have the patient stand up and perform the Valsalva maneuver
2. A 49-year-old man is referred for evaluation of a left groin mass found during
a routine screening physical. He has well-controlled hypertension but no other
chronic disease or history of prior surgery. He is 70 in (178 cm) tall and weighs
160 lb (73 kg). On physical examination, blood pressure is 132/80 mm Hg,
pulse is 75/min, and respirations are 16/min and unlabored. With the patient in
supine position, the abdomen is soft and nontender; there is no organomegaly,
and no masses are palpated. No groin or scrotal masses are appreciated, and
there is no tenderness to palpation.
Which of the following differentials should be given greatest consideration
when choosing the next step in management?
a. Epididymitis
b. Testicular torsion
c. Indirect or direct inguinal hernia
d. Direct inguinal hernia but not indirect
e. Indirect inguinal hernia but not direct: c. Indirect or direct inguinal hernia
, Wise MD
Study online at https://quizlet.com/_i0otix
3. During a routine follow-up appointment for well-controlled dyslipidemia, a
26-year-old man is evaluated for a lump in his right groin. He first noted the
lump one evening approximately 2 months ago after he helped his fiancé move
into a new apartment. The lump was moderately uncomfortable, with pain
concentrated in the groin and upper, inner aspect of his right thigh. The mass
and discomfort subsided by the next morning, but he has had recurrence of
mild to moderate pain during the week, but he is generally asymptomatic in
the morning before going to work at his job at a factory where he stands most
of the day. He has no prior surgical history, and his medical history is otherwise
unremarkable. On physical examination, a soft, reducible mass consistent with
a hernia is palpated in the right groin; the left groin appears normal. Which of
the following is the most likely diagnosis?
a. Direct inguinal hernia
b. Hydroce: d. Indirect inguinal hernia
4. uring a routine follow-up appointment for well-controlled dyslipidemia, a
26-year-old man is evaluated for a lump in his right groin. He first noted the
lump one evening approximately 2 months ago after he helped his fiancé move
into a new apartment. The lump was moderately uncomfortable, with pain
concentrated in the groin and upper, inner aspect of his right thigh. The mass
and discomfort subsided by the next morning, but he has had recurrence of
mild to moderate pain during the week, but he is generally asymptomatic in
the morning before going to work at his job at a factory where he stands most
of the day. He has no prior surgical history, and his medical history is otherwise
unremarkable. On physical examination, a soft, reducible mass consistent with
a hernia is palpated in the right groin; the left groin appears normal. Which of
the following is the most appropriate next step in management?
a. Use of a truss: Elective open inguinal hernia repair at the patient's convenience
5. During a routine follow-up appointment for well-controlled dyslipidemia, a
26-year-old man is evaluated for a lump in his right groin. He first noted the
lump one evening approximately 2 months ago after he helped his fiancé move
, Wise MD
Study online at https://quizlet.com/_i0otix
into a new apartment. The lump was moderately uncomfortable, with pain
concentrated in the groin and upper, inner aspect of his right thigh. The mass
and discomfort subsided by the next morning, but he has had recurrence of
mild to moderate pain during the week, but he is generally asymptomatic in
the morning before going to work at his job at a factory where he stands most
of the day. He has no prior surgical history, and his medical history is otherwise
unremarkable. On physical examination, a soft, reducible mass consistent with
a hernia is palpated in the right groin; the left groin appears normal. Which of
the following is the most likely source of this patient's pain?
a. Stretching of: Compression of the ilioinginal nerve by the hernia
6. During a routine physical examination for a new job, a 50-year-old man is
found to have a small inguinal hernia in the right groin. He didn't know he had
it. He is asymptomatic, and his medical history is otherwise unremarkable. His
father had successful hernia repair surgery at the age of 52 years. Which of the
following is the most appropriate treatment recommendation?
a. Close follow-up of the patient every 6 months for at least 5 years
b. Diagnostic laparoscopy to confirm the diagnosis with plans to repair it if the
defect is greater than 1.5 cm
c. Elective laparoscopic inguinal hernia repair at a convenient time
d. Elective open inguinal hernia repair at a convenient time
e. Reassurance of the patient with instructions to return if symptoms develop-
: Reassurance of the patient with instructions to return if symptoms develop
7. A 73-year-old man presents with signs and symptoms of a new, mildly symp-
tomatic right inguinal hernia. When conducting the review of system while ob-
taining the patient's medical history, which of the following lines of questioning
is LEAST likely to be relevant?
a. Pulmonary symptoms, such as chronic cough
b. Urinary symptoms, particularly benign prostatic hypertrophy
c. Hematologic symptoms, including poor clotting
, Wise MD
Study online at https://quizlet.com/_i0otix
d. Endocrine symptoms, particularly hypothyroidism
e. Gastrointestinal symptoms, including chronic constipation: Endocrine symptoms,
particularly hypothyroidism
8. A 73-year-old man presents with signs and symptoms of a new, mildly symp-
tomatic right inguinal hernia. During elective open anterior repair of the hernia,
the external oblique aponeurosis is opened in the direction of its fibers. Which
of the following can the surgeon expect to find beneath the external oblique?
a. Superficial inguinal ring
b. Internal oblique aponeurosis
c. Lacunar ligament
d. Femoral canal
e. Spermatic cord: Spermatic cord
9. A 30-year-old woman is evaluated for avone-day history of obstipation and
severe nausea with increasingly bilious emesis. She has no history of previous
abdominal surgery. On physical examination, the abdomen is distended and
diffusely tympanitic but without peritoneal signs. A firm right groin mass is pal-
pated and does not reduce in the supine position or with manual manipulation.
Which of the following is the most likely diagnosis?
a. Pantaloon hernia
b. Hyperemesis gravidarum
c. "Sports hernia"
d. Incarcerated hernia
e. Richter's hernia: Incarcerated hernia
When the contents of a hernia sac cannot be returned to their normal anatomic location, the hernia is said to be
incarcerated.
10. A 30-year-old woman is evaluated for a one-day history of obstipation and
severe nausea with increasingly bilious emesis. She has no history of previous
abdominal surgery. On physical examination, the abdomen is distended and
diffusely tympanitic but without peritoneal signs. A firm right groin mass is
Study online at https://quizlet.com/_i0otix
1. A 49-year-old man is referred for evaluation of a left groin mass found during
a routine screening physical. He has well-controlled hypertension but no other
chronic disease or history of prior surgery. He is 70 in (178 cm) tall and weighs
160 lb (73 kg). On physical examination, blood pressure is 132/80 mm Hg,
pulse is 75/min, and respirations are 16/min and unlabored. With the patient in
supine position, the abdomen is soft and nontender; there is no organomegaly,
and no masses are palpated. No groin or scrotal masses are appreciated, and
there is no tenderness to palpation.
Which of the following is the most appropriate next step in management?
a. Reassure the patient that no hernia is present
b. Order computed tomography of the pelvis
c. Have the patient stand up and perform the Valsalva maneuver
d. Advise the patient to return to clinic when the mass is protruding
e. Obtain an ultrasound of the groin: c. Have the patient stand up and perform the Valsalva maneuver
2. A 49-year-old man is referred for evaluation of a left groin mass found during
a routine screening physical. He has well-controlled hypertension but no other
chronic disease or history of prior surgery. He is 70 in (178 cm) tall and weighs
160 lb (73 kg). On physical examination, blood pressure is 132/80 mm Hg,
pulse is 75/min, and respirations are 16/min and unlabored. With the patient in
supine position, the abdomen is soft and nontender; there is no organomegaly,
and no masses are palpated. No groin or scrotal masses are appreciated, and
there is no tenderness to palpation.
Which of the following differentials should be given greatest consideration
when choosing the next step in management?
a. Epididymitis
b. Testicular torsion
c. Indirect or direct inguinal hernia
d. Direct inguinal hernia but not indirect
e. Indirect inguinal hernia but not direct: c. Indirect or direct inguinal hernia
, Wise MD
Study online at https://quizlet.com/_i0otix
3. During a routine follow-up appointment for well-controlled dyslipidemia, a
26-year-old man is evaluated for a lump in his right groin. He first noted the
lump one evening approximately 2 months ago after he helped his fiancé move
into a new apartment. The lump was moderately uncomfortable, with pain
concentrated in the groin and upper, inner aspect of his right thigh. The mass
and discomfort subsided by the next morning, but he has had recurrence of
mild to moderate pain during the week, but he is generally asymptomatic in
the morning before going to work at his job at a factory where he stands most
of the day. He has no prior surgical history, and his medical history is otherwise
unremarkable. On physical examination, a soft, reducible mass consistent with
a hernia is palpated in the right groin; the left groin appears normal. Which of
the following is the most likely diagnosis?
a. Direct inguinal hernia
b. Hydroce: d. Indirect inguinal hernia
4. uring a routine follow-up appointment for well-controlled dyslipidemia, a
26-year-old man is evaluated for a lump in his right groin. He first noted the
lump one evening approximately 2 months ago after he helped his fiancé move
into a new apartment. The lump was moderately uncomfortable, with pain
concentrated in the groin and upper, inner aspect of his right thigh. The mass
and discomfort subsided by the next morning, but he has had recurrence of
mild to moderate pain during the week, but he is generally asymptomatic in
the morning before going to work at his job at a factory where he stands most
of the day. He has no prior surgical history, and his medical history is otherwise
unremarkable. On physical examination, a soft, reducible mass consistent with
a hernia is palpated in the right groin; the left groin appears normal. Which of
the following is the most appropriate next step in management?
a. Use of a truss: Elective open inguinal hernia repair at the patient's convenience
5. During a routine follow-up appointment for well-controlled dyslipidemia, a
26-year-old man is evaluated for a lump in his right groin. He first noted the
lump one evening approximately 2 months ago after he helped his fiancé move
, Wise MD
Study online at https://quizlet.com/_i0otix
into a new apartment. The lump was moderately uncomfortable, with pain
concentrated in the groin and upper, inner aspect of his right thigh. The mass
and discomfort subsided by the next morning, but he has had recurrence of
mild to moderate pain during the week, but he is generally asymptomatic in
the morning before going to work at his job at a factory where he stands most
of the day. He has no prior surgical history, and his medical history is otherwise
unremarkable. On physical examination, a soft, reducible mass consistent with
a hernia is palpated in the right groin; the left groin appears normal. Which of
the following is the most likely source of this patient's pain?
a. Stretching of: Compression of the ilioinginal nerve by the hernia
6. During a routine physical examination for a new job, a 50-year-old man is
found to have a small inguinal hernia in the right groin. He didn't know he had
it. He is asymptomatic, and his medical history is otherwise unremarkable. His
father had successful hernia repair surgery at the age of 52 years. Which of the
following is the most appropriate treatment recommendation?
a. Close follow-up of the patient every 6 months for at least 5 years
b. Diagnostic laparoscopy to confirm the diagnosis with plans to repair it if the
defect is greater than 1.5 cm
c. Elective laparoscopic inguinal hernia repair at a convenient time
d. Elective open inguinal hernia repair at a convenient time
e. Reassurance of the patient with instructions to return if symptoms develop-
: Reassurance of the patient with instructions to return if symptoms develop
7. A 73-year-old man presents with signs and symptoms of a new, mildly symp-
tomatic right inguinal hernia. When conducting the review of system while ob-
taining the patient's medical history, which of the following lines of questioning
is LEAST likely to be relevant?
a. Pulmonary symptoms, such as chronic cough
b. Urinary symptoms, particularly benign prostatic hypertrophy
c. Hematologic symptoms, including poor clotting
, Wise MD
Study online at https://quizlet.com/_i0otix
d. Endocrine symptoms, particularly hypothyroidism
e. Gastrointestinal symptoms, including chronic constipation: Endocrine symptoms,
particularly hypothyroidism
8. A 73-year-old man presents with signs and symptoms of a new, mildly symp-
tomatic right inguinal hernia. During elective open anterior repair of the hernia,
the external oblique aponeurosis is opened in the direction of its fibers. Which
of the following can the surgeon expect to find beneath the external oblique?
a. Superficial inguinal ring
b. Internal oblique aponeurosis
c. Lacunar ligament
d. Femoral canal
e. Spermatic cord: Spermatic cord
9. A 30-year-old woman is evaluated for avone-day history of obstipation and
severe nausea with increasingly bilious emesis. She has no history of previous
abdominal surgery. On physical examination, the abdomen is distended and
diffusely tympanitic but without peritoneal signs. A firm right groin mass is pal-
pated and does not reduce in the supine position or with manual manipulation.
Which of the following is the most likely diagnosis?
a. Pantaloon hernia
b. Hyperemesis gravidarum
c. "Sports hernia"
d. Incarcerated hernia
e. Richter's hernia: Incarcerated hernia
When the contents of a hernia sac cannot be returned to their normal anatomic location, the hernia is said to be
incarcerated.
10. A 30-year-old woman is evaluated for a one-day history of obstipation and
severe nausea with increasingly bilious emesis. She has no history of previous
abdominal surgery. On physical examination, the abdomen is distended and
diffusely tympanitic but without peritoneal signs. A firm right groin mass is
