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NBME 20 Answers

 +7  upvote downvote
submitted by โˆ—hayayah(1212)
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Inguinal hernias are usually reducible, femoral hernias are not.

This is an indirect inguinal hernia. It enters internal inguinal ring lateral to inferior epigastric vessels and is superior to the inguinal ligament.

Caused by failure of processus vaginalis to close (can form hydrocele). May be noticed in infants or discovered in adulthood. Much more common in males.

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yotsubato  Heres a good picture to help with the concept. https://www.google.com/url?sa=i&source=images&cd=&ved=2ahUKEwjVkIi0yN7iAhWLjqQKHbeXCTUQjRx6BAgBEAU&url=https%3A%2F%2Fwww.herniaclinic.co.nz%2Finformation%2Ftypes-of-hernias%2F&psig=AOvVaw2BzGtQLvSmUN8ymhdvETG5&ust=1560244112252834 +5
sbryant6  Note that direct inguinal hernias typically happen in older adults. This question presents a younger baby, so it is more like to be indirect. +8
jawnmeechell  So a femoral hernia would be inferior to inguinal, but direct/indirect would be superior? +1
azharhu786  The direct and indirect hernia are both superior to the inguinal ligament but the femoral hernia is basically inferior to the inguinal ligament. The direct hernia is medial to the inferior epigastric vessels whereas, the indirect is lateral to the epigastric vessels. An indirect hernia is seen in young people whereas, direct hernia happens in adults. +6
athenathefirst  Also FEmoral hernia is more common in FEmales INdirect more common in INfants or discovered late in adulthood (FA page 364) +1



 +5  upvote downvote
submitted by โˆ—stepwarrior(29)
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This is where the hernia begins but ultimately where it bulges out varies depending on how far down the inguinal canal the hernia goes. It could pop out well below the inguinal ligament. The wording is crap, they should have just shown a picture of the patient.

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 +0  upvote downvote
submitted by โˆ—namesthegame22(13)
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  • Indirect inguinal hernias are common in children and are caused by failure of the processus vaginalis to close after migration of the testes into the scrotal sac.

  • They exit the abdominal cavity through the deep inguinal ring lateral to the inferior epigastric vessels and superior to the inguinal ligament. They allow abdominal contents to extend into the scrotal sac through the superficial inguinal ring.

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