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NBME 20 Answers

nbme20/Block 1/Question#39 (32.4 difficulty score)
A 3-month-old boy is brought to the office by ...
Lateral to the inferior epigastric artery and superior to the inguinal ligamentπŸ”

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submitted by hayayah(1056),
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nulIiang ishnaer ear uusalyl bdeic,eulr eorlafm ieshnar ear .not

iThs si na dtcenrii auiglnni hna.eir tI reenst rneilnta nigluani nrig laaltre to ferirnio acgirtseip sveessl dna is posiurer ot teh nniualig

ausedC by rfieaul fo csseposur igavaslni ot elsco (nac ofmr cyeo)dhrle. aMy eb tdncioe ni ansntif or dsircveedo ni htlu.dooda hMcu mero nommoc in lsema.

yotsubato  Heres a good picture to help with the concept. +4  
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. +7  
jawnmeechell  So a femoral hernia would be inferior to inguinal, but direct/indirect would be superior? +  
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. +4  

submitted by stepwarrior(20),

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.