1. A 6-month-old boy presents with an inguinal hernia, first noticed 2 weeks after birth.

What is the best treatment

choice?
(A) Observation
(B) Laparotomy
(C) Surgical repair when the child is fully grown
(D) Surgical repair of the affected side
(E) Surgical repair of the affected side and exploration of the nonaffected side to search for and repair a sac that
was not previously detected by clinical means

2. A 60-year-old male presents with an inguinal hernia of recent onset. Which of the following statements are
TRUE?
(A) The hernia is more likely to be direct than indirect.
(B) Presents through the posterior wall of the inguinal canal, lateral to the deep inguinal ring.
(C) Is covered anteriorly by the transversalis fascia.
(D) Is more likely than a femoral hernia to strangulate.
(E) The sac is congenital.

3. A70-year-old cigarette smoker presents with a right inguinal mass that has enlarged and has caused discomfort
in recent months. He complains of recent difficulty with micturition and nocturia. The swelling, which does not
extend to the scrotum, reduces when resting. What is the likely diagnosis?
(A) Direct inguinal hernia
(B) Strangulated indirect inguinal hernia
(C) Hydrocele
(D) Aneurysm of the femoral artery
(E) Cyst of the cord

4. A 65-year-old female requires emergency surgery for a strangulated inguinal hernia. Which of the following is
correct?
(A) The sac is formed by an unobliterated processus vaginalis.
(B) The hernia is direct rather than indirect.
(C) Such herniae never contain small intestine.
(D) Strangulation never results in bowel ischemia and gangrene requiring resection.
(E) Indirect inguinal herniae are never found in female patients.

5. An otherwise healthy, 60-year-old male has been advised to undergo surgical treatment for a left ingunial
hernia. Which of the following are acceptable standards of surgical treatment?
(A) Traditional surgical repair under general or local anesthesia
(B) Repair of the hernia and ipsilateral orchiectomy, in order to better assure closure of the inguinal canal and
reduce the possibility of recurrence
(C) Laparotomy to perform a retroperitoneal repair
(D) Surgical exploration of the contralateral groin to search for an occult hernia sac and to remove it before a
hernia develops
(E) The patient should be advised to wear a truss postoperatively, in order to reduce the incidence of recurrence

6. A62-year-old male presents with an irreducible swelling and severe pain in the left groin. He had a known
reducible hernia for 15 years prior to this. He had a bowel movement while in the emergency room. At surgery, a
Richter’s hernia was found. Which of the following statements is TRUE?
(A) It presents lateral to the rectus sheath.
(B) It presents through the lumbar triangle.
(C) It presents through the obturator foramen.
(D) It contains a Meckel’s diverticulum.
(E) It may allow normal passage of stool.

7. At surgery for a right inguinal hernia, a 72-year-old man is found to have a hernia sac that is not independent of
the bowel wall. The cecum forms part of the wall of the sac (Fig. 8–1). Such a hernia is properly referred to as
which of the following?
(A) Incarcerated
(B) Irreducible
(C) Sliding
(D) Richter’s
(E) Interstitial

8. The following structures may be injured during surgery to repair an inguinal hernia:
(A) The ilioinguinal, genitofemoral, iliohypogastric, and lateral femoral cutaneous nerves
(B) The femoral nerve
(C) The popliteal nerve
(D) The nerve to the psoas major muscle
(E) The pudendal nerve

9. Which of the following structures would be encountered during repair of an inguinal hernia in a male?
(A) Spermatic cord, cremaster muscle, transversalis fascia, deep epigastric vessels, conjoined tendon
(B) Round ligament
(C) Obturator nerve
(D) Symphysis pubis
(E) Nerve to the adductor muscles of the thigh

10. In repair of a femoral hernia, the structure most vulnerable to major injury lies:
(A) Medially
(B) Laterally
(C) Anteriorly
(D) Posteriorly
(E) Superficially

11. A 28-year-old professional football player has sudden pain and swelling in the right groin when attempting to
intercept a pass. He is admitted to the local emergency department. On examination, there is a tender swelling in
the right groin. The scrotum and penis show no abnormality. What is the next step in management?
(A) Needle aspiration to exclude hematoma
(B) Forceful manual reduction
(C) Laparotomy within 20 minutes
(D) Preoperative preparation and exploration of the groin with hernia repair
(E) Morphine and reevaluation within 12 hours

A 70-year-old woman presents with a tender irreducible mass immediately below and lateral to the pubic tubercle.
Plain abdominal x-ray shows intestinal obstruction.
12. What is the likeliest diagnosis?
(A) Small-bowel carcinoma
(B) Large-bowel carcinoma
(C) Adhesions
(D) Strangulated inguinal hernia
(E) Strangulated femoral hernia

13. Treatment with a nasogastric tube and intravenous fluids is initiated. What is the next step in treatment?
(A) Sedation to relax the patient and allow spontaneous reduction of the mass
(B) Sedation and surgery scheduled for the next elective surgical appointment
(C) Sedation and manual taxis (reduction)
(D) Emergency surgery on the left groin
(E) Emergency laparotomy for intestinal obstruction and hernia repair from the peritoneal cavity

14. A 2-year-old African American boy presents with a reducible umbilical hernia, under 2-cm diameter. This is
best managed by:
(A) Immediate surgery and repair with mesh
(B) Immediate surgery repair without mesh
(C) Laparoscopic repair with mesh
(D) Laparoscopic repair without mesh
(E) Periodic observation and evaluation

15. A 55-year-old woman, who recently had been dieting with a weight loss of 20 lb, presents with a small-bowel
obstruction and pain, which radiates down the inside of her thigh to the knee. She has no past history of
abdominal surgery. Which of the following is the likely diagnosis?
(A) Strangulated obturator hernia
(B) Obstructing neoplasm of the ileum
(C) Gallstone ileus
(D) Strangulated femoral hernia
(E) Fracture of the pubic bone

16. A50-year-old man presents with a complaint of a 1-cm moderately painful, tender mass situated one-third of
the way between the xiphisternum and the umbilicus (Fig. 8–2). What is the most likely diagnosis?
(A) Fibrosarcoma of the abdominal wall
(B) Omphalocele
(C) Spigelian hernia
(D) Fat necrosis
(E) Epigastric hernia

17. A 70-year-old, moderately obese, male presents with a large, midline incisional hernia. One year previously,
he underwent a colon resection for adenocarcinoma. Colonoscopy, metastasis workup and carcinoembryonic
antigen (CEA) are normal. Which of the following statement is TRUE?
(A) Repair with mesh can be performed laparoscopically.
(B) Strangulation is uncommon because the neck is narrow.
(C) Recurrence is common, even with the use of mesh of improved quality.
(D) Surgical repair is simple to perform under local anesthesia.
(E) Patients remain very uncomfortable, even with an adequate repair.
18. Following laparoscopic preperitoneal repair of an inguinal hernia, a 50-year-old male complains of severe
burning pain, which radiates down the lateral side of the ipsilateral thigh. The most likely cause is injury to which
of the following:
(A) Ilioinguinal nerve
(B) Iliohypogastric nerve
(C) Genitofemoral nerve
(D) Femoral nerve
(E) Lateral femoral cutaneous nerve

19. A male neonate is born with an omphalocele (shown in Fig. 8–3). This entity can be distinguished from
gastroschisis, because in an omphalocele, the protrusion is:
(A) Not covered by a sac
(B) A defect in the abdominal musculature
(C) Associated with an umbilicus attached to the abdominal wall musculature
(D) Associated with partial or complete malrotation of the bowel
(E) Really contains abdominal viscera

20. What is true of Spigelian hernia?

(A) It occurs exclusively in males.
(B) It involves part of the circumference of the bowel wall.
(C) It is best repaired by the classical Bassini technique of inguinal ligament repair.
(D) It occurs at the lateral edge of the linea semilunaris.
(E) It always contains the vermiform appendix.

21. A 56-year-old man is scheduled to have a left indirect hernia repaired. He is asymptomatic. Before surgical
treatment, he should have which of the following?
(A) Rectal examination alone
(B) Rectal examination and sigmoidoscopy
(C) Barium enema
(D) Colonoscopy
(E) Intravenous pyelogram