Lecture 7 (hernias) practice

Question 1

Sudden, sharp, well-localized, lateralizing are all characteristics of ________ pain
a) Somatic
b) Visceral

Answer 1

a) Somatic
(visceral = slow onset, poorly-localized, dull discomfort)

Question 2

An elderly person presents with AMS and hypotension. What should be an important differential?
a) Dehydration
b) Acute abdomen
c) Diverticulosis
d) BPV

Answer 2

b) Acute abdomen

Question 3

Pain out of proportion to clinical picture should raise concern for what?
a) IBD
b) Diverticulitis
c) Sigmoid volvulus
d) Mesenteric ischemia

Answer 3

d) Mesenteric ischemia

Question 4

What nerve is most frequently injured in open inguinal hernia repairs?
a) Ilioinguinal
b) Iliohypogastric
c) Genitofemoral
d) Anterior labial

Answer 4

a) Ilioinguinal

Question 5

What is the most common type of hernia in males & females (R>L)?
a) Direct inguinal
b) Indirect inguinal
c) Femoral
d) Anterior labial

Answer 5

b) Indirect inguinal

Question 6

What makes up the lateral portion Hesselbach’s triangle?
a) Inguinal ligament
b) Inferior epigastric vessels
c) Rectus abdominis
d) Transversalis fascia

Answer 6

b) Inferior epigastric vessels

Inguinal ligament = inferior portion
Rectus abdominis = medial
Transversalis fascia = floor of triangle

Question 7

T/F: H&P is usually enough for diagnosis of a hernia

Answer 7

True

Question 8

A pt with what inguinal hernia Dx is most likely to require IVF, broad-spectrum IV abx, +/- NGT, & consult surgery for emergent repair?
a) Acutely incarcerated
b) Chronically incarcerated
c) Strangulated
d) Symptomatic

Answer 8

c) Strangulated

Acutely incarcerated may require urgent or emergent surgery (usually laparoscopic), but probs not abx

Question 9

Which symptomatic pt is the best candidate to have inguinal hernia repair?
a) A sedentary but healthy 85 y/o
b) A pt with a Hx of malignant hyperthermia and poor anesthesia outcomes
c) A pregnant and healthy 24 y/o
d) A healthy 55 y/o with controlled HTN

Answer 9

d) A healthy 55 y/o with controlled HTN

Question 10

T/F: You should not repeat the same type of surgery if a hernia recurs

Answer 10

True

Question 11

What is the procedure of choice for femoral hernias?
a) The Bassini repair
b) The Shouldice repair
c) The McVay (Cooper’s ligament) repair
d) The Lichtenstein repair

Answer 11

c) The McVay (Cooper’s ligament) repair

Question 12

What is the best and most common open repair for inguinal hernias?
a) The Bassini repair
b) The Shouldice repair
c) The McVay (Cooper’s ligament) repair
d) The Lichtenstein repair

Answer 12

d) The Lichtenstein repair

Question 13

Which type of inguinal hernia needs to be separated from cord by dividing the cremaster muscle during open repair?
a) Direct
b) Indirect

Answer 13

b) Indirect

Question 14

What type of inguinal hernia typically requires inguinal canal floor repair during open surgery?
a) Direct
b) Indirect

Answer 14

a) Direct

Question 15

What type of surgery is best for bilateral & recurrent inguinal canal hernias and requires general anesthesia?
a) Open
b) Laparoscopic

Answer 15

b) Laparoscopic

Question 16

Which laparoscopic repair methods use mesh? Select all that apply
a) Transabdominal Preperitoneal (TAPP) repair
b) Total Extraperitoneal (TEP) repair
c) Intraperitoneal Onlay Mesh (IPOM) repair

Answer 16

a) Transabdominal Preperitoneal (TAPP) repair
b) Total Extraperitoneal (TEP) repair
c) Intraperitoneal Onlay Mesh (IPOM) repair

Question 17

Which type of inguinal hernias need to be isolated from transversalis fascia during laparoscopic repair?
a) Direct
b) Indirect

Answer 17

a) Direct

Question 18

Umbilical hernia repair is elective if there’s no bowel involvement, and should be deferred until after age _____ in kids. Bonus: What type of repair is recommended?

Answer 18

4
(open repair always recommended)

Question 19

What type of hernia requires surgical repair and is defined as a protrusion of intra-abdominal contents through weakness in lateral border of the rectus sheath (linea semilunaris)?
a) Incisional hernia
b) Obturator hernia
c) Epigastric hernia
d) Spigelian hernia

Answer 19

d) Spigelian hernia

Question 20

A pt has a symptomatic 1.5cm epigastric hernia. What type of repair is recommended?
a) Primary repair (sutures)
b) Mesh

Answer 20

b) Mesh
(only do sutures if <1cm)

Question 21

What is the most important risk factor for incisional hernias?
a) Age
b) Smoking
c) Obesity
d) HTN

Answer 21

c) Obesity

Question 22

The Howship-Romberg sign for obturator hernias is defined as pain down the ________ thigh with _________ rotation of knee

Answer 22

Medial; internal

Question 23

Which two are the most likely a signs of an obturator hernia? Select two
a) Bowel ischemia + obstruction
b) Symptoms of an SBO without actual obstruction
c) Palpable mass on vaginal exam or DRE
d) Gradually enlarging mass in infragluteal region

Answer 23

b) Symptoms of an SBO without actual obstruction
c) Palpable mass on vaginal exam or DRE

(actual obstruction is more likely w sciatic hernias)

Question 24

Which approach to treating sciatic hernias is less common, but reduces adhesions risk?
a) Transabdominal
b) Transgluteal

Answer 24

b) Transgluteal

Question 25

_________ hernias should be diagnosed with CT or US, whereas ____________ should be diagnosed with CT or MRI a) Sciatic; perineal b) Perineal; sciatic

Answer 25

b) Perineal; sciatic

Question 26

Which type of hernia was NOT mentioned to be a type of pelvic floor hernia? a) Sciatic b) Perineal c) Obturator d) Femoral

Answer 26

d) Femoral

Question 27

Perineal hernias a frequently asymptomatic and reducible, but what are the two most likely symptoms according to the lecture? a) Pain with sitting b) Pain with exertion c) Dysuria d) Dyspareunia

Answer 27

a) Pain with sitting c) Dysuria

Question 28

Which type of lumbar hernia is more common and goes through the Grynfeltt triangle? a) Superior b) Inferior

Answer 28

a) Superior

Question 29

T/F: Diastasis recti is a type of abdominal hernia

Answer 29

False; it’s not a type bc it doesn’t involve a fascial defect

Question 30

What is the most sensitive test for hiatal hernias? a) EGD b) 24 hour pH test c) Barium swallow

Answer 30

c) Barium swallow (but EGD can also Dx)