HERNIA REPAIR

Question 1

In what type of patient are infantile umbilical hernias most common?

Caucasian

Hispanic

African American

Asian

Answer 1

AFRICAN AMERICAN

Question 2

Laparoscopic hernia repair has revolutionized the repair of inguinal hernias. What is the main difference between the two approaches: transabdominal preperitoneal (TAPP) and total extra peritoneal (TEP) utilized to repair these hernias?

The manner in which access to the preperitoneal space

TEP relies on the use of tacking device to secure the mesh, whereas TAPP relies on intracorporeal suturing

TAPP involves the use of mesh, whereas TEP relies on tissue reapir

None of the above

Answer 2

THE MANNER IN WHICH ACCESS TO THE PREPERITONEAL SPACE

Question 3

This nerve arises from the L1 and L2 nerve roots and provides motor innervation fro the cremaster muscle:

Iliohypogastric

Genitofemoral

Ilioinguinal

External spermatic

Answer 3

GENITOFEMORAL

Question 4

The structure is a branch of the first lumbar nerve (L1), and emerges with the spermatic cord from the superficial inguinal ring.

Answer 4

ILIOINGUINAL

Question 5

Direct inguinal hernias are identified by tissue herniation:

Within the spermatic cord through the internal inguinal ring

Inferior to the inguinal ligament

Within Hasselbach’s trainagle outside the cord structure and internal inguinal ring

Directly through the abdominal wall in the region of the umbilicus

Answer 5

WITHIN HASSELBACH’S TRIANGLE OUTSIDE THE CORD STRUCTURE AND INTERNAL INGUINAL RING

Question 6

During an inguinal hernia repair on the left side, a sliding component is present. Which organ(s) could form part of the sac?

Sigmoid colon

Bladder

Small intestine

Both A and B

Answer 6

SIGMOID COLON AND BLADDER

Question 7

In what type of inguinal hernia repair is the aponeurosis of the transversus abdominis approximated to the edge of the inguinal liagment?

McVay

Lichtenstein

Shouldice

Bassini

Answer 7

BASSINI

Question 8

For pediatric inguinal hernias, which side is affected more commonly?

Left

Right

Answer 8

LEFT

Question 9

Which of the following is NOT an indication for laparoscopic inguinal hernia repair?

Recurrent hernia

Cosmesis

Bilateral inguinal hernias

Need to resume full activity as soon as possible

Answer 9

COSMESIS

Question 10

Which of the following hernias contains a Meckel’s diverticulum in the sac?

Spigelian hernia

Littres hernia

Petits hernia

Grynfelts hernia

Answer 10

LITTRES HERNIA

Question 11

Which of the following risk factors is/are associated with increase risk of development of incisional hernia?

COPD

Male

Ascites

All of the above

Answer 11

ALL OF THE ABOVE

Question 12

Which of the following nerve pairs are present and should be identified and preserved during inguinal hernia repair, especially in open preocedures: (Refer to Plate 263 in your Atlas of Human Anatomy)

Ilio-hypogastric and femoral

Ilio-inguinal and ileo-hypogastric

Genitofemoral and ileo-inguinal

Ileo-hypogastric and genitofemoral

Answer 12

Ilio-inguinal and ileo-hypogastric

Question 13

What lies in the inguinal canal of women instead of the vas deferens?

Round ligament

Rectouterine ligament

Broad ligament

Cardinal ligament

Answer 13

ROUND LIGAMENT

Question 14

What structure forms the medial border of the femoral canal?

Femoral vessels

Lucunar ligament X

Coopers ligament

Inguinal ligament X

Question 15

What is the most common organ found in an inguinal hernia sac in women?

Uterus

Ovary

Sigmoid colon

Bladder

Answer 15

OVARY

Question 16

Where in the inguinal canal does the hernia sac lie in relation to the cord structures?

Anteromedial

Anterolateral

Posterior

Posterolateral

Answer 16

ANTEROMEDIAL

Question 17

The deep inguinal ring is a defect in which of the abdominal wall musculature?

Internal oblique

Scarpa fascia

External oblique

Transversalis fascia

Answer 17

TRANSVERSALIS FASCIA

Question 18

Which of the following types of hernia consists of a protrusion of fat through defects in the abdominal wall located between the umbilicus and xiphoid process, symptoms of nausea and slight upper abdominal pain:

Epigastric

Spigelian

Interparietal

Umbilical

Answer 18

EPIGASTRIC

Question 19

An example of a common postoperative complication related to inguinal hernia surgery is:
a.
hernia recurrence.
b.
femoral canal adhesions.
c.
delayed return to activity.
d.
inguinal nerve entrapment.

Answer 19

HERNIA RECURRENCE

Question 20

The anterolateral abdominal wall consists of an arrangement of muscles, fascial layers, and muscular aponeuroses lined interiorly by peritoneum and exteriorly by skin. The key landmark of the _____________ designates the roof of the inguinal canal, and the key landmark of the __________ designates the floor of the inguinal canal.
a.
external oblique aponeurosis; Cooper ligament aponeurosis
b.
lateral rectus abdominis; transversalis aponeurosis and fascia
c.
transversalis fascia; Poupart ligament
d.
external oblique aponeurosis; transversalis aponeurosis and fascia X

Answer 20

transversalis fascia; Poupart ligament

Question 21

The mesh-plug open hernia repair technique is indicated for which type(s) of hernias?
a.
Umbilical hernias
b.
Strangulated scrotal hernias
c.
Indirect gastroesophageal hernias
d.
Direct and indirect inguinal hernias

Answer 21

DIRECT AND INDIRECT INGUINAL HERNIAS

Question 22

Implantable mesh prosthetics can be made of synthetic, biosynthetic, or biological material. What is the primary advantage of biologic mesh?
a.
Results in reduced cost.
b.
Results in reduced absorption.
c.
Forms a dense fibrous capsule.
d.
May be used in all wound classes.

Answer 22

May be used in all wound classes.

Question 23

Identify A in the diagram. This area is bounded by the lateral border of the rectus abdominis medially, the inguinal ligament inferiorly, and the inferior epigastric vessels laterally.

Hesselbach’s triangle

Triangle of Calot

Koch’s triangle

Triangle of doom

Answer 23

HESSELBACH’S TRIANGLE

Question 24

Depending on their location, hernias are classified as direct inguinal, indirect inguinal, femoral, umbilical, incisional, or epigastric. Hernias in any of these groups are either reducible or nonreducible. The characteristic “reducible” hernia can best be described as a hernia:
a.
that is an urgent diagnosis.
b.
with visceral contents that can be returned to the abdomen.
c.
that does not require surgical repair.
d.
with a narrow sac neck that is closed with adhesions.

Answer 24

with visceral contents that can be returned to the abdomen.

Question 25

A 49-year-old male had a laparoscopic hernia repair with good results and an uneventful recovery. Weeks later, as he reviewed his hospital bill, he noted that he had been charged for a preperitoneal distention balloon, polypropylene mesh, an endomechanical stapler, fibrin glue, and three endosurgical trocars. Which hernia repair technique was most likely performed on the patient? a. TEP repair b. Mesh-plug insertion repair c. TAPP repair d. Shouldice repair

Answer 25

TEP REPAIR

Question 26

During the inguinal hernia repair the aponeurosis of the transversus abdominis is approximated to the edge of the inguinal ligament? Lichtenstein McVay Bassini Shouldice

Answer 26

BASSINI

Question 27

Identify the triad of anatomic sites of abdominal wall weakness with a potential for hernias. a. Groin, ventral line, umbilicus X b. Ventral line, aponeurosis, inguinal canal c. Inguinal rings, femoral canal, incision d. Inguinal canal, femoral rings, umbilicus

Answer 27

Inguinal canal, femoral rings, umbilicus

Question 28

Which is false about an umbilical hernia? Can be due to weakness in the linea alba Common in children Always repaired in children Tend to strangulate in adults

Answer 28

ALWAYS REPAIRED IN CHILDREN

Question 29

Femoral hernias occur more frequently in which group of individuals? a. Weight lifters b. Women c. Newborns d. Postoperative obese patients

Answer 29

WOMEN

Question 30

Your patient is undergoing a laparoscopic hernia repair, and the surgeon plans to secure the mesh with a endostapler. During the placement it is vital that the surgeon does not place any staples in the shaded triangle area (area below the red line) in the diagram. As you can note, this is in inferior to the internal inguinal ring. What is this triangular area called? Hesselbach's traingle Triangle of doom Triangle of Calot Koch's triangle

Answer 30

TIRANGLE OF DOOM

Question 31

The most common structure involved in a sliding left indirect hernia is the: Bladder Cecum Sigmoid Descending colon

Answer 31

SIGMOID

Question 32

As noted, this structure is the anatomical division between the inguinal and femoral regions. Also, may be referred to an inguinal ligament. Femoral ligament Cooper's ligament X Poupart's ligament Falciform ligament

Answer 32

Poupart's ligament (INGUINAL LIGAMENT)

Question 33

Bupivacaine and ropivacaine are look-alike/sound-alike drugs. Adverse drug reactions (ADRs) can occur if a clinician confuses these two drugs. Both drugs promote nerve conduction blockage analgesia when given locally, but bupivacaine is cardiotoxic. When selecting a local anesthetic to fill an elastomeric pain pump, what is one contraindication that should be considered? a. If the patient is hypersensitive to amide local anesthetics b. If the patient had a local injection of lidocaine during the procedure X c. If the patient has cardiovascular disease X d. If the patient is confused or unconscious

Question 34

Contributing factors to hernia formation include age, gender, previous surgery, obesity, nutritional status, and pulmonary and cardiac disease. The formation of the hernia at a site of weakness is due to any number of conditions that cause: a. impaired healing and defective collagen formation. b. loss of tissue elasticity. c. increased pressure within the abdomen. d. thinning and stretching of muscle fibers. X

Answer 34

loss of tissue elasticity.

Question 35

As noted in the diagram, this hernia contains a Meckel's diverticulum is the sac. Littres Spigelian Epigastic Hiatal

Answer 35

LITTRES

Question 36

Laparoscopic inguinal hernia repair is another method of tension-free mesh repair, with several repair options. The most popular techniques include a totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) approach. Which of the two techniques provides access to the preperitoneal space without entering the peritoneum? a. The TEP technique b. Both the TEP technique and the TAPP technique if the hernias are recurrent c. Neither the TEP technique nor the TAPP technique; preperitoneal access is only possible with an open surgical approach d. The TAPP technique

Answer 36

TEP TECHNIQUE

Question 37

Hernia-entrapped viscera, typically loops of small intestine, will result in intestinal obstruction with resulting pain, vomiting, and distention. What is the appropriate descriptive diagnosis of this condition? a. Torsion of the hernia sac b. Nonreducible hernia c. Gangrenous bowel d. Incarcerated hernia

Answer 37

INCARCERATED HERNIA

Question 38

An 86-year-old retired plumber states that he has suffered from a groin hernia all of his adult life; he states, “as far back as I can remember.” Sometimes he has to push the bulge back into his abdominal wall and then he is fine until he has a coughing spell. This morning the bulge was large and tender when he woke up, and he could not reduce it. As the pain increased, he felt weak and nauseated. His daughter took him to the emergency department (ED). The patient was diagnosed with a strangulated incarcerated hernia and scheduled for emergency surgery. If the contents of the patient’s hernia sac become compromised, with strangulation of the bowel, the probable label on his surgical specimen will be: a. intestinal obstruction. b. compromised bowel. c. strangulated bowel. X d. necrotic bowel.

Answer 38

NECROTIC BOWEL

Question 39

As noted in the diagram, this structure forms that lateral boundary of a femoral hernia: Null The femoral nerve The femoral artery The femoral vein The lacunar ligament

Answer 39

FEMORAL VEIN

Question 40

Ryan has an indirect hernia that is characterized by a small neck, thin walls, and close attachment to the cord structures. Marc has a hernia with a short, wide neck, and a thick-walled sac. Based on this description, Ryan has a(n) ____________ hernia and Marc has a(n) __________ hernia. a. pantaloon; sacular b. congenital; acquired c. reducible; nonreducible d. acquired; congenital

Answer 40

congenital; acquired

Question 41

What is the anatomical component of the lining of the herniated abdominal weakness and the hernia sac? a. Muscularis b. Rectus abdominis muscle c. Fascia d. Peritoneum

Answer 41

PERITONEUM

Question 42

Which hernia type occurs within the Hesselbach triangle? a. Indirect inguinal hernia b. Umbilical hernia c. Direct inguinal hernia d. Ventral hernia

Answer 42

DIRECT INGUINAL HERNIA

Question 43

This structure emerges with the spermatic cord from the superficial inguinal ring, and needs to be preserved during an inguinal hernia repair. Located immediately below the aponeurosis. Median nerve Iliohypogastric nerve Sciatic nerve Ilioinguinal nerve

Answer 43

Ilioinguinal nerve

Question 44

Regardless of the hernia type, the mesh-plug technique is performed on an ambulatory basis, through a small incision, often laparoscopically. Which advantage of the mesh-plug technique increases patient comfort, speeds rehabilitation, and contributes to a low recurrence rate? a. Ensures a high-tension hernioplasty. X b. Is performed under local anesthesia. c. Involves minimal blood loss. X d. Has a decreased chance of nerve injury.

Question 45

Select the most common hernia that occurs in both men and women. a. Direct inguinal hernia X b. Direct femoral hernia c. Indirect inguinal hernia d. Indirect femoral hernia

Answer 45

Indirect inguinal hernia