Hernia (Inguinal, Femoral, Types, Repair) MCQs

Surgery · 117 free questions with answers & explanations.

1. A 70-year-old woman presents with a tender irreducible lump below and lateral to the pubic tubercle. On examination, the lump is below and lateral to the pubic tubercle and medial to the femoral vein. What is the most likely diagnosis?
2. During repair of an indirect inguinal hernia, the deep inguinal ring is found to be medial to the inferior epigastric vessels. This finding indicates that the hernia is actually:
3. A 55-year-old man with a large irreducible inguinal hernia develops sudden onset central colicky abdominal pain, vomiting, and absolute constipation. On examination, the hernia is tense, tender, and non-reducible. What type of hernia complication has occurred?
4. The Lichtenstein tension-free mesh repair for inguinal hernia uses which anatomical structure as the floor of the repair?
5. A 70-year-old woman presents to the emergency department with a tender, irreducible groin swelling just below and lateral to the pubic tubercle. The most likely diagnosis and the structure most at risk of ischemia in this hernia type is:
6. A Lichtenstein tension-free repair is performed for an indirect inguinal hernia. The hernia sac is found to arise lateral to the inferior epigastric vessels within the inguinal canal. Anatomically, the deep inguinal ring through which the sac passes is located just lateral to which structure?
7. A Richter's hernia strangulates. Which specific feature distinguishes it from other strangulated hernias and makes it especially dangerous?
8. In a laparoscopic totally extraperitoneal (TEP) repair of an inguinal hernia, the 'triangle of doom' and 'triangle of pain' are critical anatomical hazard zones. Which structure lies within the triangle of doom, making its inadvertent injury catastrophic?
9. A 70-year-old woman presents with a tender irreducible swelling in the upper medial thigh just below the inguinal ligament, medial to the femoral vein. The femoral canal contains which structures from medial to lateral (mnemonic NAVY)?
10. In Lichtenstein tension-free mesh repair for inguinal hernia, the medial apex of the mesh is sutured to which anatomical structure to prevent medial overlap failure?
11. A Richter's hernia is characterised by which specific feature that distinguishes it from other types of bowel-containing hernia?
12. The preperitoneal space approached in laparoscopic TEP (totally extraperitoneal) hernia repair contains the 'triangle of doom' and the 'triangle of pain'. The triangle of doom contains which critical structures?
13. A 35-year-old male athlete presents with groin pain, bulge medial to the inferior epigastric vessels, and a positive cough impulse at the superficial inguinal ring. At laparoscopy, a peritoneal bulge is confirmed medial to the inferior epigastric vessels in the Hesselbach triangle. Using the European Hernia Society (EHS) classification, which type is this hernia?
14. A 72-year-old woman presents to the emergency department with a 6-hour history of a painful, irreducible femoral hernia. CT confirms bowel obstruction with a loop of small bowel in the hernia sac. During emergency surgery, the hernial sac is opened and the bowel is found to be viable. Which anatomical structure must be divided to allow reduction of the femoral hernia and should NOT be mistaken for a structure that would compromise the patient?
15. A 55-year-old man undergoes elective laparoscopic totally extraperitoneal (TEP) repair of a right inguinal hernia. During the procedure, the surgeon dissects the myopectineal orifice (Fruchaud's orifice). The mesh placed must cover this entire orifice to prevent recurrence. Which of the following does NOT pass through Fruchaud's orifice?
16. The Shouldice repair for inguinal hernia achieves low recurrence rates through which specific technical mechanism?
17. In laparoscopic totally extraperitoneal (TEP) repair of an inguinal hernia, which key anatomical landmark — the triangle of doom — must be avoided when placing staples/tacks to prevent catastrophic vascular injury?
18. Littre's hernia is defined as a hernia sac containing which specific structure?
19. Which component of the inguinal canal floor forms the medial boundary of the deep inguinal ring, and is the structure that differentiates indirect from direct inguinal hernias on inspection during surgery?
20. The Nyhus classification of groin hernias (1991) categorizes inguinal hernias for laparoscopic repair planning. Which type corresponds to a large direct inguinal hernia with a dilated internal ring?
21. In laparoscopic totally extraperitoneal (TEP) repair, the 'triangle of doom' and 'triangle of pain' are critical anatomical danger zones. What passes through the 'triangle of doom'?
22. A 30-year-old asymptomatic man is found to have a small right inguinal hernia on routine examination. He is otherwise healthy and fit. What is the current evidence-based recommendation for management?
23. A tension-free mesh repair of an indirect inguinal hernia is performed via the Lichtenstein technique. Which nerve, running within the inguinal canal superficial to the spermatic cord, is at greatest risk of injury causing chronic inguinodynia (post-herniorrhaphy pain)?
24. A femoral hernia emerges through the femoral canal, medial to the femoral vein. The femoral canal is bounded laterally by the femoral vein, medially by the lacunar ligament (Gimbernat's ligament), anteriorly by the inguinal ligament, and posteriorly by which structure?
25. During laparoscopic TAPP (transabdominal preperitoneal) inguinal hernia repair, a 'triangle of doom' is identified. Damage to structures within this triangle causes the most catastrophic vascular injury. What are the boundaries of the triangle of doom?
26. The TEP (totally extraperitoneal) laparoscopic inguinal hernia repair differs from TAPP (transabdominal preperitoneal) in which fundamental way?
27. A 70-year-old woman presents with a tender, irreducible lump in the right groin below and lateral to the pubic tubercle. The overlying skin is erythematous. What type of hernia is this most likely to be and what is the highest priority management?
28. A Littre's hernia is defined as a hernia containing which of the following?
29. A laparoscopic totally extraperitoneal (TEP) repair for inguinal hernia is being performed. The surgeon encounters a lipoma of the cord. What is the correct management of a cord lipoma during TEP repair?
30. The EUHERNIA classification grades primary unilateral inguinal hernias for standardizing repair choice. In EuraHS classification, what factor primarily determines the grade (1-3) of an inguinal hernia?
31. In Lichtenstein's tension-free mesh hernioplasty for an indirect inguinal hernia, the mesh is positioned. At which landmark is the lateral slit in the mesh placed to recreate the deep inguinal ring?
32. According to the European Hernia Society (EHS) 2018 guidelines on inguinal hernia repair, which of the following recommendations is CORRECT regarding mesh use in primary inguinal hernia?
33. A 50-year-old obese woman (BMI 34) presents with a painful, irreducible femoral hernia. She has hypertension and is on antiplatelet therapy. At laparotomy, the hernia sac contains 10 cm of ischaemic small bowel. After reduction and assessment, the bowel does not recover despite 5 minutes of warm towel application and lack of Doppler signal. What is the correct sequence of surgical steps?
34. During laparoscopic totally extraperitoneal (TEP) inguinal hernia repair, the surgeon enters the preperitoneal space and identifies the 'triangle of doom.' The structures at RISK of injury within this triangle are:
35. A 70-year-old man with a reducible inguinal hernia is evaluated. He has a Charlson Comorbidity Index score of 4 and refuses surgery. The Dutch Hernia Study and Fitzgibbons trials support which management for asymptomatic or minimally symptomatic inguinal hernia?
36. A 55-year-old woman presents with a small painful lump below and lateral to the pubic tubercle. She has no history of prior hernia or surgery. The most likely diagnosis and its embryological basis is:
37. A 45-year-old man has a recurrent right inguinal hernia following a previous Lichtenstein repair 5 years ago. The hernia recurred medially at the pubic tubercle. The HERQL-Q and EuraHS studies demonstrate that for recurrent inguinal hernia after previous anterior repair, the recommended approach is:
38. A 38-year-old female marathon runner presents with a painful groin mass that increases with exertion and reduces with lying down. On examination there is a small mass below and lateral to the pubic tubercle. She has no bowel obstruction. Imaging confirms a femoral hernia. What is the anatomical basis for the high rate of strangulation in femoral hernias compared to inguinal hernias?
39. In the TEP (totally extraperitoneal) repair of inguinal hernia, the anatomical space dissected is:
40. A 70-year-old woman presents with a strangulated femoral hernia requiring emergency bowel resection. At surgery, which structure forms the medial boundary of the femoral canal (and is intentionally divided to enlarge the femoral ring during emergency repair)?
41. The Lichtenstein tension-free open hernioplasty uses a mesh placed in which anatomical plane?
42. During Lichtenstein tension-free hernioplasty, the surgeon must identify the 'triangle of doom' to avoid catastrophic vascular injury. What structures form the boundaries of this triangle?
43. A 75-year-old man with a right inguinal hernia presents to the emergency department with an irreducible, tender, non-transilluminable scrotal swelling for 8 hours. Abdominal X-ray shows no dilated bowel. What is the most important immediate management decision?
44. In the Stoppa technique for giant inguinal hernia repair, a large prosthetic mesh is placed in the retropubic space of Retzius. Which mechanism of mesh fixation provides the primary long-term tension-free stability in this approach?
45. A 45-year-old man undergoes laparoscopic totally extraperitoneal (TEP) inguinal hernia repair. During dissection, the surgeon identifies the 'triangle of doom' and 'triangle of pain.' What structure is at highest risk if dissection enters the triangle of doom?
46. A 70-year-old woman presents with a femoral hernia containing a Richter's hernia. What is the defining characteristic of a Richter's hernia and why is it particularly dangerous?
47. Following laparoscopic TEP inguinal hernia repair, a patient develops scrotal swelling 48 hours post-operatively. Ultrasound confirms a serohematic fluid collection without active bleeding. What is this complication called and what is the initial management?
48. A 55-year-old man undergoes laparoscopic totally extraperitoneal (TEP) repair for a right indirect inguinal hernia. During dissection, he develops haemodynamic compromise; CT reveals a large retroperitoneal haematoma. The most likely injured vessel is:
49. A 72-year-old woman with a known small reducible right femoral hernia declines elective repair. She presents acutely with a 6-hour irreducible painful lump in the right groin below and lateral to the pubic tubercle. She is haemodynamically stable. What is the most important consideration in operative management?
50. According to the EHS (European Hernia Society) guidelines and the LEVEL trial evidence, which statement about watchful waiting versus elective repair of minimally symptomatic male inguinal hernia is most accurate?
51. During laparoscopic totally extraperitoneal (TEP) inguinal hernia repair, injury to which nerve running beneath the iliopubic tract causes numbness over the scrotum and proximal medial thigh?
52. A Spigelian hernia characteristically occurs at which anatomical site?
53. In the Nyhus classification of groin hernias, which type describes a large direct hernia with disruption of the posterior inguinal wall?
54. During laparoscopic totally extraperitoneal (TEP) hernia repair, which anatomical landmark defines the 'triangle of doom' and the neurovascular structures at risk within it?
55. Lichtenstein tension-free mesh repair uses which anatomical layer for mesh placement, and what is the recurrence rate advantage over traditional tissue repairs?
56. Which hernia type is described as lying within the femoral canal, medial to the femoral vein, lateral to the lacunar ligament, and has the highest risk of strangulation among all groin hernias?
57. The European Hernia Society (EHS) classification of inguinal hernias uses which anatomical system to categorize hernia type and size, replacing the older Nyhus classification for guiding mesh selection?
58. In totally extraperitoneal (TEP) laparoscopic inguinal hernia repair, which anatomical space is developed by balloon dissection to allow mesh placement?
59. A 70-year-old man with a femoral hernia presents with 6 hours of small bowel obstruction. On exploration, a Richter's hernia is found. Which description best defines a Richter's hernia?
60. The LEVEL-TRIAL compared Lichtenstein vs TEP repair for primary unilateral inguinal hernia in men. Which outcome was superior with TEP compared to Lichtenstein at 5 years?
61. During open repair of a right indirect inguinal hernia using the Lichtenstein tension-free technique, the surgeon must identify the ilioinguinal nerve. Division of this nerve during the repair would cause:
62. A 70-year-old woman presents with a tender, irreducible swelling below and lateral to the pubic tubercle. She has vomiting and colicky abdominal pain for 12 hours. The diagnosis and emergency management are:
63. A Richter's hernia is best described as:
64. In the Stoppa (preperitoneal giant prosthetic reinforcement of the visceral sac, GPRVS) procedure for bilateral inguinal hernia repair, the large mesh is placed in which anatomical space?
65. A 55-year-old woman presents with a femoral hernia. The femoral canal boundaries are: medially the lacunar ligament, laterally the femoral vein, anteriorly the inguinal ligament, and posteriorly the pectineal (Cooper's) ligament. In the Lockwood (low) approach to femoral hernia repair, which layer is incised first?
66. A 35-year-old man undergoes laparoscopic TEP (total extraperitoneal) inguinal hernia repair. Which complication is most specifically associated with TEP repair and not typically encountered in the open Lichtenstein repair?
67. The HERNIA Trial (2012) compared Lichtenstein repair versus TEP (totally extraperitoneal) laparoscopic repair for primary inguinal hernia. Which of the following most accurately summarises its key finding?
68. A Spigelian hernia protrudes through the Spigelian aponeurosis. At which specific anatomical point is it most frequently found?
69. The TAPP (Transabdominal Preperitoneal) repair and TEP (Totally Extraperitoneal) repair are laparoscopic approaches to inguinal hernia. Which of the following best distinguishes TEP from TAPP?
70. A 55-year-old man undergoes an open right inguinal hernia repair. The 'triangle of doom' is a critical region where dissection must be avoided. What structures bound the triangle of doom?
71. A 72-year-old woman presents with a painful irreducible swelling in the right groin below and lateral to the pubic tubercle. The overlying skin is erythematous. Which hernia is most likely and what is the greatest surgical concern?
72. An 80-year-old woman presents with intermittent right thigh pain and partial bowel obstruction without a visible groin swelling. Howship-Romberg sign is positive (pain radiating to the inner thigh, aggravated by internal rotation and extension of the hip). What is the diagnosis?
73. A Richter's hernia is most likely to be misdiagnosed because of which unique characteristic?
74. A 55-year-old man has an indirect inguinal hernia. During laparoscopic repair (TEP), the surgeon identifies the 'triangle of doom'. What critical structures lie within this triangle?
75. Which of the following BEST describes a Spigelian hernia?
76. The Lichtenstein tension-free mesh repair for inguinal hernia uses which type of mesh and is associated with what recurrence rate at 5 years in experienced hands?
77. In the TEP (Totally Extraperitoneal) laparoscopic hernia repair, peritoneal entry would require conversion to which procedure?
78. Spigelian hernia characteristically presents along which anatomical line?
79. A 65-year-old man with an incarcerated right inguinal hernia undergoes emergency surgery. On exploration, the bowel loops in the sac appear dusky but vascularity recovers after 10 minutes of warm saline wrapping. The sac is found to contain two loops of small intestine with a third loop incarcerated outside the abdominal cavity in an antecolic position. This represents:
80. The Nyhus classification of inguinal hernias categorizes a complete indirect hernia with a normal internal ring but large hernial sac extending into the scrotum as:
81. A 45-year-old woman with a right femoral hernia undergoes McEvedy's approach repair. In this approach, the surgeon operates through which incision and anatomical space?
82. The Shouldice repair for inguinal hernia is a tension-based technique that involves reinforcement of which specific structure in multiple layers?
83. In a totally extraperitoneal (TEP) laparoscopic inguinal hernia repair, the space developed is the:
84. The myopectineal orifice of Fruchaud encompasses all weak areas through which groin hernias can occur. It is bounded superiorly by which structure?
85. In the Lichtenstein tension-free mesh repair for inguinal hernia, the mesh is placed in which tissue plane?
86. A 70-year-old woman presents with an irreducible, tender swelling in the right groin below and lateral to the pubic tubercle. The swelling is below and medial to the femoral pulse. The MOST likely diagnosis is:
87. The Shouldice repair for inguinal hernia is superior to simple tissue-based repairs because it involves:
88. The TAPP (transabdominal preperitoneal) laparoscopic hernia repair requires peritoneal flap closure at the end. What is the primary reason for this closure?
89. Spigelian hernia protrudes through the Spigelian aponeurosis (linea semilunaris) at the lateral edge of the rectus abdominis. What makes this hernia particularly dangerous despite often being small?
90. A 70-year-old woman presents with a small, tender swelling below and lateral to the pubic tubercle. It is irreducible. Which statement is MOST accurate regarding this hernia?
91. The Shouldice repair for inguinal hernia uses a specific tissue-based technique. Which of the following best describes its key principle?
92. A 55-year-old man undergoes laparoscopic totally extraperitoneal (TEP) repair of a right inguinal hernia. During dissection, bleeding from an unnamed vessel is encountered medially in the space of Retzius. The vessel most likely injured is:
93. A Spigelian hernia protrudes through the Spigelian aponeurosis. At which anatomical level does it most commonly occur?
94. A 60-year-old man undergoes elective repair of a right indirect inguinal hernia via open Lichtenstein technique. Which nerve, if injured during dissection of the hernia sac, results in loss of sensation over the upper medial thigh?
95. During laparoscopic totally extraperitoneal (TEP) inguinal hernia repair, the surgeon encounters the 'triangle of doom.' Which structure lies WITHIN this triangle and is at risk of injury?
96. A 75-year-old woman presents with a small, firm, tender lump in the right groin just below and lateral to the pubic tubercle. There is no bowel obstruction. She has a body mass index of 28. This presentation is MOST consistent with which type of hernia?
97. A Littré hernia is defined as a hernia containing:
98. In laparoscopic totally extraperitoneal (TEP) inguinal hernia repair, the key plane of dissection to create the preperitoneal space lies between:
99. A 55-year-old man undergoes laparoscopic totally extraperitoneal (TEP) repair of a right indirect inguinal hernia. During dissection, a vessel running in the 'triangle of doom' is injured, causing significant haemorrhage. Which structure was most likely injured?
100. A Spigelian hernia protrudes through a defect at the lateral edge of the rectus abdominis at the level of the arcuate line. What makes Spigelian hernias particularly dangerous?
101. In the TEP (totally extraperitoneal) laparoscopic inguinal hernia repair, the mesh is placed in the preperitoneal space and must cover the entire myopectineal orifice of Fruchaud. The triangle of doom in laparoscopic hernia repair contains:
102. The EuraHS (European Registry of Abdominal Wall Hernias) classification of ventral hernias uses which primary variables?
103. In a Richter's hernia, the unique feature compared to a standard incarcerated hernia is:
104. The TAPP (transabdominal preperitoneal) repair of inguinal hernia requires peritoneal flap closure to prevent which specific complication?
105. Regarding the EuraHS-QoL (European Registry for Abdominal Wall Hernias — Quality of Life) score used in hernia research, which domain is NOT included?
106. In the Lichtenstein open mesh repair of inguinal hernia, the mesh is sutured to which structure at its medial end to prevent recurrence at the pubic tubercle?
107. The EHS (European Hernia Society) classification of incisional hernias uses the location and width of the defect. A midline incisional hernia with a defect width of 8 cm is classified as:
108. In the Stoppa repair (giant prosthetic reinforcement of the visceral sac), the mesh is placed in which tissue plane?
109. The European Hernia Society (EHS) classification of inguinal hernias uses the letter 'L' for lateral, 'M' for medial, and 'F' for femoral, each graded 0–3 by defect size. A grade 2 defect measures:
110. A Spigelian hernia protrudes through the Spigelian fascia, which is located at the lateral edge of the rectus abdominis. It most commonly occurs at which level?
111. The posterior inguinal wall is reinforced by the transversalis fascia. In the Stoppa (giant prosthetic reinforcement of the visceral sac, GPRVS) procedure for bilateral or recurrent inguinal hernia, the prosthetic mesh is placed:
112. Obturator hernia is a rare hernia that passes through the obturator foramen. Which classic clinical sign is pathognomonic of obturator hernia?
113. A 70-year-old woman presents with a painful tender swelling in the right groin below and lateral to the pubic tubercle. The swelling is irreducible. Which type of hernia is MOST likely and what is a specific concern about its content?
114. A 55-year-old man undergoes laparoscopic TAPP (transabdominal preperitoneal) repair for a right inguinal hernia. The anatomical landmark called the 'triangle of doom' in laparoscopic hernia repair must be avoided to prevent injury to which structure?
115. In the TEP (totally extraperitoneal) laparoscopic hernia repair, the dissection plane developed is between the posterior rectus sheath and the peritoneum (preperitoneal space). The lateral limit of dissection must extend beyond which structure to prevent lateral recurrence?
116. A richter's hernia is defined as which of the following?
117. A 70-year-old woman presents with a small, tender lump in the right groin below the inguinal ligament and medial to the femoral vein. It is irreducible. This represents a femoral hernia. What percentage of femoral hernias present with strangulation at initial presentation compared to inguinal hernias?