anatomy 4-Femoral region- Inguinal canal- Hernias

Question 1

What structure forms the superior border of the femoral triangle?

Answer 1

The inguinal ligament

Question 2

What structure forms the lateral border of the femoral triangle?

Answer 2

The sartorius muscle

Question 3

What three main structures are contained within the femoral sheath?

Answer 3

Femoral artery, femoral vein, and femoral canal

Question 4

What femoral triangle structure lies outside of the femoral sheath?

Answer 4

The femoral nerve

Question 5

Name, from lateral to medial, the organization of vasculature, lymphatics, and nerves in the femoral region.

Answer 5

Nerve, Artery, Vein, Empty space, and Lymphatics (go from lateral to medial to find your NAVEL)

Question 6

A man is stabbed. The femoral triangle is punctured, but the femoral sheath is intact. What part of the femoral triangle may be damaged?

Answer 6

Femoral nerve

Question 7

Which of the following is most medial: femoral artery, femoral vein, or femoral nerve?

Answer 7

Femoral vein (venous near the penis, in the sense that they are both medial)

Question 8

A patient has an indirect hernia. Through which structure does this hernia protrude?

Answer 8

The internal inguinal ring

Question 9

Name the layers that compose the spermatic cord, from the most superficial to the deepest layer

Answer 9

External spermatic fascia, cremasteric muscle and fascia, internal spermatic fascia

Question 10

From the most superficial layer to the deepest, what are the three muscles that cover the internal (deep) inguinal ring?

Answer 10

External oblique, internal oblique, and transversus abdominis

Question 11

A male patient has a direct inguinal hernia. Between which two structures do you typically find a direct inguinal hernia?

Answer 11

The inferior epigastric vessels and the rectus abdominis

Question 12

A male patient has a direct inguinal hernia. Through what structure does the hernia protrude?

Answer 12

Abdominal wall

Question 13

What muscle layer does the internal spermatic fascia derive from?

Answer 13

Transversalis fascia

Question 14

A patient has a damaged cremasteric muscle in the spermatic cord. What muscle layer does the cremasteric muscle originate from?

Answer 14

Internal oblique

Question 15

What is a hernia?

Answer 15

A protrusion of peritoneum through an opening, usually a site of weakness

Question 16

A baby boy is brought to your clinic with a type of hernia. How did this hernia likely develop?

Answer 16

Failure of the process vaginalis to close (male Infant = Indirect hernia)

Question 17

How do sliding hernias and paraesophageal hernias each affect the gastroesophageal junction?

Answer 17

Sliding hernias cause a displaced gastroesophageal junction, paraesophageal hernias have normal gastroesophageal junction

Question 18

Which type of hiatal hernia is associated with gastroesophageal reflux disease refractory to medical treatment?

Answer 18

Sliding hernias (“hourglass stomach”) result in a displaced gastroesophageal junction, increasing risk for gastroesophageal reflux disease

Question 19

What structures are displaced in a paraesophageal hernia?

Answer 19

The fundus of the stomach is displaced into the thorax, whereas the gastroesophageal junction is unaffected

Question 20

In a boy, an indirect hernia travels through the internal inguinal ring, then the external inguinal ring, and finally into the ____.

Answer 20

Scrotum

Question 21

Through which structure do both direct and indirect hernias pass?

Answer 21

The external (superficial) inguinal ring

Question 22

What structure is a useful landmark for differentiating direct inguinal hernias from indirect inguinal hernias?

Answer 22

The inferior epigastric artery (Medial to inferior epigastric = Direct, Lateral toInferior epigastric = Indirect—MDs don’t LIe)

Question 23

An indirect inguinal hernia enters the internal inguinal ring ____ (medial/lateral) to the inferior epigastric artery.

Answer 23

Lateral

Question 24

You examine a boy with an indirect inguinal hernia. Given the affected developmental structure, what complication is possible?

Answer 24

Hydrocele (indirect inguinal hernia is caused by incomplete closure of the processus vaginalis)

Question 25

A direct inguinal hernia bulges directly through the abdominal wall ____ (medial/lateral) to the inferior epigastric artery

Answer 25

Medial

Question 26

If an elderly man presents to your clinic with an inguinal hernia, what type of hernia is most likely observed?

Answer 26

Direct inguinal hernia

Question 27

Relative to the pubic tubercle, where is a femoral hernia typically located?

Answer 27

Inferior and lateral to the pubic tubercle (through the femoral canal)

Question 28

A patient is found to have an incarcerated bowel due to a hernia. What is the patient’s most likely gender?

Answer 28

Female, as this is a femoral hernia (most likely cause of bowel incarceration, and femoral hernia is more common in females)

Question 29

How many layers of the spermatic fascia cover the sac of an indirect hernia? A direct hernia?

Answer 29

Indirect hernia = all three layers; direct hernia = only the external spermatic fascia

Question 30

An elderly man presents with a hernia through the inguinal triangle. How many layers of spermatic fascia cover this hernia?

Answer 30

Only the external spermatic fascia covers a direct inguinal hernia, which courses through the inguinal (Hesselbach) triangle