1. The following statements are TRUE
Medial border of the Hasselbach’s
regarding the inguinal canal EXCEPT:
a. Approximately 4- to 6-cm
long
b. Cone Shaped
c. Situated in the anterior
portion of the pelvic basin
d. NOTA
2. The following boundaries of the
inguinal canal are paired correctly
EXCEPT:
a. Anteriorly: External oblique
aponeurosis
b. Laterally: Transversalis fascia
c. Superiorly: Transversus
abdominis muscle
d. Inferiorly: Inguinal ligament
3. Inferior border of the inguinal canal
a. Anteriorly: External oblique
aponeurosis
b. Laterally: Transversalis fascia
c. Superiorly: Transversus
abdominis muscle
d. Inferiorly: Inguinal ligament
4. The following is TRUE regarding the
spermatic cord EXCEPT:
a. Traverses the inguinal canal
b. Contains two arteries, two
veins, two nerves, the
pampiniform venous plexus,
and the vas deferens
c. It is enveloped in three layers
of spermatic fascia.
d. NOTA
5. The following borders of the
Hasselbach’s Triangle is correctly
paired EXCEPT:
a. Inferiorly: Inguinal ligament
b. Superolaterally: Inferior
Epigastric Vessels
c. Laterally: External Oblique M.
d. NOTA
6.
triangle
a. Inguinal ligament
b. Inferior Epigastric Vessels
c. External Oblique M.
d. NOTA
7. Inferior border of the Hasselbach’s
Triangle
a. Inguinal ligament
b. Inferior Epigastric Vessels
c. External Oblique M.
d. NOTA
8. True about the inferior epigastric
artery EXCEPT:
a. Derived from the external
iliac artery,
b. Supplies the rectus
abdominis
c. Anastomoses with the
superior epigastric a.
d. NOTA
9. Contents found in the triangle of
doom EXCEPT:
a. External iliac vessels
b. Deep circumflex iliac vein
c. Femoral nerve
d. NOTA
10. The circle of death is formed by the
following vessels EXCEPT:
a. Common iliac a.
b. Inferior epigastric.
c. Celiac a.
d. Obturator a.
11. True regarding inguinal hernia
EXCEPT:
a. Maybe congenital or
acquired
b. Most adult inguinal hernias
are considered congenital
defects
c. The most likely risk factor for
inguinal hernia is weakness
 in the abdominal wall
musculature 17. Management for asymptomatic
d. Congenital hernias, which reducible inguinal hernia
make up the majority of a. Observation
pediatric hernias, can be b. Taxis
considered a developmental c. Herniorrhaphy
defect rather than an d. NOTA
acquired weakness.
18. Surgical intervention for a
12. True regarding Indirect Inguinal strangulated inguinal hernia should
hernia be:
a. Congenital a. Elective
b. May enter the scrotum b. Urgent
c. Within the Hassebach’s c. Taxis should be considered
Triangle d. NOTA
d. NOTA
19. Nyhus Classification for Indirect
13. True regarding Indirect Inguinal hernia; internal abdominal ring
hernia normal; typically in infants, children,
a. Weakness of the abdominal small adults
wall a. Type 1
b. Failure of the closure of the b. Type 2
abdominal wall to close c. Type 3
during fetal development d. Type 4
c. Mostly found in adults
d. NOTA 20. Nyhus Classification for Direct Hernia
a. Type 1
14. True regarding Direct Inguinal Hernia b. Type 2
a. Weakness of the abdominal c. Type 3
wall d. Type 4
b. Failure of the closure of the
abdominal wall to close 21. NYHUS classification for femoral
during fetal development hernia
c. Predilection is on the 1st a. Type 1
decade of life b. Type 2
d. NOTA c. Type 3
d. Type 4
15. True regarding Direct Inguinal Hernia
a. May enter the scrotum 22. NYHUS classification for recurrent
b. Within the Inguinal canal hernia
c. COPD is a risk factor a. Type 1
d. NOTA b. Type 2
c. Type 3
16. An irreducible hernia is also called? d. Type 4
a. Incarcerated Hernia
b. Strangulated Hernia 23. Presumed causes of groin herniation
c. Femoral Hernia EXCEPT:
d. NOTA a. Coughing
 b. Obesity
c. Pregnancy
d. NOTA
24. Connective tissue disorders
associated with groin herniation
a. Osteogenesis imperfecta
b. Marfan’s syndrome
c. alpha1-antitrypsin deficiency
d. NOTA
25. Which of the following statements is
TRUE regarding direct inguinal
hernia
a. Direct hernia is commonly
congenital and found in
younger patients
b. The risk of incarceration of a
direct hernia is high
c. A direct hernia is solely a
weakening of the inguinal
floor and does not pass
through the inguinal rings
d. An indirect hernia will never
be present with it
e. An indirect hernia may be
present with it
26. Which of the following statements is
TRUE regarding surgical technique?
a. A Bassini repair can be used
for femoral hernias
b. A shouldice repair
approximates the
transversus abdominis
aponeurosis to Cooper’s
ligament medially, and
iliopubic tract laterally. It
requires a relaxing incision
c. A total extraperitoneal repair
is a laparoscopic approach
that stays in the
preperitoneum space by
using a balloon dissector
d. A Bassini repair uses a piece
of mesh to reinforce the floor
of the inguinal canal and
re____ the internal ring in a
tension-free manner
e. A McVay repair may never
be used for femoral hernia.
27. Which of the following is true
regarding about laparoscopic
inguinal hernia anatomy?
a. The triangle of doom is
bordered by the vas
deferens, iliopubic tract, and
gonadal vessels and
contains the ilioinguinal and
iliohypogastric nerves that
must be avoided to prevent
pain.
b. The most lateral-most
border of the dissection is
the anterior superior iliac
spine.
c. The femoral branch of the
genitofemoral nerve and the
lateral femoral cutaneous
nerve are located medial
and superior to the iliopubic
tract.
d. Femoral canal cannot be
accessed through a
preperitoneal approach;
therefore, femoral hernias
cannot be repaired
laparoscopically
e. A transabdominal
preperitoneal repair (TAPP)
approach uses a dissecting
balloon to stay in
prepreritoneal space
throughout the procedure,
and a TEP approach initially
accesses the peritoneum
before creating a peritoneal
flap
28. Which of the following is false
regarding the incidence of
abdominal hernias?
 a. Two thirds of all inquired
hernias are classfied as
indirect.
b. Femoral hernia are more
common in females than in
males.
c. Indirect hernias are common
in females.
d. Hernias generally occur with
equal frequency in males
and females.
e. Premature babies have 10%
incidence of inguinal hernia.
29. Which of the following statements is
false regarding the iliopubic tract?
a. It extends from the anterior
superior iliac spine to the
pubis
b. It is a condensation of the
transversalis fascia
c. It is of anatomic interest but
has little clinical significance
d. It runs underneath the
shelving portion of the
Poupart’s ligament
e. Many branches of the
lumbar plexus run inferior to
the iliopubic tract
30. Which of the following statements is
true regarding direct inguinal
hernias?
a. Direct hernias are commonly
congenital and found in
younger patients.
b. The risk of incarceration of a
direct hernia is high
c. A direct hernia is solely a
weakening of the inguinal
floor and does not pass
through the inguinal rings
d. Contralateral inguinal
exploration is indicated
routinely because of the high
risk for bilaterality
e. Intubation of the clinically
apparent hernia sac with a
laparoscope is one method
of examining the
contralateral side
31. Which of the following statements
about the management of inguinal
hernias in infants and children is
true?
a. Repair should be delayed
until a child reaches school
age since most inguinal
hernia defects close
spontaneously
b. Repair usually requires a
Bassini procedure.
c. The distal sac should be
removed to prevent the
formation of a secondary
hydrocele.
d. Contralateral inguinal
exploration is indicated
routinely because of the high
risk for bilaterality.
e. Intubation of the clinically
apparent hernia sac with a
laparoscope is one method
of examining the
contralateral side.
32. Which of the following hernias is
most likely to recur after a primary
repair?
a. Epigastric hernia
b. Spigelian hernia
c. Indirect hernia
d. Femoral hernia
e. Incisional hernia
33. A 55-year old man with liver failure
and ascites has an enlarging
umbilical hernia. He has never
undergone diuretic therapy. The
correct therapy is:
a. Open repair with a
waterproof mesh
b. High-volume paracentesis
immediately before repair
 c. Deferring hernia repair until
correction of the ascites by
maximal medical therapy,
transjugular intrahepatic
portosystemic shunting, or
liver transplantation
d. Laparoscopic repair with an
inlay mesh
e. Repair of the hernia and use
of an abdominal binder after
the operation.
34. Which of the following statements is
true regarding femoral hernias?
a. Femoral hernias should not
be repaired through an
infrainguinal approach.
b. If an incarcerated femoral
hernia cannot be reduced
intraoperatively, the insertion
of the inguinal ligament can
be cut from the pubic
tubercle to allow more space.
c. Femoral hernias are more
common than inguinal
hernias in females
d. A laparoscopic repair is an
inappropriate choice for a
femoral hernia repair.
e. Incarcerated femoral hernias
can be observed and
managed on an elective
basis.
35-39. Match the following Surgical
Wound Classification with the hernia
repair scenario:
35. Sterile
36. Clean
37. Clean contaminated
38. Contaminated
39. Dirty
i. Explantation of
infected mesh
ii. Symptomatic
reducible inguinal
hernia
iii. Strangulated inguinal
hernia with ischemic
bowel
iv. Not a surgical wound
class
v. Small bowel
enterotomy during
ventral hernia repairI.
40. Correct statements regarding the
management of an incarcerated
groin hernia include all of the
following except:
a. A giant inguinal hernia is a
chronically incarcerated
hernia containing the
majority of the bowel. After
reduction, loss of abdominal
domain and elevated
intraabdominal pressure can
be a concern.
b. Evaluation of the contents of
the hernia sac is a step
required in the repair of an
incarcerated hernia.
c. Incarcerated femoral hernias
can be rapaired on an
elective basis.
d. A hydrocele may mimic an
incarcerated hernia
e. Inadvertent reduction of
incarcerated hernia contents
during the induction of
anesthesia does not ensure
bowel viability.
41. Which of the following is true
regarding characteristics of mesh
used in hernia repair?
a. Lightweight mesh, compared
with heavyweight mesh,
provokes an intense
inflammatory reaction in the
body, causing scarring, pain
and shrinkage.
b. Synthetic meshes can never
be placed into a
contaminated field.
 c. Polypropylene meshes have
high adhesion risks, so they
should not be placed directly
next to bowel.
d. Biologic meshes are
processed human, bovine,
and porcine tissues
composed of a collagen
matrix and immune cells.
e. =Use of a mesh reduces the
rate of surgical site infection.
42. All of the following statements
concerning the Lichtenstein repair
are true except:
a. It is performed with local
anesthesia in an outpatient
setting.
b. Polypropylene is the most
common prosthetic material
used for the repair.
c. The medial edge of the mesh
is sutured to the transversalis
fascia, and the lateral edge is
sutured to the inguinal
ligament.
d. To reduce recurrence rates,
the most cephalad tails of
the mesh should extend
2-4cm beyond the internal
ring.
e. To reduce recurrence rates,
the most caudal aspect of
the mesh should extend at
least 2 cm over the pubic
tubercle.
43. Which of the following urologic
complications does not occur with
hernia repair?
a. Ischemic orchitis
b. Transection of the vas
deferens
c. Prostatitis
d. Testicular atrophy
e. Ovarian torsion within the
hernia sac
44. The two types of collagen bound to
exist in a decreased ratio of the skin
on inguinal hernia patients are
a. Types I and II
b. Types II and III
c. Types I and III
d. Types III and IV
45. According to the Nyhus Classification
system that categorizes hernia
detects by location, size, and type,
type IIIC represents
a. Indirect hernia; internal
abdominal ring normal;
typically in infants, children,
small adults
b. Direct hernia; size is not
taken into account
c. Recurrent hernia; modifiers
A-D are sometimes added,
which correspond to indirect,
direct, femoral, and mixed
d. Femoral hernia
46. Taxis
a. Should be performed when
strangulation is suspected
b. Refers to the method of
securing mesh to the inguinal
ligament
c. Should not be repeated more
than five times
d. Should be used for
incarcerated hernias without
sequelae or strangulation
47. A hernia sac that extends into the
scrotum may
a. Require extensive dissection
and reduction
b. Require division within the
inguinal canal
c. Require amputation of the
sac
d. Require the sac to be
inverted into the
preperitoneum
48. The technique indicated for femoral b. CT-scan
hernias in cases where the prosthetic c. MRI
material is contraindicated is d. NOTA
a. Bassini repair
b. Shouldice repair 54. Most commonly utilized in cases
c. McVay repair where physical examination detects
d. Lichtenstein tension-free a groin bulge, ut where
repair ultrasonography is inconclusive
a. Ultrasound
49. The medical issue NOT associated b. CT-scan
with hernia recurrence is c. MRI
a. Malnutrition d. NOTA
b. Steroid use
c. Smoking 55. Management for asymptomatic
d. Alcohol use hernias
a. Observation
50. Nociceptive pain is b. Elective surgery
a. The result of ligamentous or c. Bassini surgery
muscular trauma and d. NOTA
inflammation
b. The result of direct nerve 56. Prophylaxis antibiotic of choice for
damage or entrapment patients who will undergo hernia
c. The result of pain conveyed repair
through afferent autonomic a. Cefazolin
pain fibers b. Cefoxitin
d. Characterized as acute c. Cefuroxime
d. NOTA
51. Failure of the peritoneum to close
between 36 and 40 weeks gestation 57. Operation of choice for infected
results in: fields
a. Acquired defect a. Open approach
b. Weakness in the abdominal b. Laparoscopic approach
wall muscle c. Robot assisted repair
c. Patent Processus Vaginalis d. NOTA
d. NOTA
58. Emergency surgery to be performed
52. Upon performing an inguinal in a strangulated hernia
occlusion test on a patient, persistent a. Open approach
hernia was noted. What is your b. Laparoscopic approach
diagnosis? c. Robot assisted repair
a. Indirect Hernia d. NOTA
b. Direct Hernia
c. Femoral Hernia 59. Most commonly performed general
d. NOTA surgical procedure
a. Tissue repair
53. Least invasive imaging technique for b. Prosthetic repair
hernia c. Plug and Patch Technique
a. Ultrasound d. NOTA
 a. Tissue Repair
60. Operative procedure which includes b. Prosthetic Repair
dissection of the spermatic cord, c. Plug and Patch Technique
dissection of the hernia sac with high d. NOTA
ligation, and extensive
reconstruction of the floor of the 66. True about prosthetic repair;
inguinal canal a. Maybe done numerous
a. Bassini Repair times in a patient
b. Shouldice Repair b. Infection is not a
c. McVay Repair complication
d. Desarda Repair c. Bassini repair is a form of
prosthetic repair
61. Recapitulates principles of the d. NOTA
Bassini repair, and its distribution of
tension over several tissue layers 67. A modification of Lichtenstein repair
results in lower recurrence rates a 3D prosthetic plug is placed in the
a. Bassini Repair previously occupied by the hernial
b. Shouldice Repair sac
c. McVay Repair a. Tissue Repair
d. Desarda Repair b. Prosthetic Repair
c. Plug and Patch Technique
62. Indicated for femoral hernias and in
cases where the use of prosthetic 68. This approach confers the
material is contraindicated advantage of an intraperitoneal
a. Bassini Repair perspective which useful for bilateral
b. Shouldice Repair hernias, large hernia defects, and
c. McVay Repair scarring from previous lower
d. Desarda Repair abdominal surgery.
a. Transabdominal
63. Consists of a mesh-free repair preperitoneal procedure
utilizing a strip of external oblique b. Totally extraperitoneal
aponeurosis. procedure
a. Bassini Repair c. Intraperitoneal Onlay mesh
b. Shouldice Repair procedure
c. McVay Repair d. NOTA
d. Desarda Repair
69. The advantage of this repair is the
64. Allows for a tension-free repair of access to the preperitoneal space
the inguinal floor by buttressing the without intra peritoneal infiltration.
floor with a prosthetic mesh Consequently, this approach
a. Bassini Repair minimizes the risk of injury to
b. Shouldice Repair intra-abdominal organs and port site
c. McVay Repair herniation through an iatrogenic
d. Lichtenstein Tension-Free defect in the abdominal wall.
Repair a. Transabdominal
Preperitoneal Procedure
65. Most commonly performed general b. Totally Extraperitoneal
surgical procedure for hernia Procedure
 c. Intraperitoneal Onlay Mesh
Procedure
d. NOTA
70. Permits the posterior approach
without preperitoneal dissection
a. Transabdominal
Preperitoneal Procedure
b. Totally Extraperitoneal
Procedure
c. Intraperitoneal Onlay Mesh
Procedure
d. NOTA
71. Most common complication of
inguinal hernia:
a. Bleeding
b. Infection
c. Seroma
d. NOTA
72. The incidence of inguinal hernias in
men has a bimodal distribution,
which peaks
a. Before the second year of
life and after age 50
b. Before the first year of life
and after age 40
c. Before the eighth year of life
and after age 40
d. d. Before the fifth year
o life and after age 50
73. The two types of collagen found to
exist in a decreased ratio of the skin
to inguinal hernia pattern (73)
a. Types I and II
b. Types II and III
c. Types I and III
d. Types III and VI
74. Taxis
a. Should be performed when
strangulation is suspected
b. Refers to the method
securing a mesh to the
inguinal ligament
c. Should not be repeated more
than five times
d. Should be used for
incarcerated hernias without
sequelae or strangulation
75. The technique indicated or femoral
hernias in cases where prosthetic
material is contraindicated is
a. Bassini Repair
b. Shouldice Repair
c. McVay Repair
d. Desarda Repair
76. General anesthesia induction
resulting in reduction of an
incarcerated or strangulated inguinal
hernia during laparoscopic repair
a. Requires no action
b. Requires abdominal
exploration or nonviable
tissue
c. Requires immediate
conversion to an open repair
d. Requires proceeding with a
totally extraperitoneal (TEP)
repair
77. When a patient develops pain,
bulging or a mass at the site of an
inguinal repair which of the following
should be considered?
a. Seroma
b. Persistent cord lipoma
c. Hernia recurrence
d. AOTA
78. The medical issue NOT associated
with hernia recurrence is
a. Malnutrition
b. Steroid use
c. Smoking
d. Alcohol use
79. Nociceptive pain is
a. The result of ligamentous or
muscular trauma and
inflammation
 b. The result of direct nerve
damage or entrapment
c. The result of pain conveyed
through afferent autonomic
pain fibers
d. Characterized as acute
80. The triangle of pain is bordered by
all of the following EXCEPT:
a. Iliopubic tract
b. Ductus deferens
c. Gonadal vessels
d. Reflected peritoneum
81. The most common cause of urinary
retention after hernia repair is
a. General anesthesia
b. Narcotic analgesia
c. Pain
d. Perioperative bladder
distention
82. The outcome found more commonly
with TAPP repair compared with TEP
repair is
a. Length of stay
b. Time to recovery
c. Risk of intra-abdominal
injuries
d. Higher short-term recurrence
rates
83. The high incidence of inguinal
hernias in preterm babies is most
often due to
a. Failure of the peritoneum to
close
b. Familial history
c. Female gender
d. Developmental dysplasia of
the hip
84. Injury to the lateral femoral
cutaneous nerve results in
a. Inguinodynia
b. Osteitis pubis
c. Meralgia paresthetica
d. Nerve entrapment
85. The hernia repair method associated
with the lowest recurrence rate is the
a. Lichtenstein tension- free
repair
b. Open elective tissue-based
repair
c. Bassini technique
d. Shouldice repair
86. A sliding hernia
a. Has an abnormally high
recurrence rate after repair
b. Can involve the bladder
c. Is more common in the right
groin
d. Occurs almost exclusively in
women
87. Associated with a higher incidence of
ileus that other modes of repair
a. Laparoscopic
transabdominal approach
b. Bassini repair
c. McVay repair
d. NOTA
88. Treatment for ischemic orchitis
except:
a. Reassurance
b. NSAIDS
c. Comfort measures
d. NOTA
89. Injury to this structure results in
infertility
a. Epigastric artery
b. Poupart’s ligament
c. Vas deferens
d. NOTA
90. The most commonly injured vessels
in laparoscopic hernia repair
a. Inferior epigastric a
b. External iliac a
c. Both a & b
d. NOTA
91. Patient who presents with d. Richter hernia
tenderness of inguinal hernia, fever,
leukocytosis most like has 97. Common issues associated with
a. Indirect inguinal hernia recurrence of hernia includes
b. Incarcerated hernia a. Malnutrition
c. Strangulated hernia b. Immunosuppresion
d. NOTA c. Smoking
d. AOTA
92. A rare type of hernia wherein the
appendix is trapped within an 98. Most common type of pain in
inguinal hernia inguinal hernia repair
a. Amyands hernia a. Nociceptive
b. Littre hernia b. Neuropathic
c. Spigelian hernia c. Visceral
d. Richter hernia d. AOTA

93. A rare type of hernia wherein the 99. Occurs as a result of direct nerve
protrusion of Meckel’s divertiuclum is damage
in an abdominal opening a. Nociceptive
a. Amyands hernia b. Neuropathic
b. Littre hernia c. Visceral
c. Spigelian hernia d. AOTA
d. Richter hernia e.
100. The most commonly performed
94. A rare type of hernia with an form of tissue repair
abdominal protrusion of abdominal a. Bassini
contents through a defect b. Shouldice
a. Amyands hernia c. McVay
b. Littre hernia d. Lichtenstein
c. Spigelian hernia
d. Richter hernia

95. A rare type of hernia wherein an

anti-mesenteric wall of the intestine
protrudes causing strangulation
without obstruction
a. Amyands hernia
b. Littre hernia
c. Spigelian hernia
d. Richter hernia

96. Defined as any combination of two

adjacent hernia sacs of the inguinal
region or femoral region -
PANTALOON “Saddlebag” HERNIA
a. Amyands hernia
b. Littre hernia
c. Spigelian hernia