WBR0807

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Histology
Sub Category	SubCategory::Gastrointestinal
Prompt	[[Prompt::A 52 year old construction worker with no significant past medical history presents to the physician's office complaining of right inguinal pain. The patient reports that his pain gradually worsens during the day and is worst at night. It is relieved when in supine position. Physical examination is remarkable for a bulge in the right inguinal region. The patient is diagnosed with a direct inguinal hernia bulging from the Hasselbach's triangle. Which anatomic structure most likely occupies the medial aspect of the patient's hernia?]]
Answer A	AnswerA::Inguinal ligament
Answer A Explanation	AnswerAExp::The inguinal ligament occupies the inferior aspect of the Hasselbach's triangle.
Answer B	AnswerB::Rectus abdominis muscle
Answer B Explanation	AnswerBExp::The rectus abdominis muscle occupies the medial aspect of the Hasselbach's triangle.
Answer C	AnswerC::Inferior epigastric artery
Answer C Explanation	AnswerCExp::The inferior epigastric vessels occupy the lateral aspect of the Hasselbach's triangle.
Answer D	AnswerD::Inferior epigastric vein
Answer D Explanation	AnswerDExp::The inferior epigastric vessels occupy the lateral aspect of the Hasselbach's triangle.
Answer E	AnswerE::Femoral vein
Answer E Explanation	AnswerEExp::The femoral vein occupies the lateral aspect of the femoral canal, a unique anatomic landmark that contains the femoral ring where femoral hernias are usually present.
Right Answer	RightAnswer::B
Explanation	[[Explanation::The patient presents with symptoms typical of direct inguinal hernia. Direct hernias bulge through the external superficial inguinal ring and occur secondary to abdominal wall weakness that occurs at old age. DIrect hernias are most commonly present in the Hasselbach's triangle, a unique region that lies low in the posterior aspect of the anterior abdomen lined medially by the rectus abdominis muscle, inferiorly by the inguinal ligament, and laterally by the inferior epigastric vein and artery. In contrast, indirect inguinal hernias are common at young age; they occur due to the persistence of the processus vaginalis with a bulge protruding from the internal deep inguinal ring. Educational Objective: References: ]]
Approved	Approved::No
Keyword	WBRKeyword::direct, WBRKeyword::inguinal, WBRKeyword::hernia, WBRKeyword::hasselbach, WBRKeyword::hasselbach's, WBRKeyword::triangle, WBRKeyword::indirect, WBRKeyword::femoral, WBRKeyword::vein, WBRKeyword::artery, WBRKeyword::medial, WBRKeyword::lateral, WBRKeyword::inferior, WBRKeyword::border, WBRKeyword::rectus, WBRKeyword::abdominis, WBRKeyword::muscle, WBRKeyword::inferior, WBRKeyword::epigastric, WBRKeyword::bulge, WBRKeyword::pain, WBRKeyword::inguinal, WBRKeyword::canal
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