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NBME 20 Answers

nbme20/Block 1/Question#39 (34.4 difficulty score)
A 3-month-old boy is brought to the office by ...
Lateral to the inferior epigastric artery and superior to the inguinal ligamentπŸ”,πŸ“Ί

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submitted by hayayah(1081),
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unInagil rhnseia ear lulsuay decebulr,i aflermo raesnhi rea no.t

sThi si na rneidtci nglianiu na.hire It tsrene ritnalen giunnial rgni ltrlaea ot rfnrioei esrctigipa lsseves dna is erurisop ot het uaiinngl miaet.ngl

udeaCs yb rulaefi of spusosecr ilvsiaagn to lcoes (can morf hec)r.olyed aMy be contedi in aitsnnf or idvrsdeoec in atuldd.oho cMhu orme ocomnm ni samle.

yotsubato  Heres a good picture to help with the concept. +4  
sbryant6  Note that direct inguinal hernias typically happen in older adults. This question presents a younger baby, so it is more like to be indirect. +7  
jawnmeechell  So a femoral hernia would be inferior to inguinal, but direct/indirect would be superior? +  
azharhu786  The direct and indirect hernia are both superior to the inguinal ligament but the femoral hernia is basically inferior to the inguinal ligament. The direct hernia is medial to the inferior epigastric vessels whereas, the indirect is lateral to the epigastric vessels. An indirect hernia is seen in young people whereas, direct hernia happens in adults. +4  

submitted by stepwarrior(22),

This is where the hernia begins but ultimately where it bulges out varies depending on how far down the inguinal canal the hernia goes. It could pop out well below the inguinal ligament. The wording is crap, they should have just shown a picture of the patient.