Case

A 45-year-old presents with a small lump at their right groin. They indicate a painless lump has occasionally appeared and disappeared at that site in the past year, but the small lump is now continuously present. In the last few days the lump has recently become painful, and the area is very tender to the touch with localized erythema.  The patient has normal bowel movements and bowel sounds are unremarkable. The patient has a temperature of 38.5°C, respiratory rate of 30 breaths/minute, pulse of 110 beats/minute and blood pressure of 90/60mmHg. The patient's response to questions is slow and a few times during interview requires repeating the question.   

Question 1/3 - What condition did the patient have over that previous year (i.e. prior to the last few days when the lump has been continuously present)?

Click on your selected option(s) below  (correct = 2, over-thinking = 3+)

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Incorrect. A femoral hernia involves herniation through the femoral canal which would result in a lump into the soft tissue of the thigh, not the groin.

Correct! A lump at the groin is highly likely to be an inguinal hernia. Inguinal hernias for individuals with testes are 10x higher than for individuals with a uterus, although both sexes can develop an inguinal hernia.

It is not possible to determine from external observation/palpation whether a hernia is direct or indirect. Direct hernia's push through the deeper layers at Hesselbach's triangle while an indirect hernia follows the spermatic cord through the inguinal canal. Both generate the same end result of an inguinal lump on observation/palpation.

Incorrect. Umbilical herniation, as the name implies, occurs at the umbilicus. This type of hernia is more common in individuals with a uterus, but can occur in either sex.  

Incorrect. The patient history indicates the lump has appeared and disappears. An incarcerated hernia is one that is 'stuck' and would be continuously present rather than appearing/disappearing over the past year. 

Correct! The description of the lump appearing and disappearing at times is consistent with a reducible hernia, in which the herniated material can reduce (move back) through the opening. 

Incorrect. While a lymphoma is possible in the inguinal lymph nodes and are painless, these are rarely large enough to make a visible lump and would not appear/disappear over time.