Rosh Pediatrics Practice Exam

In a 15-year-old boy, what is the most likely diagnosis if a bulge is palpable in the inguinal region during a sports physical examination?

1. Direct inguinal hernia

2. Femoral hernia

3. Indirect inguinal hernia

4. Spigelian hernia

The correct answer is: Direct inguinal hernia

In the case of a palpable bulge in the inguinal region during a sports physical examination in a 15-year-old boy, the most likely diagnosis is an indirect inguinal hernia. This type of hernia occurs when tissue, such as a portion of the intestine, protrudes through a weak spot in the abdominal muscles. The inguinal canal is a common site for this condition, particularly in males, due to the passage of the spermatic cord. Indirect inguinal hernias are typically congenital and are often found in younger males, which is consistent with the age of the patient in this scenario. The bulge can become more apparent when the patient is asked to cough or perform other activities that increase intra-abdominal pressure, making it easily identifiable during a physical exam. Other hernia types may present differently or be more common in different populations. Direct inguinal hernias generally occur due to acquired weakening of the abdominal wall and are less common in younger individuals. Femoral hernias primarily occur in females and present below the inguinal ligament, making them less likely in this boy. Spigelian hernias are more rare and typically occur in middle-aged individuals, often along the spigelian fascia on the lateral aspect