Summary of Key Points for OSCEs
Key anatomical landmarks |
|
Inguinal ligament |
From pubic tubercle to anterior superior iliac spine |
Internal (deep) ring |
Mid-inguinal point |
10–15 mm above femoral artery pulse |
External (superficial) ring |
Superior and medial to pubic tubercle |
Inguinal canal |
Starts at internal ring |
Ends at external ring |
Contains spermatic cord in men |
Contains round ligament in women |
4–5 cm in length |
Femoral canal |
Inferior and anterior to inguinal ligament |
Contains fat and a lymph node |
Femoral vein, femoral artery and femoral nerve lie lateral to the femoral canal (in that order) |
Types of hernia |
|
Inguinal hernias |
Superior and medial to pubic tubercle |
Femoral hernias |
Lateral and inferior to pubic tubercle |
Protrude through femoral canal |
More common in females |
Commonly strangulate: as the femoral canal is very narrow |
Direct versus indirect hernias |
|
Direct inguinal hernias |
Protrude through a muscular defect in the transversalis fascia (which is the posterior wall of the inguinal canal) |
Rarely strangulate: as the opening is wider |
Indirect inguinal hernia |
Protrude after exiting through internal inguinal ring |
>75% of inguinal hernias are indirect |
Occur due to existence of processus vaginalis and non-closure of internal inguinal ring after birth) |
Can protrude down to scrotum |
Commonly strangulate: as the internal ring is narrow |
Summary of Common Groin Lumps
|
Saphena varix |
Soft |
Disappears when supine |
Cough impulse present |
Positive tap test |
Blue tinge |
Femoral aneurysm |
Pulsatile |
Bruit |
Lymph node |
Firm |
Round |
Well-circumscribed |
Fixated to underlying soft tissue |
Could be tender (depending on cause) |
Lipoma |
Soft/firm consistency |
Well-circumscribed |
Testes |
Characteristic features |
Key Features and Location of Different Types of Hernia (Figure 12.1)
