1. Greenfield Questions Q1: Management of patients with strangulated hernias include the following except: a. antibiotics b. immediate attempts to reduce hernia through taxis c. NG suction d. end to end anastomosis of the bowel

2. Answer b. No attempts should be made to reduce hernia, strangulation of a hernia is a life threatening condition in which the hernial contents become ischemic and nonviable, gangrenous bowel should be removed and end to end anastomosis should be performed with subsequent bowel reduction into the abdominal cavity.

3. Q2: What is the prime cause of an indirect inguinal hernia?

4. Answer: A patent processus vaginalis, which is a direct result of the migration of the testis from its abdominal location of the scrotum.

5. Q3: Differential diagnosis of a groin hernia include the following: a. hydrocele b. psoas abscess c. testicular tumor d. femoral artery aneurysm e. a and c only f. all of the above

6. Answer: F. All of the above, other conditions that can be mistaken for a hernia include: varicocele, torsion of the testis, undescended testis, lipoma of spermatic cord, inguinal lymphadenopathy.

7. Q4: Describe the incision that is performed during the Lichtenstein repair of a hernia.

8. Answer: Incision starts at the pubic tubercle and is extended laterally for about 10 cm.

9. Q5: According to Greenfield what is the most important layer in the groin, in which the aim of hernia repairs should be to return this layer to normal?

10. Answer: The transversus abdominis muscle and its aponeurosis, the laparoscopic repair uses this concept by strengthening the preperitoneal area, allowing the restoration of this muscle layer.

11. Q6: What is the most common agent in vascular injury during laparoscopic repair of a hernia?

12. Answer: The insufflation needle.

13. Q7: The management of umbilical hernias is conservative in children up to the age of ___ years.

14. Answer: 2 years, 80% heal spontaneously heal by the time patient reaches this age.

15. Q8: Describe the location and contents of a Littre's Hernia?

16. Answer: Located in the groin hernia, contains Meckel's diverticulum, and sometimes also may contain the appendix.