Your 54-year-old male patient complains of a painless "lump" in his lower left abdomen that comes and goes for the past couple of weeks. When examining the abdomen, you should have the patient:

Question

A. Lie flat and take a deep breath
B. Stand and bear down against your hand
C. Prepare for a digital rectal examination
D. Lie in a left lateral recumbent position

Answer 1

ANS: B
In the majority of hernia cases, a history of heavy physical labor or heavy lifting can be elicited. Right or left lower quadrant pain that may radiate into the groin or testicle is typical. The pain is usually dull or aching unless strangulated, in which case the pain is more severe. The pain increases with straining, lifting, or movement of the lower extremities. Physical examination includes palpating the femoral area and inguinal ring for bulging or tenderness. Ask the patient to bear down against your hand.