Abdomen: abdominal wall hernia: practice question

A Anatomy question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anatomy · Abdomen: abdominal wall hernia

Sample item

A 60-year-old obese woman has a small tender bulge lateral to the rectus abdominis near the level of the arcuate line, with a cough impulse. The sac lies between the muscle layers and is hard to see. Where is the defect?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Linea semilunaris (spigelian aponeurosis)

A spigelian hernia passes through the spigelian aponeurosis, the part of the transversus abdominis aponeurosis lying lateral to the rectus muscle and bounded medially by the linea semilunaris. It is most common near the arcuate line. The sac often lies beneath the intact external oblique aponeurosis, so it can be missed clinically.

Option by option

  • A. Linea alba above the umbilicus

    A defect in the linea alba above the umbilicus produces an epigastric hernia in the midline.

  • B. Deep inguinal ring

    The deep inguinal ring is the site of an indirect inguinal hernia, in the groin.

  • C. Superior lumbar triangle

    The superior lumbar triangle is the site of a Grynfeltt hernia, in the flank.

  • D. Linea semilunaris (spigelian aponeurosis) (correct)

    Correct. The defect lies in the spigelian aponeurosis along the linea semilunaris.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Anatomy question

What is the answer to this Anatomy question?

The best answer is D, Linea semilunaris (spigelian aponeurosis). A spigelian hernia passes through the spigelian aponeurosis, the part of the transversus abdominis aponeurosis lying lateral to the rectus muscle and bounded medially by the linea semilunaris.

Why is "Linea alba above the umbilicus" not the answer?

A defect in the linea alba above the umbilicus produces an epigastric hernia in the midline.

Why is "Deep inguinal ring" not the answer?

The deep inguinal ring is the site of an indirect inguinal hernia, in the groin.

Why is "Superior lumbar triangle" not the answer?

The superior lumbar triangle is the site of a Grynfeltt hernia, in the flank.

What concept does this question test?

It tests Abdomen: abdominal wall hernia in Anatomy. It is most common near the arcuate line. The sac often lies beneath the intact external oblique aponeurosis, so it can be missed clinically.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Abdomen: abdominal wall hernia?

Learn every nerve by its route, its muscles and what a lesion looks like at the bedside. That one habit answers a large share of questions. Then use the flashcards and the other Anatomy questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.