Hernia and abdominal wall: deep ring occlusion test: practice question

A General Surgery 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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General Surgery · Hernia and abdominal wall: deep ring occlusion test

Sample item

A man has a reducible swelling in the right groin. After he lies down and the swelling is reduced, the examiner presses firmly over the deep inguinal ring and asks him to cough. No bulge appears until the pressure is released, when it descends obliquely towards the scrotum. What is the most likely diagnosis?

AIndirect inguinal herniaBFemoral herniaCDirect inguinal herniaDHydrocele of the cord

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

The answer and the reasoning

A. Indirect inguinal hernia

In the classical deep ring occlusion test, control of the bulge by pressure over the deep ring means the sac enters the canal through that ring, which points to an indirect hernia. A direct hernia bulges forwards through the posterior wall and is not held back by ring pressure.

Option by option

A. Indirect inguinal hernia (correct)
Correct. A bulge controlled by deep ring pressure and descending obliquely enters through the deep ring.
B. Femoral hernia
A femoral hernia emerges below the inguinal ligament and does not pass through the deep ring.
C. Direct inguinal hernia
A direct hernia pushes straight forward through the posterior wall medial to the ring, so ring pressure does not control it.
D. Hydrocele of the cord
A hydrocele of the cord is a fluid swelling that does not appear and disappear with reduction on coughing.

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.

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is A, Indirect inguinal hernia. In the classical deep ring occlusion test, control of the bulge by pressure over the deep ring means the sac enters the canal through that ring, which points to an indirect hernia.

Why is "Femoral hernia" not the answer?

A femoral hernia emerges below the inguinal ligament and does not pass through the deep ring.

Why is "Direct inguinal hernia" not the answer?

A direct hernia pushes straight forward through the posterior wall medial to the ring, so ring pressure does not control it.

Why is "Hydrocele of the cord" not the answer?

A hydrocele of the cord is a fluid swelling that does not appear and disappear with reduction on coughing.

What concept does this question test?

It tests Hernia and abdominal wall: deep ring occlusion test in General Surgery. A direct hernia bulges forwards through the posterior wall and is not held back by ring pressure.

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 Hernia and abdominal wall: deep ring occlusion test?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery 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.