A girl is brought to the physician with a genital mass. She was born full term without complications and has achieved age appropriate developmental milestones. Physical examination shows a mass at the right labium majora. The mass is reducible and nontender to palpation. An ultrasound of the right labium shows a herniated loop of intestine deep within it. This condition is because of failure of an embryonic structure to obliterate. From which of the following tissue layers is this structure derived?

A 32 year old man is brought to the emergency department because of groin pain. Physical examination shows the patient has a protrusion of the abdominal wall and a diagnosis of an indirect inguinal hernia is made. Which of the following nerves is compressed by the herniating structure in the inguinal canal to result in pain?

A 45 year old man is brought to the emergency department with groin pain. His vital signs are within normal limits. Physical examination shows a palpable, nonreducible mass just superior to the inguinal ligament. The patient is diagnosed with an incarcerated inguinal hernia and is scheduled for surgical repair. During the operation, a loop of intestine is observed passing through the deep inguinal ring. Which of the following types of hernias accurately represents the surgical findings?

A 45-year-old man comes to the emergency department with severe lower abdominal pain and fever for the past 2 days. His medical history is significant for an unrepaired right indirect inguinal hernia. His temperature is 40°C (102.2°F), pulse is 100/min, respirations are 20/min, and blood pressure is 98/83 mm Hg. Physical examination shows dusky skin over the right side of the scrotum. The right side of the scrotum is tender to touch and the right cremasteric reflex is absent. A diagnosis of a strangulated hernia is made. Which of the following nerves is responsible for the efferent limb of the cremasteric reflex?

 55-year-old man comes to the emergency department with severe abdominal pain. The patient says that the pain began suddenly and is progressively worsening. His past medical history is significant for peptic ulcer disease. Physical examination shows diminished bowel sounds, and a rigid, tender abdomen that is tympanic to percussion. An x-ray of the abdomen shows free air within the abdominal cavity. A gastroscopy shows a perforating ulcer in the posterior wall of the stomach. Which of the following locations would peritonitis most likely develop initially?

A 32-year-old woman comes to the emergency department with severe abdominal pain and nausea. She has a medical history of gastroesophageal (GE) reflux disease (GERD) and peptic ulcer disease, for which she is not taking any medications. Her temperature is 36.9°C (98.4°F), pulse is 100/min, respirations are 20/min, and blood pressure is 135/85 mm Hg. Physical examination shows tenderness in the epigastrium. An x-ray shows free air under the diaphragm. An exploratory laparotomy is performed. During this procedure, where would the incision most likely be made to separate the left and right rectus sheaths?

A 45-year-old man comes to the physician for surgical consultation. He recently lost 90 kg (200 lb) from his previous weight of 179 kg (395 lb). Physical examination shows loose skin around his abdomen that he would like to have removed. The patient’s preoperative assessment indicates that he is fit for the surgery and is scheduled for an abdominoplasty (“tummy-tuck”) the following week. The operation is performed without complications. As the physician closes the incision, which of the following layers of the abdominal wall will hold the sutures?