{"id":2011,"date":"2024-01-10T16:22:00","date_gmt":"2024-01-10T16:22:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=2011"},"modified":"2025-10-01T11:39:32","modified_gmt":"2025-10-01T19:39:32","slug":"usmle-step-2-question-of-the-day-endoscopic-repair","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-endoscopic-repair","title":{"rendered":"USMLE\u00ae Step 2 Question of the Day: Endoscopic repair"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-endoscopic-repair\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_2_CK_Question_is%E2%80%A6\" >The correct answer to today&#8217;s USMLE\u00ae Step 2 CK Question is&#8230;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-endoscopic-repair\/#D_Aberrant_obturator_artery\" >D. Aberrant obturator artery<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-endoscopic-repair\/#Incorrect_answer_explanations\" >Incorrect answer explanations<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-endoscopic-repair\/#A_Ilioinguinal_nerve\" >A.&nbsp;Ilioinguinal nerve<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-endoscopic-repair\/#C_Genitofemoral_nerve\" >C. Genitofemoral nerve<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-endoscopic-repair\/#E_Pudendal_nerve\" >E. Pudendal nerve<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-endoscopic-repair\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-endoscopic-repair\/#Major_takeaway\" >Major takeaway<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>We&#8217;re back with a USMLE\u00ae Step 2 CK Question of the Day!&nbsp;<strong><em>Today&#8217;s case involves a 72-year-old man presenting with groin pain and bulging, exacerbated by standing. With a diagnosis of femoral hernia, the patient is set for endoscopic repair under spinal anesthesia. Discover the intricacies of this procedure and identify the critical structure at risk of injury during the repair. Can you pinpoint the anatomical concern in this surgical scenario?<\/em><\/strong><\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 72-year-old man presents to the office because of pain and bulging in his groin. The patient reports that standing exacerbates the pain. The patient is otherwise healthy and has never had surgery. He does not take any medications. Vitals are within normal limits. Physical examination shows a bulge in the groin that is erythematous and painful to palpation. Scrotal examination is within normal limits. After further evaluation, the patient is diagnosed with a femoral hernia and is scheduled for an endoscopic repair under spinal anesthesia. Which of the following structures is at risk of injury in this patient during the repair?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Ilioinguinal nerve<\/strong><strong>B. Iliohypogastric nerve<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Genitofemoral nerve<br><\/strong><br><strong>D. Aberrant obturator artery<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Pudendal nerve<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Scroll down for the correct answer!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_2_CK_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s USMLE\u00ae Step 2 CK Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Aberrant_obturator_artery\"><\/span><strong>D. Aberrant obturator artery<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the&nbsp;<strong>Main Explanation<\/strong>, let&#8217;s see why the answer wasn&#8217;t A, B, C, or E. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_answer_explanations\"><\/span>Incorrect answer explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Today&#8217;s incorrect answers are&#8230;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_Ilioinguinal_nerve\"><\/span><strong>A.&nbsp;<\/strong>Ilioinguinal nerve<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>The ilioinguinal, iliohypogastric, and genitofemoral nerves are at risk of injury during inguinal hernia repair, which can lead to chronic residual neuralgia and postoperative constrictive scar tissue in the surgical area. However, this patient is undergoing repair for a femoral hernia, which poses risk to a different key structure.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Iliohypogastric nerve<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>The ilioinguinal, iliohypogastric, and genitofemoral nerves are at risk of injury during inguinal hernia repair, which can lead to chronic residual neuralgia and postoperative constrictive scar tissue in the surgical area. However, this patient is undergoing repair for a femoral hernia, which poses risk to a different key structure.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Genitofemoral_nerve\"><\/span><strong>C. Genitofemoral nerve<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>The ilioinguinal, iliohypogastric, and genitofemoral nerves are at risk of injury during inguinal hernia repair, which can lead to chronic residual neuralgia and postoperative constrictive scar tissue in the surgical area. However, this patient is undergoing repair for a femoral hernia, which poses risk to a different key structure.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Pudendal_nerve\"><\/span><strong>E. Pudendal nerve<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>The pudendal nerve is at risk of injury during sacrospinous ligament fixation or pelvic reconstructive procedures, during which sutures are placed in the arcus tendineus fasciae pelvis. However, this patient is undergoing repair for a femoral hernia, which poses risk to a different key structure.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient with pain and bulging in the groin is found to have a femoral hernia. During femoral hernia repair, sometimes an artery called the aberrant, or accessory, obturator artery can be injured. Typically, the obturator artery branches from the internal iliac artery. In up to 20% of people, however, there can be an additional branch coming from either the inferior epigastric artery or external iliac artery that either replaces the obturator artery or joins it; this phenomenon is called an aberrant or accessory obturator artery. In these patients, the artery runs in close proximity to the femoral ring and courses along the superior pubic rami; so, during hernia repair, it can be injured or stapled.When injury occurs, the artery retracts, making it exceedingly difficult to locate and ligate, resulting in uncontrolled bleeding. This artery has been referred to as corona mortis, which means \u201ccrown of death,\u201d as injury to it can be fatal.&nbsp;fatal.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"504\" height=\"418\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T102330.845.png\" alt=\"aberrant obturator\" class=\"wp-image-2015\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T102330.845.png 504w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T102330.845.png?resize=300,249 300w\" sizes=\"auto, (max-width: 504px) 100vw, 504px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_takeaway\"><\/span><strong>Major takeaway<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">During femoral hernia repair, sometimes an artery called the aberrant, or accessory, obturator artery (which runs in close proximity to the femoral ring and courses along the superior pubic rami), can be injured or stapled. This variant is found in about 20% of patients.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>References<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Moore, K. L., Dalley, A. F., &amp; Agur, A. (2017). Clinically oriented anatomy (8th ed.). Lippincott Williams and Wilkins\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><a href=\"https:\/\/www.osmosis.org\/plans\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_6ccb80.png\" alt=\"Ace your clerkship with clinical practice videos on osmosis ad\" class=\"wp-image-2016\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_6ccb80.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_6ccb80.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><br><em><br><strong>Want more \u00a0USMLE\u00ae Step 2 CK practice questions?\u00a0Try Osmosis by Elsevier today! Access your\u00a0<a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a>\u00a0and find out why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>We&#8217;re back with a USMLE\u00ae Step 2 CK Question of the Day!&nbsp;Today&#8217;s case involves a 72-year-old man presenting with groin pain and bulging, exacerbated by standing. With a diagnosis of femoral hernia, the patient is set for endoscopic repair under spinal anesthesia. Discover the intricacies of this procedure and identify the critical structure at risk [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":2014,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,1370,45],"tags":[],"class_list":["post-2011","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-step-2-questions","category-step-2"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 2 Question of the Day: Endoscopic repair - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-endoscopic-repair\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 2 Question of the Day: Endoscopic repair - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"We&#8217;re back with a USMLE\u00ae Step 2 CK Question of the Day!&nbsp;Today&#8217;s case involves a 72-year-old man presenting with groin pain and bulging, exacerbated by standing. 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