{"id":3842,"date":"2024-03-27T21:26:00","date_gmt":"2024-03-27T21:26:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=3842"},"modified":"2025-10-01T11:39:35","modified_gmt":"2025-10-01T19:39:35","slug":"usmle-step-2-question-of-the-day-abdominal-hernia","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-abdominal-hernia","title":{"rendered":"USMLE\u00ae Step 2 Question of the Day: Abdominal hernia"},"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-abdominal-hernia\/#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-abdominal-hernia\/#A_Elective_surgical_repair_following_hyperglycemic_control\" >A.&nbsp;Elective surgical repair following hyperglycemic control&nbsp;<\/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-abdominal-hernia\/#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-abdominal-hernia\/#B_Elective_surgical_repair_within_one_week\" >B.&nbsp;Elective surgical repair within one week<\/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-abdominal-hernia\/#C_Urgent_surgical_repair_within_12_hours\" >C.&nbsp;Urgent surgical repair within 12 hours<\/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-abdominal-hernia\/#D_Referral_to_the_emergency_department_for_surgical_consultation\" >D.&nbsp;Referral to the emergency department for surgical consultation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-abdominal-hernia\/#E_Watchful_waiting_and_surgical_repair_only_if_signs_of_strangulation_occur\" >E.&nbsp;Watchful waiting and surgical repair only if signs of strangulation occur<\/a><\/li><\/ul><\/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-abdominal-hernia\/#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-9\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-abdominal-hernia\/#Major_takeaway\" >Major takeaway<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>Prepare for USMLE Step 2 with our QOTD on limited hip abduction, Developmental Dysplasia of the Hip, &amp; Barlow maneuver. Strengthen your exam knowledge.<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 58-year-old man presents to the primary care office for evaluation of a painful abdominal lump for the last six months. He states the lump becomes painful when he lifts heavy objects. He has not had fevers, nausea, or vomiting, and his bowel movements are regular. Past medical history is significant for type II diabetes and his last HbA1c was 9.1%. He travels for work and often forgets to bring his medications. Temperature is 37.0\u00b0C (98.6\u00b0F), pulse is 80\/min, respiratory rate is 16\/min, and blood pressure is 124\/80 mmHg. Exam reveals a 3.1 cm soft, non-tender hernia over the lower midline of the abdominal wall which cannot be reduced. There are no skin changes over the affected area. Which of the following is the best next step in management?&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A.&nbsp;Elective surgical repair following hyperglycemic control&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B.&nbsp;Elective surgical repair within one week<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C.&nbsp;Urgent surgical repair within 12 hours<br><\/strong><br><strong>D.&nbsp;Referral to the emergency department for surgical consultation<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E.&nbsp;Watchful waiting and surgical repair only if signs of strangulation occur<\/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=\"A_Elective_surgical_repair_following_hyperglycemic_control\"><\/span><strong>A.&nbsp;<\/strong><strong>Elective surgical repair following hyperglycemic control&nbsp;<\/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 B, C, D, 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=\"B_Elective_surgical_repair_within_one_week\"><\/span><strong>B.&nbsp;<\/strong>Elective surgical repair within one week<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;This patient should be medically optimized prior to elective surgery given the chronic nature of the hernia and absence of strangulation. Undergoing surgery while his diabetes is poorly controlled would place him at an increased risk for surgical complications, therefore time and care should be taken to get his diabetes under control.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Urgent_surgical_repair_within_12_hours\"><\/span><strong>C.&nbsp;Urgent surgical repair within 12 hours<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Given the chronic nature of the hernia and the fact that there are no signs or symptoms of strangulation, an elective repair is appropriate after medical optimization.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Referral_to_the_emergency_department_for_surgical_consultation\"><\/span><strong>D.&nbsp;Referral to the emergency department for surgical consultation<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Emergency department evaluation with same-day surgical consultation would be indicated for an acute incarcerated hernia or if signs of strangulation were present. &nbsp;This patient has reported mild symptoms for six months and signs of strangulation are absent. Elective repair following medical optimization is appropriate.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Watchful_waiting_and_surgical_repair_only_if_signs_of_strangulation_occur\"><\/span><strong>E.&nbsp;Watchful waiting and surgical repair only if signs of strangulation occur<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>An incarcerated hernia requires surgical repair. &nbsp;This patient\u2019s hyperglycemia can be treated which will place him at a lower surgical risk.<\/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<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"934\" height=\"494\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_897c66.png\" alt=\"incarcerated ventral or incisional hernia assessment\" class=\"wp-image-3844\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_897c66.png 934w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_897c66.png?resize=300,159 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_897c66.png?resize=768,406 768w\" sizes=\"auto, (max-width: 934px) 100vw, 934px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">This patient presents with\u00a0six months of symptoms\u00a0and a\u00a0non-reducible bulge\u00a0in the abdominal wall, consistent with a\u00a0chronically incarcerated ventral hernia. \u00a0Elective surgical repair\u00a0is appropriate once\u00a0medical optimization\u00a0of modifiable risk factors (i.e. poorly controlled diabetes) has been achieved.\u00a0\u00a0<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Most&nbsp;ventral hernias require surgical repair&nbsp;due to the high lifetime risk of complications when left untreated. &nbsp;Elective repair&nbsp;is appropriate for&nbsp;symptomatic reducible hernias&nbsp;and for hernias that have been&nbsp;chronically incarcerated&nbsp;over weeks, months, or years. &nbsp;Due to the elective nature of these repairs,&nbsp;modifiable risk factors&nbsp;such as smoking, poorly controlled diabetes, alcohol use, severe obesity, and CHF should be&nbsp;optimized&nbsp;prior to surgery&nbsp;to reduce the risk of complications.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Small,&nbsp;asymptomatic hernias&nbsp;may be managed with&nbsp;watchful waiting&nbsp;in patients who wish to avoid surgery. &nbsp;It is reasonable to attempt to reduce an&nbsp;acutely incarcerated hernia&nbsp;which has been present for&nbsp;only a few hours;&nbsp;however, the likelihood of success is low and given the risk of strangulation,&nbsp;urgent surgical consultation&nbsp;should be pursued if reduction fails.&nbsp;Emergent surgical consultation&nbsp;is essential when a&nbsp;strangulated hernia&nbsp;is suspected, as patients with necrotic bowel may become septic.&nbsp;&nbsp;<\/p>\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\">Elective surgical repair is indicated for chronically incarcerated ventral hernias once modifiable risk factors have been optimized to prevent surgical complications.&nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>References<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Dabbas N, Adams K, Pearson K, Royle G. Frequency of abdominal wall hernias: is classical teaching out of date? JRSM Short Rep. 2011 Jan 19;2(1):5. doi: 10.1258\/shorts.2010.010071. PMID: 21286228; PMCID: PMC3031184.\u00a0\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013<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\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_efeee9.png\" alt=\"Ace your clerkships with clinical practice videos on Osmosis. Watch now.\" class=\"wp-image-3845\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_efeee9.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_efeee9.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Prepare for USMLE Step 2 with our QOTD on limited hip abduction, Developmental Dysplasia of the Hip, &amp; Barlow maneuver. Strengthen your exam knowledge. A 58-year-old man presents to the primary care office for evaluation of a painful abdominal lump for the last six months. He states the lump becomes painful when he lifts heavy [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":3843,"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-3842","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: Abdominal hernia - 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-abdominal-hernia\" \/>\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: Abdominal hernia - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"Prepare for USMLE Step 2 with our QOTD on limited hip abduction, Developmental Dysplasia of the Hip, &amp; Barlow maneuver. Strengthen your exam knowledge. A 58-year-old man presents to the primary care office for evaluation of a painful abdominal lump for the last six months. He states the lump becomes painful when he lifts heavy [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-abdominal-hernia\" \/>\n<meta property=\"og:site_name\" content=\"Osmosis Blog\" \/>\n<meta property=\"article:published_time\" content=\"2024-03-27T21:26:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2025-10-01T19:39:35+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T152629.275.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1080\" \/>\n\t<meta property=\"og:image:height\" content=\"1080\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/webp\" \/>\n<meta name=\"author\" content=\"Marina Horiates Kerekes, MD &amp; Team\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":[\"Article\",\"BlogPosting\"],\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-abdominal-hernia#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-abdominal-hernia\"},\"author\":{\"name\":\"Marina Horiates Kerekes, MD &amp; Team\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/#\/schema\/person\/c7e60a94ecf3ec6e6cfe4855957afafc\"},\"headline\":\"USMLE\u00ae Step 2 Question of the Day: Abdominal hernia\",\"datePublished\":\"2024-03-27T21:26:00+00:00\",\"dateModified\":\"2025-10-01T19:39:35+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-abdominal-hernia\"},\"wordCount\":782,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/#organization\"},\"image\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-abdominal-hernia#primaryimage\"},\"thumbnailUrl\":\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T152629.275.webp\",\"articleSection\":[\"Allopathic Medicine (MD)\",\"Exam Prep\",\"USMLE Step 2\",\"USMLE\u00ae Step 2\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-abdominal-hernia#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-abdominal-hernia\",\"url\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-abdominal-hernia\",\"name\":\"USMLE\u00ae Step 2 Question of the Day: Abdominal hernia - Osmosis Blog\",\"isPartOf\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-abdominal-hernia#primaryimage\"},\"image\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-abdominal-hernia#primaryimage\"},\"thumbnailUrl\":\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T152629.275.webp\",\"datePublished\":\"2024-03-27T21:26:00+00:00\",\"dateModified\":\"2025-10-01T19:39:35+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-abdominal-hernia#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-abdominal-hernia\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-abdominal-hernia#primaryimage\",\"url\":\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T152629.275.webp\",\"contentUrl\":\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T152629.275.webp\",\"width\":1080,\"height\":1080,\"caption\":\"USMLE\u00ae Step 2 Question of the Day: Abdominal hernia\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-abdominal-hernia#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/www.osmosis.org\/blog\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"USMLE\u00ae Step 2 Question of the Day: Abdominal hernia\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/#website\",\"url\":\"https:\/\/www.osmosis.org\/blog\/\",\"name\":\"Osmosis Blog\",\"description\":\"\",\"publisher\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/www.osmosis.org\/blog\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/#organization\",\"name\":\"Osmosis Blog\",\"url\":\"https:\/\/www.osmosis.org\/blog\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/#\/schema\/logo\/image\/\",\"url\":\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/07\/OsmosisElsevierStacked.png\",\"contentUrl\":\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/07\/OsmosisElsevierStacked.png\",\"width\":1276,\"height\":596,\"caption\":\"Osmosis Blog\"},\"image\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/#\/schema\/logo\/image\/\"}},{\"@type\":\"Person\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/#\/schema\/person\/c7e60a94ecf3ec6e6cfe4855957afafc\",\"name\":\"Marina Horiates Kerekes, MD &amp; Team\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/#\/schema\/person\/image\/\",\"url\":\"https:\/\/secure.gravatar.com\/avatar\/c4eaddbf095676223204097f8973e0eed2b2b435a8c32f8f6b8c06da77819aa6?s=96&d=mm&r=g\",\"contentUrl\":\"https:\/\/secure.gravatar.com\/avatar\/c4eaddbf095676223204097f8973e0eed2b2b435a8c32f8f6b8c06da77819aa6?s=96&d=mm&r=g\",\"caption\":\"Marina Horiates Kerekes, MD &amp; Team\"},\"description\":\"Authors: Marina Horiates Kerekes, MD &amp; Osmosis Question Writing Team\",\"url\":\"https:\/\/www.osmosis.org\/blog\/author\/marinahoriateskerekesandteam\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"USMLE\u00ae Step 2 Question of the Day: Abdominal hernia - Osmosis Blog","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-abdominal-hernia","og_locale":"en_US","og_type":"article","og_title":"USMLE\u00ae Step 2 Question of the Day: Abdominal hernia - Osmosis Blog","og_description":"Prepare for USMLE Step 2 with our QOTD on limited hip abduction, Developmental Dysplasia of the Hip, &amp; Barlow maneuver. Strengthen your exam knowledge. A 58-year-old man presents to the primary care office for evaluation of a painful abdominal lump for the last six months. He states the lump becomes painful when he lifts heavy [&hellip;]","og_url":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-abdominal-hernia","og_site_name":"Osmosis Blog","article_published_time":"2024-03-27T21:26:00+00:00","article_modified_time":"2025-10-01T19:39:35+00:00","og_image":[{"width":1080,"height":1080,"url":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T152629.275.webp","type":"image\/webp"}],"author":"Marina Horiates Kerekes, MD &amp; Team","twitter_card":"summary_large_image","schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":["Article","BlogPosting"],"@id":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-abdominal-hernia#article","isPartOf":{"@id":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-abdominal-hernia"},"author":{"name":"Marina Horiates Kerekes, MD &amp; Team","@id":"https:\/\/www.osmosis.org\/blog\/#\/schema\/person\/c7e60a94ecf3ec6e6cfe4855957afafc"},"headline":"USMLE\u00ae Step 2 Question of the Day: Abdominal hernia","datePublished":"2024-03-27T21:26:00+00:00","dateModified":"2025-10-01T19:39:35+00:00","mainEntityOfPage":{"@id":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-abdominal-hernia"},"wordCount":782,"commentCount":0,"publisher":{"@id":"https:\/\/www.osmosis.org\/blog\/#organization"},"image":{"@id":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-abdominal-hernia#primaryimage"},"thumbnailUrl":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T152629.275.webp","articleSection":["Allopathic Medicine (MD)","Exam Prep","USMLE Step 2","USMLE\u00ae Step 2"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-abdominal-hernia#respond"]}]},{"@type":"WebPage","@id":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-abdominal-hernia","url":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-abdominal-hernia","name":"USMLE\u00ae Step 2 Question of the Day: Abdominal hernia - Osmosis Blog","isPartOf":{"@id":"https:\/\/www.osmosis.org\/blog\/#website"},"primaryImageOfPage":{"@id":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-abdominal-hernia#primaryimage"},"image":{"@id":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-abdominal-hernia#primaryimage"},"thumbnailUrl":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T152629.275.webp","datePublished":"2024-03-27T21:26:00+00:00","dateModified":"2025-10-01T19:39:35+00:00","breadcrumb":{"@id":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-abdominal-hernia#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-abdominal-hernia"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-abdominal-hernia#primaryimage","url":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T152629.275.webp","contentUrl":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T152629.275.webp","width":1080,"height":1080,"caption":"USMLE\u00ae Step 2 Question of the Day: Abdominal hernia"},{"@type":"BreadcrumbList","@id":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-abdominal-hernia#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/www.osmosis.org\/blog"},{"@type":"ListItem","position":2,"name":"USMLE\u00ae Step 2 Question of the Day: Abdominal hernia"}]},{"@type":"WebSite","@id":"https:\/\/www.osmosis.org\/blog\/#website","url":"https:\/\/www.osmosis.org\/blog\/","name":"Osmosis Blog","description":"","publisher":{"@id":"https:\/\/www.osmosis.org\/blog\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/www.osmosis.org\/blog\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/www.osmosis.org\/blog\/#organization","name":"Osmosis Blog","url":"https:\/\/www.osmosis.org\/blog\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.osmosis.org\/blog\/#\/schema\/logo\/image\/","url":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/07\/OsmosisElsevierStacked.png","contentUrl":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/07\/OsmosisElsevierStacked.png","width":1276,"height":596,"caption":"Osmosis Blog"},"image":{"@id":"https:\/\/www.osmosis.org\/blog\/#\/schema\/logo\/image\/"}},{"@type":"Person","@id":"https:\/\/www.osmosis.org\/blog\/#\/schema\/person\/c7e60a94ecf3ec6e6cfe4855957afafc","name":"Marina Horiates Kerekes, MD &amp; Team","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.osmosis.org\/blog\/#\/schema\/person\/image\/","url":"https:\/\/secure.gravatar.com\/avatar\/c4eaddbf095676223204097f8973e0eed2b2b435a8c32f8f6b8c06da77819aa6?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/c4eaddbf095676223204097f8973e0eed2b2b435a8c32f8f6b8c06da77819aa6?s=96&d=mm&r=g","caption":"Marina Horiates Kerekes, MD &amp; Team"},"description":"Authors: Marina Horiates Kerekes, MD &amp; Osmosis Question Writing Team","url":"https:\/\/www.osmosis.org\/blog\/author\/marinahoriateskerekesandteam"}]}},"jetpack_featured_media_url":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T152629.275.webp","jetpack-related-posts":[{"id":3634,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-ventral-hernia-repair","url_meta":{"origin":3842,"position":0},"title":"USMLE\u00ae Step 2 CK Question of the Day: Ventral hernia repair","author":"Marina Horiates Kerekes, MD &amp; Team","date":"August 9, 2023","format":false,"excerpt":"Learn the cause of post-operative symptoms in a 62-year-old woman following a ventral hernia repair with mesh. Explore her medical history, vital signs, and pulmonary examination findings. Learn more now and understand the potential factors affecting her condition. Enhance your medical knowledge with this USMLE\u00ae Step 2-style practice question. A\u2026","rel":"","context":"In &quot;Allopathic Medicine (MD)&quot;","block_context":{"text":"Allopathic Medicine (MD)","link":"https:\/\/www.osmosis.org\/blog\/category\/medicine"},"img":{"alt_text":"USMLE\u00ae Step 2 CK Question of the Day: Ventral hernia repair","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T112227.340.webp","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T112227.340.webp 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T112227.340.webp 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T112227.340.webp 2x"},"classes":[]},{"id":2011,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-endoscopic-repair","url_meta":{"origin":3842,"position":1},"title":"USMLE\u00ae Step 2 Question of the Day: Endoscopic repair","author":"Marina Horiates Kerekes, MD &amp; Team","date":"January 10, 2024","format":false,"excerpt":"We're back with a USMLE\u00ae Step 2 CK Question of the Day!\u00a0Today'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\u2026","rel":"","context":"In &quot;Allopathic Medicine (MD)&quot;","block_context":{"text":"Allopathic Medicine (MD)","link":"https:\/\/www.osmosis.org\/blog\/category\/medicine"},"img":{"alt_text":"USMLE\u00ae Step 2 Question of the Day: Endoscopic repair","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/84.webp","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/84.webp 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/84.webp 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/84.webp 2x"},"classes":[]},{"id":7913,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-jaundiced-skin","url_meta":{"origin":3842,"position":2},"title":"USMLE\u00ae Step 2 CK Question of the Day:\u00a0Jaundiced skin","author":"Rowan Bell, MD &amp; Marina Horiates Kerekes, MD","date":"October 20, 2025","format":false,"excerpt":"Evaluate a patient presenting with jaundice and altered mental status using targeted physical exam findings to guide further diagnostic steps.","rel":"","context":"In &quot;Allopathic Medicine (MD)&quot;","block_context":{"text":"Allopathic Medicine (MD)","link":"https:\/\/www.osmosis.org\/blog\/category\/medicine"},"img":{"alt_text":"Step 2 Question of the Day Jaundiced Skin","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/Step-2-Question-of-the-Day-Jaundiced-Skin.jpg","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/Step-2-Question-of-the-Day-Jaundiced-Skin.jpg 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/Step-2-Question-of-the-Day-Jaundiced-Skin.jpg 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/Step-2-Question-of-the-Day-Jaundiced-Skin.jpg 2x"},"classes":[]},{"id":7518,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-dilated-bowel-loops","url_meta":{"origin":3842,"position":3},"title":"USMLE\u00ae Step 1 Question of the Day:\u00a0Dilated bowel loops","author":"Marina Horiates Kerekes, MD &amp; Team","date":"September 22, 2025","format":false,"excerpt":"A patient with a history of abdominal surgery presents with severe abdominal pain and imaging showing dilated bowel loops. What are the possible causes?","rel":"","context":"In &quot;Allopathic Medicine (MD)&quot;","block_context":{"text":"Allopathic Medicine (MD)","link":"https:\/\/www.osmosis.org\/blog\/category\/medicine"},"img":{"alt_text":"Step 1 Question of the Day Dilated bowel loops","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/09\/Step-1-Question-of-the-Day-Dilated-bowel-loops.png","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/09\/Step-1-Question-of-the-Day-Dilated-bowel-loops.png 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/09\/Step-1-Question-of-the-Day-Dilated-bowel-loops.png 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/09\/Step-1-Question-of-the-Day-Dilated-bowel-loops.png 2x"},"classes":[]},{"id":4185,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-leukocytosis","url_meta":{"origin":3842,"position":4},"title":"USMLE\u00ae Step 2 Question of the Day: Leukocytosis","author":"Marina Horiates Kerekes, MD &amp; Team","date":"August 21, 2024","format":false,"excerpt":"Prepare for the USMLE Step 2 with a case of a 45-year-old woman presenting with right upper quadrant pain, fever, and a history of biliary colic. Learn how to identify key physical exam findings, such as a positive Murphy's sign, that suggest acute cholecystitis, a common complication of gallstones.A 45-year-old\u2026","rel":"","context":"In &quot;Allopathic Medicine (MD)&quot;","block_context":{"text":"Allopathic Medicine (MD)","link":"https:\/\/www.osmosis.org\/blog\/category\/medicine"},"img":{"alt_text":"","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-leukocytosis.webp","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-leukocytosis.webp 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-leukocytosis.webp 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-leukocytosis.webp 2x"},"classes":[]},{"id":3718,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-a-syncopal-event","url_meta":{"origin":3842,"position":5},"title":"USMLE\u00ae Step 1 Question of the Day: A Syncopal Event","author":"Marina Horiates Kerekes, MD &amp; Team","date":"June 30, 2021","format":false,"excerpt":"Each week, Osmosis shares a USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics. Today's case involves a 65-year-old man after a syncopal event at home. Can you figure out the diagnosis? A 65-year-old man presents to the emergency department after a syncopal event at home. He\u2026","rel":"","context":"In &quot;Allopathic Medicine (MD)&quot;","block_context":{"text":"Allopathic Medicine (MD)","link":"https:\/\/www.osmosis.org\/blog\/category\/medicine"},"img":{"alt_text":"USMLE\u00ae Step 1 Question of the Day: A Syncopal Event","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T122639.841.webp","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T122639.841.webp 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T122639.841.webp 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T122639.841.webp 2x"},"classes":[]}],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/3842","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/users\/202"}],"replies":[{"embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/comments?post=3842"}],"version-history":[{"count":1,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/3842\/revisions"}],"predecessor-version":[{"id":3846,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/3842\/revisions\/3846"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/media\/3843"}],"wp:attachment":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/media?parent=3842"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/categories?post=3842"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/tags?post=3842"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}