410.During the visit of a 73-year-old man to your office for ongoing con-
trol of his hypertension (155/90) you note that he has lost about 5 lb since
his last visit. He reports that he just doesn’t seem to have as much room for
food or as much of an appetite. He states that he is getting tired of the food
at his nursing home. You palpate his abdomen and note that there is a mid-
line pulse, which you had initially mistaken for a heartbeat, but it is slightly
delayed. You grow quite concerned about this pulsating abdominal mass
and send him for an abdominal CT with intravenous contrast because you
think that he has which of the following?
a. A hiatal hernia
b. Splenomegaly
c. Cirrhosis of the liver
d. An aortic aneurysm
e. A horseshoe kidney
411.Most direct inguinal hernias occur in older men as the conjoint ten-
don weakens with increased abdominal pressure, often a complication of
excessive abdominal weight gain. In contrast, most indirect inguinal her-
nias occur in which of the following?
a. Teenage females
b. Multiparous women
c. Newborn boys
d. Teenage males
e. Skinny middle aged men
512 Anatomy, Histology, and Cell Biology