QuestionSBA
QuestionChoice
This patient likely has a femoral hernia based on examination findings. While imaging will likely be required, arranging this will delay a surgical opinion which is urgently needed due to the risk of strangulation. If further imaging is required, the surgical team can arrange this.
10035416
e
Arrange CT abdomen/pelvis
QuestionChoice
This patient likely has a femoral hernia. These are very prone to strangulation, so observation and follow-up is inappropriate.
10035414
c
Careful observation and follow-up
QuestionChoice
This patient likely has a femoral hernia based on examination findings. While an abdominal ultrasound will likely be required, arranging this will delay a surgical opinion which is urgently needed due to the risk of strangulation. If further imaging is required, the surgical team can arrange this.
10035415
d
Arrange an urgent abdominal ultrasound
QuestionChoice
This patient likely has a femoral hernia - clinical examination findings are suggestive of this, and she has multiple risk factors (constipation causing increased intra-abdominal pressure, female sex, increasing age, and COPD potentially causing a chronic cough). She should be referred urgently, as these hernias are prone to strangulation and therefore require prompt investigation and management.
10035412
a
Urgent referral to surgical team
QuestionChoice
This patient likely has a femoral hernia. A referral to the emergency department for emergency surgery should be made if there are features of incarceration, strangulation, or obstruction. These would include an irreducible hernia, pain, features of bowel obstruction, or other clinical concerns. At present, an urgent referral to the surgical team is sufficient.
10035413
b
Refer to the emergency department
Concept
Chapter
2693
5880
Femoral hernias
Topic
135
General surgery
19486
Femoral hernias are more common in elderly women and can lead to strangulation, requiring urgent surgical referral.
A 74-year-old woman visits her GP as she has noticed a painless lump in her groin, which she has not experienced before. She has a history of chronic constipation and COPD.

On examination, she has a soft, reducible lump below and lateral to the pubic tubercle. It is not tender to palpation and has a cough impulse.

What is the most appropriate next step in management?
a