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A 44-year-old man complains of discomfort in his right upper thigh for the past 6 months. He works in the garden department of a home improvement center. On examination, there is tenderness at the right inguinal area. When the patient performs a Valsalva maneuver (bearing down to increase intraabdominal pressure), a bulge appears superior to the inguinal crease near the pubic bone.

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