Inspection

Site: above the fold of the groin (direct or indirect); below the fold (femoral)

Size and change in size in supine position

Extension to the scrotum in men

Skin changes: redness in inflamed or strangulated hernia

Scars

Cough impulse

Palpation
Direct vs indirect To differentiate between direct and indirect inguinal hernia: apply pressure over the midinguinal point (midway between the anterior superior iliac spine and the pubic tubercle and just above the inguinal ligament) with the fingertip to control an indirect hernia and prevent it from protruding when the patient strains. A direct hernia will not be controlled with this maneuver.
Hernia vs scrotal mass

Examine the scrotum and its contents

Confirm that protrusion is a hernia and not a scrotal mass by examining its upper edge (if upper edge is felt between thumb and index finger, with a normal spermatic cord above it, it must be a scrotal swelling and not a hernia; if upper edge cannot be felt because it passes into the inguinal canal, it is likely a hernia)

Examine the hernia

Site

Temperature

Shape and size

Reducibility

Tenderness

Expansile cough impulse

Always feel the other side

Examine the abdomen