A 31-year-old woman, who works as a medical secretary, presents with a pain, swelling and tenderness in her right wrist. She’s diagnosed with De Quervain’s tenosynovitis. Which amongst the following tendons are inflamed in this condition?

A 24-year-old man sustains a 10-cm long laceration to his upper right forearm from a large piece of a broken wine bottle following an altercation at a house party. On examination, he seems to have injured his median nerve at the level of the upper forearm. Which one of the following features would help to you identify the nerve during exploration of the wound?

A 45-year-old man attends the orthopaedic clinic with a 3-day h/o pain in his left shoulder following gardening at home. Examination of the shoulder reveals no obvious bone deformities, point tenderness or weakness. The pain is reproduced when he is asked to externally rotate the shoulder against resistance. Which amongst the following tendons is most likely to be inflamed in this patient?

A 56-year-old female with known multiple sclerosis presents to the neurosurgical clinic with a 3-4 month history of double vision on horizontal gaze. On examination, when she looks to the left, the left eye abducts (with end-gaze nystagmus) but the right eye fails to adduct. Similarly, when she looks to the right, the right eye abducts (again with end-gaze nystagmus) but the left eye fails to adduct. Rest of her eye and neurological examination are unremarkable. What is the most likely diagnosis in this patient?

A 73-year-old woman is admitted to the ICU with respiratory distress and right ventricular failure following a bowel resection and anastomosis for a strangulated femoral hernia. She has soon become anuric and has developed marked acidosis. What is the leading cause of acute kidney injury in patients admitted to the intensive care unit?

You attend a trauma call in A&E where a 16-year-old boy has been brought in by blue light ambulance following a major fight involving a group of teenagers. He was repeated punched and kicked in his stomach. He is now alert and responding appropriately. His pulse is 112/min, BP is 88/56 and RR is 18/min. He is complaining of left upper quadrant pain. Which of the following would be the most appropriate first line of investigation?

A 63-year-old man was admitted to the ICU 6 days ago with acute pancreatitis. He soon develops symptoms of organ failure and is started on inotropes. His urine output continues to decrease and is becoming quite acidotic. He is being considered to be placed on haemodialysis. Which investigation is used to most accurately measure the glomerular filtration rate?

A 23-year-old man sustained an injury to his head from a highspeed RTA. During examination, he is noted to have right-sided facial nerve palsy, loss of function of lateral rectus muscle, sensorineural deafness and Horner syndrome. He has a CT scan of the head. In the scan, where would you expect a fracture that might result in the above findings?

An 83-year-old man presents with an ulcer with everted edges in the central portion of his lower lip. An excisional biopsy confirms this to be a squamous cell carcinoma. To which of the following lymph node groups is this tumour most likely to metastasise?

A 19-year-old woman presents with a sprain to her right ankle along the medial aspect. Which of the following structures is not a component of the deltoid ligament complex?

A 33-year-old man presents with a Monteggia fracture of his right forearm. On examination, he is unable to extend his fingers and thumb but is able to extend his wrist albeit with some radial deviation. There is no associated sensory loss. Movements of all digits in his hand are normal. Which nerve is most likely to have been damaged?

A 23-year-old man has sustained a deep laceration to his right upper arm. It appears that he has severed the musculocutaneous nerve. Which among the following statements regarding the musculocutaneous nerve is true?

A 19-year-old man is stabbed over the outside of his right upper back during a fight following a football derby. The penetrating injury transects the radial nerve and the profunda brachii artery in the triangular interval. Which amongst the following features will the patient not have with radial nerve injury at this level?

A 25-year-old man sustains a fracture of the surgical neck of humerus and deep laceration to his posterior deltoid following a fall. You are able to visualize the axillary nerve as it exits the quadrangular space. Which structure forms the inferior border of the quadrangular space?

A 67-year-old presents with external axillary artery compression resulting in upper extremity ischemia and distal thromboembolism. As your consultant explores the axillary artery, he identifies the clavipectoral fascia. Which amongst the following structures does not pierce the clavipectoral fascia?

You are cannulating a 6-year-old boy in his ante-cubital fossa who is due for a circumcision later in the day. Which amongst the following structures does not lie on the roof of the antecubital fossa?

A 24-year-old man sustains extensive lacerations over the flexor aspect of his right wrist. The tendons are only partially lacerated, but the median nerve is completely divided. Which amongst the following will not be a feature when you examine his hand?

A 26-year-old man sustains a deep 8-cm laceration to his right antecubital fossa after he put his forearm through a glass window when he was frustrated following defeat of his favourite football team. The laceration has exposed a number of structures in the area. Which amongst the following anatomical landmarks will help you identify the structures accurately?

A 24-year-old man presents with a glass laceration going through Zone IV of this hand at the level of the flexor retinaculum. Many structures seem to be divided and exposed at this level. When exploring the wrist, what anatomical features will help you identify the structures accurately?

 A 44-year-old man 10-day post COVID diagnosis develops sudden onset pain and paraesthesia in his right upper limb. The initial diffuse pain progressively worsened and localised to the fingers, associated with paraesthesia and numbness. CT angiogram shows complete occlusion of the second and third parts of the right axillary artery. Which amongst the following arteries does not arise from the axillary artery?

A 30-year-old man is brought to the emergency department following a stab injury to the right side of his chest. On examination, the wound is 1 cm lateral and 1 cm deep to the sternum at the level of the 4th right intercostal space. A CT scan of the chest reveals widening on the anterior mediastinum. Which structure is most likely to be injured in the patient? 

You are assisting in a thoracotomy for a penetrating thoracic injury in a 46-year-old man. Which among the following statements regarding venous drainage of the thoracic wall is correct?

You are performing an intercostal chest drain insertion on a 36-year-old man who presented with left haemothorax following a fall from height. What is the order of structures you would go through once you have pierced the skin and subcutaneous tissue?

You are assisting in an emergency thoracotomy for a perforating cardiac injury. What amongst the following group of structures would you not expect to find in the posterior mediastinum?

You are assessing a 36-year-old man with a stab injury to his upper chest. Whilst looking at the axial CT scans of the thorax, which amongst the following structures would you not expect to find at the Angle of Louis?

A 21-year-old man with recently diagnosed schizophrenia is brought to the emergency department by his parents. For the past hour he has been complaining of discomfort in his throat and neck. He admits to swallowing coins. If the patient undergoes endoscopic retrieval of the coin, at which anatomical landmark would you expect to find it?

A 73-year-old man who presented with progressive dysphagia is diagnosed to have a 3.6 cm sized squamous cell carcinoma in the mid-oesophagus. A surgical excision is being planned. Which amongst the following set of arteries supply the length of the oesophagus?

A 76-year-old man is presents to the A&E with sweating, nausea and chest pain radiating to the left arm. An ECG confirms an acute ST elevation myocardial infarction (STEMI). He is booked to have an emergency primary percutaneous coronary intervention. Which of the following arteries does not arise from the left coronary artery?

A 69-year-old man requires epicardial access for the treatment of cardiac arrhythmias. It has been decided to use one of the cardiac veins for this procedure. Which vein drains the posterior wall of both ventricles and the posterior interventricular septum?

A 44-year-old man is brought to the A&E with blunt trauma to the upper abdomen. X-ray reveals a ruptured diaphragm with loss of contour of the left hemidiaphragm, intrathoracic herniation of a stomach and contralateral mediastinal shift. Which amongst the following statements concerning the diaphragm is incorrect?

You are assisting in performing an emergency mid-line laparotomy for acute abdomen and peritonitis in a 45-year-old man. What will be order of structures your knife will go through?

You are assisting your consultant to perform a herniorrhaphy for an indirect inguinal hernia. After she has reduced the hernia, she identifies the deep inguinal ring and asks you the structure that forms the lateral edge of the deep inguinal ring.

A 15-year-old boy is undergoing exploration of his scrotum for a suspected testicular torsion. You have incised the skin, dartos muscle and external spermatic fascia. What is the next layer you will encounter?

A 46-year-old man is listed to undergo a vasectomy under local anaesthetic. Which of the following nerves are the primary source of innervation to the anterior scrotal skin?

A CT scan shows that a renal stone is obstructing this 66-year-old man’s left pelvi-ureteral junction. Which amongst the following structures would you not expect to be at this level, corresponding to the lower border of L1 vertebra?

A 36-year-old man is taken in for an emergency laparotomy following massive intraabdominal bleeding secondary to a polytrauma from a high-speed car crash. He is noticed to have severe injury to the liver and your consultant asks you to assist him by performing a Pringle’s maneuver to control the bleed. Which of the following statements regarding the foramen of Winslow is incorrect?

You are assisting your consultant to perform a laparoscopic cholecystectomy on a 56-year-old woman. She is struggling to delineate the anatomy clearly due to inflammation and requests you to focus the camera over the hepatobiliary triangle. Which amongst the following statements regarding the anatomy and relations of the CBD is incorrect?

A 56-year-old man is undergoing a Whipple procedure for an adenocarcinoma affecting the ampulla of Vater. Which one amongst the following structures is not removed in a Whipple Procedure?

A 67-year-old man presents with signs of small bowel obstruction and peritonism. He is having an emergency laparotomy to explore the obstruction. As you try to identify the site of pathology, which of the following features would help you identify the jejunum from the ileum?

A 76-year-old woman is undergoing sigmoid colectomy for diverticular disease associated with stenosis and diverticular bleed. Which amongst the following features would help you identify and preserve the left ureter?

A 33-year-old woman presents with signs of a cystocele following a difficult forceps delivery 6-weeks previously. Which amongst the following is not a muscle of the pelvic diaphragm? 

A 72-year-old man is diagnosed with 4.3 cm sized adenocarcinoma in the mid-rectum. It has sufficient clearance from the dentate line so that is suitable for low anterior resection and total mesorectal excision. Which fascial plane should the surgeon be careful of to ensure that sacral vessels and hypogastric nerves are not damaged?

A 38-year-old man is brought to the A&E with an ‘open-book’ pelvic fracture and class IV shock. He’s bleeding profusely and although it mostly appears to be venous, an arterial bleed cannot be ruled out. Which of the following is not a branch of the anterior division of the internal iliac artery?

A 76-year-old man is undergoing right hemicolectomy for Duke’s III cancer of the ascending colon. Intraoperatively, which dissecting the right colic artery, the right ureter is identified. The consultant asks you the anatomical location at which the ureter enters the urinary bladder.

A 36-year-old man presents with a spinal cord injury following a fall from height. He’s now having urinary overflow incontinence. Which amongst the following statements regarding the function of the bladder is correct?

A 68-year-old man attends the surgical out-patient clinic with a 4-6-month history of intermittent blood in his stool. On examination, there’s a 1-cm, visible anal mass located below the dentate line. He is scheduled to have a biopsy of the mass. If the mass if found to be malignant, which of the following group of lymph nodes should be evaluated for possible metastasis?

A 5-day old baby is brought to A&E with history of recurrent episodes of bilious vomiting and crying. He cries for about 15-20 mins with his legs drawn up, settles for a short while and cries again. He has passed meconium after birth. He was born full-term via a normal vaginal delivery. On examination, he is apyrexial and got a normal heart rate. The abdomen is slightly swollen but is soft and non tender. He is not actively vomiting at present. What is the best management plan for this neonate at this point?

A 67-year-old man is listed to undergo a femoral artery angioplasty and stent placement for worsening peripheral arterial disease. Which amongst the following statements regarding the femoral triangle is true?

A 74-year-old woman has undergone a revision arthroplasty of her right hip for previous fractures. She sustains a fall in the post-operative period and seems to have dislocated the hip. Now she is unable to flex her knee fully and also seems to have a foot drop. Which nerve is most likely affected to result in this patient?

A 79-year-old woman is undergoing a left hip hemiarthroplasty via an antero-lateral approach (Modified Hardinge). Which one amongst the following muscles is not attached to the greater trochanter of the femur?

You are assisting in a lobectomy for a primary bronchial carcinoma. Which amongst the following statements regarding the hilum of the lungs is correct?

A 66-year-old man is undergoing mitral valve surgery for chronic severe primary mitral regurgitation secondary to degenerative valve disease. Which amongst the following statements regarding the structures within the chambers of the heart is incorrect?

A 29-year-old man with a knife wound in his buttock walks with a waddling gait, characterized by the pelvis falling toward one side at each step. Which nerve is most likely to be damaged?

A 56-year-old man is admitted to the neurosurgical ward with right-sided hemiplegia, gait apraxia and dysphasia. He is suspected to have had a stroke affecting the cerebral hemisphere. Which one of the following statements regarding the Circle of Willis is true ?

A 31-year-old woman sustains a fracture of her right shoulder and the superior glenoid tubercle following a horse-riding accident. Which amongst the following arteries does not supply the shoulder joint?

A 42-year-old man presents to the A&E with a painful right knee 24 hours after he injured it whilst playing tennis. He also sustained a deep laceration over the anterior aspect of the knee during the incident. He is now unable to weight bear in this leg. On examination, his right knee is swollen and erythematous. There is tenderness along the medial joint line and all active movements are restricted. His temperature is 39.10C, HR is 88 beats/min, BP 122/74 and RR 15/min. What is the most likely organism causing this clinical picture?

A 56-year-old man presents with a swelling in the right popliteal fossa which is suggestive of a popliteal aneurysm. Which amongst the following structures form the upper lateral border of the popliteal fossa?

A 57-year-woman presents to the surgical outpatient with loss of sensation over the medial aspect of her right leg. She had undergone ligation and stripping of her long saphenous vein four weeks ago. The surgical wound has healed nicely. On examination, she has full range of movements in her hip and knee joints with a motor power of 5/5. There is no obvious muscle wasting. She has decreased sensation along the medial side of the leg from the level of the patella up to the medial aspect of the ankle and foot. Knee and ankle jerks are normal. She has good peripheral pulses.

A 56-year-old man sustains fracture to his right tibia from an RTA and damages his deep peroneal nerve. Which of the following set of functions is likely to be compromised?

A 28-year-old business woman presents to the A&E with complaints of pain in her right ankle. She was on her way to a business meeting when she tripped and sustained the injury. She was wearing high heels at the time of the incident. OE, there is bruise, mild pain and swelling just below her lateral malleolus, but no bone tenderness. A diagnosis of right ankle sprain is made. Which of the following structures is most likely to be damaged?

You are teaching a 4th year medical student who has been placed in your ward about the role of the autonomic nervous system in homeostasis and function. Which among the following statements regarding the autonomic nervous system is incorrect?

A 65-year-old man is suspected to have a posterior cord syndrome. Which one of the following sensations is not carried by the posterior (dorsal) column of the spinal cord?

A 4-month old baby is referred to the paediatric surgical clinic with increased irritability, noticeable scalp veins, high-pitched cry and poor feeding. On examination, she is noted to have a large head circumference and a bulging fontanelle. A diagnosis of craniosynostosis is made. Which one amongst the following suture lines separate the frontal from the parietal bones?

A 12-year-old child is undergoing a mastoidectomy for cholesteatoma. Which one amongst the following muscles is not attached to the mastoid process?

A 22-year-old man has sustained a deep laceration over the parietal region of his scalp that is profusely bleeding. Which amongst the following arteries does not supply the scalp?

A 66-year-old man is seen in the neurosurgical clinic with a headache and hearing difficulty. On examination of his eye, he has a right superior quadrantanopia. Where is the most likely pathology?

A 56-year-old lady with 42% burns who is being treated in the ICU is exhibiting signs of acute kidney injury 4 days post injury. You are discussing renal support with the ICU consultant who asks you about countercurrent multiplier in the nephron. Which amongst the following statements regarding the countercurrent multiplier is correct?

A 47-year-old man is diagnosed with a pituitary microadenoma. Which one of the following hormones is not secreted by the anterior pituitary gland?

A 59-year-old female is diagnosed with left oculomotor nerve palsy secondary to an aneurysm affecting the posterior communicating artery? She is noted to have complete ptosis and dilated pupil on this side. Which muscles would you specifically test to identify the innervation of the inferior branch of the oculomotor nerve?

A 43-year-old man is referred by his general practitioner to the ophthalmology out-patients clinic with a 2-3-month history of double vision and difficulty reading with his right eye. He was admitted to the intensive care unit with a severe head injury secondary to road traffic accident 3-months ago. On closer questioning, the patient states that his symptoms started after the accident. On examination, he is noted to have a head-tilt towards his left shoulder. His visual acuity using the Snellen chart is 6/6 in both eyes. There is no nystagmus, but he complains of double vision (diplopia) whilst looking downwards and out. Further examination reveals vertical and torsional diplopia. Which among the following ocular muscles is most likely to be involved?

A 77-year-old man is brought to the A&E with severe abdominal pain and vomiting, which is of a few hours duration. His pulse is irregular, the bowel sounds are absent and he is suspected of having mesenteric infarction. His ABG shows acidosis and if he were to be compensating, which amongst the following results would you expect?

A 2-year-old boy is noted to have ptosis, loss of normal pupillary function and ophthalmoplegia in his right eye. Which amongst the following features will confirm an oculomotor nerve palsy compared to Horner’s syndrome?

A 27-year-old woman presents with a short history of right-sided facial weakness. She has been fit and healthy before, and there is no history of trauma. Which of the following is would not be a presenting feature if the lesion of the facial nerve is in the internal acoustic meatus before the nerve exits the stylomastoid foramen?

A 78-year-old man who is on warfarin presents with anterior epistaxis. The bleeding seems to be occurring in the Little’s area. Which amongst the following vessels does not contribute to the arterial anastomosis in the Little’s area?

A 62-year-old man presents with a BCC over the tip of his nose. He is consented for excision of the lesion and skin grafting under local anaesthesia. You are about to infiltrate local anaesthesia around the area when the consultant asks you which nerve supplies the tip of the nose?

A 43-year-old woman is referred to the colorectal clinic with a 4-5 month history of burning and prickling sensation when sitting that improves when standing or lying down. She also reports of numbness and pins and needles in the pelvic area along with a sensation of an object in the perineum. She has recently noticed increased frequency of micturition. She is diagnosed with pudendal nerve entrapment syndrome. Which amongst the following structures does not pass through the lesser sciatic foramen?

A 65-year-old man who collapsed in the street is being resuscitated by the paramedics. He is cold and clammy, and they are unable to get any peripheral venous access. They decide to cannulate his external jugular vein. Which amongst the following veins contribute to the formation of the external jugular vein?

A 56-year-old woman presents with a 4-month history of gradually enlarging lump in her carotid triangle. Which one amongst the following pathologies does not cause a swelling in the anterior triangle of the neck?

A 54-year-old woman undergoes a total thyroidectomy for follicular carcinoma of the thyroid. Intra-operatively, several vessels in the left side of the neck had to be ligated to control moderate bleeding. Postoperatively, serum studies show a calcium concentration of 1.6 mmol/L, albumin concentration of 40 g/L, and parathyroid hormone concentration of 21 pmol/L (normal: 1.6 – 6.9 pmol/L). Damage to which of the following vessels has most likely to have resulted in this clinical finding?

A 44-year-old lady develops a haematoma following a thyroidectomy for a large goiter. The haematoma continues to enlarge and now she is having difficulty breathing. In which of the following fascial planes would the haemotoma accumulate?

A 67-year-old man is undergoing bilateral submandibular duct ligation for drooling after treatment with botulinum neurotoxin A. Which amongst the following nerves run in close proximity to the submandibular duct and is at risk during this procedure?

A 73-year-old man presents to the upper GI surgery clinic with dysphagia, halitosis and weight loss. He is noticed to have a lump in the right posterior triangle and a diagnosis of pharyngeal pouch is made. Between which muscles does the pharyngeal pouch commonly arise?

A 72-year-old man presents with a rapidly enlarging lesion in the right side of his tongue. A biopsy reveals this to be a squamous cell carcinoma. Which of the following muscles of the tongue is not supplied by the hypoglossal nerve?

A 63-year-old man is undergoing a partial laryngectomy for a Stage III sub-glottic cancer of the larynx (T3NOM0). Which of the following intrinsic muscles of the larynx is responsible for abduction of the vocal cords?

A 23-year-old is listed to have a surgical tracheostomy following a circumferential full thickness burns to her neck. Once past the skin and subcutaneous tissue, what will the order of structures one would go through when performing a tracheostomy until the tracheal rings are reached?

A 66-year-old man who has been a smoker for 45 years presents with an exophytic growth in the middle one-third of the right side of the tongue. What is the lymphatic drainage from the anterior 2/3rd of the tongue?

Which one of the following structures is derived from the endoderm?

You are performing lumbar puncture on a 33-year-old lady with suspected subarachnoid haemorrhage. Which layer would your needle encounter once you have pierced the interspinous ligament?

A 25-year-old man is having lumbar puncture for a suspected meningitis. Which amongst the following statements is not true regarding cerebrospinal fluid analysis?

A 23-year-old woman presents to the A&E about 20 minutes after being stung by a bee. She has mild light-headedness but no difficulty swallowing or urticaria. Her temperature is 37.4°C, pulse is 98/min, RR is 26/min, and BP is 112/68 mm Hg. She is having difficulty breathing and bilateral wheezing is heard on auscultation. Which of the following type of drug is most appropriate for this patient?

You are assisting your consultant in a laparotomy for a suspected perforation of a viscus in a patient who presented with acute peritonitis. Whilst mobilizing the small bowel, the consultant asks you which of the following structures are remnants of the ventral mesentry (ventral mesogastrium)?

You are performing an explorative laparotomy in a 72-year-old man with a suspected perforated viscus and peritonitis. You are mobilizing the intestine and wish to mobilize the colon. Which of the following is not an intraperitoneal structure?

A 67-year-old man with severe acute pancreatitis is managed in the intensive care unit. He is manifesting signs and symptoms of cardiac decompensation and depressed contractility. Which amongst the following drugs is a selective β1 agonist?

A 67-year-old is diagnosed with an adrenal tumour in the region of the cortex close to the adrenal capsule. What is the physiological function of Zona Glomerulosa in the adrenal gland?

A 46-year-old woman presents with flushing, diarrhoea, shortness of breath and palpitations. Investigations reveal evidence of carcinoid syndrome. Where is the most common site for extraintestinal (non gastrointestinal) carcinoid?

A 50-year-old lady presents with a 6-week history of tender and swollen glands in the neck and axilla, painful bones and joints, tiredness and general feeling of being unwell. She also reports of persistent dry cough, shortness of breath, wheezing and chest pain during this period. A provisional diagnosis of sarcoidosis is made. Which histological feature is most likely to be identified in an excisional lymph node biopsy?

A 77-year-old man is being assessed for a day-case knee arthroscopy. Amongst others, his current medications include ramipril for hypertension. What is the mechanism of action of angiotensin converting enzyme (ACE)?

An 80-year-man 2-days post Anterior resection has got a low urine output despite having sufficient amounts of fluids. Which amongst the following is the most potent stimulus for the release of renin from the kidneys?

A 4-week-old firstborn male baby is brought to the paediatric A&E with projective vomiting after feeding. In examination, an a mass if palpable in the right upper quadrant of the abdomen and the baby is diagnosed with congenital hypertrophic pyloric stenosis. Routine bloods, ABG and urine analysis are undertaken to aid the management. What acid-base picture would you expect?

A 47-year-old female is brought to A&E with a suspected subarachnoid haemorrhage. The GCS is 8 and the patient is intubated, sedated and ventilated. She is now awaiting a CT scan. Her BP is 146/74 mmHg, heart rate is 80/min, RR is 12/min and temp is 37.2 degree C. The baseline ABG is as follows: pH: 7.24; PaO2: 9.0 kPa; PaCo2: 10.6 kPs; Base deficit: -3 mEq/L; SaO2: 93%. What factor is most likely to increase the cerebral blood flow in this patient?

In which of the following conditions does the oxyhaemoglobin dissociation curve shift to the right?

A 4-week old baby is noted to have severe, persistent yellowing of the skin and mucous membranes. This is associated with vomiting, fever, unsatisfactory feedings secondary to kernicterus. He is diagnosed with Criggler-Nagger syndrome. Which of the following enzymes is responsible for conjugating bilirubin by converting bilirubin to bilirubin mono- and di-glucuronide?

A 47-year-old man who with history of alcohol abuse presents with pruritis, loss of weight and yellowish discolouration of the skin. Which amongst the following statements regarding bilirubin metabolism is true?

A 67-year-old woman who underwent a total hip replacement 8 days ago has developed a deep vein thrombosis. Blood investigation reveals her to be positive for anticardiolipin, beta-2 glycoprotein I and lupus anticoagulant antibodies. What is the underlying condition behind this blood picture and her DVT?

A 77-year-old man who has been on long-term high dose aspirin for recurrent MIs and strokes presents to the A&E with a massive upper GI bleed. Which amongst the following agents could be considered before surgical or radiological intervention?

You are consenting a 65-year-old with multiple comorbidities for a laparoscopic right hemicolectomy to remove a 3×3 cm sized Dukes B adenocarcinoma of the ascending colon. Which of the following medications that she is taking can be continued through surgery?

A 76-year-old woman is started on Augmentin and Clarithromycin for pneumonia 4 days post Hartmann’s procedure. Your consultant reviews the chart and informs you that you need to cross off one of his regular medications to prevent a drug reaction with clarithromycin. Which drug is it most likely to be?

A 73-year-old man undergoes a metallic mitral valve replacement and is commenced on warfarin. Which of the following is not affected by warfarin?

A 36-year-old woman presents with gross hypotension, bradycardia and clammy skin. Which of the following is not a type of distributive shock?

A 65-year-old man is brought to the A&E with complaints of severe nausea and weakness. He has had problems with peptic ulcer disease in the past and has been having similar pain for the past 2 weeks. To relieve his abdominal pain, has been drinking significant quantities of milk and consuming large quantities of antacids (calcium carbonate) bought over the counter. His bloods are as follows: Na 139, K 4.6, Cl 95, HCO3 34, Ca 2.9 mmol/L, Ur 4 mmol/L and Cr 80 mmol/L. His ABG reveals: pH 7.47, PCO2 6.5 kpa, PO2 9 Kpa, HCO3 – 34, Base deficit -3, Lactate 1 mmol/L. What does the arterial blood gas picture show?

A 69-year-old woman is commenced on warfarin for recurrent thigh DVT and one episode of PE. Regarding warfarin, which of the following statements is false?

A 46-year-old farmer presents with a 5-day history of joint pain, difficulty opening his mouth, fever and neck stiffness. He has noticed a rash over his arm, which is neither itchy nor painful. A diagnosis of Lyme disease has been made. Which one of the following is the most likely causative organism?

Mr Rogers is a 43-year-old man who presents to the surgical outpatient clinic with an ulcerated mass at the anal verge. He is accompanied by Mr Longacre who has been his partner for 12 months. A biopsy taken from the mass confirms it to be a squamous cell carcinoma of the anus. Which virus is most likely to have contributed to the development of this cancer?

A 63-year-old man undergoing a Nissen fundoplication for a hiatus hernia develops severe malignant hyperthermia intraoperatively. Which amongst the following drugs is used to treat the condition?

A 28-year-old is under follow-up for neurofibromatosis. She has been told that she is homozygous for the NF gene. Her husband does not have the condition and is not at risk. She is expecting their first child and she wants to know what’s percentage risk of their child being affected with neurofibromatosis?

A 61-year-old man presents to the orthopaedic clinic with a red, tender and swollen right big toe. A diagnosis of gout is made. Which one of the following drugs is most appropriate in the acute management of gout?

A 62-year-old post-menopausal woman presents to the orthopaedic clinic with a 4-week history of low back pain. On examination, there’s localized tenderness over L1/L2 levels and X-ray confirms a compression fracture at this level. A DEXA scan shows decreased bone mineral density. Serum Ca, PO4 and ALP levels are normal. A bisphosphonate drug is prescribed. What’s the mechanism of action of this drug?

A 42-year-old presents with a 3-year history of gynaecomastia. His is a heavy drinker and has hypertension. Which of the following is not a recognised cause of gynaecomastia?

A 30-year-old woman who is 5 weeks post-partum presents to the neurosurgical clinic with headaches, nausea, visual defects. She also has weakness of the right upper limb. An MRI scan confirms a diagnosis of cerebral venous sinus thrombosis. Which amongst the following statements regarding dural venous sinuses is incorrect?

A 63-year-man who underwent live donor related renal transplant a few years ago is noted to have progressively deteriorating renal function. What is the most likely underlying explanation?

A 45-yr-old woman is being treated in the Burns ICU with 63% flame burns to her limbs and trunk. She is day 5 post-burn and has got a low urine output and oedemas in her ankles and sacrum. She is 4.5 litres positive in her input/output chart. Which amongst the following physiological factors is responsible for leakage of fluid from the intravascular space to the interstitial third space?

An 83-year-old man sustains a blunt trauma to his chest and develops a cardiac tamponade. He is noted to have a raised JVP. He’s admitted to the ICU and is commenced on CVP monitoring. Which one amongst the following statements regarding the CVP trace is incorrect?

A 72-year-old man presents with breathing difficulties, fatigue, swelling in the legs and ankles, distended abdomen and chest pain. An echocardiogram reveals constrictive pericarditis. Which one of the following factors does not have a negative ionotropic effect on myocardial contractility?

A 77-year-old man in the surgical ward develops signs and symptoms of early septic shock following a pelvic abscess from an anastomotic leak. He’s significantly hypotensive and tachycardia with prolonged capillary refill. Which of the following organs receive the least amount of blood as a proportion of the resting cardiac output?

A 56-year-old requires a mastectomy and axillary lymph node clearance for a Stage IIIA breast cancer. Which amongst the following arteries does not supply the breast?

A 69-year-old lady is due to have an elective repair of her paraumbilical hernia. During her pre-operative assessment, it is noted that she is receiving furosemide for the treatment of hypertension. Where is the site of action of this diuretic in the nephron?

You are preparing to present a patient in the breast MDT. To gain a sound understanding of the pathologies of the breast, you are revising the basic sciences. Which amongst the following statements regarding the breast is incorrect?

A 39-year-old lady has been started on tamoxifen for Stage III carcinoma of her left breast. She wishes to understand how the drug works. Which of the following statements regarding tamoxifen is incorrect?

A 52-year-old man presents with tinnitus, vertigo and sensorineural deafness. An MRI scan reveals a 42 mm sized acoustic neuroma in his left internal acoustic meatus. Which one of the following structures does not pass through the internal acoustic meatus?

A 40-year-old man presents with a breast lump that is suspicious of a cancer. Which amongst the following genetic factors has the highest lifetime risk of developing a breast cancer in a male?

A 66-year-old lady is diagnosed with Stage IV breast cancer. To which of the following bones is metastasis most unlikely?

You are CT2 in surgery, who has been asked to conduct a study to evaluate the effectiveness of epidural analgesia in patients undergoing abdominoperineal (AP) resection. A total of 120 patients diagnosed who underwent AP resection are randomly selected to receive epidural analgesia or oral opioids. Patients completed a rating scale for their pain at days 1 and 3 post-operatively. There is statistically significant improvement in pain scores in those receiving epidural analgesia (p = 0.04). Which of the following is the most significant limitation of the study?

A 39-year-old man sustained an injury to his right eye following a fall from a train station platform onto a track. Few hours later, his right eye exhibits hyperaemia, conjunctival oedema, diplopia, and visual acuity deteriorating to hand motion. CT scan reveals a right orbital blowout fracture and optic canal fracture. Which one amongst the following structures does not run through the optic canal?

You are the CT1 in the general surgical ward. Your consultant asks you to design a study to determine if laparoscopic hernia repair is superior to open hernia repair in reducing long-term pain. Which one of the following is a major advantage of a randomised controlled trial compared to a prospective cohort study?

A 29-year-old woman who is 4 months pregnant is admitted with suspected appendicitis. During the routine pre-operative work-up, she is identified to be a carrier for Haemophilia B. She was not aware of this before. Her husband is also tested and he is found to be normal (not have the gene). They are now concerned if their baby will be affected. Which amongst the following statements is true?

A 68-year-old man presents to the A&E with complaints of passing frequent watery stools with large amounts of mucus. He was resuscitated and admitted for further investigations. Investigations reveal that he has secretory diarrhoea secondary to villous adenoma. What electrolyte imbalance is most likely in this patient?

A 66-year-old man had an extended right hemicolectomy earlier in the day. The nurses ask you to review him at night during your oncall since he has not passed any urine in the last 2 hours. You review his charts and notice that it his urine output was 30-35mls/hour was for the first 6 hours and he has had 2.5 L of IV fluids since returning from the theatre. What would be the most appropriate next step?

A diabetic patient presents to the ENT clinic with a 6-month history of otalgia, ottorhoea and headaches. She subsequently undergoes a CT scan which demonstrates enhancing soft tissue in the region of the external auditory canal and temporal bone osteomyelitis. What is the most likely organism involved?

A 63-year-old man who is on anticoagulation treatment for recurrent DVTs is having a pre-operative assessment for repair of his right inguinal hernia. Which of the following statements relating to abnormal coagulation is incorrect?

A 60-year-old female is 24 hours post elective repair of her paraumbilical hernia. Which of the following hormones is most likely to be released in reduced quantities following her operation?

A 28-year-old male presents to the maxillofacial unit 5 days following an RTA. He has pain and tenderness over the left cheek, inability to move the left eye, partial ptosis of the left eye and numbness over the left forehead. CT reveals a fracture of the lateral wall of the orbit and he is diagnosed with superior orbital fissure syndrome.  Which one amongst the following nerves does not run through the superior orbital fissure?

A 32-year-lady is diagnosed with primary hyperparathyroidism. Her serum PTH levels are elevated pre-operatively. A parathyroidectomy has been successfully performed to remove her functioning adenoma. How long will it take for the serum PTH to fall post-surgery?

A 83-year-old man is admitted to the surgical ward with acute intestinal obstruction. He’s now become cold and clammy, hypotensive and tachycardic with an associated irregular pattern in his ECG. Which part of the ECG represents atrial depolarization?

You intend to carry out a systematic review regarding the risk factors for gastric cancers. This review identifies and includes 12 cohort studies only. What level of evidence would this study be classified as per the Oxford Centre for Evidence-Based Medicine – Levels of Evidence?

A 79-year-old man is listed for insertion of a pacemaker for a complete heart block. What does Phase ‘3’ of the cardiac action potential relate to?

A 50-year old post-menopausal female of South Asian origin presents to the orthopaedic clinic with fatigue, general malaise and weakness in her lower limbs, mainly the right leg. Her serum calcium is 2.0 mmol/l. Albumin is normal. An X-ray of the right femur shows radiolucent lines several millimetres thick, sharply demarcated from the adjacent bone (Looser zones). A defect in which of the following physiological processes is most likely to be the cause of her illness?

A 63-year-old man is admitted to the urology ward with left loin pain, fever, rigors and oliguria. Which one of the following statements about the physiology of renin production is true?

A 14-year-old sustains a Grade V laceration to the spleen from a roller-skates accident and undergoes a splenectomy. Which of the following features would you not expect in a post splenectomy blood film?
 

A 61-year-old woman undergoes excision of the parathyroid glands for parathyroid adenomas resulting in hyperparathyroidism. Which of the following is not a recognised cause for high levels of ionised calcium in the blood?

As an ST3 on call, you are asked to review a 42-year-old woman over the weekend who had a total thyroidectomy on Friday for a large multinodular goitre causing compressive symptoms. She has paraesthesia in her fingers and lips and the house officer informs you that her corrected calcium level is 1.6 mmol/L. An ECG has been done. What ECG changes would you be looking for?

A 44-year-old woman presented to the ENT clinic with a 10-day history of left-sided visual loss, headache and pain in her jaw when chewing. She was suspected to have giant cell arteritis and was commenced on high dose steroids. Since her symptoms failed to resolve, a temporal artery biopsy was carried out. What would be the typical biopsy finding in giant cell arteritis?

A 3-month-old baby is brought to the paediatric surgical clinic with poor weight gain, irritability and prolonged episodes of crying. The mother states that she has noticed the baby’s lips and tongue going blue a few times. On examination, there’s a systolic ejection murmur at the left upper sternal border. Which of the following is not a component of the classical Tetralogy of Fallot?

A 67-year-old man presents with a reducible indirect right inguinal hernia. Once you have reduced the hernia, pressure over which area will maintain the reduction?

A 70-year old man presents to the A&E with rapidly increasing shortness of breath on minimal exertion with worsening cough. He is known to the surgical team with known lung-cancer and he is 10 days post-chemotherapy. He is diagnosed to have pneumonia that is confirmed on chest X-ray. Which organism is most likely to cause pneumonia in this patient who’s immunocompromised?

An 8-year-old boy is seen in the paediatric surgical clinic with headaches and episodes of recurrent epistaxis. His parents state that he complains of intermittent pains and weakness in his legs. He is markedly hypertensive in the right arm, although not in the left arm or in either leg. What is the most likely diagnosis in this child?

A 42-year-old man is seen in the orthopaedic clinic with a 6-month history of tiredness, loss of energy, and muscle and joint pain. He also reports of intermittent altered sensation in his upper limbs and muscle cramps during this period. On detailed questioning, he states that he developed high fever, shivering and headache a few days after he visited his sister in rural New Jersey (USA) about 8 months ago and also had noticed a ‘bulls-eye’ rash in his upper arm that has gradually subsided but still persists. What is the most likely diagnosis in this patient?

A 78-year-old man presents with a 3/12 h/o a lump near his back passage. On examination, a 2-cm sized well circumscribed, non-ulcerated lump can be palpated in the anal verge just below the Hilton’s white line. Examination of the groin reveals a palpable lymph node and you decide to do an FNAC. If the aspirate confirms the presence of tumour cells, which amongst the following features would you not be able to elicit from an FNAC?

A 67-year-old man presents with a 4-month history of indigestion and general malaise. He has been previously under surveillance for Barrett’s oesophagus. He undergoes an endoscopic evaluation and is identified to have a suspicious lesion in the lower oesophagus. A biopsy taken from this reveals a high grade dysplasia and his pathology report is being discussed in the MDT. Which amongst the following features will be used to distinguish an in-situ lesion from an invasive lesion?

A 9-year-old boy sustains a blunt trauma to his abdomen that injures his spleen and necessitating a splenectomy. Following splenectomy, which amongst the following vaccinations does he not have to receive?  

A 25-year-old woman undergoes a splenectomy for hereditary spherocytosis. Howell-Jolly bodies are detected in the post-splenectomy blood film. Which stain is most likely to have been used in this diagnosis?

A 45-year-old woman, BMI 26, ASA 2, Type II DM is undergoing a laparoscopic cholecystectomy. She takes metformin for DM and is not on any other medications. Which of the following drugs can be used for induction of anaesthesia?

A 78-year-old woman is diagnosed with Stage IV gastric cancer. A decision has been made to insert a PICC line to secure venous access for TPN. The PICC line is inserted into the basilic vein at the elbow. As the catheter is advanced towards the heart, which vein is the tip of the catheter most likely to encounter first?

A 59-year-old man has been on salbutamol inhaler for many years for symptomatic relief and prevention of bronchospasm due to bronchial asthma. He presents to the A&E with severe exacerbation of the asthma which requires intravenous salbutamol. Which of the following is not a function or a side-effect of this β2 agonist drug?

A 33-year-old woman presents with signs and symptoms of inflammatory bowel disease. Which amongst the following features would be more suggestive of Crohn’s disease than ulcerative colitis?

A 21-year-old man is undergoing colonoscopy for altered bowel habits. He is found to have multiple colonic polyps during the colonoscopy. On further questioning, he states that he has noticed lumps in his jaw and skull as well as lumps and cysts in his skin. What is the most likely diagnosis?

A concerned mother presents to the A&E with her tearful 18-month-old child, who she believes swallowed an unknown object 35 minutes earlier. An initial single plain chest X-ray in the AP view shows a circular object in the oesophagus. Which of the following would be the next most appropriate step in the management?

A 72-year-old man, who has been a smoker for 45 years, is referred to the thoracic clinic with a 3-month history of cough, shortness of breath, chest pain and weight loss. An X-ray confirms the presence of a suspicious lesion in the right lung closer to the hilum in the peribronchial location. The histology from a CT-guided biopsy reveals sheets of small, round to spindled cells with dark nuclei, scant cytoplasm, and fine, granular (‘salt and pepper’) nuclear chromatin. The nucleoli is indistinct. What type of cancer is it most likely to be?

A 41-year-old painter is referred to the orthopaedic clinic with a 4-week h/o difficulty and pain in raising his right arm, shoulder weakness and struggling to lift objects. He states that he hears popping or clicking sounds when moving his arm. On further questioning, he states that the shoulder pain worsens at night or when resting his arm. On examination, there’s mild atrophy of the shoulder when viewed from the back and there’s limited range of movement with pain in the middle segment when the shoulder is abducted. What is the most likely diagnosis in this patient?

A 54-year-old man is undergoing fixation of a fracture involving the neck of the scapula and superior glenoid tubercle via a posterior to shoulder approach. Which nerve is most likely to be at risk with this approach?

A 66-year-old lady is undergoing a mastectomy and level III axillary node clearance for Stage 3A breast cancer. Which of the following group of structures is most likely to be encountered and are commonly at risk during level III axillary dissection?

A 44-year-old woman is undergoing a right carpal tunnel decompression under local anaesthetic. What would be your ideal surgical landmark when placing the skin incision to avoid damage to vital structures?

A 72-year-old man is diagnosed with tumour in the apex of this right lung. Which amongst the following is not a recognised feature of Pancoast’s syndrome?

A 67-year-old man presents with severe mediastinal pain and preliminary investigations reveal a perforation of the oesophagus. Which of the following is the most common cause of oesophageal perforation?

A 40-year-old man presents to the urology clinic with a 3-4 month history of hard, craggy lump in his left scrotum associated with a dull ache. On examination, the lump is not separate from the testis and you can get above the swelling. A provisional diagnosis of testicular tumour is made. Which of the following is not a recognised risk factor for testicular tumours?

Which amongst the following conditions is not an indication for diagnostic lumbar puncture?

A 4-year-old child pulls her hand away from a needle whilst you perform a blood test. With regards to the nerve action potential that was triggered for her to perceive pain, which amongst the following physiological statements is incorrect?

A 56-year-old man presents with a deep-seated infection in his neck following a Quincy. A CT scan of the neck reveals a retropharyngeal abscess. Which of the following structures does not form a border or boundary of the retropharyngeal space?

A 49-year-old woman presents with swelling and pain in her right submandibular region. Which amongst the following muscles separate the superficial from the deep lobe of the submandibular gland?

A 21-year-old motorcyclist is brought to the Emergency department having been involved in a high-speed RTA. He seems to have a significant loss of function in his right upper limb and clinical examination suggests high brachial plexus injury. Which one amongst the following nerves does not arise from the posterior cord of the brachial plexus?

A 63-year-old man is diagnosed with a lower oesophageal cancer. Which one of the following layers is not present in the oesophagus?