1. Which of the following modes of anaesthesia is the best for a 70-year-old gentleman on warfarin for aortic valve replacement done 10 years ago. He is also known for COPD on steroids. He has been planned for inguinal hernia repair.

2. A 55 year old man presents with a history of progressive dysphagia over the past 4 weeks. For the preceding 5 years he had regularly attended his general practitioner with symptoms of dyspepsia and reflux.

3. A 4-week-old boy baby has been brought by his parents with complaints of 1 day history of abdominal distention and non-bilious vomiting. On palpation of the abdomen, there is an olive shaped mass noted in the epigastrium. What is the most likely diagnosis?

4. A 34-year-old patient undergoes bilateral breast reduction. During the operation, her arms are placed out in supine position. The theatre assistant forgets to place a gel pad. Which nerve is at risk of compression at the level of the elbow?

5. A 45-year-old man has a 4 week history of epigastric discomfort which is relieved by eating. He develops haematemesis and undergoes an upper GI endoscopy. An actively bleeding ulcer is noted in the first part of the duodenum. What is the best management?

6. A 4-year-old girl has been brought with complaints of failure to thrive and occasional abdominal pain. She has abdominal fullness with a solid right flank mass. What is the most likely diagnosis?

7. A 32-year-old lady is seen in the outpatients. She has had multiple episodes of biliary colic and ultrasound shows thin-walled gallbladder with multiple calculi. Her ALT is slightly raised but other parameters are normal. What is the most appropriate management for this lady?

8. A 45-year-old woman, with a vague history of pulmonary embolism (PE), has developed a deep vein thrombosis (DVT) following a laparoscopic cholecystectomy. She is currently taking warfarin but has begun to notice multiple areas of skin necrosis on her body.

9. A newborn baby boy presents with mild abdominal distension, bilious vomiting and failure to pass meconium after 24 hours. Plain abdominal X-ray reveals dilated loops of bowel with fluid levels, and barium enema demonstrates a segment of the colon with a conical appearance.

10. A 65-year-old man is admitted with jaundice and investigations demonstrate a carcinoma of the pancreatic head. An ERCP is attempted but the surgeon is unable to cannulate the ampulla. The patient has started developing fever spikes. What is the next line of management?

11. You are attending a trauma call for a patient with head injuries. Following a CT head, the radiologist calls you to say the patient has a fracture through the superior orbital fissure. Which of the following nerves pass through the superior orbital fissure?

12. You are in the colorectal clinic and a lady is asking about a screening test for colon cancer they have read about in the newspapers. In devising a suitable screening test for malignant cancer, which of the following would be most useful?

13. A 20 year old girl comes with complaints of noticing a lump in the neck for the past 3 weeks. It is not painful but she is become more and more aware of it. FNAC done reports pale empty nuclei. What is the most likely diagnosis?

14. Consider the spinal cord, which statement is most accurate?

15. A 28-year-old man, who is a keen bodybuilder, presents with a short history of left upper limb discomfort and difficulty in moving his shoulder. On examination he is noticed to have winging of the left scapula. There is no wasting of the shoulder girdle muscles. With stabilisation of the scapula, he has a full range of movement and is able to elevate the shoulder. Sensory testing is normal, as are upper limb reflexes. What is the likely anatomical origin of his problem?

16. A 35-year-old lady undergoes right breast mastectomy and immediate reconstruction with a free flap. She is closely monitored post-operatively. Her physiological parameters are monitored in an attempt to assess her stress response to surgery. Which of the following hormones is raised during the stress response after surgery?

17. During a fundoplication surgery being performed, your consultant demonstrates the vagus nerve to you and poses a question. Which of the following effects can be seen on activation of the parasympathetic nervous system?

18. A patient arrives in resus with a core temperature of 34oC, and a pulse of 35bpm. The most appropriateimmediate step in management of this patient is?

19. A young man sustains brachial plexus injury following a stabbing incident. He presented with weakness of triceps and wrist extension. Which part of the brachial plexus has been transected?

20. Consider the surface markings of the pleura, which of the following is correct?

21. The anatomical description of Barton‟s fracture is?

22. A 33 year old lady has been diagnosed with a pituitary adenoma with suprasellar extension. Which structure is most likely affected?

23. A patient has prosthetic valve replacement and he develops endocarditis 8 months later. Organism responsible is:

24. A 76-year-old patient is admitted to the acute admission unit with septic shock. Pulse is 106 and BP 90/40 mmHg. Urinary catheterisation produces 75 ml of concentrated urine. Which of the following principles applies to the choice of an appropriate intravenous fluid for resuscitation?

25. A 68-year-old lady is admitted to the ITU having sustained 40% burns in a house fire. Over the next few days she develops increasing respiratory needs, wheeze and reduced pO2. You suspect she has developed ARDS. Which of the following statements regarding ARDS is correct?