The goals of our book are to prepare students for final examinations and to prime them and young surgeons to face the real world of surgical practice. To achieve these goals, we have been listening to feedback from students and colleagues whose advice has been invaluable. Accordingly, in this fourth edition, we have made changes in the content as well as the format. We have been warned that many eager students move to the provided adjacent answer before allowing time to solve a question on their own. The advice was to move answers to the end of each chapter. We hope this change will generate, in students, enough sense of excitement and curiosity to motivate them to think, analyze and choose the most appropriate diagnosis and management. We have made more extensive changes in the content. The number of plain MCQs has risen from 678 to 753. Two new section of clinical photographs and clinical imaging-based questions have added further 117 MCQs. Stress has been laid on more case scenario questions, with the aim of consolidating knowledge obtained from textbooks and adapting it for use under common surgical situations. We still encourage students to use this book for evaluation of their grasp of the science of surgery and for the purpose of a quick review before examinations. We hope it will be of value in this regard and that it will be as enjoyable and thought stimulating for the reader as it has been for us in the process of composing.