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2026 Statistics
Key Facts: Cert Critical Care(SA) Anaes Exam
100
High-Yield Practice MCQs
OpenExamPrep
R24 650
CMSA Examination Fee
CMSA Fee Schedule
4 Domains
Core Content Sections (25% each)
CMSA Blueprint
FCA(SA)
Prerequisite Specialist Qualification
CMSA Regulations
The CMSA Cert Critical Care(SA) Anaes examination tests specialist anaesthetists on advanced intensive care medicine across 4 key domains: Ventilation & ARDS (25%), Hemodynamics (25%), Cardiothoracic & Neuro-ICU (25%), and Sepsis/Trauma/ECMO/RRT (25%). Fee is R24 650. This bank contains 100 practice MCQs with detailed explanations.
Sample Cert Critical Care(SA) Anaes Practice Questions
Try these sample questions to test your Cert Critical Care(SA) Anaes exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.
1According to the Berlin definition of Acute Respiratory Distress Syndrome (ARDS), which criterion is mandatory for establishing the diagnosis and severity classification?
A.Pulmonary artery wedge pressure (PAWP) <= 18 mmHg
B.Lung compliance < 30 mL/cmH2O
C.PaO2/FiO2 ratio <= 300 mmHg on PEEP or CPAP >= 5 cmH2O
D.Bilateral opacities on chest radiography with clear cardiomegaly
Explanation: The Berlin definition requires acute onset within 1 week of a known clinical insult, bilateral opacities on chest imaging not fully explained by effusions/collapse, respiratory failure not fully explained by cardiac failure or fluid overload, and a PaO2/FiO2 ratio <= 300 mmHg with a minimum PEEP/CPAP requirement of >= 5 cmH2O.
2In patients with ARDS receiving mechanical ventilation, driving pressure (P_driving) has been identified as a key variable correlated with hospital survival. How is driving pressure calculated on a volume-controlled mode during a passive breath?
A.Plateau pressure minus PEEP (Pplat - PEEP)
B.Peak inspiratory pressure minus PEEP (PIP - PEEP)
C.Peak inspiratory pressure minus Plateau pressure (PIP - Pplat)
D.Mean airway pressure minus PEEP (Pmean - PEEP)
Explanation: Driving pressure (P_driving = Pplat - PEEP) represents the pressure amplitude applied to the respiratory system relative to compliance (P_driving = VT / C_stat). Amato et al. demonstrated that driving pressure is the ventilator variable that most strongly correlates with survival in ARDS, with targets kept < 14-15 cmH2O.
3When initiating lung-protective mechanical ventilation in a male patient who is 175 cm tall with severe ARDS, what is the initial target tidal volume?
A.8 mL/kg of actual body weight
B.6 mL/kg of predicted body weight (PBW)
C.10 mL/kg of predicted body weight (PBW)
D.6 mL/kg of actual body weight
Explanation: The ARDSNet ARMA trial established that tidal volume must be calculated based on Predicted Body Weight (PBW), derived from patient height and sex, starting at 6 mL/kg PBW (and titratable down to 4 mL/kg if plateau pressure exceeds 30 cmH2O). Actual body weight overestimates lung size in obese patients.
4Based on the landmark PROSEVA trial, which clinical parameter and protocol duration define the indication for prone positioning in severe ARDS?
A.PaO2/FiO2 < 300 mmHg, applied only after failure of inhaled nitric oxide
B.PaO2/FiO2 < 150 mmHg with FiO2 >= 0.6 and PEEP >= 10 cmH2O, applied for >= 16 consecutive hours per session
C.PaO2/FiO2 < 100 mmHg with PEEP >= 15 cmH2O, applied continuously for 72 hours without turning back
D.PaO2/FiO2 < 200 mmHg with PEEP >= 5 cmH2O, applied for 4-6 hours daily
Explanation: The PROSEVA trial demonstrated a significant 28-day mortality reduction (16% vs 32.8%) when prone positioning was applied early in severe ARDS (PaO2/FiO2 < 150 mmHg, FiO2 >= 0.6, PEEP >= 10 cmH2O) for at least 16 consecutive hours per session.
5During mechanical ventilation of a patient with severe COPD exacerbation, auto-PEEP (intrinsic PEEP) is suspected. Which ventilator graphic maneuver confirms the presence and magnitude of auto-PEEP?
A.Inspiratory hold maneuver at the end of inspiration
B.Expiratory hold maneuver at the end of expiration in a passively breathing patient
C.Increasing inspiratory flow rate during volume control
D.Measuring peak inspiratory pressure during spontaneous breathing
Explanation: An end-expiratory occlusion (hold) maneuver allows alveolar pressure to equilibrate across open airways at the end of expiration in a passively ventilated patient, allowing the ventilator transducer to measure total PEEP. Intrinsic PEEP = Total PEEP - Extrinsic PEEP.
6Permissive hypercapnia is often tolerated during lung-protective ventilation in ARDS to prevent volutrauma. In which of the following clinical scenarios is permissive hypercapnia ABSOLUTELY contraindicated?
A.Mild sinus tachycardia (HR 105 bpm)
B.Acute traumatic brain injury with raised intracranial pressure (ICP)
C.Compensated metabolic acidosis
D.Mild hyperkalemia (K+ 5.1 mmol/L)
Explanation: Permissive hypercapnia causes arterial vasodilation in the cerebral vasculature, which sharply increases cerebral blood volume and intracranial pressure (ICP). Therefore, it is strictly contraindicated in patients with raised ICP or acute traumatic brain injury.
7What were the primary conclusions of major randomized controlled trials (OSCAR and OSCILLATE) evaluating High-Frequency Oscillatory Ventilation (HFOV) in adult ARDS?
A.HFOV decreased ventilator-associated pneumonia but had no impact on mortality
B.HFOV is superior to prone positioning in severe ARDS
C.HFOV significantly reduced 28-day mortality in severe ARDS
D.HFOV showed no mortality benefit over conventional lung-protective ventilation and was associated with increased harm/mortality in OSCILLATE
Explanation: The OSCAR and OSCILLATE trials demonstrated that routine use of HFOV in adult ARDS does not improve survival. In fact, OSCILLATE was stopped early due to increased in-hospital mortality in the HFOV arm, attributed to hemodynamic compromise and higher sedation/vasopressor requirements.
8A mechanically ventilated patient with ARDS has a set Tidal Volume of 420 mL, PEEP of 10 cmH2O, Peak Inspiratory Pressure (PIP) of 34 cmH2O, and Plateau Pressure (Pplat) of 24 cmH2O. What is the calculated static compliance (Cstat) of the respiratory system?
A.24 mL/cmH2O
B.42 mL/cmH2O
C.30 mL/cmH2O
D.17.5 mL/cmH2O
Explanation: Static compliance equation: Cstat = Vt / (Pplat - PEEP). Here, Vt = 420 mL, Pplat = 24 cmH2O, PEEP = 10 cmH2O. Driving pressure = 24 - 10 = 14 cmH2O. Cstat = 420 / 14 = 30 mL/cmH2O.
9In Airway Pressure Release Ventilation (APRV), how should the release time at low pressure (T_low) be titrated to optimize alveolar recruitment while preventing alveolar collapse?
A.Set T_low based strictly on arterial pH regardless of flow waveforms
B.Set T_low to equal T_high to achieve a 1:1 I:E ratio
C.Set T_low to 2.5 to 3.0 seconds to allow complete exhalation to zero flow
D.Set T_low so that peak expiratory flow terminates at 75% of the peak expiratory flow rate (PEFR)
Explanation: In APRV, T_low is titrated by observing the expiratory flow waveform so that exhalation is terminated when flow drops to 75% (or 50-75%) of the Peak Expiratory Flow Rate (PEFR). This brief release (typically 0.4-0.6 seconds) creates intrinsic PEEP and prevents alveolar derecruitment while allowing CO2 clearance.
10Ventilator-Induced Lung Injury (VILI) occurs through several distinct physical and biological mechanisms. Which pair correctly matches the VILI term with its underlying physiological mechanism?
A.Volutrauma — high transpulmonary pressure caused exclusively by excessive PEEP
B.Biotrauma — mechanical disruption of the visceral pleura causing pneumothorax
C.Barotrauma — regional overdistension caused by excessive end-expiratory tidal volume
D.Atelectrauma — shear stress caused by repetitive opening and collapse of unstable alveoli
Explanation: Atelectrauma occurs at low lung volumes when cyclic opening and closing of unstable, recruitment-prone alveoli generates high localized shear forces, causing tissue strain and cellular detachment. PEEP prevents atelectrauma.
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