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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.

About the Cert Critical Care(SA) Anaes Exam

The Sub-specialty Certificate in Critical Care (Cert Critical Care(SA) Anaes) is awarded by the College of Anaesthetists of the Colleges of Medicine of South Africa. It represents the gold-standard qualification for specialist anaesthetists practicing advanced intensive care medicine in South Africa. The examination assesses expertise across advanced mechanical ventilation, hemodynamic monitoring, cardiothoracic and neuro-intensive care, severe sepsis, trauma, extracorporeal membrane oxygenation (ECMO), and renal replacement therapy (RRT). Candidates must hold the FCA(SA) or equivalent HPCSA-registered specialist qualification. This question bank features 100 clinically rigorous MCQs with teaching explanations aligned to the CMSA curriculum.

Assessment

Two components each contributing 50%: a written component (short-answer written papers) and an oral/OSCE/OSPE/clinical component. Content spans 4 core domains (Ventilation & ARDS, Hemodynamics & Inotropes, Cardiothoracic & Neuro-ICU, Sepsis/Trauma/ECMO/RRT).

Time Limit

Written short-answer papers plus an OSCE and viva component.

Passing Score

Overall pass mark 50% with a 50% subminimum in each of the two components (written and oral/OSCE/OSPE/clinical).

Exam Fee

R24 650 (Colleges of Medicine of South Africa (CMSA), College of Anaesthetists)

Cert Critical Care(SA) Anaes Exam Content Outline

25%

Advanced Mechanical Ventilation & ARDS

Ventilator modes (APRV, NAVA, HFOV), ARDS lung protection, driving pressure, prone positioning, VV-ECMO, VILI mechanisms, and dyssynchrony

25%

Hemodynamic Monitoring, Shock & Inotropes

PAC, PiCCO, TEE, dynamic fluid responsiveness (PPV/SVV), inotropes, vasopressors, septic, cardiogenic, and vasoplegic shock

25%

Cardiothoracic & Neuro-Intensive Care

Post-CABG care, vasoplegia, right heart failure, IABP, Impella, TBI management, ICP/CPP monitoring, SAH, and TTM

25%

Severe Sepsis, Trauma, ECMO & Renal Replacement Therapy

Sepsis-3, damage control resuscitation, TEG/ROTEM, VA/VV ECMO, CRRT modalities (CVVHDF), citrate anticoagulation, and rhabdomyolysis

How to Pass the Cert Critical Care(SA) Anaes Exam

What You Need to Know

Passing score: Overall pass mark 50% with a 50% subminimum in each of the two components (written and oral/OSCE/OSPE/clinical).
Assessment: Two components each contributing 50%: a written component (short-answer written papers) and an oral/OSCE/OSPE/clinical component. Content spans 4 core domains (Ventilation & ARDS, Hemodynamics & Inotropes, Cardiothoracic & Neuro-ICU, Sepsis/Trauma/ECMO/RRT).
Time limit: Written short-answer papers plus an OSCE and viva component.
Exam fee: R24 650

Keys to Passing

Work through all 100 available questions
Review every answer and explanation
Track weak areas and revisit them
Use our AI tutor for tough concepts

Cert Critical Care(SA) Anaes Study Tips from Top Performers

1Focus on physiological principles behind ventilator waveforms, esophageal manometry, and mechanical power in ARDS.

2Master hemodynamic equations (SVRI, RVSWI, oxygen delivery DO2, P(v-a)CO2 gap) and echocardiographic assessments of RV/LV function.

3Review neuro-monitoring targets (CPP 60-70 mmHg, PbtO2 > 20 mmHg, SjvO2 50-75%) and post-cardiac surgery complications (tamponade, vasoplegia).

4Understand CRRT prescription details, regional citrate anticoagulation stoichiometry, and ECMO cannulation and troubleshooting.

Frequently Asked Questions

What is the structure of the CMSA Cert Critical Care(SA) Anaes exam?

The exit examination has two components, each contributing 50%: a written component (short-answer written papers) and an oral/OSCE/OSPE/clinical component. Candidates must achieve an overall 50% with a 50% subminimum in each component. This free question bank provides 100 practice MCQs as a study aid and does not replicate the official format.

What is the fee for the Cert Critical Care(SA) Anaes examination?

The examination fee set by the Colleges of Medicine of South Africa (CMSA) is R24 650.

Who is eligible to take the Cert Critical Care(SA) Anaes exam?

Candidates must hold an HPCSA-registered specialist qualification in Anaesthesiology (FCA(SA) or equivalent) and have completed an accredited sub-specialty registrar training period in intensive care medicine.

What topics are weighted most heavily in the exam?

The exam is divided equally (25% each) across four main domains: Advanced Mechanical Ventilation & ARDS; Hemodynamic Monitoring, Shock & Inotropes; Cardiothoracic & Neuro-Intensive Care; and Severe Sepsis, Trauma, ECMO & RRT.

What is the pass mark for the examination?

Candidates must achieve an overall pass mark of 50%, with a 50% subminimum in each of the two components (the written component and the oral/OSCE/OSPE/clinical component).