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2026 Statistics
Key Facts: Cert Critical Care(SA) Phys Exam
2 components
Written + oral/OSCE
CMSA Regulations
50% each
Subminimum per component
CMSA Regulations
R24 650
Exam Fee
CMSA 2026 Fee Schedule
50% overall
Pass Mark
CMSA Regulations
CMSA
Exam Body
College of Physicians of SA
The Cert Critical Care(SA) Phys is a two-component sub-specialty exit examination (written short-answer papers plus an oral/OSCE/clinical component, each 50%) assessing expert intensive care physician practice in South Africa.
Sample Cert Critical Care(SA) Phys Practice Questions
Try these sample questions to test your Cert Critical Care(SA) Phys 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 Surviving Sepsis Campaign 2021 guidelines, which agent is recommended as the first-line vasopressor for initial hemodynamic resuscitation in patients with septic shock?
A.Noradrenaline (Norepinephrine)
B.Dopamine
C.Adrenaline (Epinephrine)
D.Vasopressin
Explanation: Noradrenaline (norepinephrine) is strong recommendation #1 as the first-line vasopressor in septic shock. It potentates alpha-1 receptor vasoconstriction with modest beta-1 inotropic activity, increasing MAP with less arrhythmia risk compared to dopamine.
2For adult patients with septic shock undergoing initial vasopressor resuscitation, what is the recommended target Mean Arterial Pressure (MAP)?
A.75 mmHg
B.65 mmHg
C.55 mmHg
D.85 mmHg
Explanation: The Surviving Sepsis Campaign 2021 guidelines recommend an initial target MAP of 65 mmHg in patients with septic shock requiring vasopressors. Targeting higher MAPs (e.g. 75-85 mmHg) does not improve overall mortality and increases vasopressor exposure and dysrhythmias, except potentially in chronic hypertension.
3What is the recommended initial crystalloid fluid volume for resuscitation in sepsis-induced hypoperfusion or septic shock within the first 3 hours?
A.At least 30 mL/kg IV balanced crystalloid
B.50 mL/kg IV 5% Dextrose
C.10 mL/kg IV 0.9% Normal Saline
D.20 mL/kg IV 20% Albumin
Explanation: The Surviving Sepsis Campaign recommends providing at least 30 mL/kg of IV crystalloids within the first 3 hours of resuscitation for patients with sepsis-induced tissue hypoperfusion or septic shock.
4Per the Sepsis-3 consensus definitions, which combination of clinical criteria defines septic shock?
A.SIRS criteria ≥ 2 plus positive blood cultures
B.Sepsis with systolic blood pressure < 90 mmHg resolving after 1000 mL saline
C.SOFA score increase ≥ 2 points with normal serum lactate
D.Sepsis requiring vasopressors to maintain MAP ≥ 65 mmHg AND serum lactate > 2 mmol/L despite adequate fluid resuscitation
Explanation: Sepsis-3 defines septic shock as a subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality. Clinically, it requires vasopressors to maintain MAP ≥ 65 mmHg AND a serum lactate > 2 mmol/L (18 mg/dL) despite volume resuscitation.
5Which fluid type is preferred over 0.9% Normal Saline for acute resuscitation of patients with sepsis or septic shock?
A.0.45% Sodium Chloride
B.Balanced crystalloids (e.g., Plasmalyte-148 or Ringer's Lactate)
C.Hydroxyethyl starch (HES 130/0.4)
D.10% Dextrose in Water
Explanation: Balanced crystalloids (such as Plasmalyte or Ringer's Lactate) are suggested over 0.9% saline based on SMART and SALT-ED trials showing reduced incidence of acute kidney injury, hyperchloremic metabolic acidosis, and renal replacement therapy requirement.
6When noradrenaline titration reaches moderate-to-high doses in septic shock, which agent is recommended as the second-line vasopressor to be added?
A.Vasopressin at a fixed dose of 0.03 units/min
B.Isoprenaline continuous infusion
C.Phenylephrine infusion titrated to MAP
D.Dopamine infusion at 15 mcg/kg/min
Explanation: Surviving Sepsis Campaign guidelines recommend adding Vasopressin (at a fixed non-titrated dose of 0.03 units/min) when noradrenaline dosage is increasing (e.g. > 0.25-0.5 mcg/kg/min) to raise MAP or reduce noradrenaline dosage.
7What is the recommended daily dose of intravenous hydrocortisone for patients with septic shock who have ongoing vasopressor requirements despite fluid resuscitation?
A.500 mg q8h IV bolus
B.100 mg once daily oral
C.200 mg/day IV (administered as 50 mg q6h or continuous infusion)
D.1000 mg IV single bolus
Explanation: Surviving Sepsis Campaign guidelines recommend IV hydrocortisone at a dose of 200 mg/day (given as 50 mg IV every 6 hours or as a continuous infusion) for septic shock refractory to fluid and vasopressor therapy (ongoing vasopressor requirement for > 4 hours).
8Which bed-side physiological target is recommended during initial sepsis resuscitation to guide macro- and micro-vascular perfusion recovery?
A.Daily cumulative positive fluid balance > 3000 mL
B.Serum lactate clearance / normalization and Capillary Refill Time (CRT)
C.Pulmonary Artery Wedge Pressure (PAWP) > 18 mmHg
D.Central Venous Pressure (CVP) target strictly 12-15 mmHg
Explanation: Serum lactate clearance (aiming for a reduction towards normal) and peripheral perfusion indices such as Capillary Refill Time (CRT < 3 seconds, evaluated in the ANDROMEDA-SHOCK trial) are recommended dynamic markers of successful microvascular resuscitation.
9What is the primary neuroendocrine rationale for adding low-dose vasopressin in vasodilatory septic shock?
A.Enhancement of endogenous cortisol release from the adrenal cortex
B.Relative vasopressin deficiency caused by neurohypophyseal store depletion and impaired autonomic synthesis
C.Direct inhibition of endothelial nitric oxide synthase (eNOS)
D.Upregulation of beta-2 adrenergic receptors in the vascular wall
Explanation: In early septic shock, circulating vasopressin surges, but within 24-48 hours, neurohypophyseal stores are depleted, resulting in circulating vasopressin deficiency relative to severe hypotension. Exogenous low-dose vasopressin restores vascular tone via V1a receptors.
10A patient with septic shock remains oliguric with persistent lactic acidosis (4.8 mmol/L) and low ScvO2 (52%) despite reaching a MAP of 68 mmHg with noradrenaline and receiving 35 mL/kg fluids. Echocardiogram reveals diffuse left ventricular hypokinesis (LVEF 30%). What is the most appropriate next therapeutic step?
A.Increase noradrenaline to target MAP 85 mmHg
B.Give an additional 30 mL/kg crystalloid bolus
C.Add Dobutamine infusion or switch to Adrenaline
D.Administer IV furosemide 80 mg bolus
Explanation: Surviving Sepsis Campaign guidelines recommend adding Dobutamine (or substituting/adding Adrenaline) in patients who show evidence of persistent hypoperfusion (low ScvO2, elevated lactate) despite adequate intravascular volume and adequate MAP, due to sepsis-induced myocardial dysfunction (septic cardiomyopathy).
About the Cert Critical Care(SA) Phys Practice Questions
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