Free Practice Questions for Cert Critical Care(SA) Phys

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Exam Review

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 review concepts for the Cert Critical Care(SA) Phys exam. 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 Exam

The Sub-specialty Certificate in Critical Care [Cert Critical Care(SA) Phys] is the definitive sub-specialty qualification administered by the College of Physicians of South Africa for specialist physicians qualifying in Critical Care Medicine. It assesses advanced clinical knowledge in hemodynamics, sepsis, mechanical ventilation, renal replacement therapy, severe infectious diseases, neurocritical care, and ICU toxicology.

Exam sponsor: College of Physicians of South Africa (Colleges of Medicine of South Africa). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

Two components each contributing 50%: a written component (short-answer written papers) and an oral/OSCE/OSPE/clinical component. Content spans 5 core domain areas: Sepsis, Septic Shock & Multiorgan Dysfunction (25%), Acute Respiratory Failure & Ventilator Management (25%), Acute Kidney Injury & CRRT (20%), Critical Care Infectious Diseases & Metabolic Emergencies (15%), and Neurocritical Care & ICU Toxicology (15%).

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 / Certification Fees

R24 650

Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Official sources

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

25%

Sepsis, Septic Shock & Multiorgan Dysfunction

Pathophysiology and management of sepsis/septic shock, Surviving Sepsis Campaign 2021 guidelines, vasopressor and inotropic support, resuscitation endpoints, lactate clearance, septic cardiomyopathy, and multiorgan dysfunction syndrome (MODS).

25%

Acute Respiratory Failure & Ventilator Management

Diagnosis and ARDSNet ventilatory strategies for ARDS, lung-protective ventilation, driving pressure optimization, PEEP titration, prone positioning, neuromuscular blockade, VV-ECMO indications, dynamic hyperinflation, and weaning protocols.

20%

Acute Kidney Injury & CRRT

KDIGO classification of AKI, renal replacement modalities (CVVH, CVVHD, CVVHDF, SLED), circuit anticoagulation (regional citrate vs heparin), fluid overload management, acid-base disorders, and Stewart physicochemical approach.

15%

Critical Care Infectious Diseases & Metabolic Emergencies

Multi-drug resistant organisms (ESBL, CRE, MRSA, Acinetobacter), fungal ICU infections, SA-endemic HIV/TB critical care emergencies, PK/PD therapeutic drug monitoring, DKA, HHS, adrenal crisis, and thyroid storm.

15%

Neurocritical Care & ICU Toxicology

Traumatic brain injury (TBI) guidelines, ICP and CPP management, subarachnoid haemorrhage vasospasm, refractory status epilepticus, and acute poisoning (organophosphates, paracetamol, calcium channel blockers, beta-blockers).

Preparing for the Cert Critical Care(SA) Phys 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 5 core domain areas: Sepsis, Septic Shock & Multiorgan Dysfunction (25%), Acute Respiratory Failure & Ventilator Management (25%), Acute Kidney Injury & CRRT (20%), Critical Care Infectious Diseases & Metabolic Emergencies (15%), and Neurocritical Care & ICU Toxicology (15%).
Time limit: Written short-answer papers plus an OSCE and viva component.
Exam / certification fees: R24 650 Official sources

Using Our Practice Resources

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Cert Critical Care(SA) Phys: Suggested Study Strategy

1Master the 2021 Surviving Sepsis Campaign recommendations, particularly first-line vasopressors (noradrenaline), second-line vasopressors (vasopressin), and inotropic selection (dobutamine).

2Understand mechanical ventilation mechanics in ARDS, including tidal volume calculation based on predicted body weight (PBW), driving pressure target (<15 cmH2O), PEEP/FiO2 tables, and prone positioning indications.

3Review regional citrate anticoagulation mechanisms and troubleshooting (citrate toxicity, calcium ratio >2.5) during Continuous Renal Replacement Therapy (CRRT).

Frequently Asked Questions

What is the format of the CMSA Cert Critical Care(SA) Phys examination?

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 passing criteria 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).

What domain areas are included in the Cert Critical Care(SA) Phys blueprint?

Content is weighted across five domains: Sepsis & Septic Shock (25%), Acute Respiratory Failure & Mechanical Ventilation (25%), Acute Kidney Injury & CRRT (20%), ICU Infectious Diseases & Metabolic Emergencies (15%), and Neurocritical Care & ICU Toxicology (15%).