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100+ Free FCA(SA) Final Practice Questions
Fellowship of the College of Anaesthetists of South Africa Final Examination practice questions are available now; exam metadata is being verified.
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2026 Statistics
Key Facts: FCA(SA) Final Exam
3 Written + OSCE
Exam Format
CMSA Regulations
50% + Subminimum
Pass Score
CMSA Senate Policy
R24 650
Exam Fee
CMSA SS2026 Fee Schedule
36 Months
Registrar Training
College of Anaesthetists
The CMSA FCA(SA) Part II Final comprises three 3-hour written papers (MCQ/SBA, short answers, and data interpretation) plus a minimum 12-station OSCE, with an exam fee of R24 650 and a 50% pass mark with written subminimum. This study bank provides 100 practice MCQs covering advanced clinical anaesthesia, critical care, and subspecialty perioperative management.
Sample FCA(SA) Final Practice Questions
Try these sample questions to test your FCA(SA) Final exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.
1During cardiopulmonary bypass (CPB) weaning in a 58-year-old man after mitral valve replacement, the perfusionist reports rising left atrial pressure, falling cardiac output, and a new holosystolic murmur. TEE shows severe mitral regurgitation with a flail posterior leaflet. What is the most appropriate immediate management?
A.Increase inotropic support and proceed with planned separation from CPB
B.Return to full CPB, reassess repair, and consider re-exploration for leaflet prolapse
C.Administer intravenous nitroglycerin infusion to reduce afterload
D.Extubate early to reduce intrathoracic pressure on the left atrium
Explanation: Acute severe mitral regurgitation with haemodynamic compromise after valve surgery indicates repair failure or leaflet injury. The patient should be returned to full CPB, the valve reassessed on TEE, and re-exploration considered before another separation attempt. Inotropes alone cannot compensate for mechanical regurgitation.
2A 170 cm male requires a left-sided thoracotomy for lung resection. According to standard double-lumen tube (DLT) sizing, which size is most appropriate?
A.35 Fr left-sided DLT
B.39 Fr left-sided DLT
C.41 Fr right-sided DLT
D.32 Fr single-lumen endotracheal tube
Explanation: For adult males approximately 170 cm tall, a 39 Fr left-sided DLT is the standard initial choice for left thoracic surgery, providing adequate lung isolation with acceptable airway trauma risk. Left-sided tubes are preferred for most procedures because the left bronchus is longer distal to the carina.
3During TEE assessment of a patient with suspected aortic stenosis, which transoesophageal view is most useful for measuring the aortic valve area using the continuity equation?
A.Midesophageal four-chamber view
B.Deep transgastric long-axis (LVOT) view
C.High oesophageal view of the aortic arch
D.Midesophageal bicaval view
Explanation: The deep transgastric long-axis view aligns the left ventricular outflow tract (LVOT) and aortic valve insonation, enabling pulsed-wave Doppler measurement of LVOT velocity and aortic jet velocity for continuity equation calculation of valve area.
4An intra-aortic balloon pump (IABP) is placed for cardiogenic shock. During 1:1 counterpulsation, the balloon should inflate during which phase of the cardiac cycle?
A.Early systole immediately after the R wave
B.Diastole, triggered after aortic valve closure (dicrotic notch)
C.Late diastole just before the P wave
D.Throughout systole to augment forward flow
Explanation: IABP inflation occurs in diastole after aortic valve closure (dicrotic notch), displacing blood proximally to augment coronary and cerebral perfusion. Deflation occurs just before systole to reduce afterload and improve LV ejection.
5During one-lung ventilation for right thoracotomy, SpO2 falls to 88% despite FiO2 1.0 and optimal DLT position confirmed on fibreoptic bronchoscopy. What is the most appropriate next step?
A.Apply continuous positive airway pressure (CPAP) of 5–10 cmH2O to the dependent (ventilated) lung
B.Apply CPAP of 5–10 cmH2O to the non-dependent (surgical) lung
C.Immediately clamp the pulmonary artery to the operative lung
D.Convert to total intravenous anaesthesia with propofol
Explanation: Hypoxaemia during one-lung ventilation results from shunt through the non-ventilated lung. Applying low-level CPAP (5–10 cmH2O) to the non-dependent surgical lung recruits alveoli, reduces shunt fraction, and improves oxygenation without significantly impairing surgical exposure.
6A 78-year-old man with severe symptomatic aortic stenosis (valve area 0.7 cm²) undergoes transfemoral TAVR under monitored anaesthesia care. Thirty minutes post-deployment, blood pressure is 72/40 mmHg with a new murmur and ST elevation in leads V1–V4. What is the most likely complication?
A.Complete heart block requiring permanent pacemaker
B.Coronary ostial obstruction from valve frame or supravalvular positioning
C.Acute severe mitral regurgitation from leaflet tethering
D.Retroperitoneal haematoma from femoral access
Explanation: Acute hypotension with new murmur and anterior ST elevation immediately after TAVR strongly suggests coronary ostial obstruction from the prosthetic frame or malposition, causing acute myocardial ischaemia. Emergency coronary angiography and percutaneous intervention may be required.
7A patient with severe pulmonary hypertension (mean PAP 55 mmHg) develops acute right ventricular failure after induction of general anaesthesia. Which vasopressor/inotrope combination is most appropriate to support RV function?
A.High-dose phenylephrine infusion
B.Noradrenaline with low-dose inhaled nitric oxide or epoprostenol
C.Large fluid bolus of 2 litres crystalloid
D.Intravenous nitroglycerin infusion
Explanation: Acute RV failure in pulmonary hypertension requires maintaining systemic perfusion (noradrenaline) while reducing pulmonary vascular resistance with selective pulmonary vasodilators (inhaled NO or epoprostenol). Phenylephrine increases PVR; nitroglycerin reduces preload critically needed by the failing RV.
8During off-pump coronary artery bypass (OPCAB), the surgeon requests deep pericardial stitches for cardiac positioning. Heart rate rises to 110 bpm and blood pressure falls. What is the most appropriate immediate anaesthetic intervention?
A.Deepen anaesthesia and administer a beta-blocker or esmolol bolus
B.Administer atropine 600 µg intravenously
C.Increase FiO2 and add 10 cmH2O PEEP
D.Start a dopamine infusion at 10 µg/kg/min
Explanation: Cardiac manipulation during OPCAB triggers sympathetic reflexes causing tachycardia and hypotension. Deepening anaesthesia and judicious beta-blockade (e.g., esmolol) reduce myocardial oxygen demand and improve haemodynamic stability during grafting.
9A 52-year-old man presents with acute tearing chest pain radiating to the back. CT angiography confirms Stanford Type A aortic dissection with pericardial effusion and tamponade physiology. What is the priority before induction of anaesthesia?
A.Obtain cross-matched blood and establish large-bore arterial and central venous access with invasive monitoring
B.Administer thrombolysis to dissolve the intramural haematoma
C.Delay surgery for 48 hours of blood pressure control with oral agents
D.Perform transoesophageal echocardiography only after induction
Explanation: Stanford Type A dissection with tamponade is a surgical emergency. Large-bore IV access, arterial line, and preparation for massive transfusion are essential before induction, as positive-pressure ventilation and vasodilation can precipitate cardiovascular collapse.
10During cardiac surgery on cardiopulmonary bypass, cold blood cardioplegia is delivered antegrade into the aortic root. What is the primary mechanism by which hypothermic cardioplegia protects the myocardium?
A.Inducing sustained ventricular fibrillation to reduce metabolic demand
B.Depolarization arrest with hypothermia reducing myocardial oxygen consumption
C.Diluting coronary blood to reduce haematocrit below 15%
D.Increasing coronary perfusion pressure above 200 mmHg
Explanation: Cardioplegia solutions (high potassium) induce electromechanical arrest while hypothermia (typically 4–8°C for blood cardioplegia) reduces myocardial metabolic rate and oxygen demand, protecting the heart during the ischaemic period of CPB.
About the FCA(SA) Final Practice Questions
Verified exam format metadata for Fellowship of the College of Anaesthetists of South Africa Final Examination is pending. The practice questions above remain available while official exam length, timing, passing score, fee, and administrator details are reviewed.