100+ Free FCA(SA) Final Practice Questions

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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 Exam

The FCA(SA) Final is the exit fellowship examination conducted by the College of Anaesthetists of South Africa. It evaluates high-level clinical decision making and practical competency across cardiovascular/thoracic anaesthesia, neuroanaesthesia, obstetric & paediatric subspecialty care, intensive care, chronic pain, advanced TEE monitoring, and perioperative medicine.

Assessment

Written component: (i) one 3-hour MCQ/SBA paper (minimum 120 questions), (ii) one 3-hour short-answer paper (minimum 20 questions), (iii) one 3-hour data-interpretation paper (minimum 20 questions); plus an OSCE with a minimum of 12 stations.

Time Limit

Three 3-hour written papers plus OSCE (minimum 12 stations)

Passing Score

Overall 50% with written subminimum

Exam Fee

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

FCA(SA) Final Exam Content Outline

18%

Cardiovascular & Thoracic Anaesthesia

Cardiopulmonary bypass weaning, TEE assessment of valve dysfunction, one-lung ventilation management, thoracic aortic aneurysms, and intra-aortic balloon pump/VAD support.

14%

Neuroanaesthesia & Neurointensive Care

ICP/CPP optimization in TBI, posterior fossa venous air embolism, cerebral aneurysm clipping/coiling, subarachnoid hemorrhage, and intraoperative neuro-monitoring (MEP/SSEP).

18%

Obstetric & Paediatric Anaesthesia

Severe pre-eclampsia with pulmonary oedema, massive obstetric hemorrhage protocols, maternal cardiac disease, neonatal resuscitation, TEF repair, and pediatric CHD management.

20%

Intensive Care & Perioperative Medicine

ARDS lung-protective ventilation, septic shock vasoactive titration, CRRT prescription in AKI, DOAC reversal agents, preoperative cardiac risk assessment, and ERAS pathways.

15%

Regional Anaesthesia & Chronic Pain

Ultrasound-guided trunk/plexus blocks, 20% lipid emulsion for LAST toxicity, neuraxial hematoma management, neuromodulation, CRPS, and neuropathic pain pharmacotherapy.

15%

Advanced Monitoring & Pharmacology

TEE hemodynamics, ROTEM/TEG guided blood transfusion, processed EEG depth monitoring (pEEG/BIS), TIVA target-controlled infusion models, and sugammadex NMB reversal.

How to Pass the FCA(SA) Final Exam

What You Need to Know

Passing score: Overall 50% with written subminimum
Assessment: Written component: (i) one 3-hour MCQ/SBA paper (minimum 120 questions), (ii) one 3-hour short-answer paper (minimum 20 questions), (iii) one 3-hour data-interpretation paper (minimum 20 questions); plus an OSCE with a minimum of 12 stations.
Time limit: Three 3-hour written papers plus OSCE (minimum 12 stations)
Exam fee: R24 650

Keys to Passing

Work through all 100 available questions
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FCA(SA) Final Study Tips from Top Performers

1Master transoesophageal echocardiography (TEE) views and hemodynamic interpretation, including grading of valve regurgitation and right ventricular failure.

2Review lung-protective ventilation in ARDS, management of hypoxemia during double-lumen tube one-lung ventilation, and ROTEM-guided transfusion algorithms.

3Focus on crisis management protocols for LAST, malignant hyperthermia, failed obstetric airway, massive postpartum hemorrhage, and spinal hematoma.

Frequently Asked Questions

What is the format of the CMSA FCA(SA) Final examination?

The Part II examination comprises three 3-hour written papers (MCQ/SBA with minimum 120 questions, short answers with minimum 20 questions, and data interpretation with minimum 20 questions) plus an OSCE with a minimum of 12 stations.

What is the passing standard for the FCA(SA) Final?

Candidates must achieve an overall aggregate mark of 50% with a mandatory subminimum score in the written papers before being accredited or progressing through the clinical components.

What are the prerequisites for writing the FCA(SA) Final?

Candidates must have passed FCA(SA) Part I, completed at least 36 months of accredited Anaesthetics registrar training, submitted an approved CMSA portfolio of learning, and hold valid resuscitation certifications.

What is the examination fee for the FCA(SA) Final?

The Part II examination fee is R24 650 (VAT inclusive) per the CMSA SS2026 fee schedule.

100+ Free FCA(SA) Final Practice Questions

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