100+ Free FC Emerg Med(SA) Part II Practice Questions

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2026 Statistics

Key Facts: FC Emerg Med(SA) Part II Exam

Written + OSCE + Oral

Exam Format

CMSA Regulations

50% + Subminimum

Pass Score

CMSA Senate Policy

R21 500

Exam Fee

CMSA Fee Schedule

36 Months

Registrar Training

College of Emergency Medicine

The CMSA FC Emerg Med(SA) Part II exit examination tests comprehensive specialist emergency medicine competence across written, OSCE, and oral formats with an exam fee of R21 500. This practice bank offers 100 high-yield clinical MCQs adapted for examination prep.

Sample FC Emerg Med(SA) Part II Practice Questions

Try these sample questions to test your FC Emerg Med(SA) Part II exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 45-year-old male is brought to the resuscitation bay following a motor vehicle collision with severe maxillofacial trauma, active bleeding into the airway, and severe trismus. Which of the following is the most appropriate primary airway management strategy?

A.Invasive surgical cricothyroidotomy

B.Rapid sequence intubation with direct laryngoscopy

C.Awake fiberoptic intubation without sedation

D.Video laryngoscopy following standard induction without neuromuscular blockade

Explanation: Invasive surgical cricothyroidotomy is the definitive choice when face-to-face airway management is impossible due to massive maxillofacial trauma, active bleeding obscuring visual anatomical landmarks, and severe jaw trismus. Standard or video laryngoscopy will fail due to poor visualization and inability to open the mouth. Performing a surgical airway immediately secures oxygenation and prevents asphyxiation in a 'cannot intubate, cannot oxygenate' scenario.

2A 62-year-old female presents in septic shock secondary to urosepsis with persistent hypotension (BP 78/44 mmHg) despite 30 mL/kg intravenous crystalloid resuscitation. Which of the following is the initial vasopressor of choice?

A.Norepinephrine infusion titrated to MAP >= 65 mmHg

B.Dopamine infusion at 10 mcg/kg/min

C.Epinephrine infusion at 0.1 mcg/kg/min

D.Phenylephrine bolus 100 mcg IV every 5 minutes

Explanation: Norepinephrine infusion titrated to MAP >= 65 mmHg is recommended as the first-line vasopressor in septic shock by international Surviving Sepsis Campaign guidelines. Norepinephrine acts predominantly as a potent alpha-1 adrenergic agonist to increase systemic vascular resistance while providing modest beta-1 inotropic support. Compared to dopamine, norepinephrine demonstrates significantly lower incidence of dysrhythmias and lower overall mortality.

3A 58-year-old male with a history of heart failure presents with crushing chest pain, dyspnoea, BP 72/40 mmHg, HR 115 bpm, and bilateral pulmonary crackles. Bedside echocardiogram shows left ventricular ejection fraction of 15% with a non-dilated, underfilled right ventricle. What is the most appropriate initial pharmacological agent?

A.Dobutamine combined with low-dose norepinephrine infusion

B.Intravenous bolus of 500 mL normal saline

C.Intravenous furosemide 80 mg IV push

D.Intravenous sublingual nitroglycerin spray 400 mcg every 5 minutes

Explanation: Dobutamine combined with low-dose norepinephrine infusion is indicated for cardiogenic shock characterized by severe LV systolic dysfunction, elevated filling pressures, and systemic hypoperfusion. Dobutamine provides beta-1 ionotropic support to enhance cardiac output, while norepinephrine offsets dobutamine-induced vasodilation to maintain organ perfusion pressure. Nitroglycerin and fluid boluses are contraindicated in severe hypotension, and standalone high-dose loop diuretics can further worsen hypotension before perfusing organs.

4A 34-year-old male suffers out-of-hospital cardiac arrest with initial rhythm of ventricular fibrillation. After 3 shocks, 1 mg epinephrine, and high-quality CPR, refractory VF persists. What is the recommended next pharmacological intervention?

A.Amiodarone 300 mg IV push

B.Calcium chloride 1 g IV

C.Atropine 1 mg IV

D.Sodium bicarbonate 50 mEq IV

Explanation: Amiodarone 300 mg IV push is indicated for refractory ventricular fibrillation or pulseless ventricular tachycardia following defibrillation attempts and vasopressor administration. Lidocaine (1 to 1.5 mg/kg) is an alternative antiarrhythmic, but amiodarone is standard first-line in ACLS algorithms for shock-refractory VF. Calcium, atropine, and sodium bicarbonate are not indicated for routine shockable arrest without specific toxicological or electrolyte etiologies.

5Following successful targeted temperature management and post-cardiac arrest resuscitation, a 50-year-old comatose post-VF arrest patient has an arterial blood gas showing PaO2 of 240 mmHg on FiO2 1.0. What is the most appropriate action regarding arterial oxygenation?

A.Titrate FiO2 downward to maintain SpO2 between 92% and 98%

B.Maintain FiO2 at 1.0 to ensure maximal oxygen delivery to ischaemic neural tissue

C.Hyperventilate to achieve PaCO2 of 28 mmHg to control cerebral edema

D.Increase positive end-expiratory pressure (PEEP) to 15 cmH2O to prevent atelectasis

Explanation: Titrate FiO2 downward to maintain SpO2 between 92% and 98% (or PaO2 80-100 mmHg) is critical in post-cardiac arrest care because hyperoxia (PaO2 > 200 mmHg) increases reactive oxygen species formation and neuronal apoptosis, causing brain reperfusion injury. Normoxia and normocapnia (PaCO2 35-45 mmHg) should be targeted to optimize cerebral blood flow and minimize reperfusion harm.

6A 28-year-old female presents with severe anaphylactic shock following a wasp sting, presenting with stridor, severe wheezing, and BP 65/35 mmHg. What is the most important initial therapeutic intervention?

A.Intramuscular epinephrine 0.5 mg in the anterolateral thigh

B.Intravenous hydrocortisone 200 mg

C.Nebulised salbutamol 5 mg with ipratropium bromide 0.5 mg

D.Intravenous diphenhydramine 50 mg push

Explanation: Intramuscular epinephrine 0.5 mg in the anterolateral thigh is the single most critical, life-saving intervention for anaphylaxis. Epinephrine acts rapidly on alpha-1 receptors to reverse peripheral vasodilation and airway edema, and on beta-1/beta-2 receptors to produce bronchodilation and positive inotropy. Antihistamines and corticosteroids are adjunctive secondary medications and do not reverse immediate life-threatening airway collapse or distributive shock.

7During rapid sequence intubation of a critically ill, hypotensive trauma patient, which induction agent exhibits the most favorable hemodynamic profile to minimize post-intubation collapse?

A.Etomidate 0.3 mg/kg IV

B.Propofol 2 mg/kg IV

C.Thiopental 4 mg/kg IV

D.Midazolam 0.3 mg/kg IV

Explanation: Etomidate 0.3 mg/kg IV provides stable hemodynamics during induction because it lacks direct myocardial depressant effects and does not cause significant venodilation or arterial vasodilation. Ketamine (1.5 to 2 mg/kg IV) is another excellent option in shock, but etomidate remains a classic choice for maintaining blood pressure in trauma and septic shock patients undergoing emergency RSI.

8A 70-year-old male with chronic renal failure presents with severe muscle weakness, chest pressure, and an ECG demonstrating peaked T waves, PR prolongation, and wide QRS complexes ('sine wave' pattern). What is the mandatory immediate first drug step in management?

A.Intravenous calcium gluconate 10% 10-20 mL over 5-10 minutes

B.Intravenous insulin 10 units with 50 mL 50% dextrose

C.Nebulised salbutamol 20 mg

D.Oral sodium polystyrene sulfonate 30 g

Explanation: Intravenous calcium gluconate 10% (10-20 mL) is the imperative first step to stabilize the cardiac membrane potential against hyperkalemia-induced cardiotoxicity. Calcium antagonizes the membrane depolarizing effects of hyperkalemia without shifting serum potassium levels. After membrane stabilization, intracellular shifting agents (insulin/dextrose, salbutamol) and elimination methods (furosemide, hemodialysis) are administered.

9A 52-year-old male with massive pulmonary embolism develops cardiac arrest (PEA). CPR is ongoing. What specific resuscitation intervention is indicated?

A.Immediate bolus of alteplase 50 mg IV push with continued CPR for at least 60-90 minutes

B.High-dose intravenous calcium chloride 2 g push

C.Immediate pericardiocentesis

D.Infusion of hypertonic saline 3% 250 mL

Explanation: Immediate bolus of alteplase (rtPA) 50 mg IV push is indicated in cardiac arrest caused by suspected or proven massive pulmonary embolism. Following thrombolytic administration, CPR should be continued for at least 60 to 90 minutes to allow the fibrinolytic agent adequate time to lyse the pulmonary artery occlusion and restore right ventricular outflow.

10In a patient presenting with neurogenic shock following a high cervical spinal cord injury (C4 level), which physiologic feature distinguishes this state from hypovolemic shock?

A.Bradycardia combined with hypotension and warm, dry peripheries

B.Tachycardia with narrow pulse pressure

C.Cool, clammy extremities with capillary refill > 4 seconds

D.Marked elevation in systemic vascular resistance (SVR)

Explanation: Bradycardia combined with hypotension and warm, dry peripheries is characteristic of neurogenic shock. Loss of sympathetic vascular tone below the level of the spinal cord lesion causes profound vasodilation (warm extremities) and un-opposed vagal tone (bradycardia). In contrast, hypovolemic shock features compensatory tachycardia, cool clammy skin, and elevated systemic vascular resistance.

About the FC Emerg Med(SA) Part II Exam

The Fellowship of the College of Emergency Medicine of South Africa Part II [FC Emerg Med(SA) Part II] is the definitive exit qualification for emergency medicine specialists in South Africa. It evaluates expert-level clinical judgment, advanced resuscitation, trauma resuscitation, critical care management in the emergency department, paediatric emergencies, procedural competence, and emergency department leadership.

Assessment

The exit examination comprises written components (Paper 1 Short Answer Questions/MCQs and Paper 2 Clinical Scenarios/Data Interpretation), followed by an Objective Structured Clinical Examination (OSCE) and a Structured Oral Examination (VIVA).

Time Limit

Written papers (2 x 3 hours) plus practical OSCE and Oral Examination

Passing Score

Overall 50% with written subminimum

Exam Fee

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

FC Emerg Med(SA) Part II Exam Content Outline

15%

Advanced Resuscitation & Shock

Airway management, rapid sequence intubation (RSI), cardiac arrest care, post-cardiac arrest syndrome, cardiogenic/septic/distributive shock, fluid responsiveness, and invasive monitoring.

20%

Major Trauma & Polytrauma

Advanced Trauma Life Support (ATLS), massive transfusion protocols, traumatic brain injury (TBI), severe chest trauma, pelvic fractures, abdominal trauma, burns, and spinal injury.

15%

Emergency Critical Care & Mechanical Ventilation

ARDS strategies, invasive/non-invasive mechanical ventilation, vasoactive pressor/inotrope titration, acute kidney injury, renal replacement in ED, and severe sepsis management.

15%

Emergency Cardiology & Pulmonology

Acute coronary syndromes, complex dysrhythmias, acute decompensated heart failure, hypertensive emergencies, massive pulmonary embolism, severe asthma, and COPD exacerbations.

10%

Toxicology & Environmental Emergencies

Organophosphate poisoning, paracetamol overdose, toxic alcohol toxicity, snakebite and scorpion envenomation, severe hypothermia, heat stroke, and hyperbaric/dive emergencies.

10%

Paediatric Emergency Medicine

Paediatric Advanced Life Support (PALS), neonatal resuscitation, paediatric major trauma, severe paediatric respiratory distress, status epilepticus, and non-accidental injury.

10%

Emergency Ultrasound & Procedures

eFAST, RUSH protocol, cardiac POCUS, ultrasound-guided regional nerve blocks, tube thoracostomy, pericardiocentesis, and central venous/arterial line placement.

ED Administration, Triage & Disaster Medicine

South African Triage Scale (SATS), disaster preparedness, mass casualty triage, ED overcrowding, clinical governance, medical ethics, and HPCSA legal framework.

How to Pass the FC Emerg Med(SA) Part II Exam

What You Need to Know

Passing score: Overall 50% with written subminimum
Assessment: The exit examination comprises written components (Paper 1 Short Answer Questions/MCQs and Paper 2 Clinical Scenarios/Data Interpretation), followed by an Objective Structured Clinical Examination (OSCE) and a Structured Oral Examination (VIVA).
Time limit: Written papers (2 x 3 hours) plus practical OSCE and Oral Examination
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

FC Emerg Med(SA) Part II Study Tips from Top Performers

1Master the emergency management of polytrauma, including massive transfusion protocols, REBOA indications, and ED thoracotomy guidelines.

2Review lung-protective mechanical ventilation, trouble-shooting high peak/plateau pressures, and advanced POCUS applications (RUSH and eFAST).

3Familiarize yourself with local South African clinical practice guidelines (EMSSA standards, SATS triage rules, and SAMJ toxicological management protocols).

Frequently Asked Questions

What is the format of the CMSA FC Emerg Med(SA) Part II examination?

The examination consists of a written component (Paper 1 and Paper 2), followed by a practical Objective Structured Clinical Examination (OSCE) and a Structured Oral Examination (VIVA).

What is the pass mark for the FC Emerg Med(SA) Part II exam?

The pass mark is an overall score of 50%, with candidates required to meet a mandatory written subminimum threshold before progressing to or passing the clinical examination components.

What are the prerequisites to sit the Part II examination?

Candidates must have passed FC Emerg Med(SA) Part I, completed a minimum of 36 months in an accredited Emergency Medicine registrar training program, submitted an approved portfolio of learning, and hold valid ATLS, ACLS, APLS, and EMUS certificates.

What is the examination fee for the FC Emerg Med(SA) Part II?

The examination fee is R21 500 as listed on the official CMSA fee schedule.

100+ Free FC Emerg Med(SA) Part II Practice Questions

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