100+ Free FCP(SA) Part II Practice Questions

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2026 Statistics

Key Facts: FCP(SA) Part II Exam

Written + Clinical + Oral

Exam Format

CMSA Regulations

50% + Subminimum

Pass Score

CMSA Senate Policy

R24 650

Exam Fee

CMSA Fee Schedule SS2026

36 Months

Registrar Training

College of Physicians

The CMSA FCP(SA) Part II exit examination comprises SCA written papers, an Objective Test, clinical bedside cases, and structured oral examination (VIVA) with an examination fee of R24 650. This practice bank provides 100 English-language MCQs as a study adaptation.

Sample FCP(SA) Part II Practice Questions

Try these sample questions to test your FCP(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 62-year-old male presents 5 days after an anterior ST-elevation myocardial infarction with sudden hemodynamic deterioration, dyspnea, and a new harsh holosystolic murmur heard loudest at the lower left sternal border with an associated parasternal thrill. Oxygen saturation drops from a right atrial sample of 65% to a right ventricular sample of 84% during bedside pulmonary artery catheterization. Which of the following is the most definitive immediate management strategy?

A.Urgent surgical repair or transcatheter closure with intra-aortic balloon pump stabilization

B.Emergent bed-side pericardiocentesis and bolus fluid administration

C.Urgent mitral valve replacement with coronary artery bypass grafting

D.Immediate intravenous thrombolysis with tenecteplase and systemic heparinization

Explanation: The clinical presentation and cardiac catheterization oxygen step-up from 65% in the right atrium to 84% in the right ventricle confirm an acute post-infarction ventricular septal defect (VSD). Emergency mechanical stabilization with an intra-aortic balloon pump (IABP) combined with urgent surgical or percutaneous repair is required due to high mortality with conservative medical therapy alone. Fluid loading or pericardiocentesis is indicated for cardiac tamponade, not VSD.

2A 74-year-old female presents with progressive exertional angina and presyncope. Echocardiography demonstrates a calcified aortic valve with an aortic valve area (AVA) of 0.7 cm², a mean transvalvular gradient of 28 mmHg, and a left ventricular ejection fraction (LVEF) of 32%. A low-dose dobutamine stress echocardiogram is performed. Which of the following findings confirms true severe low-flow, low-gradient aortic stenosis?

A.Increase in mean gradient to 30 mmHg and AVA increase to 1.3 cm² with increased stroke volume

B.Increase in mean gradient to >= 40 mmHg with AVA remaining <= 1.0 cm² as stroke volume increases

C.No change in stroke volume, mean gradient, or AVA despite maximum dobutamine infusion

D.Decrease in mean gradient below 20 mmHg with an increase in LVEF to 55%

Explanation: True severe low-flow, low-gradient aortic stenosis with reduced LVEF is diagnosed on dobutamine stress echocardiography when contractile reserve is demonstrated (stroke volume increases by >= 20%) and the mean gradient increases to >= 40 mmHg while the AVA remains <= 1.0 cm². If AVA increases above 1.0 cm² as flow increases, pseudo-severe aortic stenosis is present. Lack of stroke volume increase indicates absence of contractile reserve.

3A 58-year-old male with long-standing ischemic heart disease and an LVEF of 28% remains symptomatic (NYHA Class III) on enalapril 10 mg twice daily and carvedilol 25 mg twice daily. Blood pressure is 124/76 mmHg, heart rate is 68 bpm, serum potassium is 4.3 mmol/L, and eGFR is 62 mL/min/1.73m². What is the most appropriate next step in optimizing guideline-directed medical therapy (GDMT)?

A.Add digoxin and increase carvedilol to 50 mg twice daily

B.Discontinue carvedilol and initiate ivabradine 5 mg twice daily

C.Switch enalapril to sacubitril/valsartan, and add spironolactone and dapagliflozin

D.Add hydralazine and isosorbide dinitrate while maintaining current enalapril

Explanation: Foundational quadruple therapy for HFrEF includes an ARNI (sacubitril/valsartan replacing an ACEi/ARB after a 36-hour washout), an evidence-based beta-blocker, a mineralocorticoid receptor antagonist (MRA such as spironolactone), and an SGLT2 inhibitor (dapagliflozin or empagliflozin). This combination significantly reduces all-cause mortality and heart failure hospitalizations. Digoxin and hydralazine/nitrates are second- or third-line options.

4A 45-year-old male with a mechanical aortic valve presents with fever, new heart failure symptoms, and blood cultures positive for Staphylococcus aureus. Transesophageal echocardiography reveals a 14 mm mobile vegetation on the prosthetic valve with a perivalvular abscess and a new second-degree AV block. Which of the following is the most urgent intervention?

A.Initiate intravenous vancomycin, gentamicin, and rifampicin and observe for 4 weeks

B.Perform urgent temporary transvenous pacing followed by outpatient oral antibiotic therapy

C.Increase intravenous antibiotic dosing and repeat echocardiography in 14 days

D.Initiate targeted intravenous antibiotics and refer for emergency cardiac surgery

Explanation: Prosthetic valve infective endocarditis complicated by S. aureus infection, perivalvular abscess, conduction abnormality (new AV block), and heart failure constitutes a mandatory indication for emergency surgical intervention alongside systemic bactericidal antimicrobial therapy. Medical therapy alone is insufficient when perivalvular tissue destruction or invasive abscess formation is present.

5A 22-year-old competitive athlete is diagnosed with hypertrophic cardiomyopathy (HCM). Echocardiography shows asymmetric septal hypertrophy of 32 mm and a peak resting left ventricular outflow tract (LVOT) gradient of 45 mmHg. His father died suddenly at age 35. He reports no syncope. Which of the following is the primary indication for secondary or primary prevention implantable cardioverter-defibrillator (ICD) insertion in this patient?

A.Maximal wall thickness >= 30 mm and family history of sudden cardiac death

B.Resting LVOT gradient of 45 mmHg alone

C.Asymmetric septal ratio greater than 1.3

D.NYHA Functional Class I status

Explanation: Primary prevention of sudden cardiac death (SCD) with an ICD in HCM is indicated when major risk factors are present, including maximal left ventricular wall thickness >= 30 mm, family history of premature SCD in a first-degree relative, unexplained syncope, non-sustained VT on Holter, or extensive late gadolinium enhancement (> 15% of LV mass) on cardiac MRI. Massive LVH (>= 30 mm) and family history independently confer high SCD risk.

6A 36-year-old female with severe rheumatic mitral stenosis and atrial fibrillation presents for stroke prevention advice. She has no other medical co-morbidities. Which of the following is the recommended long-term oral anticoagulant regimen?

A.Rivaroxaban 20 mg once daily

B.Adjusted-dose Warfarin targeting an INR of 2.0 to 3.0

C.Apixaban 5 mg twice daily

D.Dabigatran 150 mg twice daily

Explanation: In patients with atrial fibrillation and moderate-to-severe rheumatic mitral stenosis or mechanical heart valves (valvular AF), Vitamin K antagonists (Warfarin targeting INR 2.0-3.0) remain the mandatory standard of care. Direct oral anticoagulants (DOACs like rivaroxaban, apixaban, and dabigatran) are contraindicated in moderate-to-severe rheumatic mitral stenosis due to lack of efficacy and increased thromboembolic risk in clinical trials.

7A 48-year-old male presents with acute dyspnea, tachycardia (128 bpm), hypotension (82/54 mmHg), elevated jugular venous pressure with absent y-descent, and muffled heart sounds. ECG reveals low voltage QRS complexes with electrical alternans. Which hemodynamic abnormality is pathognomonic of this clinical emergency?

A.Pulsus bisferiens with rapid arterial upstroke

B.Exaggerated drop in systolic blood pressure > 10 mmHg during inspiration (pulsus paradoxus)

C.Fixed splitting of the second heart sound

D.Prominent v-wave in the jugular venous pulse

Explanation: The patient presents with Beck's triad (hypotension, JVP elevation, muffled heart sounds) and electrical alternans, indicative of acute cardiac tamponade. Pulsus paradoxus—an abnormally large decrease in systolic blood pressure (> 10 mmHg) during normal inspiration—is a hallmark clinical finding resulting from ventricular interdependence within a non-compliant, fluid-filled pericardial sac.

8A 38-year-old female presents with complete heart block and biventricular dysfunction. High-resolution cardiac magnetic resonance (CMR) imaging displays patchy late gadolinium enhancement (LGE) predominantly involving the basal septum and mid-myocardial wall. Serum ACE level is elevated, and endomyocardial biopsy demonstrates non-caseating granulomatous inflammation. Which of the following is the first-line disease-modifying therapy?

A.High-dose Oral Corticosteroids (Prednisone)

B.High-dose Intravenous Immunoglobulin (IVIG)

C.Colchicine plus Ibuprofen

D.Sacubitril/Valsartan plus Empagliflozin

Explanation: Cardiac sarcoidosis presents with heart block, ventricular arrhythmias, and heart failure. High-dose oral corticosteroid therapy (prednisone 40-60 mg daily) is the first-line disease-modifying treatment to suppress active granulomatous inflammation, preserve LV function, and prevent progression of conduction heart block.

9A 65-year-old male with prior anterior myocardial infarction is admitted to the cardiac ICU in monomorphic ventricular tachycardia (VT) storm, defined by 4 discrete episodes of sustained VT in 24 hours requiring electrical cardioversion. He is intubated and receiving intravenous amiodarone and full beta-blockade. Which of the following is the most appropriate definitive intervention?

A.Emergency catheter-based radiofrequency ablation of the VT substrate

B.Implantation of a dual-chamber permanent pacemaker

C.Urgent surgical coronary artery bypass grafting

D.Initiation of intravenous diltiazem infusion

Explanation: In patients with ischemic heart disease experiencing recurrent monomorphic VT storm refractory or recurrent despite antiarrhythmic drugs (amiodarone plus beta-blockers), emergency catheter ablation of the scar-related VT re-entry substrate significantly reduces VT recurrences and improves clinical outcomes.

10A 29-year-old primigravida presents 4 weeks postpartum with acute pulmonary edema. Echocardiography demonstrates global left ventricular hypokinesis with an LVEF of 22% and a small apical mural thrombus. She is diagnosed with peripartum cardiomyopathy (PPCM). In addition to standard heart failure therapy, which specific disease-targeted agent has been shown to enhance LVEF recovery?

A.Bromocriptine

B.Cabergoline

C.Levosimendan

D.Milrinone

Explanation: Peripartum cardiomyopathy (PPCM) is driven in part by prolactin cleavage into an anti-angiogenic and pro-apoptotic 16-kDa prolactin fragment. Addition of bromocriptine (a prolactin secretion inhibitor) to standard heart failure therapy leads to higher rates of full LV functional recovery. Prophylactic anticoagulation is mandatory when bromocriptine is given due to prothrombotic risk, and also because of her apical LV thrombus.

About the FCP(SA) Part II Exam

The Fellowship of the College of Physicians of South Africa Part II [FCP(SA) Part II] is the flagship specialist qualification in Internal Medicine in South Africa. It evaluates expert-level clinical decision-making, patient assessment, therapeutic management according to international and South African tertiary guidelines, and diagnostic interpretation across all internal medicine subspecialties.

Assessment

The FCP(SA) Part II exit examination comprises Single Correct Answer (SCA) written papers (two sessions of 75 best-of-four MCQs in 2 hours each), an Objective Test, clinical bedside examinations, and structured oral examinations (VIVA). Component weights: SCA 20%, Objective Test 20%, clinical 20%, structured oral 40%.

Time Limit

Written papers plus clinical bedside cases and structured oral examinations

Passing Score

Overall 50% with written subminimum

Exam Fee

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

FCP(SA) Part II Exam Content Outline

12%

Cardiology

Ischemic heart disease, heart failure, valvular heart disease, dysrhythmias, pericardial disease, cardiomyopathy, and hypertension.

12%

Pulmonology & Critical Care

ARDS, interstitial lung disease, severe asthma, COPD, pulmonary hypertension, pulmonary embolism, and pleural diseases.

10%

Gastroenterology & Hepatology

Portal hypertension, cirrhosis complications, acute/chronic pancreatitis, inflammatory bowel disease, and viral/autoimmune hepatitis.

10%

Nephrology & Hypertension

Acute kidney injury, glomerulonephritis, nephrotic syndrome, electrolyte disorders, acid-base, and hypertensive emergencies.

10%

Endocrinology & Metabolism

Diabetes complications, adrenal disorders, thyroid crises, pituitary disease, metabolic bone disease, and secondary hypertension.

14%

Infectious Diseases, HIV & TB

Tuberculosis (MDR/XDR-TB), advanced HIV medicine, opportunistic infections, severe sepsis, malaria, and tropical infections.

10%

Haematology & Medical Oncology

Acute leukemias, multiple myeloma, lymphomas, myeloproliferative neoplasms, thrombotic microangiopathies, and bleeding disorders.

10%

Neurology & Neuro-medicine

Stroke thrombolysis/thrombectomy, status epilepticus, neuromuscular crises, movement disorders, neuro-infection, and neuro-immunology.

Rheumatology & Clinical Immunology

Systemic lupus erythematosus, rheumatoid arthritis, ANCA vasculitis, systemic sclerosis, inflammatory myopathies, and crystal arthropathies.

Clinical Pharmacology & Toxicology

Acute poisoning, organophosphate toxicity, drug overdoses, toxidromes, therapeutic drug monitoring, and adverse drug reactions.

How to Pass the FCP(SA) Part II Exam

What You Need to Know

Passing score: Overall 50% with written subminimum
Assessment: The FCP(SA) Part II exit examination comprises Single Correct Answer (SCA) written papers (two sessions of 75 best-of-four MCQs in 2 hours each), an Objective Test, clinical bedside examinations, and structured oral examinations (VIVA). Component weights: SCA 20%, Objective Test 20%, clinical 20%, structured oral 40%.
Time limit: Written papers plus clinical bedside cases and structured oral examinations
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

FCP(SA) Part II Study Tips from Top Performers

1Focus on comprehensive differential diagnosis and evidence-based management for complex multimorbid medical patients.

2Review South African National Department of Health Tertiary and Quaternary Essential Medicines List (EML) guidelines for TB, HIV, and chronic disease management.

3Practice structured clinical case presentation and data interpretation (ECGs, chest X-rays, HRCTs, lab panels) under timed examination conditions.

Frequently Asked Questions

What is the format of the CMSA FCP(SA) Part II examination?

The examination comprises Single Correct Answer (SCA) written papers (two sessions of 75 best-of-four MCQs in 2 hours each), an Objective Test, clinical bedside cases, and structured oral examinations (VIVA). Component weights are SCA 20%, Objective Test 20%, clinical 20%, and structured oral 40%.

What is the pass mark for the FCP(SA) Part II exam?

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

What are the requirements to register for the Part II exam?

Candidates must have passed FCP(SA) Part I, completed 36 months of accredited Internal Medicine registrar training, submitted an approved portfolio of learning, and completed a research component.

What is the examination fee for the FCP(SA) Part II?

The examination fee is R24 650 as specified on the CMSA fee schedule (SS2026).

100+ Free FCP(SA) Part II Practice Questions

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