100+ Free FCS(SA) Final Practice Questions

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2026 Statistics

Key Facts: FCS(SA) Final Exam

100 Qs

MCQ Study Adaptation

OpenExamPrep Practice Bank

R21 500

Exam Fee

CMSA Fee Structure 2026

50%

Passing Score

CMSA College of Surgeons Regulations

verified

Metadata Status

CMSA Official Blueprint

The CMSA FCS(SA) Final is the specialist exit examination for general surgeons in South Africa. This practice bank provides 100 high-yield, clinically sophisticated MCQs tailored to the official South African general surgery fellowship syllabus.

Sample FCS(SA) Final Practice Questions

Try these sample questions to test your FCS(SA) Final 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 with dysphagia to solid foods and unintentional weight loss. Endoscopy reveals an adenocarcinoma extending from 1 cm above to 2 cm below the oesophagogastric junction (Siewert Type II). Staging CT and PET show T3N1M0 disease. What is the most appropriate definitive management strategy?

A.Primary endoscopic mucosal resection followed by oral proton pump inhibitor therapy

B.Neoadjuvant chemoradiotherapy followed by transthoracic or transhiatal subtotal oesophagectomy with proximal gastrectomy

C.Immediate total gastrectomy with Roux-en-Y reconstruction without neoadjuvant therapy

D.Definitive chemoradiotherapy alone without surgical resection

Explanation: Siewert Type II oesophagogastric junction adenocarcinoma (true cardia cancer extending from 1 cm above to 2 cm below the EGJ) with locally advanced features (T3N1M0) is optimally managed with neoadjuvant chemoradiotherapy (e.g., CROSS protocol) followed by surgical resection (transthoracic or transhiatal subtotal oesophagectomy with proximal gastrectomy and lymphadenectomy). Preoperative multimodality therapy significantly improves overall survival and R0 resection rates. Endoscopic mucosal resection is limited to early mucosal (T1a) lesions, while surgery alone is inadequate for T3N1 tumors.

2A 54-year-old male presents with severe lower retrosternal pain, fever, and subcutaneous emphysema of the neck 4 hours after a bout of violent emesis following heavy alcohol ingestion. Chest X-ray demonstrates a left-sided pleural effusion and pneumomediastinum. What is the most definitive initial diagnostic investigation to confirm the clinical suspicion?

A.Flexible upper gastrointestinal endoscopy

B.Water-soluble contrast swallow fluoroscopy (or contrast-enhanced CT with oral water-soluble contrast)

C.High-resolution oesophageal manometry

D.24-hour ambulatory pH monitoring

Explanation: The clinical presentation describes Boerhaave syndrome (spontaneous transmural oesophageal rupture). Water-soluble contrast swallow fluoroscopy (e.g., Gastrografin) or contrast-enhanced CT of the chest/abdomen with oral water-soluble contrast is the definitive diagnostic procedure of choice to demonstrate the transmural perforation site and extravasation. Endoscopy should be avoided in acute suspected perforation due to the risk of converting a small tear into a larger defect via insufflation. Manometry and pH monitoring play no role in acute trauma or perforation.

3A 58-year-old woman is found to have a 4 cm submucosal lesion in the gastric body on upper endoscopy. Endoscopic ultrasound-guided fine-needle biopsy confirms a Gastrointestinal Stromal Tumour (GIST) positive for CD117 (c-KIT). Staging CT shows no metastatic disease. What is the standard surgical approach?

A.Total gastrectomy with formal D2 lymph node dissection

B.Wedge resection of the stomach with macroscopic negative (R0) margins without routine lymphadenectomy

C.Endoscopic mucosal capping without surgical excision

D.En-bloc total gastrectomy, splenectomy, and distal pancreatectomy

Explanation: Surgical management of localized gastric GISTs (>2 cm) requires wedge resection with clean macroscopic and microscopic negative margins (R0 resection). Routine lymphadenectomy is not indicated because GISTs metastasize hematogenously rather than lymphatically. Complete radical gastrectomy with lymph node dissection or organ resections is unnecessary unless direct invasion into adjacent organs occurs.

4A 72-year-old man presents with progressive cervical dysphagia, regurgitation of undigested food, halitosis, and recurrent aspiration pneumonia. Contrast swallow reveals a 4 cm posterior pharyngeal pouch above the cricopharyngeus muscle. What is the definitive treatment of choice?

A.Long-term oral proton pump inhibitor therapy

B.Cricopharyngeal myotomy with endoscopic stapled diverticulotomy (or open diverticulectomy/diverticulopexy)

C.Balloon dilatation of the lower oesophageal sphincter

D.Subtotal oesophagectomy with gastric pull-up

Explanation: Zenker diverticulum is a false pulsion diverticulum arising through Killian triangle above the cricopharyngeus muscle. Definitive treatment requires division of the underlying hypertonic cricopharyngeus muscle (cricopharyngeal myotomy) combined with diverticular division or excision via transoral endoscopic stapling (endoscopic diverticulotomy) or open pouch excision/pexy. Medical therapy, LES dilatation, or oesophagectomy do not correct cricopharyngeal dysfunction or pouch mechanics.

5A 40-year-old female presents with dysphagia to solids and liquids. High-Resolution Manometry (HRM) shows integrated relaxation pressure (IRP) >15 mmHg with failure of peristalsis and premature (spastic) contractions in >20% of swallows (Chicago Classification Type III Achalasia). Which therapeutic option offers superior clinical efficacy for Type III achalasia?

A.Laparoscopic Heller Myotomy with Dor fundoplication

B.Peroral Endoscopic Myotomy (POEM)

C.Pneumatic balloon dilatation

D.Botulinum toxin injection into the lower oesophageal sphincter

Explanation: Type III (spastic) achalasia is characterized by distal oesophageal spasm alongside elevated IRP. Peroral Endoscopic Myotomy (POEM) allows a longer, tailored oesophageal muscle myotomy (extending high into the smooth muscle body to encompass spastic segments) compared to standard laparoscopic Heller myotomy. POEM achieves significantly higher clinical success rates in Type III achalasia than Heller myotomy or pneumatic dilatation.

6During a curative gastrectomy for antral gastric adenocarcinoma, a D2 lymphadenectomy is performed. Which lymph node stations are specifically dissected in a D2 resection beyond the D1 stations (stations 1–6)?

A.Stations 1, 3, and 5 only

B.Stations 7 (left gastric), 8a (common hepatic), 9 (coeliac axis), 11p (proximal splenic), and 12a (proper hepatic)

C.Stations 16a and 16b (para-aortic nodes)

D.Stations 14v (superior mesenteric vein) and 13 (retropancreatic) only

Explanation: A standard D2 lymphadenectomy for gastric cancer encompasses the perigastric nodes (D1: stations 1 to 6) plus the lymph nodes along the main branches of the coeliac axis: station 7 (left gastric artery), station 8a (anterosuperior common hepatic artery), station 9 (coeliac trunk), station 11p (proximal splenic artery), and station 12a (proper hepatic artery). Station 16 (para-aortic) represents D3/D4 dissection and is not routine.

7A 42-year-old male who underwent laparoscopic Roux-en-Y gastric bypass (RYGB) 18 months ago presents with epigastric pain, nausea, and hematemesis. Endoscopy reveals a 1.5 cm ulceration on the jejunal side of the gastrojejunostomy. What is the most critical modifiable risk factor and initial management strategy?

A.Immediate conversion to sleeve gastrectomy

B.Cessation of NSAIDs and smoking, combined with high-dose oral PPI therapy and sucralfate

C.Emergency distal pancreatectomy

D.Vagotomy and subtotal jejunal resection

Explanation: Marginal ulceration post-RYGB occurs at or adjacent to the gastrojejunal anastomosis, most commonly driven by mucosal ischemia, acid exposure, NSAID use, and cigarette smoking. First-line management involves strict cessation of NSAIDs and smoking, coupled with high-dose proton pump inhibitor (PPI) therapy and sucralfate. Surgery is reserved for perforation, bleeding refractory to endoscopic intervention, or dense stricture formation.

8A 30-year-old male is brought to the emergency department after accidental ingestion of industrial liquid sodium hydroxide (caustic lye). He has odynophagia and oral mucosal burns. What is the recommended timing for diagnostic flexible upper gastrointestinal endoscopy?

A.Immediately within 1 hour without airway assessment

B.Between 12 and 48 hours post-ingestion after airway stabilization

C.Between 7 and 14 days post-ingestion to allow tissue sloughing

D.At 6 weeks post-ingestion to evaluate stricture formation

Explanation: Early diagnostic endoscopy following corrosive ingestion should be performed between 12 and 48 hours after ingestion, provided the patient is hemodynamically stable and the airway is secured. Performing endoscopy within this window allows accurate Zargar grading of mucosal injury while minimizing perforation risk (which increases dramatically after 48 hours due to tissue softening and necrosis during days 3–14).

9A 65-year-old man presents with massive, painless upper gastrointestinal bleeding. Urgent upper endoscopy demonstrates an aberrantly large, tortuous submucosal arteriole protruding through normal-appearing gastric mucosa on the lesser curvature near the cardia, with active spurting hemorrhage. What is the diagnosis?

A.Dieulafoy lesion

B.Watermelon stomach (Gastric Antral Vascular Ectasia)

C.Mallory-Weiss tear

D.Cameron lesion

Explanation: A Dieulafoy lesion is a large-caliber, dysplastic submucosal artery that fails to branch normally and erodes through mucosal epithelium into the lumen, typically along the proximal lesser curvature of the stomach. It manifests as severe, recurrent, pulsatile bleeding through otherwise normal gastric mucosa. Management involves endoscopic haemostasis (hemoclips, thermocoagulation, or band ligation).

10A 50-year-old male with a 15-year history of refractory duodenal ulcer disease presents with persistent non-bilious vomiting, dehydration, and hypochloremic hypokalemic metabolic alkalosis. Saline loading test confirms gastric outlet obstruction. CT scan shows chronic scarring without malignancy. After medical resuscitation and PPI therapy, definitive surgical management is planned. What is the traditional surgical option of choice?

A.Total gastrectomy with Roux-en-Y reconstruction

B.Truncal vagotomy and antrectomy (or truncal vagotomy with drainage/gastrojejunostomy)

C.Omental patch repair (Graham patch)

D.Endoscopic balloon dilation alone as sole permanent therapy

Explanation: Chronic peptic gastric outlet obstruction due to scarring and fibrosis that fails endoscopic balloon dilatation requires surgical decompression and acid-reduction. Truncal vagotomy with antrectomy (Billroth I or II) or truncal vagotomy with gastrojejunostomy provides effective drainage and lowers ulcer recurrence. Graham patch is for acute perforations, not chronic outlet obstruction.

About the FCS(SA) Final Exam

The FCS(SA) Final is the exit fellowship examination for general surgeons in South Africa, conferring specialist registration with the Health Professions Council of South Africa (HPCSA). The examination tests comprehensive clinical, operative, and decision-making skills in upper GI, colorectal, HPB, vascular, breast & endocrine, surgical oncology, severe trauma, surgical critical care, and laparoscopic surgery.

Assessment

Written Paper 1 (Principles and Practice of General Surgery), Written Paper 2 (Specialised & Emergency General Surgery), clinical patient examinations, and viva voce.

Time Limit

Two 3-hour written papers plus clinical and oral examinations

Passing Score

Overall 50% with written subminimum

Exam Fee

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

FCS(SA) Final Exam Content Outline

15%

Upper Gastrointestinal Surgery

Oesophageal carcinoma, GERD/hiatal hernia, peptic ulcer disease, gastric cancer, motility disorders, bariatric surgical emergencies, and upper GI bleeding.

15%

Colorectal Surgery & Proctology

Colorectal adenocarcinoma, inflammatory bowel disease (Crohn's, UC), acute diverticulitis, intestinal obstruction, pelvic floor disorders, and anorectal conditions.

15%

Hepatobiliary & Pancreatic (HPB) Surgery

Gallstone disease, choledocholithiasis, cholangitis, acute and chronic pancreatitis, pancreatic adenocarcinoma, hepatocellular carcinoma, and liver metastases.

12%

Vascular Surgery

Abdominal aortic aneurysm (ruptured & elective), acute limb ischaemia, chronic limb-threatening ischaemia, carotid artery stenosis, vascular trauma, and DVT/VTE management.

12%

Breast & Endocrine Surgery

Invasive breast cancer, ductal carcinoma in situ, thyroid nodules and carcinoma, hyperparathyroidism, adrenal tumours, and MEN syndromes.

10%

Surgical Oncology & Soft Tissue

Soft tissue sarcoma, cutaneous melanoma, peritoneal surface malignancies, retroperitoneal masses, oncologic staging, and multidisciplinary treatment principles.

13%

Severe Trauma & Surgical Critical Care

ATLS principles, damage control laparotomy, penetrating abdominal/thoracic trauma, abdominal compartment syndrome, sepsis/septic shock, and ventilator management.

Laparoscopic & Minimally Invasive Surgery

Laparoscopic complications, pneumoperitoneum physiology, laparoscopic hernia repair (TAPP/TEP), minimally invasive resection, and energy device safety.

How to Pass the FCS(SA) Final Exam

What You Need to Know

Passing score: Overall 50% with written subminimum
Assessment: Written Paper 1 (Principles and Practice of General Surgery), Written Paper 2 (Specialised & Emergency General Surgery), clinical patient examinations, and viva voce.
Time limit: Two 3-hour written papers plus clinical and 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

FCS(SA) Final Study Tips from Top Performers

1Master evidence-based clinical algorithms for acute surgical emergencies, including acute pancreatitis, bowel ischemia, and ruptured AAA.

2Review surgical anatomy and surgical techniques for major procedures (Siewert classification for EGJ cancer, TME for rectal cancer, Whipple procedure steps, TAPP/TEP groin hernia).

3Understand damage control surgery resuscitation principles, trauma protocols (massive transfusion protocol, resuscitative thoracotomy), and critical care management of septic shock.

Frequently Asked Questions

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

The examination comprises two written papers (Paper 1 Principles and Paper 2 Specialised General Surgery), followed by clinical case examinations (long case and short cases) and viva voce oral examinations.

What is the pass mark for the FCS(SA) Final?

The overall passing score is 50% with a mandatory subminimum score across the written component to qualify for the clinical and viva examinations.

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

The examination fee is R21 500 as listed on the Colleges of Medicine of South Africa (CMSA) portal.

What are the entry prerequisites for the FCS(SA) Final examination?

Candidates must have passed the FCS(SA) Primary and Intermediate examinations, completed a minimum of 48 months in an accredited registrar post, submitted an approved research component/MMed dissertation, and presented a certified logbook.

100+ Free FCS(SA) Final Practice Questions

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