100+ Free CMSA FCS(SA) Intermediate Practice Questions

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Key Facts: CMSA FCS(SA) Intermediate Exam

2 × 3 h

Online MCQ papers, then paper cases + OSCE

FCS(SA) Regulations Effective FS 2023 §8

≥50%

Required average on each paper (no rounding up)

FCS(SA) Regulations §8.2

R 17 350

Intermediate fee incl. VAT (SS2026/FS2027)

CMSA Exam Fees SS2026/FS2027

6 years

Maximum time from Intermediate pass to Final

FCS(SA) Regulations §1.0

FCS(SA) Intermediate is two CMSA online MCQ papers (3 hours each) plus a performance component (paper cases + OSCE) after ≥50% on each paper. Fee listed as R 17 350 incl. VAT on the SS2026/FS2027 schedule. This free bank offers 100 practice questions split across both official written blueprints.

Sample CMSA FCS(SA) Intermediate Practice Questions

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

1During rapid-sequence intubation of a trauma patient, which manoeuvre is most appropriate for initial airway opening before laryngoscopy?

A.Head-tilt chin-lift in a suspected cervical spine injury

B.Blind nasal intubation as first-line in facial trauma

C.Jaw thrust with manual in-line stabilisation when C-spine injury is possible

D.Immediate surgical cricothyroidotomy without attempting bag-mask ventilation

Explanation: When cervical spine injury is possible, airway opening uses jaw thrust with manual in-line stabilisation rather than head-tilt chin-lift. Bag-mask and planned intubation remain first-line; surgical airway is reserved for failed airway pathways. Blind nasal intubation is relatively contraindicated in midface/basilar skull trauma.

2In a ventilated patient with ARDS, which strategy best reflects lung-protective ventilation principles?

A.Tidal volumes of 12–15 mL/kg actual body weight to prevent atelectasis

B.Zero PEEP to minimise barotrauma in all ARDS patients

C.Tidal volumes of about 6 mL/kg predicted body weight with plateau pressure usually ≤30 cmH2O

D.Mandatory hyperventilation to PaCO2 <25 mmHg regardless of pH

Explanation: ARDSNet-style lung-protective ventilation uses low tidal volumes (~6 mL/kg predicted body weight) and limits plateau pressure (commonly ≤30 cmH2O), with PEEP titrated to oxygenation. High traditional tidal volumes worsen volutrauma; zero PEEP often worsens derecruitment; permissive hypercapnia may be accepted rather than forced extreme hypocapnia.

3Which blood-gas pattern is most consistent with acute hypoventilatory (Type 2) respiratory failure?

A.Low PaO2 with low PaCO2 and respiratory alkalosis

B.Normal PaO2 with metabolic alkalosis only

C.Low PaO2 with raised PaCO2 and respiratory acidosis

D.High PaO2 with low bicarbonate from hyperventilation

Explanation: Type 2 (ventilatory) failure is characterised by hypoxaemia plus hypercapnia from inadequate alveolar ventilation, producing respiratory acidosis. Type 1 failure is hypoxaemia with normal or low PaCO2.

4Which statement best distinguishes hypoxia from hypoxaemia in critical care?

A.Hypoxaemia is inadequate tissue oxygen use; hypoxia is only low PaO2

B.The terms are interchangeable and both mean low FiO2 only

C.Hypoxaemia refers to low arterial oxygen content/PaO2; hypoxia is inadequate tissue oxygenation

D.Hypoxia always implies anaemia whereas hypoxaemia never does

Explanation: Hypoxaemia denotes reduced arterial oxygen tension or content. Hypoxia denotes inadequate oxygen delivery or utilisation at tissue level and may occur with normal PaO2 (e.g., anaemia, low cardiac output, histotoxic hypoxia).

5A postoperative patient develops sudden respiratory distress, SpO2 85% on oxygen, unilateral absent breath sounds and tracheal deviation away from the silent side. The most urgent next step is:

A.Urgent CT chest before any intervention

B.Observation with nasal cannula only

C.Immediate needle decompression / emergency management of tension pneumothorax then definitive chest drain

D.Flexible bronchoscopy as the first intervention

Explanation: Clinical features of tension pneumothorax require immediate decompression without delaying for CT. After emergency decompression, definitive intercostal drain is placed. Bronchoscopy is not first-line for this presentation.

6Which weaning criterion most strongly supports a trial of spontaneous breathing after prolonged mechanical ventilation?

A.FiO2 1.0 with PEEP 15 cmH2O and unstable haemodynamics

B.Adequate oxygenation on modest support, haemodynamic stability, and ability to initiate breaths with manageable secretions

C.Ongoing high-dose vasopressors and deep neuromuscular blockade

D.Persistent GCS 3 without airway reflexes

Explanation: Successful weaning requires adequate gas exchange on reduced support, cardiovascular stability, neurological readiness to protect the airway, and controllable secretions. High FiO2/PEEP, deep paralysis, or unprotected airway argue against weaning.

7A bleeding trauma patient has tachycardia, cool peripheries, narrowed pulse pressure and lactate rising despite crystalloid. Which shock class physiology is most likely?

A.Distributive septic shock as the primary process

B.Cardiogenic shock from primary pump failure without volume loss

C.Hypovolaemic/haemorrhagic shock with inadequate oxygen delivery

D.Neurogenic shock from isolated vasodilation with bradycardia

Explanation: Cool, tachycardic, volume-responsive physiology with rising lactate after haemorrhage indicates hypovolaemic/haemorrhagic shock from inadequate DO2. Septic shock is typically warm/vasodilated early; cardiogenic shock features pump failure; classic neurogenic shock includes hypotension with bradycardia.

8Which agent is primarily a vasopressor increasing systemic vascular resistance rather than a pure inotrope?

A.Noradrenaline (norepinephrine)

B.Dobutamine

C.Milrinone

D.Isoprenaline

Explanation: Noradrenaline predominantly stimulates α1 receptors, raising SVR and supporting blood pressure in vasodilatory shock; it has some β1 effect but is used as a vasopressor. Dobutamine and milrinone are mainly inodilators; isoprenaline is a β agonist increasing heart rate and contractility with vasodilation.

9Elevated serum lactate in haemorrhagic shock is most usefully interpreted as evidence of:

A.Guaranteed irreversible cell death in all tissues

B.Tissue hypoperfusion and anaerobic metabolism; a marker to guide resuscitation endpoints

C.Primary respiratory alkalosis only

D.Exclusive renal failure without circulatory compromise

Explanation: Lactate rises when tissue oxygen delivery is inadequate relative to demand. Serial lactate clearance is used as a resuscitation endpoint, though lactate is not specific and must be interpreted clinically.

10Central venous pressure (CVP) monitoring in the ICU is best described as:

A.A perfect standalone predictor of fluid responsiveness in all patients

B.A direct measure of left ventricular end-diastolic volume

C.A pressure estimate of right atrial filling that must be interpreted with trends and clinical context, not in isolation

D.Unnecessary because pulse oximetry replaces all haemodynamic data

Explanation: CVP approximates right atrial pressure and is influenced by venous tone, RV function, PEEP and measurement technique. Absolute CVP poorly predicts fluid responsiveness; trends plus dynamic indices and clinical assessment are preferred.

About the CMSA FCS(SA) Intermediate Exam

FCS(SA) Intermediate is the Colleges of Medicine of South Africa mid-training examination for the Fellowship of the College of Surgeons. It sits between Primary (applied basic sciences) and Final (specialty theory and practice). Candidates sit two MCQ papers on general surgical critical care/peri-operative principles and cross-specialty emergency principles (≥50% on each paper), then a performance examination of paper cases and OSCE. The Final must be passed within six years of Intermediate. This free bank offers 100 best-of-four practice MCQs weighted to the official Paper 1 and Paper 2 blueprints.

Assessment

Two 3-hour online MCQ papers, then a performance examination for candidates who achieve ≥50% on each paper. Paper 1 tests principles of surgery in general (critical care, trauma, peri-operative care, burns, HIV, infection and research/ethics). Paper 2 tests principles of the surgical specialties (general surgery heavily weighted, plus neurosurgery, ENT, ophthalmology, maxillofacial, orthopaedics, urology, cardiothoracic, vascular, paediatric, plastic, obstetrics & gynaecology, oncology and transplant). MCQ types may include choose-the-best-option and extended matching. Performance: two paper cases (one general, one specialty principles) plus a 20-station OSCE (10+10), per FCS(SA) Regulations Effective FS 2023.

Time Limit

3 hours per MCQ paper; separate performance sitting (paper cases + OSCE)

Passing Score

≥50% on each MCQ paper (no rounding up) to pass written and gain invitation to performance; final mark combines MCQ, paper case and OSCE (~33.3% each) per paper

Exam Fee

R 17 350 including VAT (CMSA SS2026/FS2027 schedule; confirm for your diet) (Colleges of Medicine of South Africa (CMSA), College of Surgeons)

CMSA FCS(SA) Intermediate Exam Content Outline

50%

Paper 1 — Principles of surgery in general

Oxygenation/ventilation, circulation, trauma, inflammatory syndromes, organ dysfunction, endocrine/metabolic, nutrition, peri-operative care, burns, HIV, infection and research/ethics (official Paper 1 SBA weights).

50%

Paper 2 — Principles of surgical specialties

General surgery (32% of Paper 2) plus neurosurgery, ENT, ophthalmology, maxillofacial, orthopaedics, urology, cardiothoracic, vascular, paediatric, plastic, O&G, oncology and transplant principles.

How to Pass the CMSA FCS(SA) Intermediate Exam

What You Need to Know

Passing score: ≥50% on each MCQ paper (no rounding up) to pass written and gain invitation to performance; final mark combines MCQ, paper case and OSCE (~33.3% each) per paper
Assessment: Two 3-hour online MCQ papers, then a performance examination for candidates who achieve ≥50% on each paper. Paper 1 tests principles of surgery in general (critical care, trauma, peri-operative care, burns, HIV, infection and research/ethics). Paper 2 tests principles of the surgical specialties (general surgery heavily weighted, plus neurosurgery, ENT, ophthalmology, maxillofacial, orthopaedics, urology, cardiothoracic, vascular, paediatric, plastic, obstetrics & gynaecology, oncology and transplant). MCQ types may include choose-the-best-option and extended matching. Performance: two paper cases (one general, one specialty principles) plus a 20-station OSCE (10+10), per FCS(SA) Regulations Effective FS 2023.
Time limit: 3 hours per MCQ paper; separate performance sitting (paper cases + OSCE)
Exam fee: R 17 350 including VAT (CMSA SS2026/FS2027 schedule; confirm for your diet)

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

CMSA FCS(SA) Intermediate Study Tips from Top Performers

1Study to the published Paper 1 and Paper 2 blueprints (impact × frequency competence levels), not only Final operative surgery texts.

2After written MCQ mastery, practise paper-case reasoning and OSCE stations—performance contributes equally with each MCQ paper to the final mark.

3Split revision time roughly evenly between Paper 1 critical care/peri-operative topics and Paper 2 specialty emergencies, matching equal paper pass requirements.

4Drill damage-control, massive transfusion, ACS, TBI secondary prevention and airway algorithms—these recur across Paper 1 trauma and Paper 2 specialty items.

5Use Southern African trauma and ICU references (e.g., Handbook of Trauma for Southern Africa; Marino/Oh ICU texts listed in Appendix B) alongside Schwartz/Sabiston principles texts.

Frequently Asked Questions

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

Intermediate comprises two 3-hour MCQ papers on the CMSA online platform (Paper 1: principles of surgery in general; Paper 2: principles of the surgical specialty disciplines), followed by a performance examination of two paper cases and a 20-station OSCE for candidates who achieve ≥50% on each MCQ paper (FCS(SA) Regulations Effective FS 2023). MCQ types may include choose-the-best-option and extended matching.

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

Candidates must achieve at least 50% on each MCQ paper (marks are not rounded up) to pass the written component and be invited to the performance examination. The final mark for each paper combines the MCQ, paper-case and OSCE contributions (each approximately one-third) per the Effective FS 2023 regulations. CMSA also applies an internationally referenced standard-setting process.

How much does FCS(SA) Intermediate cost?

The CMSA examination fee schedule for Second Semester 2026 and First Semester 2027 lists FCS(SA) Intermediate at R 17 350 including VAT (R 15 087 + VAT R 2 263). Always confirm the amount payable on the CMSA examination portal for your diet.

What topics do the official Intermediate blueprints cover?

Paper 1 weights critical care and peri-operative domains (ventilation, circulation, trauma, sepsis/MODS, organ failure, endocrine/metabolic, nutrition, peri-operative care, burns, HIV, infection and research/ethics). Paper 2 weights general surgery most heavily (32%) with remaining items across neurosurgery, ENT, ophthalmology, maxillofacial, orthopaedics, urology, cardiothoracic, vascular, paediatric, plastic, obstetrics & gynaecology, oncology and transplant.