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100+ Free CMSA H Dip Surg(SA) Practice Questions

Pass your Higher Diploma in Surgery of the College of Surgeons of South Africa [H Dip Surg(SA)] exam on the first try — instant access, no signup required.

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2026 Statistics

Key Facts: CMSA H Dip Surg(SA) Exam

100

Practice Questions

za-cmsa-hdip-surg Question Bank

50%

Passing Mark

Aggregated overall CMSA examination mark

R 22,500

Exam Fee

College of Surgeons of South Africa (CMSA)

2 Years

In-Service Training

6 mo trauma + 18 mo surgery requirement

5

Assessment Components

Portfolio (20%), Paper 1 (20%), Paper 2 (20%), Oral 1 (15%), Oral 2 (15%)

The CMSA H Dip Surg(SA) is a postgraduate diploma awarded by the College of Surgeons of South Africa. The examination consists of two written papers (Paper 1 & Paper 2), a clinical/oral OSCE component, and portfolio evaluation. An aggregated overall mark of 50% is required to pass. The examination fee is approximately R 22,500. This practice bank provides 100 high-yield, guideline-aligned multiple-choice questions adapted for exam preparation.

Sample CMSA H Dip Surg(SA) Practice Questions

Try these sample questions to test your CMSA H Dip Surg(SA) 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 man with well-controlled type 2 diabetes mellitus (HbA1c 6.8%) and no end-organ damage is scheduled for an elective laparoscopic cholecystectomy. According to the American Society of Anesthesiologists (ASA) Physical Status Classification System, what is his correct preoperative classification?
A.ASA Physical Status I
B.ASA Physical Status II
C.ASA Physical Status III
D.ASA Physical Status IV
Explanation: ASA Class II is defined as a patient with mild systemic disease without substantive functional limitations, such as well-controlled diabetes mellitus, well-controlled hypertension, or mild lung disease. ASA Class I represents a completely healthy patient, whereas ASA Class III involves severe systemic disease with functional limitations (e.g., poorly controlled diabetes or end-organ damage). ASA Class IV represents severe systemic disease that is a constant threat to life.
2In accordance with Surgical Care Improvement Project (SCIP) guidelines and standard surgical antimicrobial prophylaxis protocols, when should intravenous Cefazolin be administered prior to elective abdominal surgery?
A.2 to 3 hours before skin incision in the preoperative holding area
B.Within 60 minutes prior to skin incision, ideally during anesthesia induction
C.Immediately after skin incision once surgical access is established
D.At the time of skin closure in the operating theatre
Explanation: Antimicrobial prophylaxis with beta-lactam antibiotics such as Cefazolin should be administered within 60 minutes before skin incision (ideally at anesthesia induction) to establish tissue drug concentrations exceeding minimum inhibitory concentrations (MIC) when incision occurs. Administering prophylaxis too early (>60 min) results in suboptimal tissue levels during surgery, while administration after incision significantly increases surgical site infection (SSI) rates. Vancomycin or fluoroquinolones are exceptions requiring administration within 120 minutes due to longer infusion times.
3A 68-year-old woman undergoing elective open anterior resection for rectal carcinoma has a calculated Caprini score of 6 (high risk for venous thromboembolism). Assuming no active bleeding or high bleeding risk, what is the recommended VTE prophylaxis strategy?
A.Early ambulation alone without mechanical or pharmacological prophylaxis
B.Intermittent pneumatic compression (IPC) devices alone
C.Combined pharmacological prophylaxis (LMWH) and mechanical prophylaxis (IPC)
D.Unfractionated heparin 10,000 units subcutaneously three times daily alone
Explanation: For surgical oncology patients undergoing major abdominal/pelvic surgery with a high Caprini risk score (≥5), guidelines strongly recommend dual VTE prophylaxis combining pharmacological prophylaxis (Low Molecular Weight Heparin [LMWH] such as Enoxaparin 40 mg daily) and mechanical prophylaxis (Intermittent Pneumatic Compression [IPC]). Dual prophylaxis provides synergistic protection against deep vein thrombosis (DVT) and pulmonary embolism (PE). Post-discharge extended LMWH prophylaxis for 4 weeks is also recommended in abdominal/pelvic cancer surgery.
4Which serum protein marker has the shortest half-life (approximately 2 to 3 days) and serves as the most sensitive indicator of acute changes in nutritional status during nutritional support in surgical patients?
A.Serum Albumin
B.Serum Transferrin
C.Serum Prealbumin (Transthyretin)
D.Retinol-Binding Protein
Explanation: Prealbumin (also known as Transthyretin) has a short half-life of 2 to 3 days and a small pool size, making it the most sensitive laboratory marker for monitoring recent changes in visceral protein synthesis and response to nutritional therapy. Serum albumin has a long half-life of 18 to 20 days and is strongly influenced by intravascular volume status, capillary leak, and hepatic acute-phase response, making it a poor indicator of short-term nutritional changes.
5A severely malnourished surgical patient with chronic intestinal obstruction is started on high-calorie total parenteral nutrition (TPN). On day 2, he develops confusion, muscle weakness, and ventricular arrhythmias. Which electrolyte abnormality is the cardinal hallmark of refeeding syndrome?
A.Severe Hypophosphatemia
B.Severe Hyperkalemia
C.Severe Hypercalcemia
D.Severe Hypernatremia
Explanation: Severe hypophosphatemia is the classic hallmark of refeeding syndrome. When carbohydrates are reintroduced in a starved/malnourished patient, insulin secretion is stimulated, driving glucose, phosphate, potassium, and magnesium into cells to support glycolysis and ATP production. This rapid intracellular shift causes severe extracellular drop in phosphate, leading to cardiac arrhythmias, respiratory muscle failure, muscle weakness, seizure, and death. Thiamine deficiency must also be co-treated.
6A patient undergoing major emergency laparotomy receives 6 liters of 0.9% Normal Saline for intraoperative fluid resuscitation. Postoperative arterial blood gas reveals pH 7.26, Chloride 118 mmol/L, and HCO3 16 mmol/L with a normal anion gap. What is the mechanism of this acid-base disturbance?
A.Lactic acidosis secondary to tissue hypoperfusion
B.Hyperchloremic metabolic acidosis due to high chloride load relative to plasma
C.Respiratory acidosis caused by hypoventilation
D.Metabolic alkalosis caused by sodium retention
Explanation: 0.9% Normal Saline contains 154 mmol/L of Na+ and 154 mmol/L of Cl-, which is significantly higher than physiological plasma chloride (98-106 mmol/L). Infusing large volumes of 0.9% saline delivers a massive chloride load, causing renal bicarbonate excretion and dilution of plasma bicarbonate, resulting in hyperchloremic non-anion gap metabolic acidosis. Balanced salt solutions (such as Ringer's Lactate or Plasmalyte) reduce this risk.
7Ten minutes after commencing a unit of packed red blood cells (PRBCs) during an elective hip replacement, the awake patient complains of retrosternal chest pain, flank pain, dyspnea, and chills. Vital signs show SBP 80/50 mmHg, HR 125 bpm, and temperature 38.8 C. Dark red urine is noted in the Foley catheter. What is the immediate priority?
A.Stop the transfusion immediately and maintain IV access with normal saline
B.Administer IV diphenhydramine and slow the transfusion rate
C.Administer IV furosemide and continue the transfusion with blood warmer
D.Send a repeat blood sample for crossmatch while continuing the infusion
Explanation: The clinical presentation (flank pain, fever, hypotension, dyspnea, hemoglobinuria) is pathognomonic for an acute intravascular hemolytic transfusion reaction, usually caused by ABO incompatibility. The most critical immediate action is to stop the transfusion instantly to prevent further red cell lysis, preserve IV line with 0.9% saline, notify blood bank, and initiate aggressive IV hydration to prevent acute tubular necrosis from free hemoglobin.
8A 58-year-old man develops a temperature of 38.3 C on postoperative day 1 following an open upper abdominal surgery. He is comfortable, oxygen saturation is 94% on room air, surgical incision is clean, and physical exam demonstrates decreased breath sounds with fine crackles at both lung bases. What is the most likely etiology of his fever?
A.Atelectasis
B.Urinary tract infection
C.Surgical site infection
D.Deep vein thrombosis
Explanation: Atelectasis is the most common cause of early postoperative fever occurring in the first 24 to 48 hours (POD 1-2). Abdominal surgery impairs diaphragmatic movement and leads to shallow breathing, alveolar collapse, and low-grade pyrexia. Early mobilization, deep breathing exercises, and incentive spirometry are effective interventions. UTIs typically occur POD 3, SSIs POD 5-7, and DVTs POD 7-10.
9A 62-year-old patient with a history of coronary artery stent placement 3 years ago is scheduled for elective major colectomy. How many days prior to surgery should Clopidogrel (Plavix) be routinely discontinued to allow adequate recovery of platelet function?
A.1 day
B.3 days
C.5 days
D.14 days
Explanation: Clopidogrel is an irreversible P2Y12 platelet adenosine diphosphate (ADP) receptor inhibitor. To ensure recovery of adequate functional circulating platelets (platelet lifespan is 7-10 days), Clopidogrel should be held for 5 days prior to elective surgery. Aspirin may be continued in select high cardiac risk patients, but P2Y12 inhibitors increase perioperative surgical bleeding if not held for 5 days (Ticagrelor 3-5 days, Prasugrel 7 days).
10A postoperative renal transplant patient develops serum potassium of 7.1 mmol/L. ECG demonstrates tall peaked T waves and widening of the QRS complex. What is the immediate first-line intravenous medication administered to stabilize cardiac membranes?
A.Sodium Bicarbonate 8.4%
B.10% Calcium Gluconate
C.Insulin 10 units IV with 50 mL 50% Dextrose
D.Sodium Polystyrene Sulfonate (Kayexalate)
Explanation: Intravenous Calcium Gluconate (10 mL of 10% solution over 2-5 minutes) is the vital first-line treatment for severe hyperkalemia with ECG changes. Calcium antagonizes the membrane depolarizing effects of hyperkalemia and stabilizes cardiac myocytes within 1 to 3 minutes, preventing fatal ventricular arrhythmias. It does not lower serum potassium; shift agents (insulin/dextrose, salbutamol) and elimination agents (furosemide, resins, dialysis) must follow immediately.

About the CMSA H Dip Surg(SA) Exam

The Higher Diploma in Surgery of the College of Surgeons of South Africa [H Dip Surg(SA)] is a prestigious postgraduate diploma designed to certify competence in general surgical principles, emergency surgery, trauma care, surgical critical care, and essential minor procedures. Candidates complete 2 years of accredited clinical in-service training (6 months trauma/ICU and 18 months surgery) and submit a verified surgical logbook. Note: The practice multiple-choice questions provided in this study bank represent an English-language study adaptation designed to assist candidates in preparing for the written and clinical assessments of the official CMSA examination.

Questions

100 scored questions

Time Limit

2 written papers (~3 hrs each) + Clinical/OSCE

Passing Score

50% overall aggregated mark

Exam Fee

R 22,500 (College of Surgeons of South Africa (CMSA))

CMSA H Dip Surg(SA) Exam Content Outline

~25%

General Surgical Principles & Perioperative Care

Covers preoperative physical risk assessment (ASA, RCRI), fluid and electrolyte balance (crystalloids, Plasmalyte, hyperchloremic acidosis), blood transfusion reactions (TRALI, acute hemolytic), antibiotic prophylaxis (cefazolin timing), VTE prophylaxis (Caprini score, LMWH), ERAS protocols, refeeding syndrome management, local anesthetic systemic toxicity (LAST), and postoperative fever workup.

~25%

Trauma & Emergency Surgery

Focuses on ATLS 10th edition primary/secondary survey, tension pneumothorax, massive hemothorax, cardiac tamponade, damage control resuscitation, massive transfusion protocol (1:1:1 ratio, TXA within 3 hours), FAST scan, pelvic binder for unstable pelvic fractures, AAST organ injury scaling (liver, spleen, kidney), extremity compartment syndrome, and severe burn resuscitation (Parkland formula).

~25%

Abdominal & Gastrointestinal Surgery

Encompasses small bowel obstruction, acute appendicitis, acute cholecystitis (Tokyo Guidelines 2018), perforated peptic ulcer (Graham patch repair), acute pancreatitis (revised Atlanta classification), diverticulitis (Hinchey classification), sigmoid and cecal volvulus, acute mesenteric ischemia, colorectal cancer, total mesorectal excision (TME), and bariatric surgery complications.

~15%

Surgical Critical Care & Shock

Includes classification and management of shock (hypovolemic, septic, cardiogenic, obstructive), Surviving Sepsis Campaign 2021 hour-1 bundle, norepinephrine vasopressor therapy, mechanical ventilation in ARDS (low tidal volume 6 mL/kg IBW, prone positioning), abdominal compartment syndrome (WSACS guidelines), acute kidney injury (KDIGO, CRRT), ICU delirium (CAM-ICU), and CLABSI/VAP prevention.

~10%

Minor Surgical Procedures & Local Anesthesia

Details local anesthetic pharmacology (lidocaine, bupivacaine, epinephrine additives and safety limits), digital ring block technique, abscess incision and drainage principles, excision of benign and malignant cutaneous lesions (BCC, SCC, melanoma margins), ingrowing toenail matricectomy, and skin graft take mechanics.

How to Pass the CMSA H Dip Surg(SA) Exam

What You Need to Know

  • Passing score: 50% overall aggregated mark
  • Exam length: 100 questions
  • Time limit: 2 written papers (~3 hrs each) + Clinical/OSCE
  • Exam fee: R 22,500

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 H Dip Surg(SA) Study Tips from Top Performers

1Master ATLS 10th Edition trauma algorithms: Always prioritize airway with cervical spine protection, breathing (needle decompression for tension pneumothorax), circulation (1:1:1 blood products, TXA within 3 hours), disability (GCS), and exposure. Memorize Parkland formula for burn resuscitation: 4 mL x kg x %TBSA in 24 hours.
2Know perioperative antibiotic and VTE prophylaxis rules: Cefazolin should be administered within 60 minutes prior to surgical incision and re-dosed every 4 hours or after 1500 mL blood loss. Caprini score determines LMWH timing.
3Understand acute abdomen management: Differentiate SBO (adhesions) from mechanical volvulus (sigmoid decompression vs cecal emergency resection). Memorize Hinchey classification for diverticulitis and Tokyo 2018 guidelines for acute cholecystitis.
4Review Surviving Sepsis Campaign 2021: Hour-1 bundle requires measuring lactate, taking blood cultures prior to antibiotics, initiating broad-spectrum IV antibiotics, giving 30 mL/kg crystalloids for hypotension/lactate ≥4, and using norepinephrine for target MAP ≥65 mmHg.
5Understand local anesthesia safe dosages: Lidocaine plain max 4.5 mg/kg, Lidocaine with epinephrine max 7 mg/kg, Bupivacaine plain max 2 mg/kg. Recognize LAST early and know lipid emulsion 20% rescue therapy.

Frequently Asked Questions

What is the H Dip Surg(SA) credential?

The Higher Diploma in Surgery [H Dip Surg(SA)] is a postgraduate diploma conferred by the College of Surgeons of South Africa (CMSA). It validates advanced competence in general surgical principles, trauma management, emergency surgery, critical care, and minor surgical procedures for medical practitioners operating in South Africa and regional healthcare systems.

What are the entry and training requirements for H Dip Surg(SA)?

Candidates must hold an MBChB or equivalent medical degree registered with the HPCSA and complete 2 years of full-time accredited in-service training. This training must include 6 months in trauma (with ICU exposure) and 18 months in surgery (with at least 12 months in general surgery). Candidates must also maintain a signed CMSA surgical logbook and hold a valid ATLS certificate.

What is the structure of the CMSA H Dip Surg(SA) examination?

The examination comprises two written papers (Paper 1 and Paper 2), a clinical/oral assessment (such as an OSCE), and evaluation of the candidate's surgical portfolio. The overall mark is weighted: Portfolio (20%), Paper 1 (20%), Paper 2 (20%), Oral 1 (15%), and Oral 2 (15%).

What is the passing score for H Dip Surg(SA)?

Candidates must achieve an overall aggregated mark of 50% or higher across all examination components (portfolio, written papers, and clinical/oral examinations) to be awarded the diploma.

How much is the examination fee for 2026?

The examination fee set by the CMSA is approximately R 22,500. Candidates should verify the exact fee for the current academic session on the official CMSA website (cmsa.co.za).

How are these practice questions structured?

This practice question bank contains 100 single-best-answer multiple-choice questions (MCQs) mapped to the 5 official CMSA H Dip Surg(SA) content domains. Each question features 4 options, a detailed clinical explanation, and rationale for all incorrect options. Note: These local MCQs are an English-language study adaptation to assist candidates preparing for the official CMSA assessment.