100+ Free CMSA Intermediate Surgery Practice Questions

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2026 Statistics

Key Facts: CMSA Intermediate Surgery Exam

240

Total Written MCQs

CMSA FCS(SA) Intermediate Written Examination (120 per paper)

6 hours

Total Written Exam Time

Two 3-hour written MCQ sessions

≥50%

Required Pass Mark Per Paper

CMSA College of Surgeons Regulations

R17,350

2026 Examination Fee

CMSA Official Fee Schedule

12 Months

Min Approved Surgical Training

6 mo Gen Surg, 3 mo ICU, 3 mo Trauma

6 Years

Pass Result Validity

CMSA Fellowship Regulations

The CMSA FCS(SA) Intermediate Examination in Surgery assesses core principles of general surgery and surgical specialties for South African surgical registrars. The written assessment comprises two 3-hour single-best-answer MCQ papers (120 questions each, total 240 questions) requiring a minimum score of 50% per paper to qualify for oral/OSCE components. Exam fee is R17,350.

Sample CMSA Intermediate Surgery Practice Questions

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

1A 55-year-old postoperative male patient following an emergency laparotomy develops asymptomatic mild hyponatremia with a serum sodium level of 131 mmol/L on postoperative day 2. He is euvolemic on clinical examination. What is the most appropriate initial management?

A.Infusion of 3% hypertonic saline at 50 mL/h

B.Restriction of hypotonic intravenous fluid administration and clinical monitoring

C.Immediate administration of intravenous furosemide 40 mg

D.Administration of oral sodium chloride tablets 2 g three times daily

Explanation: Mild asymptomatic postoperative hyponatremia (130-134 mmol/L) is most commonly caused by non-osmotic release of anti-diuretic hormone (SIADH-like response) triggered by pain, surgical stress, and administration of hypotonic IV fluids. The appropriate management is restriction of hypotonic fluids and serial monitoring of electrolytes. Hypertonic saline (3%) is reserved for severe symptomatic hyponatremia (e.g., seizures, coma) to avoid osmotic demyelination syndrome.

2A 68-year-old female patient in the surgical ICU develops severe hyperkalemia with a serum potassium of 6.8 mmol/L following repair of a ruptured abdominal aortic aneurysm. Her ECG displays peaked T waves and widening of the QRS complex. What is the immediate first step in medical management?

A.Intravenous administration of 10 mL 10% calcium gluconate over 2 to 5 minutes

B.Intravenous bolus of 10 units regular insulin with 50 mL 50% dextrose

C.Nebulized salbutamol 10 mg

D.Emergency hemodialysis

Explanation: Intravenous calcium gluconate (or calcium chloride) antagonizes the membrane excitability effects of hyperkalemia on cardiac myocytes, stabilizing the cardiac membrane within minutes without shifting serum potassium. It is the immediate first step when ECG changes (peaked T waves, QRS widening) are present. Insulin with dextrose and beta-2 agonists drive potassium intracellularly but do not provide immediate myocardial stabilization.

3A 42-year-old female patient develops perioral numbness, carpopedal spasm, and a positive Chvostek sign 36 hours after total thyroidectomy for retrosternal multinodular goiter. Her corrected serum calcium is 1.72 mmol/L (normal 2.15–2.55 mmol/L). What is the most appropriate emergency therapy?

A.Oral calcium carbonate 1,500 mg daily plus oral calcitriol 0.5 mcg daily

B.Slow intravenous infusion of 10 mL 10% calcium gluconate diluted in 100 mL 5% dextrose over 10 to 15 minutes

C.Intravenous magnesium sulfate 2 g bolus over 1 hour

D.Subcutaneous recombinant human parathyroid hormone (rhPTH)

Explanation: Acute symptomatic hypocalcemia post-thyroidectomy presents with neuromuscular irritability (tetany, Trousseau/Chvostek signs) and requires immediate slow IV calcium gluconate to prevent laryngospasm or cardiac dysrhythmias. Oral calcium and calcitriol are added for maintenance therapy once acute symptoms resolve. Checking and correcting concurrent hypomagnesemia is important, but IV calcium is the direct emergency treatment.

4Arterial blood gas analysis of a 30-year-old polytrauma patient in hemorrhagic shock reveals: pH 7.22, PaCO2 30 mmHg, PaO2 92 mmHg, HCO3- 12 mmol/L, Base Excess -14 mmol/L, Na+ 138 mmol/L, Cl- 102 mmol/L. What is the primary acid-base disorder and calculated anion gap?

A.High anion gap metabolic acidosis; Anion gap = 24 mmol/L

B.Normal anion gap (hyperchloremic) metabolic acidosis; Anion gap = 12 mmol/L

C.Primary respiratory acidosis with metabolic compensation; Anion gap = 18 mmol/L

D.Mixed metabolic acidosis and respiratory acidosis; Anion gap = 30 mmol/L

Explanation: The pH is acidemic (< 7.35) with a low HCO3- (12 mmol/L), indicating primary metabolic acidosis. The PaCO2 (30 mmHg) is decreased due to respiratory compensation (Winter's formula expected PaCO2 = 1.5 x 12 + 8 ± 2 = 26 mmol/L). Anion gap = Na - (Cl + HCO3) = 138 - (102 + 12) = 24 mmol/L (elevated above normal 8-12 mmol/L), driven by lactic acidosis from tissue hypoperfusion.

5A 3-week-old male infant presents with non-bilious projectile vomiting, dehydration, and a palpable olive-shaped right upper quadrant mass. Which metabolic abnormality is classic for this condition?

A.Hypochloremic, hypokalemic metabolic alkalosis with paradoxical aciduria

B.Hyperchloremic, hyperkalemic metabolic acidosis

C.High anion gap metabolic acidosis with ketonuria

D.Normochloremic metabolic alkalosis with hyperkalemia

Explanation: Infantile hypertrophic pyloric stenosis causes persistent loss of gastric juice rich in hydrochloric acid and potassium. This produces a hypochloremic, hypokalemic metabolic alkalosis. As volume depletion progresses, aldosterone stimulation leads to renal sodium resorption at the expense of H+ excretion in urine, causing paradoxical aciduria. Resuscitation with normal saline is mandatory prior to surgery.

6A severely malnourished 45-year-old chronic alcoholic male is re-fed aggressively with high-carbohydrate total parenteral nutrition (TPN). On day 3, he develops severe muscle weakness, cardiac arrhythmias, and confusion. Which electrolyte deficiency is the hallmark of refeeding syndrome?

A.Hypophosphatemia

B.Hypermagnesemia

C.Hypercalcemia

D.Hypernatremia

Explanation: Refeeding syndrome occurs when carbohydrate administration triggers insulin surge in malnourished patients. Insulin drives glucose, phosphate, potassium, and magnesium into cells, causing rapid severe hypophosphatemia. Severe hypophosphatemia leads to ATP depletion, cardiac failure, neuromuscular weakness, and hematologic dysfunction. Thiamine deficiency must also be co-treated.

7A 60-year-old male receives total parenteral nutrition (TPN) for 6 weeks via a central venous catheter due to an enterocutaneous fistula. Which hepatic complication is most specifically associated with long-term TPN therapy?

A.Steatosis, cholestasis, and biliary sludging/acalculous cholecystitis

B.Acute hepatic necrosis with elevated transaminases > 5,000 U/L

C.Hepatic vein thrombosis (Budd-Chiari syndrome)

D.Cirrhosis with portal hypertension within 4 weeks

Explanation: Long-term TPN deprives the gut of luminal nutrients, abolishing CCK release and leading to gallbladder stasis, biliary sludge formation, acalculous cholecystitis, hepatic steatosis, and cholestasis. Cyclic TPN infusion and early minimal enteral nutrition help mitigate TPN-associated liver dysfunction.

8Comparing normal saline (0.9% NaCl) to balanced crystalloids (such as Ringer's Lactate or Plasmalyte) for large-volume fluid resuscitation in septic shock, what is a major adverse consequence of high-volume normal saline administration?

A.Hyperchloremic metabolic acidosis and renal vasoconstriction leading to acute kidney injury

B.Severe metabolic alkalosis with hypokalemia

C.Hyperkalemic metabolic acidosis

D.Hypo-osmolar cerebral edema

Explanation: 0.9% Normal Saline has a high chloride concentration (154 mmol/L) relative to plasma (100 mmol/L). Large-volume administration causes hyperchloremic metabolic acidosis, decreases renal cortical perfusion due to chloride-induced renal vasoconstriction, and increases the risk of acute kidney injury and renal replacement therapy compared to balanced crystalloids.

9During the acute neuroendocrine stress response following major surgical trauma, which hormonal alterations characteristically occur?

A.Increased ACTH, cortisol, glucagon, and catecholamines with suppression of insulin sensitivity

B.Decreased cortisol, increased insulin, and suppressed growth hormone

C.Increased insulin, decreased glucagon, and decreased epinephrine

D.Suppression of aldosterone and antidiuretic hormone (ADH)

Explanation: Surgical stress stimulates the sympathetic nervous system and hypothalamic-pituitary-adrenal axis, elevating ACTH, cortisol, catecholamines (epinephrine/norepinephrine), and glucagon. This counter-regulatory hormone response mobilizes energy substrate and causes peripheral insulin resistance, resulting in stress hyperglycemia and protein catabolism.

10A 52-year-old male with a high-output ileostomy (2,500 mL/day) presents with lethargy, poor skin turgor, and blood pressure 90/60 mmHg. ABG shows pH 7.28, HCO3- 14 mmol/L, Na+ 132 mmol/L, K+ 3.1 mmol/L, Cl- 110 mmol/L. What is the mechanism of his acid-base disturbance?

A.Direct gastrointestinal loss of bicarbonate-rich intestinal fluid resulting in normal anion gap metabolic acidosis

B.Retention of carbon dioxide due to hypoventilation causing respiratory acidosis

C.Accumulation of unmeasured organic acids causing high anion gap metabolic acidosis

D.Renal tubular loss of hydrogen ions leading to metabolic alkalosis

Explanation: Ileostomy fluid is rich in sodium, potassium, and bicarbonate. High-output losses result in direct GI loss of HCO3-, producing a normal anion gap (hyperchloremic) metabolic acidosis (Anion gap = 132 - (110 + 14) = 8 mmol/L). Management includes volume replacement, potassium/bicarbonate repletion, and antimotility agents.

About the CMSA Intermediate Surgery Exam

The FCS(SA) Intermediate Examination in Surgery is administered by the College of Surgeons of South Africa (CMSA) as a requirement for surgical registrars progressing toward fellowship certification. The written component consists of two 3-hour single-best-answer MCQ papers: Paper 1 covers Principles of Surgery in General (~50% weighting, including fluids/electrolytes, wound healing, surgical infection, oncology, immunology, and surgical critical care), and Paper 2 covers Principles of Surgical Specialties (~50% weighting, including vascular, cardiothoracic, paediatric surgery, neurosurgery, urology, plastic surgery, and orthopaedics). Candidates scoring at least 50% on each written paper proceed to the clinical OSCE and paper case examinations. Note: This practice question bank is an English-language study aid adapted for MCQ prep for the official CMSA FCS(SA) Intermediate Examination.

Questions

240 scored questions

Time Limit

6 hours (Two 3-hour MCQ papers)

Passing Score

≥50% mark per written paper

Exam Fee

R17,350 (CMSA fee schedule) (College of Surgeons of South Africa (CMSA))

CMSA Intermediate Surgery Exam Content Outline

~12%

Fluids, Electrolytes & Metabolic Response

Surgical fluid management, severe electrolyte derangements, acid-base disorders, TPN and enteral nutrition, refeeding syndrome, and surgical endocrine-metabolic stress response.

~12%

Wound Healing, Infection & Sepsis

Phases of wound repair, hypertrophic/keloid scarring, surgical site infection prophylaxis, necrotizing soft tissue infections (LRINEC score), tetanus management, and Surviving Sepsis Campaign guidelines.

~10%

Surgical Oncology, Immunology & Organ Transplant

Tumor biology, AJCC TNM staging, surgical resection margins, sentinel lymph node concept, graft rejection mechanisms, immunosuppressants, and brain death criteria.

~16%

Perioperative Care & Surgical Critical Care

Cardiac and pulmonary preop risk stratification, blood component therapy and massive transfusion protocol (1:1:1), ARDS ventilation (6 mL/kg IBW), acute kidney injury, abdominal compartment syndrome, and ERAS protocols.

~10%

Vascular & Endovascular Surgery Principles

AAA screening and repair criteria, acute limb ischemia 6 Ps, Rutherford classification, chronic limb-threatening ischemia, carotid endarterectomy, aortic dissection, mesenteric ischemia, and AV fistula creation.

~8%

Cardiothoracic Surgery Principles

Thoracic trauma (tension pneumothorax, flail chest, cardiac tamponade, aortic tear), solitary pulmonary nodule management, lung cancer staging and surgical resection, and empyema decortication.

~8%

Paediatric Surgery Principles

Infantile hypertrophic pyloric stenosis, intussusception reduction, malrotation with midgut volvulus (Ladd procedure), congenital diaphragmatic hernia, TEF/esophageal atresia, Hirschsprung disease, and necrotizing enterocolitis.

~8%

Neurosurgery & Neurotrauma Principles

Glasgow Coma Scale, epidural vs subdural hematoma, intracranial pressure elevation (Monro-Kellie doctrine, CPP targets), subarachnoid hemorrhage, neurogenic shock, and cauda equina syndrome.

~6%

Urology & Renal Surgery Principles

Nephrolithiasis and emergency decompression, testicular torsion, benign prostatic hyperplasia and post-TURP hyponatremia, renal cell carcinoma, and bladder cancer.

~5%

Plastic & Reconstructive Surgery Principles

Burn TBSA and Parkland resuscitation, reconstructive ladder, hand compartment syndrome and escharotomy, and skin cancer surgical excision margins.

~5%

Orthopaedic Surgery & Trauma Principles

Acute lower extremity compartment syndrome (4-compartment fasciotomy), Gustilo-Anderson open fracture management, unstable pelvic fracture resuscitation, fat embolism, and septic arthritis.

How to Pass the CMSA Intermediate Surgery Exam

What You Need to Know

Passing score: ≥50% mark per written paper
Exam length: 240 questions
Time limit: 6 hours (Two 3-hour MCQ papers)
Exam fee: R17,350 (CMSA fee schedule)

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 Intermediate Surgery Study Tips from Top Performers

1Target high-yield critical care topics: ARDS net low tidal volume ventilation (6 mL/kg IBW, plateau pressure < 30 cmH2O), Surviving Sepsis Campaign hour-1 bundle (30 mL/kg crystalloids, norepinephrine target MAP ≥ 65 mmHg), and Massive Transfusion Protocol (1:1:1 plasma:platelets:RBC).

2Master emergency surgical decision making: distinction between acute limb ischemia (6 Ps, immediate heparinization) and chronic limb-threatening ischemia; acute mesenteric ischemia (SMA embolus vs NOMI); and tension pneumothorax decompression (5th intercostal space anterior axillary line).

3Focus on paediatric surgical emergencies: fluid resuscitation in pyloric stenosis (correct hypochloremic hypokalemic metabolic alkalosis with 0.9% saline before surgery); malrotation with midgut volvulus (Ladd procedure); and intussusception air reduction criteria.

4Review neurotrauma and pelvic trauma algorithms: GCS scoring, epidural (middle meningeal artery) vs subdural hematoma, Monro-Kellie doctrine (CPP = MAP - ICP, target CPP 60-70 mmHg), and unstable pelvic fracture management (pelvic binder across greater trochanters, pre-peritoneal packing).

Frequently Asked Questions

What is the CMSA FCS(SA) Intermediate Examination in Surgery?

The FCS(SA) Intermediate Examination is a board examination administered by the College of Surgeons of South Africa (CMSA). It evaluates a surgical registrar's knowledge of the Principles of Surgery in General (Paper 1) and Principles of Surgical Specialties (Paper 2) after completing basic surgical training.

What is the structure and passing mark of the written exam?

The written examination consists of two 3-hour papers containing 120 single-best-answer multiple-choice questions each (total 240 questions). Candidates must achieve a score of at least 50% on Paper 1 AND at least 50% on Paper 2 to qualify for the oral paper case and OSCE clinical examinations.

What are the eligibility requirements for the FCS(SA) Intermediate?

Candidates must have completed the FCS(SA) Primary examination and at least 12 months of approved surgical training, including a minimum of 6 months in General Surgery, 3 months in Intensive Care Unit (ICU), and 3 months in Trauma / Emergency Surgery.

How much is the examination fee?

The current examination fee is R17,350 (inclusive of VAT). Candidates should always verify the latest fee schedule directly on the official CMSA website (www.cmsa.co.za).

Is this question bank an official CMSA resource?

No. This practice question bank is an independent, English-language study adaptation designed for multiple-choice question practice based on the publicly available CMSA FCS(SA) Intermediate blueprint and standard surgical literature.

100+ Free CMSA Intermediate Surgery Practice Questions

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