100+ Free Cert Cardiology(SA) Paed Practice Questions

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2026 Statistics

Key Facts: Cert Cardiology(SA) Paed Exam

2 components

Written + oral/OSCE

CMSA Cert Cardiology(SA) Paed Regulations

50% each

Subminimum per component

CMSA Examination Regulations

R24 650

Exam Fee

CMSA SS2026/FS2027 Fee Schedule

50% overall

Pass Mark

CMSA Examination Regulations

CMSA

Exam Body

College of Paediatricians of SA

The Cert Cardiology(SA) Paed is a two-component sub-specialty exit examination (written short-answer papers plus an oral/OSCE/clinical component, each 50%) assessing sub-specialist paediatric cardiology competency for medical doctors completing fellowship training in South Africa.

Sample Cert Cardiology(SA) Paed Practice Questions

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

1A 3-month-old infant with a known perimembranous ventricular septal defect (VSD) is evaluated on follow-up echocardiography. The defect size has decreased from 6 mm to 2 mm. Which anatomical structure is primarily responsible for the spontaneous closure or reduction in size of perimembranous VSDs?

A.Tricuspid valve septal leaflet tissue and pouch formation

B.Hypertrophy of the crista supraventricularis muscle bundle

C.Prolapse of the right coronary cusp of the aortic valve

D.Growth of the muscular ventricular septum

Explanation: Perimembranous VSDs frequently undergo spontaneous closure or size reduction through the adherence of tricuspid valve tissue (specifically the septal leaflet and its chordae), forming a pseudo-aneurysm of the membranous septum. This tissue partially or completely occludes the defect over the first few years of life.

2An asymptomatic 4-year-old child is referred for evaluation of a cardiac murmur discovered during a routine check-up. Auscultation reveals a wide, fixed splitting of the second heart sound (S2) and a 2/6 mid-systolic ejection murmur at the upper left sternal border. What is the underlying cause of the wide, fixed split S2?

A.Delayed closure of the aortic valve during expiration

B.Persistent volume overload of the right ventricle causing delayed closure of the pulmonary valve regardless of respiration

C.Equal right and left ventricular stroke volumes throughout the respiratory cycle

D.Severe pulmonary hypertension delaying the A2 component

Explanation: In an ostium secundum ASD, left-to-right shunting causes chronic right ventricular volume overload. The increased right ventricular stroke volume delays closure of the pulmonary valve (P2). During inspiration, venous return to the RV increases while ASD shunting decreases; during expiration, venous return to the RV decreases while ASD shunting increases. This keeps RV stroke volume and P2 timing constant across respiration, producing a fixed, wide split S2.

3A 28-week premature infant weighing 950 grams develops bounding peripheral pulses, a hyperdynamic precordium, and a continuous machinery murmur at the left infraclavicular area on day 4 of life. Chest radiography shows cardiomegaly and pulmonary plethora. Before initiating intravenous ibuprofen for ductal closure, which clinical condition represents an absolute contraindication?

A.Mild respiratory distress syndrome requiring nasal CPAP

B.Serum bilirubin of 120 micromol/L

C.Active necrotizing enterocolitis (NEC) or intestinal perforation

D.Platelet count of 180,000 /microliter

Explanation: Cyclooxygenase inhibitors (indomethacin and ibuprofen) inhibit prostaglandin synthesis, which can decrease mesenteric and renal blood flow. Absolute contraindications include active necrotizing enterocolitis (NEC), active gastrointestinal bleeding, severe renal impairment (oliguria or elevated creatinine), active intracranial hemorrhage, and severe thrombocytopenia (<50,000/microL).

4A newborn with trisomy 21 (Down syndrome) undergoes a screening electrocardiogram (ECG) on day 2 of life. The ECG demonstrates a superior QRS axis (-60 to -120 degrees) with counterclockwise frontal loop rotation and first-degree AV block. Which congenital cardiac lesion is most strongly associated with these ECG findings?

A.Isolated Patent Ductus Arteriosus

B.Coarctation of the Aorta

C.D-Transposition of the Great Arteries

D.Complete Atrioventricular Septal Defect (AVSD)

Explanation: Complete AVSD (endocardial cushion defect) is present in approximately 40-50% of infants with Down syndrome. The displacement of the conduction system (posterior and inferior displacement of the AV node and bundle of His) results in a characteristic superior QRS axis (left axis deviation or extreme axis deviation) with a counterclockwise frontal QRS loop on ECG.

5A 10-day-old infant is brought to the emergency department in severe circulatory shock with tachypnea, poor perfusion, and profound metabolic acidosis. Femoral pulses are absent, whereas brachial pulses are palpable. Echocardiography confirms severe coarctation of the aorta with closure of the ductus arteriosus. What is the immediate first-line medical intervention?

A.Continuous intravenous infusion of Prostaglandin E1 (Alprostadil)

B.High-dose intravenous furosemide bolus

C.Intravenous sodium bicarbonate bolus

D.Immediate administration of digoxin

Explanation: In duct-dependent systemic circulation (such as severe neonatal coarctation of the aorta, interrupted aortic arch, or HLHS), spontaneous closure of the ductus arteriosus leads to acute lower body hypoperfusion, severe metabolic acidosis, and cardiovascular collapse. Continuous PGE1 infusion reopens the ductus, restoring lower body systemic perfusion and stabilizing the infant prior to surgical intervention.

6A 9-month-old infant with unrepaired Tetralogy of Fallot (TOF) experiences a hypercyanotic ('tet') spell while crying during a blood draw. The infant becomes deeply cyanotic, hyperpneic, and lethargic. Which physiological change is the primary goal of placing the infant in the knee-chest position?

A.Decreasing venous return from the lower extremities to relieve RV volume overload

B.Increasing systemic vascular resistance (SVR) to favor blood flow across the RVOT into the pulmonary artery

C.Increasing systemic vascular resistance (SVR) to promote right-to-left shunting

D.Decreasing pulmonary vascular resistance (PVR) through chest compression

Explanation: Hypercyanotic spells in TOF occur when infundibular spasm or decreased SVR leads to increased right-to-left shunting across the VSD and reduced pulmonary blood flow. Knee-chest positioning kinks the femoral arteries, significantly increasing SVR. This higher systemic pressure reduces right-to-left VSD shunting and forces more blood across the obstructed RV outflow tract into the pulmonary circulation.

7A newborn infant presents at 4 hours of life with severe cyanosis (SaO2 62%) that fails to respond to 100% oxygen administration (hyperoxia test). Chest radiograph shows a narrow mediastinal shadow ('egg on a string' appearance) and increased pulmonary vascular markings. Echocardiography confirms D-transposition of the great arteries (d-TGA) with an intact ventricular septum and restrictive patent foramen ovale. Which emergency bedside catheter procedure is indicated?

A.Balloon aortic valvuloplasty

B.Coarctation balloon angioplasty

C.Rashkind balloon atrial septostomy (BAS)

D.Patent ductus arteriosus stent placement

Explanation: In d-TGA with an intact ventricular septum, survival depends on adequate interatrial mixing between the parallel pulmonary and systemic circulations. If the atrial septum is intact or restrictive, severe hypoxemia occurs. Urgent bedside Rashkind balloon atrial septostomy tears the atrial septum, improving interatrial mixing and oxygenation until definitive arterial switch surgery is performed.

8A 3-week-old infant presents with mild cyanosis, bounding peripheral pulses, and early signs of heart failure (diaphoresis with feeding, tachypnea). Auscultation reveals a single loud S2 and an ejection systolic murmur with a short diastolic flow murmur. Dysmorphic features include micrognathia, low-set ears, and a cleft palate. Genetic testing confirms 22q11.2 microdeletion (DiGeorge syndrome). Which conotruncal defect is most characteristically associated with this syndrome?

A.Cor triatriatum sinistrum

B.Ostium secundum atrial septal defect

C.Inlet ventricular septal defect

D.Truncus Arteriosus

Explanation: Conotruncal anomalies (including Truncus Arteriosus, Tetralogy of Fallot, and Interrupted Aortic Arch Type B) are strongly associated with 22q11.2 deletion syndrome (DiGeorge / Velocardiofacial syndrome). Truncus arteriosus occurs due to failure of neural crest cell migration required for septation of the truncus arteriosus into the aorta and pulmonary artery.

9A 12-hour-old full-term infant develops severe cyanosis, tachypnea, and marked respiratory distress. Physical exam shows cool peripheries and severe subcostal retractions. Chest radiograph demonstrates a small heart size with diffuse, bilateral reticulonodular opacities ('ground-glass' appearance resembling RDS) and severe pulmonary edema. Echocardiography shows no direct connection of pulmonary veins to the left atrium, with a vertical vein draining below the diaphragm. What is the definitive initial management strategy for this obstructed infradiaphragmatic TAPVC?

A.Immediate surgical repair / surgical decompression

B.Elective outpatient follow-up at 6 months of age

C.Long-term oral sildenafil therapy

D.Inhaled nitric oxide monotherapy without surgical intervention

Explanation: Infradiaphragmatic Total Anomalous Pulmonary Venous Connection (TAPVC Type III) is almost always obstructed because the anomalous conduit passes through the esophageal hiatus and hepatic parenchyma before joining the IVC. This causes severe pulmonary venous congestion, pulmonary hypertension, hypoxemia, and rapid mortality. Emergency surgical repair is required immediately.

10A 2-day-old cyanotic infant is evaluated in the neonatal intensive care unit. Echocardiography confirms Tricuspid Atresia with a restrictive VSD. Which of the following classic electrocardiographic triad combinations strongly supports the diagnosis of Tricuspid Atresia in a cyanotic newborn?

A.Right axis deviation, right ventricular hypertrophy, and right atrial enlargement

B.Left axis deviation, left ventricular hypertrophy, and tall peaked P waves (right atrial enlargement)

C.Normal axis, biventricular hypertrophy, and PR interval prolongation

D.Extreme right axis deviation, isolated left atrial enlargement, and diffuse Q waves

Explanation: Most cyanotic congenital heart defects in newborns cause right ventricular hypertrophy and right axis deviation. Tricuspid Atresia is a classic exception: because the right ventricle is hypoplastic and the left ventricle is dominant, the ECG demonstrates left axis deviation (0 to -90 degrees), left ventricular hypertrophy, and tall P waves (p-tricuspidale) due to right atrial enlargement.

About the Cert Cardiology(SA) Paed Exam

The Sub-specialty Certificate in Cardiology (Paediatric) - Cert Cardiology(SA) Paed - is the exit examination administered by the College of Paediatricians of South Africa. It assesses sub-specialist level expertise in congenital heart disease, paediatric arrhythmias, cardiomyopathies, cardiac imaging, haemodynamics, rheumatic heart disease, and post-operative intensive care for paediatric cardiologists.

Assessment

Two components each contributing 50%: a written component (short-answer written papers) and an oral/OSCE/OSPE/clinical component. Content spans 5 domains: Congenital Heart Defects (35%), Paediatric Arrhythmias & Electrophysiology (20%), Heart Failure, Cardiomyopathies & Myocarditis (20%), Echocardiography, Catheterization & MRI (15%), and Pulmonary Hypertension, RHD & Post-Op Management (10%).

Time Limit

Written short-answer papers plus an OSCE and viva component.

Passing Score

Overall pass mark 50% with a 50% subminimum in each of the two components (written and oral/OSCE/OSPE/clinical).

Exam Fee

R24 650 (Colleges of Medicine of South Africa (CMSA), College of Paediatricians)

Cert Cardiology(SA) Paed Exam Content Outline

35%

Congenital Heart Defects (Acyanotic & Cyanotic)

Acyanotic shunts (VSD, ASD, PDA, AVSD), obstructive lesions (Coarctation, AS, PS), cyanotic lesions (TOF, D-TGA, TAPVC, Tricuspid Atresia, HLHS, Ebstein Anomaly, Truncus Arteriosus, Single Ventricle physiology).

20%

Paediatric Arrhythmias & Cardiac Electrophysiology

Supraventricular tachycardias (AVNRT, AVRT, WPW, PJRT), ventricular arrhythmias, channelopathies (LQTS, CPVT, Brugada), congenital AV block, pacemakers and ICDs, electrophysiology mapping and ablation.

20%

Heart Failure, Cardiomyopathies & Myocarditis in Children

Dilated, hypertrophic, restrictive, and non-compaction cardiomyopathies, acute viral myocarditis, Kawasaki disease, MIS-C, metabolic storage diseases, paediatric heart failure pharmacotherapy, VADs, and heart transplantation.

15%

Echocardiography, Cardiac Catheterization & MRI

Segmental echocardiography, Doppler hemodynamics, cardiac catheterization (pressure tracings, Qp/Qs, PVRI, balloon valvuloplasty, device closures), and Cardiac MRI (volume quantification, phase-contrast flow, late gadolinium enhancement).

10%

Pulmonary Hypertension, Rheumatic Heart Disease & Post-Operative Management

Paediatric PAH guidelines and targeted therapies, Rheumatic Heart Disease (Jones criteria, secondary penicillin prophylaxis, PTMC), and cardiac ICU post-operative care (LCOS, JET, chylothorax, pulmonary hypertensive crises).

How to Pass the Cert Cardiology(SA) Paed Exam

What You Need to Know

Passing score: Overall pass mark 50% with a 50% subminimum in each of the two components (written and oral/OSCE/OSPE/clinical).
Assessment: Two components each contributing 50%: a written component (short-answer written papers) and an oral/OSCE/OSPE/clinical component. Content spans 5 domains: Congenital Heart Defects (35%), Paediatric Arrhythmias & Electrophysiology (20%), Heart Failure, Cardiomyopathies & Myocarditis (20%), Echocardiography, Catheterization & MRI (15%), and Pulmonary Hypertension, RHD & Post-Op Management (10%).
Time limit: Written short-answer papers plus an OSCE and viva component.
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

Cert Cardiology(SA) Paed Study Tips from Top Performers

1Focus heavily on segmental approach to congenital heart disease, hemodynamics of single ventricle palliation (Norwood, Glenn, Fontan), and cathetarization parameters (Qp/Qs, PVRI).

2Master ECG interpretation for paediatric arrhythmias, accessory pathways (WPW, PJRT), channelopathies (LQTS, CPVT), and pacing/ICD indications.

3Review South African specific guidelines for Rheumatic Heart Disease diagnosis (revised Jones criteria) and mandatory secondary penicillin prophylaxis schedules.

Frequently Asked Questions

What is the format of the CMSA Cert Cardiology(SA) Paed examination?

The exit examination has two components, each contributing 50%: a written component (short-answer written papers) and an oral/OSCE/OSPE/clinical component. Candidates must achieve an overall 50% with a 50% subminimum in each component. This free question bank provides 100 practice MCQs as a study aid and does not replicate the official format.

What is the fee for the Cert Cardiology(SA) Paed examination?

The examination fee set by the Colleges of Medicine of South Africa (CMSA) is R24 650.

What topics are included in the Cert Cardiology(SA) Paed examination blueprint?

The exam covers 5 major domains: Congenital Heart Defects (35%), Paediatric Arrhythmias & Electrophysiology (20%), Heart Failure, Cardiomyopathies & Myocarditis (20%), Echocardiography, Catheterization & MRI (15%), and Pulmonary Hypertension, RHD & Post-Operative Management (10%).