100+ Free Cert Cardiology(SA) Phys Practice Questions

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2026 Statistics

Key Facts: Cert Cardiology(SA) Phys Exam

2 components

Written + oral/OSCE

CMSA Cert Cardiology Regulations

50% each

Subminimum per component

CMSA Examination Regulations

R24 650

Exam Fee

CMSA 2026 Fee Schedule

50% overall

Pass Mark

CMSA Examination Regulations

CMSA

Exam Body

College of Physicians of SA

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

Sample Cert Cardiology(SA) Phys Practice Questions

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

1A 54-year-old male presents to a rural district hospital in the Eastern Cape 90 minutes after the onset of severe substernal chest pain. His ECG shows 4 mm ST-segment elevation in leads V1-V4 with reciprocal ST depression in II, III, and aVF. Transfer time to the nearest PCI-capable hospital is estimated at 3.5 hours. He has no contraindications to fibrinolysis. According to ESC and SA Heart guidelines, what is the most appropriate initial reperfusion strategy?

A.Conservative medical management with dual antiplatelet therapy and statin, reserving angiography for recurrent ischemia

B.Immediate transfer for primary PCI without administering fibrinolytic therapy

C.Immediate administration of a weight-adjusted bolus of tenecteplase (fibrinolysis) followed by urgent transfer for pharmacoinvasive PCI

D.Administration of unfractionated heparin and clopidogrel, delaying reperfusion until transfer to the tertiary center

Explanation: When primary PCI cannot be performed within 120 minutes of STEMI diagnosis (as in this case with an estimated 3.5-hour transfer delay), guideline-directed therapy requires immediate fibrinolysis (preferably with a weight-based bolus of tenecteplase within 10 minutes of diagnosis) followed by immediate transfer to a PCI-capable center for rescue PCI if lysis fails or routine pharmacoinvasive angiography within 2-24 hours if successful.

2A 68-year-old female presents with acute NSTEMI. Her GRACE risk score is calculated at 152 (high risk). She is hemodynamically stable without recurrent pain, heart failure, or ventricular arrhythmias. According to current NSTEMI guidelines, what is the recommended timeframe for invasive coronary angiography?

A.Immediate emergency angiography within 2 hours of presentation

B.Ischemia-guided non-invasive stress testing prior to deciding on angiography

C.Invasive angiography within 24 hours of presentation (early invasive strategy)

D.Elective angiography within 72 hours of presentation

Explanation: High-risk NSTEMI patients—defined by a GRACE score >140, dynamic ST-T segment changes, or troponin elevation—should undergo an early invasive strategy within 24 hours. Immediate angiography (<2 hours) is reserved for very high-risk features (hemodynamic instability, cardiogenic shock, refractory chest pain, life-threatening arrhythmias, acute heart failure, or ST elevation on aVR/V1).

3A 60-year-old male undergoes successful primary PCI with a drug-eluting stent (DES) for an acute anterior STEMI. He has no history of stroke, transient ischemic attack (TIA), bleeding diathesis, or oral anticoagulation requirement. Which P2Y12 inhibitor is preferred over clopidogrel as part of dual antiplatelet therapy (DAPT)?

A.Ticagrelor 90 mg twice daily (or Prasugrel 10 mg daily)

B.Dipyridamole 200 mg twice daily

C.Cangrelor intravenous infusion for 12 months

D.Clopidogrel 75 mg daily

Explanation: Potent P2Y12 inhibitors (ticagrelor or prasugrel) are superior to clopidogrel in acute coronary syndromes undergoing PCI, reducing ischemic events, stent thrombosis, and all-cause mortality (PLATO and TRITON-TIMI 38 trials). Prasugrel is contraindicated in patients with a prior history of stroke/TIA.

4On day 4 post-inferior STEMI, a 62-year-old male suddenly develops severe dyspnea, hypotension (BP 82/50 mmHg), and pulmonary edema. Physical exam reveals a new pan-systolic murmur at the apex radiating to the axilla. Echocardiogram demonstrates hyperdynamic left ventricle with severe acute mitral regurgitation and a flail posteromedial mitral leaflet. What is the definitive management?

A.Intravenous furosemide, high-dose nitroglycerin, and outpatient cardiology follow-up

B.Percutaneous coronary intervention to the right coronary artery followed by conservative monitoring

C.Thrombolytic therapy to dissolve suspected prosthetic thrombus

D.Emergency cardiac surgery for mitral valve repair or replacement with intra-aortic balloon pump (IABP) stabilization

Explanation: Post-MI papillary muscle rupture (most commonly posteromedial papillary muscle due to single blood supply from the PDA/RCA) presents with acute pulmonary edema, cardiogenic shock, and severe MR. Emergency surgical repair/replacement combined with hemodynamic stabilization (IABP/Impella and vasopressors/afterload reduction) is mandatory as medical therapy alone carries >80% mortality.

5A 58-year-old male presents with acute inferior STEMI and marked hypotension (BP 78/45 mmHg), clear lungs, and elevated jugular venous pressure (Kussmaul sign positive). Right-sided ECG (V4R) shows 2 mm ST elevation. What is the most appropriate immediate medical intervention?

A.Intravenous beta-blocker (metoprolol) 5 mg slow push

B.Intravenous sublingual or IV nitroglycerin titration

C.Intravenous furosemide 80 mg bolus

D.Intravenous isotonic saline fluid boluses (0.9% NaCl)

Explanation: Right ventricular infarction (RVI) causes RV failure, reducing RV stroke volume and LV preload. Treatment relies on aggressive volume expansion (IV isotonic saline) to optimize RV preload and maintain cardiac output. Nitrates, diuretics, and opioids lower preload and are dangerous in RVI.

6A 42-year-old female presents with clinical features of acute MI, troponin elevation, and ST elevation on ECG. Immediate invasive coronary angiography demonstrates completely normal smooth coronary arteries without epicardial obstruction (MINOCA). What is the gold-standard imaging modality to elucidate the underlying etiology (e.g., myocarditis vs. MINOCA vs. Takotsubo)?

A.Repeat invasive coronary angiography with acetylcholine provocation test only

B.CT Coronary Angiography (CTCA)

C.Cardiac Magnetic Resonance (CMR) imaging with late gadolinium enhancement (LGE) and T1/T2 mapping

D.Exercise stress echocardiography

Explanation: Cardiac Magnetic Resonance (CMR) imaging is the cornerstone gold-standard diagnostic tool in MINOCA. It identifies the cause in >85% of patients by distinguishing true myocardial infarction (subendocardial/transmural LGE), acute myocarditis (subepicardial/mid-wall LGE with T2 edema), Takotsubo syndrome (apical ballooning without LGE), or non-ischemic cardiomyopathies.

7A 71-year-old female on day 5 post-anterior STEMI suddenly collapses with pulseless electrical activity (PEA). Bedside echocardiogram reveals severe pericardial effusion with right ventricular diastolic collapse and dense echo-contrast in the pericardial sac. What is the most likely diagnosis?

A.Dressler syndrome (post-MI pericarditis)

B.Ventricular septal rupture with left-to-right shunt

C.Acute pulmonary embolism

D.Left ventricular free wall rupture resulting in acute hemopericardium and cardiac tamponade

Explanation: LV free wall rupture typically occurs between day 3 and 7 post-MI (especially in elderly females, first MI, hypertension, or delayed reperfusion). It manifests as sudden electromechanical dissociation / PEA collapse due to acute hemopericardium and cardiac tamponade.

8A 50-year-old male presents 4 weeks after an anterior STEMI with pleuritic chest pain that improves when leaning forward, low-grade fever, and a pericardial friction rub. CRP is elevated. ECG shows widespread PR depression and diffuse concave ST elevation. What is the first-line pharmacotherapy?

A.Ibupofen 800 mg 8-hourly plus oral anticoagulation

B.Low-molecular-weight heparin plus ticagrelor

C.High-dose Prednisone 1 mg/kg daily monotherapy

D.High-dose Aspirin (500–1000 mg 8-hourly) plus Colchicine 0.5 mg daily

Explanation: This patient has Dressler syndrome (post-cardiac injury syndrome). In post-MI pericarditis, high-dose aspirin (500–1000 mg every 8 hours) combined with colchicine (0.5 mg daily for 3 months) is the treatment of choice. Non-aspirin NSAIDs (like ibuprofen or indomethacin) are avoided post-MI as they impair myocardial scar formation and increase rupture risk.

9A 64-year-old male with chronic coronary syndrome remains symptomatic with effort angina (CCS Class II) despite maximum tolerated doses of metoprolol (100 mg twice daily) and ramipril. His resting heart rate is 58 bpm and BP is 118/74 mmHg. Echocardiogram shows EF 55%. Which antianginal drug is the most appropriate add-on agent?

A.Verapamil 240 mg daily

B.Long-acting nitrate (or Ranolazine / Nicorandil)

C.Diltiazem 180 mg daily

D.Ivabradine 5 mg twice daily

Explanation: When heart rate is already low (<60 bpm) on beta-blockers, adding heart rate-reducing drugs like Ivabradine, Diltiazem, or Verapamil is contraindicated or ineffective (Ivabradine requires HR >70 bpm; Diltiazem/Verapamil cause severe bradycardia and AV block when combined with beta-blockers). Second-line antianginals that do not lower heart rate, such as long-acting nitrates, ranolazine, or nicorandil, are indicated.

10A 59-year-old diabetic male undergoes diagnostic coronary angiography for angina. Results reveal complex three-vessel coronary artery disease with involvement of the proximal LAD. SYNTAX score is calculated at 34 (high complexity). Echocardiography shows EF 48%. What is the recommended revascularization modality according to ESC/EACTS guidelines?

A.Medical therapy alone without revascularization

B.Coronary Artery Bypass Grafting (CABG) (Class I, Level A)

C.Multivessel Percutaneous Coronary Intervention (PCI) with drug-eluting stents

D.Hybrid PCI followed by TAVI

Explanation: In diabetic patients with multivessel CAD, especially with high SYNTAX scores (>22) or proximal LAD involvement, CABG provides significant survival benefits and lower rates of repeat revascularization and MI compared to PCI (FREEDOM trial, SYNTAX 10-year extended follow-up).

About the Cert Cardiology(SA) Phys Exam

The Sub-specialty Certificate in Cardiology [Cert Cardiology(SA) Phys] is the specialist sub-specialty qualification administered by the College of Physicians of South Africa. It validates expert consultant-level competency across adult cardiology, acute coronary care, heart failure, electrophysiology, structural heart disease, interventional cardiology, non-invasive imaging, and cardiovascular pharmacotherapy.

Assessment

Two components each contributing 50%: a written component (short-answer written papers) and an oral/OSCE/OSPE/clinical component. Content spans 5 domain areas: Ischaemic Heart Disease & Acute Coronary Syndromes (25%), Heart Failure, Cardiomyopathies & Heart Transplantation (25%), Cardiac Arrhythmias & Electrophysiology (20%), Valvular Heart Disease & Adult Congenital Heart Disease (15%), Interventional Cardiology, Imaging & Hypertension (15%).

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 (College of Physicians of South Africa (Colleges of Medicine of South Africa))

Cert Cardiology(SA) Phys Exam Content Outline

25%

Ischaemic Heart Disease & Acute Coronary Syndromes

Pathophysiology of atherosclerosis, STEMI/NSTEMI guidelines, antiplatelet/anticoagulation therapy, revascularization strategies, cardiogenic shock, and post-MI complications.

25%

Heart Failure, Cardiomyopathies & Heart Transplantation

HFrEF/HFpEF guideline-directed medical therapy, dilated/hypertrophic/restrictive cardiomyopathies, peripartum cardiomyopathy, HIV heart disease, cardiac amyloidosis, advanced HF devices, and heart transplantation.

20%

Cardiac Arrhythmias & Electrophysiology

Atrial fibrillation and flutter management, supraventricular tachycardias, ventricular arrhythmias, inherited channelopathies (LQTS, Brugada, CPVT), pacing, ICDs, and cardiac resynchronization therapy (CRT).

15%

Valvular Heart Disease & Adult Congenital Heart Disease

Rheumatic heart disease, aortic stenosis/regurgitation, mitral regurgitation/stenosis, infective endocarditis, prosthetic valves, and ACHD (ASD, VSD, Coarctation, Tetralogy of Fallot, Eisenmenger syndrome).

15%

Interventional Cardiology, Imaging (Echo/CT/MRI) & Hypertension

Transthoracic/transesophageal echocardiography, cardiac CT/MRI parameters, invasive hemodynamics, coronary angiography/PCI principles, severe hypertension, and aortic diseases.

How to Pass the Cert Cardiology(SA) Phys 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 domain areas: Ischaemic Heart Disease & Acute Coronary Syndromes (25%), Heart Failure, Cardiomyopathies & Heart Transplantation (25%), Cardiac Arrhythmias & Electrophysiology (20%), Valvular Heart Disease & Adult Congenital Heart Disease (15%), Interventional Cardiology, Imaging & Hypertension (15%).
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) Phys Study Tips from Top Performers

1Focus on ESC/ACC/AHA and South African Heart Association clinical practice guidelines for ACS, heart failure, AF ablation, and valvular heart disease.

2Master hemodynamic calculations (Fick principle, valve areas by continuity equation, shunt calculations Qp/Qs) and cardiac MRI tissue characterization (late gadolinium enhancement patterns).

3Understand regional South African cardiovascular pathologies, including tuberculous pericarditis, rheumatic heart disease, peripartum cardiomyopathy, and HIV-associated cardiovascular manifestations.

Frequently Asked Questions

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

The official CMSA examination fee is R24 650.

What is the passing criteria for the examination?

Candidates must achieve an overall pass mark of 50%, with a 50% subminimum in each of the two components (the written component and the oral/OSCE/OSPE/clinical component).

What content areas are tested on the examination?

Content is weighted across 5 domains: Ischaemic Heart Disease & ACS (25%), Heart Failure & Cardiomyopathies (25%), Cardiac Arrhythmias & EP (20%), Valvular & Adult Congenital Heart Disease (15%), and Interventional Cardiology, Imaging & Hypertension (15%).