100+ Free Cert Clin Haematology(SA) Paed Practice Questions

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2026 Statistics

Key Facts: Cert Clin Haematology(SA) Paed Exam

2 components

Written + oral/OSCE

CMSA Regulations

50% each

Subminimum per component

CMSA Regulations

R24 650

Examination Fee

CMSA Fee Schedule

50% overall

Pass Mark

CMSA Examination Regulations

College of Paediatricians

CMSA College

CMSA South Africa

The Cert Clin Haematology(SA) Paed is a two-component sub-specialty exit examination (written short-answer papers plus an oral/OSCE/clinical component, each 50%) evaluating advanced paediatric haematology, oncology, bleeding disorders, marrow failure, and blood banking for specialist paediatricians in South Africa.

Sample Cert Clin Haematology(SA) Paed Practice Questions

Try these sample questions to test your Cert Clin Haematology(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 12-month-old infant of African descent undergoes screening for hemoglobinopathy. High-performance liquid chromatography (HPLC) reveals HbA 0%, HbS 88%, HbF 9%, and HbA2 3.0%. Both parents are confirmed carriers of the sickle cell trait (HbAS). Which diagnosis is most consistent with these laboratory findings?

A.Sickle Hereditary Persistence of Fetal Hemoglobin (HbS/HPFH)

B.Sickle Cell Trait (HbAS)

C.Sickle Beta-Plus Thalassemia (HbS/β+)

D.Homozygous Sickle Cell Anaemia (HbSS)

Explanation: The complete absence of HbA combined with a predominant HbS percentage (>80%), moderate HbF, and normal/slightly elevated HbA2 in an infant whose parents both have sickle cell trait confirms homozygous Sickle Cell Anaemia (HbSS).

2A 4-year-old child with sickle cell anaemia (HbSS) is initiated on hydroxyurea disease-modifying therapy. Which physiological mechanism accounts for the primary therapeutic benefit of hydroxyurea in reducing vaso-occlusive pain crises?

A.Induction of gamma-globin gene expression and increased fetal hemoglobin (HbF)

B.Competitive inhibition of 2,3-bisphosphoglycerate (2,3-BPG) synthesis

C.Direct inhibition of sickle hemoglobin polymer cross-linking

D.Irreversible binding to RBC membrane Band 3 protein to enhance deformability

Explanation: Hydroxyurea acts primarily as a ribonucleotide reductase inhibitor that stimulates gamma-globin gene synthesis, increasing fetal hemoglobin (HbF) levels. HbF interferes with HbS polymerization, thereby reducing erythrocyte sickling, hemolysis, and vaso-occlusive crises.

3A 6-year-old boy with HbSS presents to the emergency department with fever (38.9°C), cough, chest pain, tachypnoea, and a new segmental infiltrate on chest radiography. Pulse oximetry shows oxygen saturation of 91% on room air. What is the immediate first-line medical management package?

A.Supplemental oxygen, empiric IV ceftriaxone plus oral azithromycin, analgesia, and simple blood transfusion

B.Empiric oral amoxicillin and outpatient follow-up in 48 hours

C.Immediate urgent high-dose IV dexamethasone and plasmapheresis

D.Hyperbaric oxygen therapy and immediate therapeutic anticoagulation with therapeutic LMWH

Explanation: Acute chest syndrome (ACS) is a life-threatening complication defined by a new radiographical infiltrate accompanied by fever or respiratory symptoms. Immediate therapy includes supplemental oxygen (target SpO2 >95%), empiric broad-spectrum antibiotics covering atypical organisms (ceftriaxone + macrolide), adequate analgesia, and simple blood transfusion to improve oxygen-carrying capacity.

4Annual Transcranial Doppler (TCD) screening in a 5-year-old girl with sickle cell anaemia demonstrates a time-averaged maximum mean velocity (TAMMV) of 215 cm/s in the right middle cerebral artery. According to international guidelines (STOP trial criteria), what is the most appropriate long-term management strategy?

A.Initiation of a regular chronic blood transfusion program to maintain HbS < 30%

B.Discontinuation of hydroxyurea and initiation of low-dose aspirin monotherapy

C.Repeat TCD ultrasonography in 6 months without changing therapy

D.Immediate surgical revascularization (encephaloduroarteriosynangiosis / EDAS)

Explanation: A TCD TAMMV >= 200 cm/s indicates an abnormal high stroke risk (~10% per year without intervention). The landmark STOP trial established that initiating a regular chronic blood transfusion program to suppress HbS to <30% reduces primary stroke incidence by over 90%.

5An 8-month-old infant presents with progressive pallor, failure to thrive, hepatosplenomegaly, and severe microcytic hypochromic anaemia (Hb 4.8 g/dL, MCV 54 fL). Hemoglobin analysis reveals HbF 94%, HbA2 4.5%, and HbA 0%. What is the underlying genetic condition?

A.Beta-Thalassemia Minor (Trait)

B.Alpha-Thalassemia Trait (--/αα)

C.Beta-Thalassemia Major (β0/β0)

D.Hemoglobin H Disease (--/-α)

Explanation: Homozygous beta-zero thalassemia (β0/β0) results in complete inability to produce beta-globin chains, leading to severe transfusion-dependent anaemia in early infancy, marked elevation of HbF (>90%), elevated HbA2, and complete absence of HbA.

6A 5-year-old boy presents with sudden dark urine, jaundice, and lethargy 48 hours after receiving cotrimoxazole for an upper respiratory infection. Laboratory testing shows Hb 6.5 g/dL, elevated indirect bilirubin, and low haptoglobin. Supravital staining of the peripheral blood film reveals Heinz bodies and 'bite cells' (degmacytes). What is the most likely diagnosis?

A.Autoimmune Hemolytic Anaemia

B.Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency

C.Hereditary Spherocytosis

D.Pyruvate Kinase Deficiency

Explanation: Acute intravascular oxidative hemolysis triggered by medications (like sulfonamides/cotrimoxazole, primaquine) or infections in a young male is classic for G6PD deficiency (X-linked). Oxidized hemoglobin precipitates as Heinz bodies, which are plucked out by splenic macrophages, forming bite cells (degmacytes).

7A 7-year-old child with a family history of gallstones presents with recurrent jaundice, splenomegaly, and a mean corpuscular hemoglobin concentration (MCHC) of 37.2 g/dL. Peripheral blood film demonstrates numerous microspherocytes. Which diagnostic modality is currently considered the most sensitive and specific first-line confirmatory test?

A.Direct Antiglobulin Test (DAT)

B.Traditional unbuffered saline osmotic fragility test

C.Eosin-5-maleimide (EMA) binding test by flow cytometry

D.Hemoglobin electrophoresis

Explanation: Flow cytometric evaluation of Eosin-5-maleimide (EMA) binding to erythrocyte membrane proteins (spectrin, ankyrin, band 3) has superseded traditional osmotic fragility due to superior sensitivity (>93%), specificity, and rapid turnaround.

8A 3-year-old toddler is evaluated for microcytic anaemia. Full blood count shows: Hb 9.2 g/dL, MCV 58 fL, RBC count 5.8 x 10^12/L, and RDW 13.1%. The calculated Mentzer Index (MCV / RBC count) is 10.0. Which clinical diagnosis is strongly suggested by a Mentzer Index less than 13?

A.Nutritional Iron Deficiency Anaemia

B.Anaemia of Chronic Inflammation

C.Beta-Thalassemia Trait

D.Sideroblastic Anaemia

Explanation: The Mentzer Index (MCV in fL divided by RBC count in millions/uL) differentiates microcytic anaemias. An index <13 indicates high RBC production relative to cell size, strongly pointing to Thalassemia Trait. An index >13 suggests Iron Deficiency Anaemia.

9A 14-month-old infant with sickle cell anaemia is brought to the clinic lethargic and pale. Physical examination reveals tachycardia (175 bpm), cold peripheries, and a acutely enlarged, firm spleen palpable 6 cm below the costal margin (previously non-palpable). Hb has dropped from a baseline of 8.5 g/dL to 3.2 g/dL, with reticulocytes 14%. What is the immediate life-saving intervention?

A.Intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA)

B.Immediate IV fluid resuscitation and prompt red blood cell transfusion aimed at restoring hemodynamic stability

C.Emergency total splenectomy within 2 hours of arrival

D.High-dose IV methylprednisolone and broad-spectrum antibiotics

Explanation: Acute splenic sequestration crisis (ASSC) is a medical emergency in young infants with HbSS where massive blood pooling in the spleen causes acute hypovolemic shock and severe anaemia. Immediate volume expansion and cautious packed RBC transfusion to restore intravascular volume and Hb to safe levels (target 7-9 g/dL) is life-saving.

10A 7-year-old child receiving hydroxyurea 25 mg/kg/day for HbSS presents for routine safety monitoring. Full blood count shows: Hb 9.8 g/dL, ANC 1.1 x 10^9/L, Platelets 85 x 10^9/L, Reticulocytes 60 x 10^9/L. The patient is asymptomatic. What is the most appropriate dose management step?

A.Temporarily hold hydroxyurea, monitor FBC weekly until marrow recovery, then restart at a lower dose (by 5 mg/kg/day)

B.Increase hydroxyurea dose to 30 mg/kg/day to overcome marrow suppression

C.Continue hydroxyurea at 25 mg/kg/day unchanged and recheck in 3 months

D.Permanently discontinue hydroxyurea and switch to chronic exchange transfusions

Explanation: Hydroxyurea toxicity parameters include ANC < 1.25 x 10^9/L, platelets < 80-100 x 10^9/L, or reticulocytes < 80 x 10^9/L (with Hb < 9). Because ANC (1.1) and platelets/reticulocytes demonstrate mild myelosuppression, hydroxyurea should be temporarily held until blood counts recover, then resumed at a dose reduced by 2.5-5.0 mg/kg/day.

About the Cert Clin Haematology(SA) Paed Exam

The Sub-specialty Certificate in Clinical Haematology [Cert Clin Haematology(SA) Paed] is a higher specialist qualification granted by the College of Paediatricians of the Colleges of Medicine of South Africa (CMSA). Designed for sub-specialist paediatric haematologist-oncologists, the examination assesses expert clinical decision-making, diagnostic interpretation, and patient management across congenital and acquired paediatric blood disorders, leukemias, lymphomas, bleeding diatheses, thrombosis, bone marrow failure syndromes, and paediatric transfusion therapy.

Assessment

Two components each contributing 50%: a written component (short-answer written papers) and an oral/OSCE/OSPE/clinical component. Content spans: Paediatric Anaemias & Hemoglobinopathies (25%), Paediatric Malignant Haematology (30%), Hemostasis, Thrombosis & Bleeding Disorders (25%), and Pediatric Bone Marrow Failure & Transfusion Medicine (20%).

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 (CMSA Fee Schedule) (College of Paediatricians (Colleges of Medicine of South Africa))

Cert Clin Haematology(SA) Paed Exam Content Outline

25%

Paediatric Anaemias & Hemoglobinopathies (Sickle Cell, Thalassemia)

Pathophysiology, diagnosis, acute crises, hydroxyurea therapy, stroke prevention, iron overload management, alpha/beta-thalassemia, enzymatic defects (G6PD, PK deficiency), immune/non-immune hemolytic anaemias, and nutritional anaemias.

30%

Paediatric Malignant Haematology (ALL, AML, Lymphomas)

Biology, risk stratification, immunophenotyping, cytogenetics, targeted therapies, chemotherapy protocols, CNS prophylaxis, minimal residual disease (MRD) monitoring, Hodgkin and non-Hodgkin lymphomas, histiocytic disorders, and oncologic emergencies.

25%

Hemostasis, Thrombosis & Bleeding Disorders (Hemophilia, ITP)

Congenital and acquired bleeding disorders, Hemophilia A/B, Factor VIII/IX inhibitors, von Willebrand disease, immune thrombocytopenia (ITP), neonatal/paediatric thrombosis, thrombophilia screening, anticoagulation, and antiplatelet management.

20%

Pediatric Bone Marrow Failure & Transfusion Medicine

Inherited marrow failure syndromes (Fanconi anaemia, Diamond-Blackfan anaemia, Shwachman-Diamond, Dyskeratosis Congenita), acquired severe aplastic anaemia, hematopoietic stem cell transplantation (HSCT), paediatric transfusion thresholds, massive transfusion protocols, TRALI/TACO, and irradiated/leukoreduced blood products.

How to Pass the Cert Clin Haematology(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: Paediatric Anaemias & Hemoglobinopathies (25%), Paediatric Malignant Haematology (30%), Hemostasis, Thrombosis & Bleeding Disorders (25%), and Pediatric Bone Marrow Failure & Transfusion Medicine (20%).
Time limit: Written short-answer papers plus an OSCE and viva component.
Exam fee: R24 650 (CMSA Fee Schedule)

Keys to Passing

Work through all 100 available questions
Review every answer and explanation
Track weak areas and revisit them
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Cert Clin Haematology(SA) Paed Study Tips from Top Performers

1Master sickle cell disease management: transcranial Doppler (TCD) velocity interpretation, hydroxyurea dosing/monitoring, acute chest syndrome treatment, and indications for exchange transfusion.

2Review pediatric ALL risk stratification: cytogenetic risk groups (ETV6-RUNX1, hyperdiploidy, BCR-ABL1, KMT2A-rearranged, hypodiploidy), end-of-induction flow/PCR MRD thresholds, and CNS prophylaxis.

3Focus on hemostasis: Hemophilia A/B factor replacement calculations, emicizumab prophylaxis mechanisms, Factor VIII inhibitor eradication (ITI), von Willebrand subtypes (1, 2A, 2B, 2M, 2N, 3), and pediatric VTE anticoagulation.

4Understand marrow failure and blood banking: Fanconi anemia diagnostic screening (diepoxybutane/mitomycin C chromosomal breakage), immunosuppressive therapy (ATG + cyclosporine) vs HSCT in severe aplastic anemia, irradiated blood product indications (TA-GVHD prevention), and pediatric red cell/platelet transfusion thresholds.

Frequently Asked Questions

What is the examination format for Cert Clin Haematology(SA) Paed?

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 primary qualification is required before sitting this sub-specialty examination?

Candidates must hold an FC Paed(SA) or equivalent specialist qualification recognized by the HPCSA, alongside completed accredited sub-specialty paediatric haematology training.

How are the examination questions weighted across topic domains?

Questions are distributed as 25% Paediatric Anaemias & Hemoglobinopathies, 30% Paediatric Malignant Haematology, 25% Hemostasis, Thrombosis & Bleeding Disorders, and 20% Pediatric Bone Marrow Failure & Transfusion Medicine.

What standard guidelines inform the question content?

Questions align with contemporary international and South African clinical evidence, including SACCSG protocols, CMSA syllabus guidelines, ISTH recommendations, and WHO/ICC haematolymphoid classifications.