100+ Free CMSA Cert Gastroenterology(SA) Paed Practice Questions

Prepare for the Sub-specialty Certificate in Gastroenterology of the College of Paediatricians of South Africa: Cert Gastroenterology(SA) Paed exam with instant access — no signup required.

✓ No registration✓ No credit card✓ No hidden fees✓ Start practicing immediately

100+ Questions

100% Free

Loading practice questions...

Same family resources

Explore More CMSA Sub-specialty Certificate Examinations (South Africa)

Continue into nearby exams from the same family. Each card keeps practice questions, study guides, flashcards, videos, and articles in one place.

CMSA Sub-specialty Certificate in Allergology Cert Allerg(SA) Phys — South Africa

Practice Questions100 questions

CMSA Sub-specialty Certificate in Cardiology Cert Cardiology(SA) Paed — South Africa

Practice Questions100 questions

CMSA Sub-specialty Certificate in Cardiology Cert Cardiology(SA) Phys — South Africa

Practice Questions100 questions

CMSA Sub-specialty Certificate in Clinical Haematology Cert Clin Haematology(SA) Paed — South Africa

Practice Questions100 questions

CMSA Sub-specialty Certificate in Clinical Haematology Cert Clin Haematology(SA) Path — South Africa

Practice Questions100 questions

CMSA Sub-specialty Certificate in Clinical Haematology Cert Clin Haematology(SA) Phys — South Africa

Practice Questions100 questions

Sample CMSA Cert Gastroenterology(SA) Paed Practice Questions

Try these sample questions to test your CMSA Cert Gastroenterology(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-year-old boy presents with a 4-month history of lethargy, intermittent non-bloody diarrhea, rights-sided lower abdominal pain, and a weight loss of 5 kg. Laboratory investigations reveal microcytic anemia, elevated C-reactive protein (CRP 45 mg/L), and erythrocyte sedimentation rate (ESR 52 mm/hr). Colonoscopy shows patchy aphthous ulceration in the cecum and ascending colon with a normal rectum. Terminal ileoscopy reveals linear ulceration and cobblestoning. Which Paris classification location code best describes his luminal disease distribution?

A.L3 (Ileocolonic)

B.L2 (Colonic)

C.L1 (Ileal)

D.L4a (Upper GI proximal to ligament of Treitz)

Explanation: The Paris classification for paediatric Crohn's disease classifies disease involving both the terminal ileum (or cecum) and any portion of the colon as L3 (Ileocolonic). L1 is isolated ileal disease, L2 is isolated colonic disease, and L4 represents upper GI involvement (L4a proximal to Treitz, L4b distal to Treitz).

2A 4-year-old girl with chronic diarrhea, abdominal distension, and failure to thrive undergoes serological screening for coeliac disease. Her total serum IgA is normal (1.4 g/L). Tissue transglutaminase IgA (tTG-IgA) is 150 U/mL (upper limit of normal 10 U/mL; >=10x ULN). Endomysial antibody IgA (EMA-IgA) tested on a separate blood sample is positive. According to the ESPGHAN 2020 guidelines, what is the most appropriate next management step?

A.Initiate a gluten-free diet without requiring an esophagogastroduodenoscopy (EGD) biopsy

B.Repeat the tTG-IgA assay after 3 months of a normal gluten-containing diet

C.Proceed directly to diagnostic upper GI endoscopy and duodenal biopsies

D.Perform HLA-DQ2/DQ8 genetic testing prior to starting a gluten-free diet

Explanation: According to the updated ESPGHAN 2020 coeliac disease guidelines, a non-biopsy strategy is recommended for diagnosis in children if serum tTG-IgA is >=10 times the upper limit of normal AND EMA-IgA is positive on a second, independent blood sample (with normal total IgA). HLA-DQ2/DQ8 testing is no longer required as part of the initial diagnostic algorithm.

3A 10-year-old girl with known ulcerative colitis presents with severe bloody diarrhea (8 bloody stools/day), nocturnal stooling, temperature of 38.2°C, and tachycardia. Her Paediatric Ulcerative Colitis Activity Index (PUCAI) score is calculated at 75. What is the initial recommended first-line induction therapy?

A.Intravenous methylprednisolone 1 mg/kg/day (maximum 40 mg/day)

B.Oral 5-aminosalicylate (mesalazine) 80 mg/kg/day

C.Infliximab 10 mg/kg single infusion

D.Exclusive Enteral Nutrition (EEN) for 6 weeks

Explanation: A PUCAI score >=65 indicates Acute Severe Colitis (ASC). According to the ECCO/ESPGHAN guidelines, the first-line medical therapy for ASC is intravenous corticosteroid therapy (methylprednisolone 1 mg/kg/day, up to 40 mg/day). Infliximab or ciclosporin are second-line rescue therapies if there is no response by day 3 to 5.

4A 14-month-old infant presents with severe pan-colitis, recurrent perianal abscesses, folliculitis, and refractory failure to thrive since 2 months of age. Genetic evaluation reveals a loss-of-function mutation in the Interleukin-10 Receptor subunit alpha (IL10RA) gene. Which definitive therapeutic modality offers long-term cure for this Very Early Onset IBD (VEO-IBD)?

A.Subtotal colectomy with end ileostomy

B.Allogeneic Hematopoietic Stem Cell Transplantation (HSCT)

C.Long-term dual anti-TNF and anti-integrin biological therapy

D.High-dose intravenous immunoglobulin (IVIG) maintenance

Explanation: Loss-of-function mutations in IL10, IL10RA, or IL10RB impair IL-10 immunoregulatory signaling, leading to severe monogenic Very Early Onset IBD (VEO-IBD) within the first months of life. Traditional immunosuppressants and biologics fail, and allogeneic Hematopoietic Stem Cell Transplantation (HSCT) is the only curative treatment.

5A 13-year-old boy with active Crohn's disease shows significant growth deceleration (height velocity < 3rd centile) despite minimal GI symptoms. Which pro-inflammatory cytokine is primarily responsible for systemic growth impairment by inducing hepatic Insulin-like Growth Factor 1 (IGF-1) resistance?

A.Interleukin-4 (IL-4)

B.Interleukin-6 (IL-6)

C.Interleukin-17 (IL-17)

D.Transforming Growth Factor beta (TGF-beta)

Explanation: Interleukin-6 (IL-6) and TNF-alpha are key systemic inflammatory cytokines in Crohn's disease. Elevated IL-6 suppresses growth hormone receptor signaling in hepatocytes and decreases circulating IGF-1 levels while inducing peripheral IGF-1 resistance, directly inhibiting epiphyseal growth plate chondrocytes.

6A 11-year-old girl is diagnosed with mild-to-moderate luminal Crohn's disease of the terminal ileum and ascending colon. According to ESPGHAN/ECCO paediatric Crohn's guidelines, what is the recommended first-line induction therapy?

A.Oral Azathioprine 2.5 mg/kg/day monotherapy

B.Oral Budesonide 9 mg/day for 12 months

C.Infliximab infusions at 0, 2, and 6 weeks

D.Exclusive Enteral Nutrition (EEN) for 6–8 weeks

Explanation: Exclusive Enteral Nutrition (EEN) for 6–8 weeks is recommended as the first-line therapy to induce remission in children with active luminal Crohn's disease. EEN achieves equivalent clinical remission rates to oral corticosteroids while promoting superior mucosal healing, growth, and nutritional recovery without steroid toxicity.

7A 14-year-old boy with Crohn's disease receiving infliximab maintenance therapy (5 mg/kg every 8 weeks) experiences clinical relapse with rising faecal calprotectin (850 mcg/g). Therapeutic drug monitoring reveals a serum infliximab trough level of 1.2 mcg/mL (target 5–10 mcg/mL) and high titers of anti-infliximab antibodies. What is the most appropriate management plan?

A.Add oral mesalazine 3 g/day to the current infliximab regimen

B.Switch class to Adalimumab monotherapy

C.Shorten the infliximab infusion interval to every 4 weeks at 10 mg/kg

D.Switch to an alternative biologic class (e.g., Ustekinumab) combined with an immunomodulator

Explanation: The presence of high-titer anti-drug antibodies combined with low trough levels and secondary loss of response indicates immune-mediated pharmacokinetic failure. Dose escalation of the same anti-TNF agent is ineffective when high-titer neutralizing antibodies are present. Switching out-of-class (e.g., Ustekinumab or Vedolizumab) with co-prescription of an immunomodulator to prevent immunogenicity is the optimal approach.

8A 5-year-old boy evaluated for chronic diarrhea and failure to thrive has a total serum IgA level of 0.05 g/L (below age-adjusted lower limit of detection, indicating selective IgA deficiency). Which serological screening test combination is necessary to accurately assess for coeliac disease in this child?

A.Faecal calprotectin and serum anti-saccharomyces cerevisiae antibodies (ASCA)

B.IgA endomysial antibody (EMA-IgA) and HLA-DQ2/DQ8

C.IgG tissue transglutaminase (IgG-tTG) and IgG deamidated gliadin peptides (IgG-DGP)

D.Standard IgA tissue transglutaminase (tTG-IgA) only

Explanation: Selective IgA deficiency occurs in 2-3% of coeliac patients (10-15x higher than the general population). Standard IgA-based serology (tTG-IgA, EMA-IgA) yields false-negative results. Diagnostic testing in IgA-deficient individuals requires IgG-based serology, specifically IgG-tTG and IgG-DGP.

9A 15-year-old girl with Crohn's disease presents with painful perianal discharge and a complex high transsphincteric fistula identified on pelvic MRI. An Examination Under Anaesthesia (EUA) is performed. Which combination therapy represents the gold standard evidence-based medical and surgical approach?

A.Fistula plug insertion combined with high-dose oral corticosteroids

B.Long-term oral Metronidazole monotherapy for 12 months

C.Surgical fistulotomy alone without medical therapy

D.Non-cutting seton placement combined with anti-TNF (Infliximab) therapy

Explanation: Management of complex perianal Crohn's fistulae requires combined surgical and medical therapy. Surgical placement of a non-cutting seton maintains drainage and prevents recurrent abscess formation, while Infliximab (anti-TNF) induces mucosal and fistulous healing. Surgical fistulotomy of high transsphincteric fistulae risks sphincter disruption and incontinence.

10A 12-year-old boy admitted with Acute Severe Colitis is treated with IV methylprednisolone 1 mg/kg/day. On Day 3 of admission, his PUCAI score is 70 (stool frequency 7/day, 4 bloody, severe nocturnal stooling). According to ECCO/ESPGHAN criteria, what is the most appropriate action?

A.Prepare for second-line rescue therapy (Infliximab or Ciclosporin) if PUCAI remains >45 on Day 3 to 5

B.Discharge on oral Prednisolone 2 mg/kg/day and 5-ASA

C.Immediately perform emergency total colectomy

D.Continue IV methylprednisolone unchanged until Day 7

Explanation: A PUCAI score >45 on Day 3 of IV corticosteroid therapy predicts steroid failure in up to 85% of paediatric acute severe colitis cases. Guidelines recommend screening for infection (CMV, C. difficile), obtaining abdominal radiology, and initiating second-line rescue therapy with Infliximab (or IV Ciclosporin) on Day 3 to 5.

About the CMSA Cert Gastroenterology(SA) Paed Exam

The Sub-specialty Certificate in Gastroenterology of the College of Paediatricians of South Africa [Cert Gastroenterology(SA) Paed] is the subspecialty examination for paediatricians seeking qualification as subspecialist paediatric gastroenterologists in South Africa. The exam tests comprehensive clinical knowledge across paediatric IBD, coeliac disease, hepatology, biliary atresia, liver failure, nutrition, intestinal failure, motility disorders, esophageal diseases, and diagnostic/therapeutic paediatric endoscopy.

Assessment

Two components each contributing 50%: a written component (short-answer written papers) and an oral/OSCE/OSPE/clinical component. Content spans paediatric gastroenterology, hepatology, and nutrition, testing clinical decision-making, diagnosis, investigation, pharmacology, and management.

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)

CMSA Cert Gastroenterology(SA) Paed Exam Content Outline

25%

Paediatric Inflammatory Bowel Disease & Coeliac Disease

Paediatric IBD diagnosis, classification, biological therapies, EEN, VEO-IBD, and ESPGHAN coeliac guidelines.

25%

Paediatric Hepatology, Biliary Atresia & Liver Failure

Biliary atresia, Kasai procedure, acute liver failure, Wilson disease, AIH, PFIC, portal hypertension, and transplantation.

20%

Paediatric Nutrition, Malabsorption & Intestinal Failure

Short bowel syndrome, GLP-2 analogues, IFALD, SAM, refeeding syndrome, congenital diarrheas, and EPI.

15%

Functional GI Disorders & Esophageal Pathology

Rome IV functional GI disorders, EoE, achalasia, GERD, Hirschsprung disease, CVS, and caustic strictures.

15%

Diagnostic & Therapeutic Paediatric Endoscopy

Sedation, EVL, non-variceal GI bleeding haemostasis, foreign body extraction, ERCP, PEG, and endoscopic quality.

How to Pass the CMSA Cert Gastroenterology(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 gastroenterology, hepatology, and nutrition, testing clinical decision-making, diagnosis, investigation, pharmacology, and management.
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

CMSA Cert Gastroenterology(SA) Paed Study Tips from Top Performers

1Focus heavily on ESPGHAN and NASPGHAN guidelines for Paediatric IBD, Coeliac Disease, EoE, and Neonatal Cholestasis.

2Master the diagnostic evaluation and management of biliary atresia, including timing of Kasai portoenterostomy and post-Kasai complications.

3Review paediatric clinical nutrition in detail: SAM management protocols (WHO F-75/F-100), refeeding syndrome electrolyte shifts, short bowel syndrome intestinal adaptation, and IFALD prevention.

4Understand diagnostic criteria and therapeutic interventions in paediatric endoscopy, including sedation protocols, foreign body removal, and endoscopic variceal ligation.

Frequently Asked Questions

What is the examination format for Cert Gastroenterology(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.

Who is eligible to sit the CMSA Cert Gastroenterology(SA) Paed exam?

Candidates who hold the FC Paed(SA) qualification or an equivalent specialist registration in Paediatrics with the HPCSA, and who have completed or are completing an accredited subspecialty training fellowship in Paediatric Gastroenterology in South Africa.

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

The examination fee set by the CMSA is R24 650.