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100+ Free Cert ID(SA) Paed Practice Questions

Prepare for the CMSA Sub-specialty Certificate in Infectious Diseases Cert ID(SA) Paed — South Africa exam with instant access — no signup required.

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2026 Statistics

Key Facts: Cert ID(SA) Paed Exam

2 components

Written + oral/OSCE

CMSA Regulations

50% each

Subminimum per component

CMSA Regulations

R24 650

Exam Fee

CMSA SS2026/FS2027 Fee Schedule

50% overall

Pass Mark

CMSA Regulations

CMSA

Exam Body

College of Paediatricians of SA

The Cert ID(SA) Paed is a comprehensive two-component sub-specialty exit examination (written short-answer papers plus an oral/OSCE/clinical component, each 50%) testing advanced paediatric infectious disease diagnosis and management for specialist paediatricians in South Africa. This bank provides 100 practice MCQs as a study aid.

Sample Cert ID(SA) Paed Practice Questions

Try these sample questions to test your Cert ID(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 14-month-old HIV-infected boy on Abacavir/Lamivudine/Dolutegravir presents with a 3-week history of persistent non-remitting cough, weight loss, and failure to thrive. Gastric aspirate for Xpert MTB/RIF Ultra returns positive with Mycobacterium tuberculosis detected (trace) and rifampicin resistance not detected. According to the South African National Department of Health (NDoH) paediatric TB guidelines, what is the recommended first-line intensive phase treatment regimen and duration?
A.Rifampicin and Isoniazid (RH) for 2 months plus High-dose Levofloxacin
B.Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol (RHZE) for 2 months
C.Rifampicin, Isoniazid, and Ethambutol (RHE) for 3 months
D.Rifampicin, Isoniazid, and Pyrazinamide (RHZ) for 2 months
Explanation: According to the South African NDoH Paediatric TB Guidelines, children with confirmed pulmonary TB who are HIV-infected or have severe/extensive disease should receive a 4-drug intensive phase consisting of Rifampicin (R), Isoniazid (H), Pyrazinamide (Z), and Ethambutol (E) for 2 months, followed by a 4-month continuation phase of Rifampicin and Isoniazid (RH). Ethambutol is included in HIV-infected children to prevent treatment failure due to potential initial drug resistance.
2A 4-week-old infant weighing 3.4 kg is confirmed HIV-1 positive via PCR at birth (confirmed on repeat sample). The infant is clinically stable with normal serum creatinine and ALT. According to the current South African ART guidelines, which first-line antiretroviral regimen should be initiated?
A.Tenofovir Alafenamide + Emtricitabine + Dolutegravir (TAF + FTC + DTG)
B.Abacavir + Lamivudine + Dolutegravir 10mg dispersible (ABC + 3TC + DTG)
C.Zidovudine + Lamivudine + Nevirapine (AZT + 3TC + NVP)
D.Abacavir + Lamivudine + Lopinavir/ritonavir (ABC + 3TC + LPV/r)
Explanation: South African National ART guidelines recommend Abacavir (ABC) + Lamivudine (3TC) + Dolutegravir (DTG 10mg dispersible tablets) as the preferred first-line regimen for all newly diagnosed HIV-infected infants and children aged at least 4 weeks and weighing at least 3 kg. DTG dispersible tablets provide superior virological suppression, higher barrier to resistance, and better tolerability compared to LPV/r.
3A 2-year-old child presents with a 2-week history of lethargy, low-grade fever, vomiting, and cranial nerve VI palsy. Lumbar puncture demonstrates xanthochromic CSF with elevated opening pressure, clear fluid, WBC count 280/mm³ (85% lymphocytes), protein 2.4 g/L, and CSF glucose 1.1 mmol/L (simultaneous blood glucose 5.5 mmol/L). GeneXpert Ultra on CSF detects M. tuberculosis (medium). What adjunctive therapy is critical to reduce mortality and neurological sequelae in this child?
A.High-dose Intravenous Immunoglobulin (IVIG) for 5 days
B.Intraventricular Streptomycin instillations
C.Interferon-gamma adjunctive therapy for 2 weeks
D.Systemic Corticosteroids (Dexamethasone or Prednisolone) for 4–6 weeks
Explanation: In Tuberculous Meningitis (TBM), adjunctive systemic corticosteroid therapy (Dexamethasone 0.4 mg/kg/day or Prednisolone 2 mg/kg/day tapered over 4–6 weeks) significantly reduces mortality and severe neurological deficits by reducing basal meningeal exudates, cerebral edema, and vasculitis-induced infarcts.
4A 6-year-old HIV-infected child who commenced ART (ABC/3TC/DTG) 3 weeks ago presents with high fever, tender bilateral cervical lymphadenopathy, and enlarging right supraclavicular lymph node abscess. Pre-ART CD4 count was 45 cells/mm³ (3.2%) and viral load was 850,000 copies/mL. Current viral load has dropped to 1,200 copies/mL. A needle aspirate of the lymph node shows acid-fast bacilli (AFB) positive, and culture grows M. tuberculosis. What is the most appropriate management strategy?
A.Continue ART, initiate 4-drug anti-TB therapy, and add systemic corticosteroids for IRIS
B.Drain the lymph node and withhold anti-TB therapy as this represents dead bacilli clearance
C.Switch ART to a 2nd-line protease inhibitor regimen and stop anti-TB drugs
D.Discontinue ART immediately and treat TB for 6 months before restarting ART
Explanation: This presentation is characteristic of Unmasking Tuberculous Immune Reconstitution Inflammatory Syndrome (TB-IRIS) following rapid immune recovery on DTG. The correct management is to continue ART, initiate standard 4-drug anti-TB treatment (RHZE), and add systemic corticosteroids (prednisolone 1-2 mg/kg/day) to control severe inflammatory manifestations.
5A 3-year-old HIV-exposed, HIV-uninfected child lives in a household with a mother who was diagnosed 2 days ago with bacteriological-confirmed rifampicin-susceptible pulmonary TB. The child is asymptomatic, tuberculin skin test (TST) is 3 mm, and chest radiograph is normal. What is the correct preventive management according to South African guidelines?
A.Give a booster dose of BCG vaccine immediately
B.Start full 4-drug active TB treatment (RHZE) for 6 months
C.Initiate TB Preventive Therapy (TPT) with 3 months of weekly Isoniazid and Rifapentine (3HP) or 3 months of daily Rifampicin and Isoniazid (3RH)
D.No intervention required as the child is HIV-uninfected and TST is negative
Explanation: In South Africa, all household child contacts under 5 years of age exposed to a confirmed case of drug-susceptible pulmonary TB must receive TB Preventive Therapy (TPT) after excluding active TB disease, regardless of HIV status or TST result. Recommended regimens include 3RH (daily rifampicin + isoniazid for 3 months) or 3HP (weekly rifapentine + isoniazid for 12 weeks in children ≥2 years).
6An 18-month-old child with MDR-TB (resistant to Rifampicin and Isoniazid) is being evaluated for a second-line anti-TB treatment regimen. According to current WHO and South African paediatric MDR-TB guidelines, which novel oral agent is approved for inclusion in all-oral short regimens for paediatric MDR-TB from 0 years of age?
A.Delamanid
B.Pretomanid
C.Bedaquiline
D.Capreomycin
Explanation: Bedaquiline is a diarylquinoline antimycobacterial agent approved by WHO and SA NDoH for inclusion in all-oral paediatric MDR-TB treatment regimens for children of all ages (including infants from birth/0 years). Bedaquiline inhibits mycobacterial ATP synthase and replaces injectable agents (like amikacin/capreomycin).
7A 4-month-old infant with perinatally acquired HIV infection who was NOT started on Cotrimoxazole (TMP-SMX) prophylaxis presents with severe tachypnoea, hypoxia (SpO2 82% on room air), dry cough, bilateral diffuse interstitial infiltrates on chest X-ray, and a CD4 percentage of 8%. Induced sputum Real-Time PCR confirms Pneumocystis jirovecii. What is the first-line acute treatment of choice?
A.High-dose Intravenous Cotrimoxazole (TMP-SMX 15–20 mg/kg/day of TMP) plus adjunctive systemic corticosteroids
B.Oral Fluconazole 12 mg/kg/day plus oral Clarithromycin
C.Intravenous Pentamidine isethionate 4 mg/kg/day alone
D.Inhaled Pentamidine 300 mg once weekly plus oral Dapsone
Explanation: First-line treatment for acute severe Pneumocystis jirovecii pneumonia (PJP) in children is high-dose intravenous Cotrimoxazole (15-20 mg/kg/day of trimethoprim component in 3-4 divided doses) for 21 days. In children with moderate-to-severe PJP (PaO2 <70 mmHg or SpO2 <92%), early adjunctive corticosteroid therapy (prednisolone 1-2 mg/kg/day tapered over 21 days) significantly reduces respiratory failure and mortality.
8A 9-month-old infant on ABC + 3TC + DTG for 5 months presents for routine review. The baseline viral load at ART initiation was >1,000,000 copies/mL. Current viral load is 8,500 copies/mL. Pharmacy pick-up records show 95% adherence, and the mother confirms giving the dispersible DTG tablets correctly every morning. What is the most appropriate clinical action according to SA NDoH paediatric ART guidelines?
A.Immediately switch ART to 2nd-line Zidovudine + Lamivudine + Lopinavir/ritonavir
B.Stop all ART immediately for 2 weeks to perform a drug wash-out before restarting
C.Assess adherence barriers, provide intensive adherence support, ensure correct weight-based DTG dosing, and repeat Viral Load in 3 months
D.Add Nevirapine to the current 3-drug regimen to create a 4-drug intensification protocol
Explanation: In a child on a Dolutegravir-based first-line regimen with an unsuppressed viral load (VL >50 copies/mL), the initial step is to thoroughly evaluate adherence, administration technique, and weight-based dosing accuracy, provide targeted adherence support, and recheck the viral load in 3 months. DTG has a high genetic barrier to resistance, and virological rebound or delayed suppression is most frequently driven by adherence/dosing gaps rather than resistance mutations.
9A 6-week-old infant receives BCG vaccine at birth. At 8 weeks of age, the infant develops a 2.5 cm ipsilateral non-tender, non-fluctuant axillary lymph node without fever or systemic signs. The infant is HIV-uninfected and growing well along the 50th centile. What is the recommended management strategy?
A.Conservative observation and reassurance without anti-TB therapy or surgery
B.Needle aspiration followed by instillation of topical isoniazid powder
C.Immediate surgical excision of the enlarged lymph node
D.Initiate 4-drug anti-TB therapy (RHZE) for 6 months
Explanation: Non-suppurative BCG lymphadenitis (ipsilateral axillary or supraclavicular lymph node enlargement <3 cm without fluctuation or systemic symptoms) is a benign self-limiting reaction to BCG vaccination. Recommended management is conservative observation and parental reassurance; it resolves spontaneously over several months.
10A 7-year-old child with advanced HIV infection (CD4 50 cells/mm³) presents with progressive headache, low-grade fever, and confusion over 2 weeks. Serum cryptococcal antigen (CrAg) test is positive (titre 1:1024). Lumbar puncture shows opening pressure of 320 mm H2O, CSF CrAg positive, and India ink positive for encapsulated yeasts. What is the preferred induction regimen for cryptococcal meningitis in children according to WHO guidelines?
A.Standard Amphotericin B deoxycholate + Oral Itraconazole for 4 weeks
B.Intravenous Fluconazole 6 mg/kg/day + Intravenous Vancomycin for 14 days
C.Oral Fluconazole 12 mg/kg/day monotherapy for 8 weeks
D.Liposomal Amphotericin B (3–4 mg/kg/day IV) + Oral Flucytosine (25 mg/kg QID) for 2 weeks
Explanation: WHO cryptococcal meningitis treatment guidelines recommend induction therapy with Liposomal Amphotericin B (3-4 mg/kg/day IV) combined with Oral Flucytosine (100 mg/kg/day in 4 divided doses) for 2 weeks (or single high-dose Liposomal Ampho B 10 mg/kg on day 1 plus 14 days of flucytosine + fluconazole), followed by consolidation therapy with Fluconazole (12 mg/kg/day up to 800 mg) for 8 weeks.

About the Cert ID(SA) Paed Exam

The Certificate in Infectious Diseases of the College of Paediatricians of South Africa - Cert ID(SA) Paed - is the exit sub-specialty examination for paediatricians completing sub-specialty training in Paediatric Infectious Diseases. It assesses advanced clinical knowledge, diagnostic reasoning, management of complex HIV/TB co-infections, neonatal sepsis, emerging infectious threats, and public health immunization strategies relevant to South Africa and Sub-Saharan Africa.

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: Paediatric TB & HIV (30%), Paediatric Bacterial, Viral & Fungal Infections (25%), Neonatal Sepsis & Congenital Infections (TORCH) (20%), Vaccines & Infection Control (15%), and Tropical & Parasitic Diseases (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 (College of Paediatricians (Colleges of Medicine of South Africa))

Cert ID(SA) Paed Exam Content Outline

30%

Paediatric Tuberculosis & HIV Management

South African Paediatric TB and ART guidelines, GeneXpert Ultra, stool Xpert Ultra, urine LAM, TBM staging and steroids, MDR-TB regimens (Bedaquiline, Linezolid), TPT protocols, EID algorithms, virological failure, TB-IRIS, PJP and OI management.

25%

Paediatric Bacterial, Viral & Fungal Infections

Acute bacterial meningitis, severe CAP and empyema (tPA/DNase), septic shock, viral respiratory pathogens (RSV, croup, influenza), childhood exanthems, invasive fungal infections (Aspergillosis, Mucormycosis, Candidiasis), osteomyelitis, septic arthritis, rheumatic fever, and SSSS.

20%

Neonatal Sepsis & Congenital Infections (TORCH)

Early-onset vs late-onset neonatal sepsis (GBS, E. coli, ESBL Klebsiella), Congenital Syphilis, Congenital CMV (valganciclovir), Congenital Toxoplasmosis, Rubella, Neonatal HSV, Parvovirus B19 hydrops, Neonatal Candidiasis, and Neonatal Tetanus.

15%

Vaccines, Immunization & Infection Control in Paediatrics

South African EPI schedule (Hexaxim, Rotarix, PCV13, Measles), vaccine indications and contraindications in HIV, vaccine anaphylaxis management, IPC isolation precautions, cold chain logistics, outbreak control, and rabies PEP.

10%

Tropical & Parasitic Diseases in Children

Severe P. falciparum malaria (IV Artesunate), urogenital and intestinal Schistosomiasis, soil-transmitted helminths (Ascaris, Hookworm), Hydatid disease, Amoebic liver abscess, Neurocysticercosis, Enteric fever, and Toxocariasis.

How to Pass the Cert ID(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 domain areas: Paediatric TB & HIV (30%), Paediatric Bacterial, Viral & Fungal Infections (25%), Neonatal Sepsis & Congenital Infections (TORCH) (20%), Vaccines & Infection Control (15%), and Tropical & Parasitic Diseases (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 ID(SA) Paed Study Tips from Top Performers

1Master the latest South African NDoH Paediatric TB and ART guidelines, including weight-based Dolutegravir dosing, Bedaquiline/Linezolid for MDR-TB, stool Xpert Ultra, and urine LAM indications.
2Focus heavily on TORCH infections (especially congenital CMV 6-month valganciclovir protocol, congenital syphilis penicillin regimens, and neonatal HSV high-dose acyclovir).
3Be fluent in the South African EPI-SA immunization schedule, vaccine contraindications in severely immunocompromised HIV-infected children, and rabies post-exposure prophylaxis.

Frequently Asked Questions

What is the format of the CMSA Cert ID(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 passing criteria for the Cert ID(SA) Paed 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 topic areas are covered in the Cert ID(SA) Paed blueprint?

The exam covers five main domains: Paediatric Tuberculosis & HIV Management (30%), Paediatric Bacterial, Viral & Fungal Infections (25%), Neonatal Sepsis & Congenital Infections (TORCH) (20%), Vaccines, Immunization & Infection Control in Paediatrics (15%), and Tropical & Parasitic Diseases in Children (10%).