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2026 Statistics

Key Facts: Cert ID(SA) Phys Exam

2 components

Written + oral/OSCE

CMSA Regulations

50% each

Subminimum per component

CMSA Regulations

R24 650

Exam Fee

CMSA 2026 Fee Schedule

50% overall

Pass Mark

CMSA Regulations

CMSA

Exam Body

College of Physicians of SA

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

Sample Cert ID(SA) Phys Practice Questions

Try these sample questions to test your Cert ID(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 34-year-old HIV-positive man (CD4 count 45 cells/µL, ART-naïve) presents with a 3-week history of productive cough, fever, and night sweats. Sputum Xpert MTB/RIF Ultra detects Mycobacterium tuberculosis complex with 'Rifampicin resistance DETECTED'. Second-line line probe assay (LPA) reveals fluoroquinolone susceptibility and no resistance to amikacin. Which of the following is the most appropriate initial treatment regimen for this patient according to updated South African national drug-resistant TB guidelines?

A.Standard 9-month injectable-containing regimen (Amikacin, Moxifloxacin, Ethionamide, Terizidone)

B.Bedaquiline, Pretomanid, Linezolid, and Moxifloxacin (BPaLM) for 6 months

C.Longer individualised regimen of 18-24 months containing Bedaquiline, Levofloxacin, Linezolid, Clofazimine, and Cycloserine

D.Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol at double doses

Explanation: The 6-month oral BPaLM regimen (Bedaquiline, Pretomanid, Linezolid, and Moxifloxacin) is the WHO and South African NDoH recommended preferred regimen for patients aged ≥ 14 years with rifampicin-resistant/multidrug-resistant TB (RR/MDR-TB) who are fluoroquinolone-susceptible and have not had prior exposure to bedaquiline, pretomanid, or linezolid (> 1 month).

2A 29-year-old woman with newly diagnosed HIV infection presents for ART initiation. She is completely asymptomatic. Her CD4 count returns at 38 cells/µL. Serum Cryptococcal Antigen (CrAg) screening is positive. She has no headache, fever, neck stiffness, or altered mental status. What is the most appropriate next step in management?

A.Administer IV Liposomal Amphotericin B 3 mg/kg daily for 14 days as inpatient induction

B.Perform a diagnostic lumbar puncture to measure opening pressure and rule out subclinical cryptococcal meningitis

C.Start Dolutegravir-based ART immediately on the same day and monitor for cryptococcal symptoms

D.Initiate oral Fluconazole 800 mg daily immediately without further investigation

Explanation: In asymptomatic HIV-infected individuals with a positive serum CrAg screening test, a lumbar puncture (LP) must be performed to evaluate for subclinical cryptococcal meningitis before initiating preemptive oral fluconazole. Subclinical meningitis is present in up to 30% of serum CrAg-positive asymptomatic patients and requires full induction antifungal therapy rather than preemptive fluconazole.

3A 42-year-old HIV-infected man with CD4 count 18 cells/µL is admitted with severe cryptococcal meningitis confirmed on India ink and CSF CrAg. CSF opening pressure is 32 cm H2O. What is the preferred induction antifungal regimen according to current Southern African HIV Clinicians Society guidelines?

A.Amphotericin B deoxycholate 1 mg/kg/day IV plus Fluconazole 800 mg/day for 4 weeks

B.Fluconazole 1200 mg daily monotherapy for 14 days

C.Voriconazole 400 mg IV twice daily for 7 days followed by oral Itraconazole

D.Single high-dose Liposomal Amphotericin B (10 mg/kg) on day 1 PLUS Flucytosine 100 mg/kg/day and Fluconazole 1200 mg/kg/day for 14 days (AMBITION-cm trial regimen)

Explanation: The single high-dose Liposomal Amphotericin B (10 mg/kg IV on day 1) combined with 14 days of oral Flucytosine (100 mg/kg/day in 4 divided doses) and Fluconazole (1200 mg daily) is the gold-standard induction regimen demonstrated in the landmark AMBITION-cm trial. It offers equivalent efficacy to 7-14 day daily amphotericin regimens with significantly fewer adverse events (anemia, hypokalemia, nephrotoxicity).

4A 38-year-old man with advanced HIV infection (CD4 count 12 cells/µL) is treated for confirmed Cryptococcal Meningitis. Induction therapy is successfully completed, CSF opening pressure has normalized, and he is clinically well on Fluconazole consolidation therapy. When should antiretroviral therapy (ART) be initiated in this patient?

A.After 6 months of fluconazole secondary prophylaxis is completed

B.On the same day as antifungal induction therapy (Day 1)

C.4 to 6 weeks after the initiation of antifungal induction therapy

D.Within 1 to 2 weeks of starting antifungal therapy

Explanation: Antiretroviral therapy (ART) must be delayed for 4 to 6 weeks after starting antifungal therapy in patients with Cryptococcal Meningitis. Early initiation of ART (within 1-2 weeks) in cryptococcal meningitis is associated with significantly increased mortality driven by life-threatening intracranial Immune Reconstitution Inflammatory Syndrome (IRIS) and elevated intracranial pressure.

5A 50-year-old woman with pre-XDR pulmonary tuberculosis (rifampicin-resistant and moxifloxacin-resistant) is started on an individualized treatment regimen containing Linezolid 600 mg daily, Bedaquiline, Pretomanid, Clofazimine, and Terizidone. Four weeks into therapy, she develops progressive numbness, tingling, and burning pain in both feet, along with routine laboratory monitoring showing hemoglobin drop from 11.5 g/dL to 8.1 g/dL. Which drug is responsible for these adverse effects, and what is the optimal management?

A.Pretomanid; discontinue pretomanid and monitor liver enzymes weekly

B.Linezolid; reduce dose to 300 mg daily (or temporary hold if severe) and administer Pyridoxine (Vitamin B6)

C.Terizidone; stop terizidone and initiate Pyrazinamide

D.Bedaquiline; stop bedaquiline permanently and switch to Amikacin

Explanation: Linezolid causes dose- and duration-dependent mitochondrial toxicity leading to peripheral neuropathy, optic neuritis, and bone marrow suppression (anemia, thrombocytopenia). Management of Linezolid toxicity involves dose reduction to 300 mg daily or temporary interruption until myelosuppression resolves, along with Pyridoxine (Vitamin B6) supplementation (50-100 mg daily).

6A 31-year-old pregnant woman (gestational age 18 weeks) with advanced HIV (CD4 62 cells/µL) presents with dyspnea, non-productive cough, and fever. Chest radiography demonstrates diffuse bilateral interstitial infiltrates. Arterial blood gas on room air shows PaO2 58 mmHg and alveolar-arterial oxygen gradient 42 mmHg. Sputum PCR confirms Pneumocystis jirovecii. What is the most appropriate acute management?

A.High-dose Trimethoprim-Sulfamethoxazole monotherapy without corticosteroids due to fetal risk

B.IV Pentamidine monotherapy as first-line treatment during pregnancy

C.High-dose oral/IV Trimethoprim-Sulfamethoxazole (Cotrimoxazole) PLUS adjunctive Prednisone initiated before antibiotic administration

D.Atovaquone oral suspension combined with Clindamycin

Explanation: First-line treatment for moderate-to-severe Pneumocystis jirovecii pneumonia (PJP defined by PaO2 < 70 mmHg or A-a gradient ≥ 35 mmHg) is high-dose Trimethoprim-Sulfamethoxazole (15-20 mg/kg/day of TMP component) PLUS adjunctive corticosteroids (Prednisone 40 mg BD for 5 days, then 40 mg daily for 5 days, then 20 mg daily to complete 21 days). Corticosteroids significantly reduce respiratory failure and mortality and must not be withheld in pregnancy when severe hypoxia is present.

7A 36-year-old HIV-infected man with CD4 count 24 cells/µL is diagnosed with pulmonary tuberculosis (drug-susceptible MTB). He is started on fixed-dose combination HRZE (Isoniazid, Rifampicin, Pyrazinamide, Ethambutol). He is ART-naïve. When should ART (Tenofovir/Lamivudine/Dolutegravir - TLD) be initiated?

A.8 to 12 weeks after starting anti-tuberculosis therapy upon completion of the intensive phase

B.On the same day as anti-tuberculosis therapy

C.Within 2 weeks of starting anti-tuberculosis therapy

D.After completion of the full 6-month tuberculosis treatment course

Explanation: In HIV-infected patients with severe immunosuppression (CD4 count < 50 cells/µL), ART should be initiated within 2 weeks of starting anti-tuberculosis treatment (except in TB meningitis). Early ART significantly reduces all-cause mortality in severely immunocompromised patients with TB co-infection.

8A 28-year-old HIV-infected man taking Tenofovir disoproxil fumarate, Lamivudine, and Dolutegravir (TLD) and Rifampicin-based anti-TB treatment (HRZE) presents with therapeutic drug monitoring questions. Because Rifampicin is a potent inducer of CYP3A4 and UGT1A1 enzymes, how should the Dolutegravir dosage be adjusted during concurrent Rifampicin therapy?

A.Switch Dolutegravir to Efavirenz 600 mg once daily

B.Double the dose of TLD to two combination tablets once daily

C.Increase Dolutegravir to 50 mg twice daily (supplemental 50 mg dose 12 hours after the fixed TLD tablet)

D.Maintain standard TLD once daily without dose adjustment

Explanation: Rifampicin markedly induces UGT1A1 and CYP3A4, reducing plasma concentrations of Dolutegravir by approximately 54%. To overcome this induction, Dolutegravir must be increased to 50 mg twice daily (an additional single 50 mg DTG tablet taken 12 hours after the morning TLD combination dose). This dose adjustment must be continued for 2 weeks after stopping Rifampicin.

9A 45-year-old man with Tuberculous Meningitis (TBM) and HIV co-infection (CD4 count 32 cells/µL) has completed 10 days of anti-tuberculosis therapy and adjunctive dexamethasone. He is clinically stabilizing. When should antiretroviral therapy be introduced?

A.Deferred until dexamethasone tapering is completely finished at 6 months

B.Initiated on Day 1 alongside anti-tuberculosis therapy

C.Initiated immediately within the first 14 days

D.Deferred to 4 to 8 weeks after commencing anti-tuberculosis therapy

Explanation: In Tuberculous Meningitis (TBM), ART initiation should be deferred for 4 to 8 weeks after starting anti-TB treatment, regardless of CD4 count. Clinical trials (e.g. TBM-IRIS trials) demonstrated that early ART in TBM does not improve survival and is associated with significantly more severe, life-threatening neurological adverse events and intracranial IRIS.

10A 38-year-old HIV-infected woman on first-line ART (TLD) for 18 months presents with confirmed virological failure (viral load 45,000 copies/mL despite documented high adherence). Genotypic resistance testing reveals the G140S + Q148H mutations in the integrase gene, conferring high-level resistance to Dolutegravir and cross-resistance to Bictegravir/Raltegravir. What is the most appropriate second-line ART regimen?

A.Boosted Protease Inhibitor (Darunavir/ritonavir 800/100 mg daily or 600/100 mg BD) PLUS 2 NRTIs optimized by resistance testing (e.g. Zidovudine + Lamivudine)

B.Increase Dolutegravir to 50 mg twice daily and add Efavirenz

C.Initiate Maraviroc monotherapy

D.Switch Dolutegravir to Bictegravir and retain TDF/3TC

Explanation: When dolutegravir resistance is confirmed (mutations like G140S/Q148H or R263K), the patient must be switched to a ritonavir-boosted protease inhibitor-based regimen (preferably Darunavir/ritonavir or Lopinavir/ritonavir) combined with two nucleoside reverse transcriptase inhibitors (NRTIs) selected based on NRTI resistance testing (e.g., Zidovudine + Lamivudine or optimized nucleoside backbone).

About the Cert ID(SA) Phys Exam

The CMSA Sub-specialty Certificate in Infectious Diseases [Cert ID(SA) Phys] is the sub-specialty board examination for specialist physicians in South Africa seeking sub-specialist registration in Infectious Diseases. The exam rigorously tests evidence-based management of complex infections including HIV, drug-resistant tuberculosis, critical care infectious diseases, transplant infectious diseases, antimicrobial stewardship, and local tropical/zoonotic medicine.

Assessment

Two components each contributing 50%: a written component (short-answer written papers) and an oral/OSCE/OSPE/clinical component. Content spans 5 core domain areas: Adult TB & Advanced HIV (30%), Antimicrobial Therapy & Stewardship (25%), Severe Bacterial, Fungal & Viral Infections (20%), Infections in Immunocompromised Hosts (15%), and Tropical Diseases, Zoonoses & Travel Medicine (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 Physicians of South Africa (Colleges of Medicine of South Africa))

Cert ID(SA) Phys Exam Content Outline

30%

Adult Tuberculosis (DS/DR-TB) & Advanced HIV Medicine

Pathogenesis, diagnosis (GeneXpert Ultra, LPA, culture), regimen design for drug-susceptible and drug-resistant TB (bedaquiline, pretomanid, linezolid), HIV ART regimens, opportunistic infections (Cryptococcal meningitis, PCP, CMV, Kaposi sarcoma), IRIS, renal/hepatic organ dysfunction.

25%

Antimicrobial Therapy, Stewardship & Resistance

Pharmacokinetics/pharmacodynamics (PK/PD), mechanism of resistance (ESBL, carbapenemases, CRE, VRE, MRSA), therapeutic drug monitoring (vancomycin, aminoglycosides, voriconazole), antimicrobial stewardship interventions, and hospital outbreak control.

20%

Severe Bacterial, Fungal & Viral Infections in Adults

Sepsis and septic shock management, infective endocarditis, central nervous system infections (bacterial, viral meningitis, brain abscess), severe community-acquired and nosocomial pneumonia, invasive candidiasis, aspergillosis, severe COVID-19, influenza, and viral hemorrhagic fevers.

15%

Infections in Immunocompromised Hosts (Transplant, Chemotherapy)

Febrile neutropenia empirical management, solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) infectious complications, CMV reactivations, PJP prophylaxis, invasive fungal infections (Aspergillus, Mucorales), and pre-transplant screening.

10%

Tropical Diseases, Zoonoses & Travel Medicine

Severe Plasmodium falciparum malaria (artesunate therapy), viral hemorrhagic fevers (Ebola, Marburg, Crimean-Congo), rickettsia (tick-bite fever), leptospirosis, rabies post-exposure prophylaxis, schistosomiasis, neurocysticercosis, and pre-travel vaccination.

How to Pass the Cert ID(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 core domain areas: Adult TB & Advanced HIV (30%), Antimicrobial Therapy & Stewardship (25%), Severe Bacterial, Fungal & Viral Infections (20%), Infections in Immunocompromised Hosts (15%), and Tropical Diseases, Zoonoses & Travel Medicine (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) Phys Study Tips from Top Performers

1Master current South African NDoH and Southern African HIV Clinicians Society guidelines for drug-resistant TB (BPaL/BPaLM regimens) and advanced HIV disease.

2Review antimicrobial resistance mechanisms (Ambler classification of carbapenemases like NDM, KPC, OXA-48) and PK/PD principles for beta-lactams, polymyxins, and aminoglycosides.

3Understand diagnostic algorithms and preemptive strategies for opportunistic infections in transplant recipients (CMV PCR monitoring, galactomannan testing for invasive aspergillosis).

Frequently Asked Questions

What is the format of the CMSA Cert ID(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 are the eligibility requirements for the Cert ID(SA) Phys?

Candidates must hold an FCP(SA) or equivalent specialist qualification in Internal Medicine, be registered with the HPCSA as a Specialist Physician, and have completed accredited sub-specialty registrar training in Infectious Diseases.

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).