100+ Free Cert Medical Oncology(SA) Phys Practice Questions

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2026 Statistics

Key Facts: Cert Medical Oncology(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 Medical Oncology(SA) Phys is a rigorous two-component sub-specialty exit examination (written short-answer papers plus an oral/OSCE/clinical component, each 50%) for specialist physicians completing sub-specialty medical oncology fellowship training in South Africa. This bank provides 100 practice MCQs as a study aid.

Sample Cert Medical Oncology(SA) Phys Practice Questions

Try these sample questions to test your Cert Medical Oncology(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 48-year-old premenopausal woman undergoes a left lumpectomy and sentinel lymph node biopsy for a 2.2 cm invasive ductal carcinoma. Pathology reveals Nottingham Grade 2 tumor, ER 95%, PR 80%, HER2 1+ (negative), and 0/2 lymph nodes involved (pT2N0M0). Genomic profiling with the 21-gene Recurrence Score (Oncotype DX) yields a score of 28. Which of the following is the most appropriate systemic adjuvant therapy recommendation based on TAILORx and RxPONDER trials?

A.Adjuvant chemotherapy (e.g., TC - docetaxel/cyclophosphamide) followed by tamoxifen combined with ovarian function suppression

B.Adjuvant tamoxifen monotherapy for 5 years without chemotherapy or ovarian function suppression

C.Adjuvant aromatase inhibitor (letrozole) monotherapy for 5 years without chemotherapy

D.Adjuvant trastuzumab plus paclitaxel for 12 weeks followed by single-agent tamoxifen

Explanation: In premenopausal women with node-negative HR+/HER2- breast cancer and an Oncotype DX Recurrence Score (RS) of 26-100, chemotherapy provides a substantial reduction in distant recurrence risk (TAILORx trial). For premenopausal women with RS 26-100, adjuvant chemotherapy followed by endocrine therapy incorporating ovarian function suppression (OFS) plus Tamoxifen or an Aromatase Inhibitor is standard. Tailored endocrine therapy with OFS yields superior outcomes in high-risk premenopausal patients (SOFT/TEXT trials).

2A 54-year-old woman presents with newly diagnosed metastatic HER2-positive invasive breast cancer with multiple liver and bone metastases. Echocardiogram demonstrates a left ventricular ejection fraction (LVEF) of 62%. Baseline lab tests are normal. According to the landmark CLEOPATRA trial and international guidelines, what is the preferred first-line systemic regimen?

A.Trastuzumab emtansine (T-DM1) monotherapy

B.Pertuzumab + Trastuzumab + Docetaxel

C.Trastuzumab + Paclitaxel + Lapatinib

D.Trastuzumab deruxtecan (T-DXd) + Capecitabine

Explanation: The CLEOPATRA trial established dual HER2-blockade with Pertuzumab, Trastuzumab, and Docetaxel as the gold-standard first-line systemic treatment for metastatic HER2-positive breast cancer. Dual targeting of HER2 subdomains II (pertuzumab) and IV (trastuzumab) produces synergistic inhibition of HER2 dimerization and downstream PI3K/AKT signaling, significantly improving overall survival compared to trastuzumab plus docetaxel alone.

3A 52-year-old female with metastatic HER2-positive breast cancer experiences disease progression in the liver and lungs while receiving first-line Pertuzumab, Trastuzumab, and Docetaxel. Her ECOG performance status is 1. What is the most appropriate second-line systemic treatment choice supported by the DESTINY-Breast03 phase III trial?

A.Lapatinib + Capecitabine

B.Trastuzumab emtansine (T-DM1)

C.Trastuzumab deruxtecan (T-DXd)

D.Tucatinib + Trastuzumab + Capecitabine

Explanation: The DESTINY-Breast03 phase III trial demonstrated that Trastuzumab deruxtecan (T-DXd), an antibody-drug conjugate carrying a potent topoisomerase I inhibitor payload with a high drug-to-antibody ratio (8:1), provided statistically superior progression-free survival (PFS) and overall survival (OS) compared to T-DM1 in patients with HER2-positive metastatic breast cancer previously treated with trastuzumab and a taxane.

4A 42-year-old female is diagnosed with stage IIB triple-negative breast cancer (TNBC, cT2cN1M0). Core biopsy shows Nottingham Grade 3 invasive ductal carcinoma, ER <1%, PR 0%, HER2 0, PD-L1 CPS = 15. Staging scans show no distant metastases. What is the standard neoadjuvant systemic therapy strategy based on the KEYNOTE-522 trial?

A.Dose-dense AC (doxorubicin/cyclophosphamide) followed by paclitaxel monotherapy

B.Pembrolizumab monotherapy for 4 cycles followed by delayed definitive mastectomy

C.Carboplatin + Paclitaxel for 4 cycles followed immediately by breast-conserving surgery

D.Pembrolizumab + Carboplatin + Paclitaxel, followed by Pembrolizumab + AC, then post-operative adjuvant Pembrolizumab

Explanation: The KEYNOTE-522 trial established that adding Pembrolizumab to neoadjuvant chemotherapy (carboplatin + paclitaxel for 4 cycles, followed by doxorubicin/cyclophosphamide or epirubicin/cyclophosphamide for 4 cycles), followed by adjuvant Pembrolizumab post-surgery, significantly improves pathological complete response (pCR) rate and event-free survival (EFS) in patients with stage II or III triple-negative breast cancer regardless of PD-L1 status.

5A 62-year-old postmenopausal female presents with de novo metastatic ER-positive, HER2-negative breast cancer involving multiple bone lesions and asymptomatic subcentimeter lung nodules. She has an ECOG performance status of 0. Which of the following represents the preferred first-line systemic management?

A.A CDK4/6 inhibitor (e.g., Ribociclib or Abemaciclib) combined with a non-steroidal aromatase inhibitor (Letrozole or Anastrozole)

B.Dose-dense AC (doxorubicin and cyclophosphamide) chemotherapy for 6 cycles

C.Single-agent Fulvestrant 500 mg intramuscular injection monthly

D.Single-agent Tamoxifen 20 mg oral daily

Explanation: First-line systemic therapy for postmenopausal women with HR+/HER2- metastatic breast cancer without visceral crisis is a CDK4/6 inhibitor (Ribociclib, Abemaciclib, or Palbociclib) combined with an aromatase inhibitor (or Fulvestrant). Phase III landmark trials (MONALEESA-2, MONARCH-3, PALOMA-2) demonstrated significant improvements in median progression-free survival (doubling PFS to ~25-28 months) and overall survival (for Ribociclib and Abemaciclib).

6A 39-year-old female with known germline BRCA1 mutation develops recurrent metastatic triple-negative breast cancer following prior adjuvant anthracycline and taxane-based chemotherapy. She has no active CNS metastases. Which oral targeted agent is indicated based on the OLYMPIAD phase III trial?

A.Alpelisib

B.Olaparib

C.Niraparib

D.Capivasertib

Explanation: Olaparib is an oral Poly(ADP-ribose) Polymerase (PARP) inhibitor approved for germline BRCA1/2-mutated, HER2-negative metastatic breast cancer based on the OLYMPIAD trial. OLYMPIAD demonstrated a statistically significant improvement in median PFS (7.0 vs 4.2 months, HR 0.58) and response rate for Olaparib compared to physician's choice single-agent chemotherapy (capecitabine, eribulin, or vinorelbine). Talazoparib is similarly approved (EMBRACA trial).

7A 56-year-old postmenopausal woman undergoes mastectomy for a 4.5 cm invasive ductal carcinoma. Pathology confirms ER 90%, PR 75%, HER2 0, with 5 positive axillary lymph nodes (pT2N2aM0, Nottingham Grade 3, Ki-67 35%). She completes adjuvant AC-T chemotherapy and post-mastectomy radiotherapy. Based on the monarchE trial, which addition to her adjuvant endocrine therapy is recommended?

A.Palbociclib for 1 year

B.Ribociclib for 1 year

C.Abemaciclib for 2 years

D.Trastuzumab emtansine for 3 years

Explanation: The monarchE phase III trial evaluated high-risk node-positive (>=4 positive nodes, or 1-3 positive nodes with Grade 3, tumor size >=5cm, or Ki-67 >=20%) HR+/HER2- early breast cancer. The addition of Abemaciclib (150 mg twice daily) for 2 years to standard adjuvant endocrine therapy significantly improved invasive disease-free survival (iDFS) and distant relapse-free survival (dRFS) with sustained benefit beyond completion of treatment.

8Pathology from a core biopsy of a breast mass in a 45-year-old female shows Nottingham Grade 3 invasive carcinoma with ER 3% positive staining (low positive), PR 0%, HER2 1+. Gene expression profiling and clinical studies indicate that ER-low positive breast cancers (ER 1-10%) resemble which intrinsic molecular subtype?

A.Luminal A subtype

B.HER2-enriched subtype

C.Normal-like subtype

D.Basal-like / Triple-Negative Breast Cancer (TNBC)

Explanation: ASCO/CAP guidelines recognize ER-low positive breast cancers (ER 1-10%) as a distinct category. Broad genomic, transcriptomic, and clinical trial analyses demonstrate that the vast majority of ER-low positive tumors (>85%) have gene expression profiles and clinical outcomes identical to basal-like / triple-negative breast cancer (TNBC). They derive minimal benefit from endocrine therapy and should be managed with systemic chemotherapy strategies similar to TNBC.

9A 60-year-old female with metastatic HR-negative breast cancer previously treated with paclitaxel and doxorubicin presents with disease progression. Re-evaluation of liver biopsy tissue confirms HER2 2+ by IHC and non-amplified (ratio 1.4) by FISH, classifying the tumor as 'HER2-low'. Which agent demonstrated overall survival benefit in this patient population in the DESTINY-Breast04 trial?

A.Trastuzumab deruxtecan (T-DXd)

B.Trastuzumab emtansine (T-DM1)

C.Pertuzumab + Trastuzumab

D.Sacituzumab govitecan

Explanation: DESTINY-Breast04 established a new paradigm by demonstrating that Trastuzumab deruxtecan (T-DXd) significantly improved progression-free survival and overall survival compared to physician's choice chemotherapy in patients with HER2-low (IHC 1+ or IHC 2+/FISH-negative) unresectable or metastatic breast cancer who had received one or two prior lines of chemotherapy.

10A 38-year-old premenopausal woman completes adjuvant AC-T chemotherapy for node-positive (2/12 nodes) ER+/PR+/HER2- breast cancer. She remains premenopausal with regular menses restored. According to joint analysis of the SOFT and TEXT trials, which endocrine management strategy produces the highest rate of freedom from distant recurrence in high-risk premenopausal women?

A.Tamoxifen 20 mg daily monotherapy for 5 years

B.Ovarian function suppression (Goserelin) plus Exemestane for 5 years

C.Ovarian function suppression plus Tamoxifen for 2 years, then stopped

D.Letrozole monotherapy without ovarian function suppression

Explanation: Combined analysis of the SOFT and TEXT phase III trials showed that premenopausal women with high-risk HR+ early breast cancer (especially those requiring adjuvant chemotherapy) achieved statistically significant improvements in disease-free survival and freedom from distant recurrence when treated with ovarian function suppression (OFS, e.g. Goserelin or Triptorelin) combined with an aromatase inhibitor (Exemestane) compared to Tamoxifen alone or OFS plus Tamoxifen.

About the Cert Medical Oncology(SA) Phys Exam

The Sub-specialty Certificate in Medical Oncology [Cert Medical Oncology(SA) Phys] is the specialist sub-specialty qualification administered by the College of Physicians of South Africa. It validates expert consultant-level competency across systemic anti-cancer therapies, tumor biology, molecular oncology, clinical trial interpretation, toxicity management, oncological emergencies, and palliative oncology.

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: Breast & Gynecological Cancers (25%), Gastrointestinal & Thoracic Malignancies (25%), Genitourinary, Melanoma & Head/Neck Cancers (20%), Principles of Chemotherapy, Immunotherapy & Targeted Therapy (15%), Oncological Emergencies, Palliative Care & Toxicity Management (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 Medical Oncology(SA) Phys Exam Content Outline

25%

Breast & Gynecological Cancers

Adjuvant, neoadjuvant, and metastatic treatment of ER/PR-positive, HER2-positive, and triple-negative breast cancer; epithelial ovarian cancer, cervical carcinoma, endometrial carcinoma, and gestational trophoblastic disease.

25%

Gastrointestinal & Thoracic Malignancies

Colorectal, gastric, esophageal, pancreatic, hepatocellular, and biliary tract cancers; non-small cell lung cancer (NSCLC), small cell lung cancer (SCLC), and malignant pleural mesothelioma.

20%

Genitourinary, Melanoma & Head/Neck Cancers

Prostate, renal cell, urothelial, and germ cell testicular tumors; cutaneous melanoma and non-melanoma skin cancers; squamous cell carcinoma of the head and neck (HNSCC).

15%

Principles of Chemotherapy, Immunotherapy & Targeted Therapy

Pharmacokinetics, pharmacodynamics, cell-cycle specificity, alkylating agents, antimetabolites, cytotoxic antibiotics, immune checkpoint inhibitors (anti-PD-1/PD-L1, CTLA-4), antibody-drug conjugates (ADCs), and small molecule kinase inhibitors.

15%

Oncological Emergencies, Palliative Care & Toxicity Management

Febrile neutropenia, spinal cord compression, hypercalcemia of malignancy, tumor lysis syndrome, immune-related adverse events (irAEs), chemotherapy-induced nausea/vomiting (CINV), cardiotoxicity, and end-of-life care.

How to Pass the Cert Medical Oncology(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: Breast & Gynecological Cancers (25%), Gastrointestinal & Thoracic Malignancies (25%), Genitourinary, Melanoma & Head/Neck Cancers (20%), Principles of Chemotherapy, Immunotherapy & Targeted Therapy (15%), Oncological Emergencies, Palliative Care & Toxicity Management (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 Medical Oncology(SA) Phys Study Tips from Top Performers

1Focus on ESMO, NCCN, and South African Oncology Consortium (SAOC) clinical practice guidelines for breast, GI, thoracic, GU, and gynecological malignancies.

2Master landmark clinical trials (e.g., MONALEESA, CLEOPATRA, DESTINY-Breast, ADAURA, PACIFIC, KEYNOTE-048, EV-302, TOPAZ-1) and their clinical endpoints.

3Understand mechanisms and management of immune-related adverse events (irAEs), antibody-drug conjugates (T-DXd, Sacituzumab govitecan, Enfortumab vedotin), and pharmacogenomic testing (DPYD, TPMT, UGT1A1).

Frequently Asked Questions

What is the format of the CMSA Cert Medical Oncology(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 Medical Oncology(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: Breast & Gynecological Cancers (25%), Gastrointestinal & Thoracic Malignancies (25%), Genitourinary, Melanoma & Head/Neck Cancers (20%), Principles of Chemotherapy, Immunotherapy & Targeted Therapy (15%), and Oncological Emergencies, Palliative Care & Toxicity Management (15%).