100+ Free Cert Neonatology(SA) Paed Practice Questions

Prepare for the Sub-specialty Certificate in Neonatology of the College of Paediatricians of South Africa exam with instant access — no signup required.

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2026 Statistics

Key Facts: Cert Neonatology(SA) Paed 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 Paediatricians of SA

The Cert Neonatology(SA) Paed is a two-component sub-specialty exit examination (written short-answer papers plus an oral/OSCE/clinical component, each 50%) for specialist paediatricians completing sub-specialty fellowship training in neonatology. This bank provides 100 practice MCQs as a study aid.

Sample Cert Neonatology(SA) Paed Practice Questions

Try these sample questions to test your Cert Neonatology(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 term infant is born via emergency caesarean section for fetal distress. At birth, the baby is limp, apneic, and cyanotic. According to the NRP 8th Edition guidelines, what is the correct initial management sequence?

A.Initiate chest compressions at a 3:1 ratio with 100% supplemental oxygen

B.Immediate endotracheal intubation and administration of surfactant

C.Provide warmth, position airway, suction secretions if obstructed, dry, and stimulate

D.Administer IV adrenaline 0.02 mg/kg via umbilical venous catheter

Explanation: According to NRP 8th Edition, the initial steps of resuscitation for any non-vigorous infant involve placing the baby under a radiant warmer, positioning the head and neck (sniffing position) to open the airway, suctioning secretions if airway is obstructed, drying thoroughly, and providing tactile stimulation. If apnea or heart rate < 100 bpm persists after these initial steps (completed within 30 seconds), positive pressure ventilation (PPV) must be initiated.

2A 29-week preterm infant requires positive pressure ventilation (PPV) in the delivery room due to persistent apnea. What is the recommended initial fraction of inspired oxygen (FiO2) for initiating PPV in this infant?

A.21% to 30%

B.50% to 60%

C.100%

D.80% to 100%

Explanation: For preterm infants born at <35 weeks gestation, resuscitation should be initiated using 21% to 30% FiO2 (air or low oxygen concentration blended). Hyperoxia causes oxidative stress and lung injury, while hypoxia must be avoided by targeting pre-ductal oxygen saturations using pulse oximetry.

3A 28-week preterm infant develops grunting, nasal flaring, tachypnea, and intercostal retractions 30 minutes after birth. An anteroposterior chest radiograph displays diffuse reticulonodular infiltrates with prominent air bronchograms and low lung volumes. What is the primary underlying pathophysiology?

A.Developmental deficiency of pulmonary surfactant and structural alveolar immaturity

B.Bacterial pneumonia secondary to Group B Streptococcus intra-amniotic infection

C.Delayed clearance of fetal lung fluid secondary to caesarean delivery

D.Meconium aspiration causing small airway obstruction and chemical pneumonitis

Explanation: Respiratory Distress Syndrome (RDS) in preterm infants is primarily caused by a deficiency of pulmonary surfactant (produced by Type II pneumocytes) combined with structural immaturity of the lungs. This leads to high alveolar surface tension, microatelectasis, ventilation-perfusion mismatch, and classic ground-glass radiograph appearances with air bronchograms.

4What is the recommended initial continuous positive airway pressure (CPAP) setting for a spontaneously breathing 28-week neonate with Respiratory Distress Syndrome (RDS) immediately after birth?

A.5 to 6 cm H2O

B.9 to 10 cm H2O

C.12 to 14 cm H2O

D.2 to 3 cm H2O

Explanation: European and international RDS guidelines recommend initiating CPAP at 5 to 6 cm H2O via nasal prongs or mask immediately after birth for spontaneously breathing infants at risk of RDS. This maintains functional residual capacity (FRC) and reduces the need for intubation.

5According to South African neonatal screening guidelines, which criteria mandate Retinopathy of Prematurity (ROP) screening by an ophthalmologist?

A.Birth weight < 1500 g or gestational age < 32 weeks

B.Birth weight < 1000 g or gestational age < 28 weeks

C.Birth weight < 2500 g or gestational age < 37 weeks

D.Only infants requiring mechanical ventilation for > 14 days regardless of weight

Explanation: In South Africa, national ROP guidelines recommend screening all infants with a birth weight < 1500 g or gestational age < 32 weeks, as well as selected infants between 1500-2000 g with unstable clinical courses (e.g., prolonged supplemental oxygen exposure).

6During neonatal resuscitation of a term newborn, effective positive pressure ventilation (PPV) with chest movement has been performed for 30 seconds. The heart rate is audited via electrocardiogram and remains 50 bpm. What is the immediate next step?

A.Initiate chest compressions coordinated with PPV and increase FiO2 to 100%

B.Administer IV bolus of 20 mL/kg 0.9% normal saline over 10 minutes

C.Administer endotracheal atropine 0.02 mg/kg

D.Continue PPV alone for another 60 seconds at 21% oxygen

Explanation: If the newborn's heart rate remains below 60 bpm despite at least 30 seconds of effective PPV that inflates the lungs (confirmed by chest movement), chest compressions must be initiated immediately, and the oxygen concentration should be increased to 100% FiO2.

7What is the recommended ratio of chest compressions to ventilation events during CPR in a neonatal resuscitation scenario?

A.3 compressions to 1 ventilation

B.30 compressions to 2 ventilations

C.5 compressions to 1 ventilation

D.15 compressions to 2 ventilations

Explanation: The standard ratio for neonatal CPR is 3 compressions to 1 ventilation (3:1 ratio). This delivers 90 compressions and 30 breaths per minute (total 120 events per minute), emphasizing that asphyxia/hypoxia is the predominant cause of cardiac arrest in neonates.

8A pregnant woman presents at 30 weeks gestation in active preterm labor. Administration of antenatal corticosteroids (dexamethasone or betamethasone) is initiated. What is the principal proven neonatal benefit of this intervention?

A.Eliminates the risk of necrotizing enterocolitis completely

B.Prevents congenital bacterial sepsis and premature rupture of membranes

C.Accelerates renal glomerular filtration and prevents hyperkalemia

D.Reduces the incidence and severity of RDS, intraventricular hemorrhage, and neonatal mortality

Explanation: Antenatal corticosteroids administered to mothers at risk of preterm birth between 24 and 34 weeks gestation accelerate fetal lung maturity and decrease neonatal mortality, Respiratory Distress Syndrome (RDS), intraventricular hemorrhage (IVH), and necrotizing enterocolitis (NEC).

9Which statement best describes the Less Invasive Surfactant Administration (LISA) procedure in preterm infants with RDS?

A.Surfactant is injected directly into the pleural cavity via thoracostomy

B.Surfactant is nebulized continuously through a nasal cannula circuit

C.Surfactant is instilled through a thin vascular catheter placed into the trachea while the infant remains on CPAP

D.The infant is intubated, given surfactant, mechanically ventilated for 24 hours, and then extubated

Explanation: LISA involves introducing a thin catheter (e.g., vascular catheter or dedicated semirigid catheter) through the vocal cords into the trachea using direct or video laryngoscopy while the infant continues spontaneously breathing on nasal CPAP. This avoids positive pressure mechanical ventilation.

10What is the primary mechanism of action of caffeine citrate in the treatment of apnea of prematurity?

A.Inhibition of central GABA-A receptors leading to generalized muscular spasticity

B.Direct agonist action on pulmonary beta-2 adrenergic receptors causing bronchodilation

C.Antagonism of central adenosine A1 and A2A receptors stimulating respiratory centers

D.Stimulation of peripheral dopamine D2 receptors in the carotid body

Explanation: Caffeine citrate is a methylxanthine that acts as a competitive antagonist of central adenosine receptors (A1 and A2A). Adenosine inhibits respiratory drive; blocking adenosine increases central respiratory drive, enhances medullary sensitivity to hypercapnia, and improves diaphragmatic contractility.

About the Cert Neonatology(SA) Paed Exam

The Sub-specialty Certificate in Neonatology [Cert Neonatology(SA) Paed] is the benchmark specialist sub-specialty credential administered by the College of Paediatricians of South Africa. It validates expert consultant-level competency in neonatal intensive care, resuscitation, extreme prematurity, therapeutic hypothermia, neonatal sepsis, congenital surgical anomalies, and neonatal metabolic/nutritional management in Southern Africa.

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: Prematurity, RDS & Neonatal Resuscitation (30%), Neonatal Sepsis & Infectious Diseases (20%), Neonatal Neurology, HIE & Seizures (20%), Congenital Anomalies & Surgical Conditions in Neonates (15%), and Neonatal Nutrition, Fluid/Electrolytes & Hyperbilirubinemia (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 Paediatricians of South Africa (Colleges of Medicine of South Africa))

Cert Neonatology(SA) Paed Exam Content Outline

30%

Prematurity, RDS & Neonatal Resuscitation

NRP guidelines, T-piece resuscitator management, surfactant therapy (LISA/INSURE), CPAP/ventilation, bronchopulmonary dysplasia, retinopathy of prematurity, and PDA management.

20%

Neonatal Sepsis & Infectious Diseases

Early and late-onset neonatal sepsis, GBS, Gram-negative pathogens, congenital infections (TORCH, Syphilis, CMV, HSV), HIV PMTCT protocols, birth PCR screening, and neonatal TB.

20%

Neonatal Neurology, HIE & Seizures

Hypoxic-ischemic encephalopathy (HIE) Sarnat staging, therapeutic hypothermia protocols (33.5°C for 72 hours), aEEG, neonatal seizures, IVH grading, and periventricular leukomalacia.

15%

Congenital Anomalies & Surgical Conditions in Neonates

Congenital diaphragmatic hernia (CDH), abdominal wall defects (gastroschisis, omphalocele), necrotizing enterocolitis (Bell staging), tracheoesophageal fistula, intestinal atresia, and ductal-dependent CHD.

15%

Neonatal Nutrition, Fluid/Electrolytes & Hyperbilirubinemia

Enteral nutrition, human milk fortification, parenteral nutrition (TPN), neonatal fluid-electrolyte physiology, physiological/pathological jaundice, exchange transfusion, and kernicterus prevention.

How to Pass the Cert Neonatology(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 core domain areas: Prematurity, RDS & Neonatal Resuscitation (30%), Neonatal Sepsis & Infectious Diseases (20%), Neonatal Neurology, HIE & Seizures (20%), Congenital Anomalies & Surgical Conditions in Neonates (15%), and Neonatal Nutrition, Fluid/Electrolytes & Hyperbilirubinemia (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 Neonatology(SA) Paed Study Tips from Top Performers

1Focus on NRP 8th Edition guidelines, CPAP/surfactant protocols (LISA vs INSURE), and BPD management strategies.

2Master South African specific clinical guidelines, including birth HIV PCR testing protocols, PMTCT regimens, congenital syphilis workup/treatment, and neonatal TB exposure pathways.

3Review therapeutic hypothermia inclusion/exclusion criteria, Sarnat staging, aEEG background patterns, and first-line anti-seizure dosing (phenobarbital vs levetiracetam).

Frequently Asked Questions

What is the format of the CMSA Cert Neonatology(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 official examination fee for Cert Neonatology(SA) Paed?

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 are the key blueprint domains covered in the exam?

Content is weighted across 5 core domains: Prematurity, RDS & Neonatal Resuscitation (30%), Neonatal Sepsis & Infectious Diseases (20%), Neonatal Neurology, HIE & Seizures (20%), Congenital Anomalies & Surgical Conditions (15%), and Neonatal Nutrition, Fluid/Electrolytes & Hyperbilirubinemia (15%).