Free Practice Questions for Cert Nephrology(SA) Paed

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Exam Review

Key Facts: Cert Nephrology(SA) Paed Exam

2 components

Written + oral/OSCE

CMSA Cert Nephrology(SA) Paed Regulations

50% each

Subminimum per component

CMSA Examination Guidelines

R24 650

Exam Fee

CMSA Sub-specialty Fee Schedule

50% overall

Pass Mark

CMSA Examination Regulations

CMSA

Exam Body

College of Paediatricians

The Cert Nephrology(SA) Paed is a two-component sub-specialty exit exam (written short-answer papers plus an oral/OSCE/clinical component, each 50%) for paediatricians completing sub-specialty fellowship training in paediatric nephrology in South Africa.

Sample Cert Nephrology(SA) Paed Practice Questions

Try these sample questions to review concepts for the Cert Nephrology(SA) Paed exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1An antenatal ultrasound performed at 28 weeks of gestation reveals a male fetus with bilateral hydroureteronephrosis, a thickened and trabeculated urinary bladder wall, and a dilated posterior urethra. Which classic sonographic sign is associated with this condition?

A.Whirlpool sign

B.Double bubble sign

C.Keyhole sign

D.Target sign

Explanation: The 'keyhole sign' on antenatal ultrasound represents a dilated posterior urethra proximal to the obstruction alongside a thick-walled, distended urinary bladder, which is pathognomonic for posterior urethral valves (PUV) in a male fetus.

2A newborn infant is found to have an asymptomatic left multicystic dysplastic kidney (MCDK) on routine postnatal renal ultrasonography. The contralateral right kidney is morphologically normal. What is the standard initial management approach for this infant?

A.Immediate laparoscopic nephrectomy of the dysplastic kidney

B.Prophylactic low-dose oral amoxicillin until 1 year of age

C.Percutaneous aspiration and sclerotherapy of the renal cysts

D.Conservative serial renal ultrasonography and clinical follow-up

Explanation: Unilateral multicystic dysplastic kidney (MCDK) in an asymptomatic neonate with a normal solitary functioning contralateral kidney is managed conservatively with serial renal ultrasonography, blood pressure monitoring, and urinalysis, as the majority undergo spontaneous regression over childhood.

3What is the most common anatomical cause of primary intrinsic urinary tract obstruction leading to congenital hydronephrosis in newborn infants?

A.Posterior urethral valves (PUV)

B.Ureteropelvic junction (UPJ) obstruction

C.Ureterovesical junction (UVJ) obstruction

D.Ectopic ureterocele

Explanation: Ureteropelvic junction (UPJ) obstruction is the single most common cause of congenital upper urinary tract obstruction and primary antenatal hydronephrosis, accounting for approximately 40-50% of cases.

4A voiding cystourethrogram (VCUG) in a 6-month-old female shows reflux of contrast into a moderately dilated ureter and renal pelvis with blunting of the calyceal fornices, but without severe tortuosity. According to the International Reflux Study Classification, which grade of vesicoureteral reflux (VUR) is present?

A.Grade II

B.Grade III

C.Grade V

D.Grade IV

Explanation: Grade IV VUR is characterized by moderate dilation and tortuosity of the ureter and renal pelvis with complete blunting of the calyceal fornices while preserving some calyceal impressions. Grade III shows mild dilation without blunting, and Grade V shows severe gross dilation and tortuosity with loss of papillary impressions.

5Which classic triad of clinical features defines Prune Belly Syndrome (Eagle-Barrett syndrome) in a male neonate?

A.Exstrophy of the bladder, epispadias, and imperforate anus

B.Renal hypoplasia, congenital heart disease, and tracheoesophageal fistula

C.Deficiency of abdominal wall musculature, bilateral cryptorchidism, and urinary tract anomalies

D.Multicystic dysplastic kidney, intestinal malrotation, and polydactyly

Explanation: Prune Belly Syndrome (Eagle-Barrett syndrome) is characterized by the classic clinical triad of: (1) partial or complete absence/hypoplasia of abdominal wall muscles, (2) bilateral cryptorchidism, and (3) urinary tract anomalies (dilated megaureters, megacystis, renal dysplasia).

6According to the Weigert-Meyer law governing complete duplex collecting systems, how are the upper and lower pole ureters typically positioned and affected clinically?

A.Upper and lower pole ureters merge at the bladder base and both reflux equally

B.Upper pole ureter inserts lateral/superior and tends to reflux; lower pole ureter inserts ectopic/inferomedial and tends to obstruct

C.Upper pole ureter inserts ectopic/inferomedial and tends to obstruct; lower pole ureter inserts lateral/superior and tends to reflux

D.Upper pole ureter always refluxes; lower pole ureter always forms an ectopic ureterocele

Explanation: The Weigert-Meyer law dictates that in a complete duplex system, the upper pole ureter drains ectopic, inferomedial to the lower pole orifice, and is prone to obstruction/ureterocele formation. The lower pole ureter inserts more superiorly and laterally with a short intravesical tunnel, making it prone to vesicoureteral reflux (VUR).

7During fetal development of a horseshoe kidney, normal cephalic migration of the fused renal parenchyma is arrested when the central isthmus becomes trapped beneath which vascular structure?

A.Inferior mesenteric artery (IMA)

B.Superior mesenteric artery (SMA)

C.Common iliac artery

D.Celiac axis

Explanation: In a horseshoe kidney, fusion of the lower poles occurs in the pelvis. As the fused kidney ascends during development, its central parenchymal or fibrous isthmus is trapped anterior to the abdominal aorta by the root of the inferior mesenteric artery (IMA) at the level of L3.

8Autosomal Recessive Polycystic Kidney Disease (ARPKD) is caused by mutations in the PKHD1 gene encoding fibrocystin. Which extrarenal hepatic lesion is universally present in patients with ARPKD?

A.Congenital hepatic fibrosis (biliary dysgenesis)

B.Biliary atresia

C.Hepatocellular adenoma

D.Hepatic hemangiomatosis

Explanation: All patients with ARPKD have varying degrees of congenital hepatic fibrosis characterized by ductal plate malformation, periportal fibrosis, and dilated intrahepatic bile ducts, which can lead to portal hypertension and hypersplenism.

9A newborn male infant born at 37 weeks is diagnosed immediately at birth with severe posterior urethral valves, severe bladder distension, and acute post-renal renal failure. What is the most appropriate immediate bedside intervention to decompress the urinary tract?

A.Immediate percutaneous suprapubic cystostomy catheter insertion

B.Urgent vesicostomy creation in the operating theatre within 2 hours

C.Placement of a 6 Fr feeding tube or small urethral catheter into the bladder

D.Emergency bilateral percutaneous nephrostomy placement

Explanation: The initial decompression of posterior urethral valves in a neonate is performed by transurethral insertion of a small (5 or 6 Fr) feeding tube or specialized non-balloon urethral catheter. Suprapubic catheters are avoided initially due to risks of bladder wall tears or bleeding.

10A 4-month-old infant with left hydronephrosis undergoes a Technetium-99m mercaptoacetyltriglycine (99mTc-MAG3) diuresis renogram with furosemide administration at 20 minutes (F+20 protocol). Which clearance parameter confirms significant mechanical UPJ obstruction?

A.Furosemide excretion half-life (T1/2) > 20 minutes

B.Furosemide excretion half-life (T1/2) < 10 minutes

C.Differential renal function of 50% in the left kidney

D.Peak activity reached within 3 minutes of tracer injection

Explanation: On a 99mTc-MAG3 diuresis renogram, a tracer clearance half-life (T1/2) greater than 20 minutes following furosemide administration indicates significant mechanical urinary obstruction. A T1/2 < 10 minutes indicates non-obstructed drainage, while 10-20 minutes is equivocal.

About the Cert Nephrology(SA) Paed Exam

The Sub-specialty Certificate in Nephrology of the College of Paediatricians of South Africa [Cert Nephrology(SA) Paed] is the sub-specialist credentialing examination for paediatricians specializing in paediatric nephrology. Candidates are evaluated on complex nephrological diagnosis, renal histopathology interpretation, dialysis and transplant mechanics, and pediatric electrolyte/acid-base management.

Exam sponsor: Colleges of Medicine of South Africa (CMSA), College of Paediatricians. The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

Two components each contributing 50%: a written component (short-answer written papers) and an oral/OSCE/OSPE/clinical component. Content spans 4 core domains: Congenital Anomalies of Kidney & Urinary Tract (25%), Paediatric Glomerular Diseases (25%), Paediatric AKI, Dialysis & Kidney Transplantation (25%), and Paediatric Hypertension, Tubular Disorders & UTIs (25%).

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 / Certification Fees

R24 650

Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Official sources

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

25%

Congenital Anomalies of Kidney & Urinary Tract (CAKUT)

Renal agenesis, dysplasia, multicystic dysplastic kidney, vesicoureteral reflux (VUR), posterior urethral valves (PUV), duplex collecting systems, UPJ obstruction, prune belly syndrome, and congenital cystic renal diseases.

25%

Paediatric Glomerular Diseases (Nephrotic Syndrome & Nephritis)

Minimal change disease, steroid-resistant nephrotic syndrome (FSGS, genetic mutations NPHS1/NPHS2), congenital nephrotic syndrome, post-infectious GN, IgA vasculitis (Henoch-Schönlein purpura) nephritis, lupus nephritis, MPGN, Alport syndrome, and C3 glomerulopathy.

25%

Paediatric AKI, Dialysis & Kidney Transplantation

KDIGO criteria for paediatric AKI, typical/atypical HUS, peritoneal dialysis prescription/complications, continuous renal replacement therapy (CRRT) access and mechanics, paediatric kidney transplant immunosuppression, rejection, and donor matching.

25%

Paediatric Hypertension, Tubular Disorders & UTIs

AAP paediatric hypertension guidelines, renal tubular acidosis (RTA Types 1, 2, 4), Bartter and Gitelman syndromes, nephrogenic diabetes insipidus, cystinuria, nephrocalcinosis, pyelonephritis diagnosis and imaging workup.

Preparing for the Cert Nephrology(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 4 core domains: Congenital Anomalies of Kidney & Urinary Tract (25%), Paediatric Glomerular Diseases (25%), Paediatric AKI, Dialysis & Kidney Transplantation (25%), and Paediatric Hypertension, Tubular Disorders & UTIs (25%).
Time limit: Written short-answer papers plus an OSCE and viva component.
Exam / certification fees: R24 650 Official sources

Using Our Practice Resources

Work through all 100 available questions
Review every answer and explanation
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Cert Nephrology(SA) Paed: Suggested Study Strategy

1Review the IPNA guidelines on steroid-resistant nephrotic syndrome, including genetic testing indications and second-line immunosuppressive agents.

2Understand emergency management of posterior urethral valves in neonates, including urinary catheter choice, electrolyte monitoring, and valve ablation indications.

3Master the differential diagnosis of acid-base and electrolyte patterns in inherited tubulopathies (Bartter, Gitelman, distal RTA, proximal RTA).

Frequently Asked Questions

What is the examination format for Cert Nephrology(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.

What is the fee for the CMSA sub-specialty certificate in paediatric nephrology?

The fee is R24 650 according to the Colleges of Medicine of South Africa fee structure.

What core blueprint domains are assessed?

The exam is divided into four equal domains (25% each): CAKUT, Paediatric Glomerular Diseases, Paediatric AKI/Dialysis/Transplantation, and Paediatric Hypertension/Tubular Disorders/UTIs.