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2026 Statistics
Key Facts: Cert Rheumatology(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 Rheumatology(SA) Phys is a rigorous two-component sub-specialty exit examination (written short-answer papers plus an oral/OSCE/clinical component, each 50%) for physicians completing consultant rheumatology fellowship training in South Africa. This bank provides 100 practice MCQs as a study aid.
Sample Cert Rheumatology(SA) Phys Practice Questions
Try these sample questions to test your Cert Rheumatology(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 woman presents with an 8-week history of symmetrical joint pain and swelling in both hands and wrists, accompanied by 2 hours of morning stiffness. On examination, she has synovitis in 4 PIP joints, 4 MCP joints, and both wrists (10 small joints total). Laboratory investigations reveal a high-positive anti-CCP antibody titer (>3 times upper limit of normal) and an elevated CRP level. According to the 2010 ACR/EULAR Classification Criteria for Rheumatoid Arthritis, what is her total classification score?
A.8 points (Joint involvement: 3, Serology: 3, Acute phase reactants: 1, Duration: 1)
B.9 points (Joint involvement: 5, Serology: 3, Acute phase reactants: 1, Duration: 0)
C.10 points (Joint involvement: 5, Serology: 3, Acute phase reactants: 1, Duration: 1)
D.7 points (Joint involvement: 3, Serology: 2, Acute phase reactants: 1, Duration: 1)
Explanation: According to the 2010 ACR/EULAR criteria, a total score of >= 6/10 classifies a patient as having definite Rheumatoid Arthritis. In this patient: Joint involvement of >10 joints (at least one small joint) awards 5 points; high-positive anti-CCP antibody awards 3 points; abnormal CRP awards 1 point; and symptom duration >= 6 weeks awards 1 point. Total score = 5 + 3 + 1 + 1 = 10 points.
2Which autoantibody possesses the highest specificity (>95%) for diagnosing Rheumatoid Arthritis and is strongly associated with progressive erosive joint damage?
A.IgM Rheumatoid Factor (RF)
B.Anti-cyclic citrullinated peptide (anti-CCP / ACPA)
C.Anti-nuclear antibody (ANA)
D.Anti-mutated citrullinated vimentin (anti-MCV)
Explanation: Anti-cyclic citrullinated peptide antibodies (anti-CCP / ACPA) have a diagnostic specificity of 95–98% for Rheumatoid Arthritis, significantly higher than Rheumatoid Factor (75–85%). ACPA positivity is also a key prognostic marker for aggressive, erosive disease course.
3A 52-year-old male with active rheumatoid arthritis is initiated on Oral Methotrexate 15 mg weekly. Which of the following baseline laboratory monitoring panels is mandatory prior to commencing treatment?
A.Serum creatinine, anti-dsDNA, serum complement C3/C4, and 24-hour urinary protein
B.Liver transaminases, serum ferritin, HLA-B27 genotype, and stool occult blood
C.Full blood count, serum uric acid, erythrocyte sedimentation rate, and thyroid stimulating hormone
D.Full blood count, liver transaminases (ALT/AST), serum creatinine/eGFR, chest X-ray, and Hepatitis B/C serology
Explanation: Prior to initiating Methotrexate, mandatory baseline evaluation includes Full Blood Count (to rule out baseline cytopenias), liver function tests (ALT/AST), renal function (creatinine/eGFR, as MTX is renally excreted), baseline Chest X-ray (to evaluate underlying lung disease/fibrosis), and viral hepatitis B/C screening.
4Why is Folic Acid supplementation (e.g., 5 mg weekly taken 24–48 hours after Methotrexate) routinely co-prescribed with Methotrexate in patients with Rheumatoid Arthritis?
A.It enhances the binding affinity of Methotrexate to dihydrofolate reductase in synovial macrophages
B.It neutralizes circulating methotrexate anti-metabolites to prevent bone marrow aplasia
C.It reduces gastrointestinal mucosal toxicity, stomatitis, and hepatic transaminase elevation without compromising DMARD efficacy
D.It prevents methotrexate-induced acute renal tubular necrosis by alkalinizing the urine
Explanation: Routine folic acid supplementation (5 mg once weekly or 1 mg daily except on MTX dosing day) significantly reduces common methotrexate toxicities, including mucosal ulceration (stomatitis), nausea, GI distress, and elevated liver enzymes, without attenuating its anti-inflammatory disease-modifying efficacy.
5Which of the following clinical features strongly distinguishes Rheumatoid Arthritis from Hand Osteoarthritis?
A.Prominent involvement of the distal interphalangeal (DIP) joints with bony Heberden's nodes
B.Asymmetrical joint space narrowing with subchondral sclerosis and osteophyte formation
C.Brief morning stiffness lasting less than 15 minutes that worsens after prolonged weight-bearing activity
D.Symmetrical involvement of MCP and wrist joints with morning stiffness lasting more than 60 minutes
Explanation: Rheumatoid Arthritis characteristically causes symmetrical inflammatory polyarthritis affecting MCP joints, PIP joints, and wrists, sparing DIP joints, accompanied by prolonged morning stiffness (>60 minutes). Hand OA typically involves DIP joints (Heberden nodes), PIP joints (Bouchard nodes), and 1st CMC joint, with brief morning stiffness (<30 minutes).
6A 26-year-old man presents with chronic low back pain and morning stiffness lasting 90 minutes, which improves with physical exercise but not with rest. Which Major Histocompatibility Complex (MHC) class I allele is present in over 85–90% of Caucasian and South African patients with primary Ankylosing Spondylitis?
A.HLA-B51
B.HLA-DQ8
C.HLA-DR4
D.HLA-B27
Explanation: HLA-B27 is strongly associated with Ankylosing Spondylitis and axial spondyloarthritis, being present in approximately 85–95% of patients with primary AS.
7Radiographic evaluation of the lumbar spine in a 45-year-old male with long-standing, untreated Ankylosing Spondylitis shows complete bony ankylosis of adjacent vertebral bodies due to bridging marginal syndesmophytes. What is the classical clinical descriptive term for this imaging finding?
A.Penciling of vertebral endplates
B.Rugger-jersey spine
C.Bamboo spine
D.Fish-mouth vertebrae
Explanation: Ossification of the outer fibers of the annulus fibrosus forms vertical marginal syndesmophytes bridging adjacent vertebral bodies. When widespread along the spinal column, this creates the classic 'bamboo spine' appearance on plain radiographs.
8Under the CASPAR (Classification Criteria for Psoriatic Arthritis), a patient requires established inflammatory articular disease plus at least 3 points from specific categories. Which of the following parameters awards 2 points under CASPAR?
A.Presence of dactylitis (current or recorded by a rheumatologist)
B.Current personal skin or scalp psoriasis
C.Personal history of psoriasis (not currently present)
D.Juxta-articular new bone formation on hand/foot radiographs
Explanation: Under CASPAR criteria: Current psoriasis receives 2 points. All other criteria (history of psoriasis, family history of psoriasis, psoriatic nail dystrophy, negative RF, current/past dactylitis, and juxta-articular new bone formation) receive 1 point each. A total score of >= 3 is required.
9A 24-year-old male presents with acute asymmetrical oligoarthritis of the right knee and left ankle 2 weeks following an episode of dysuria and mucopurulent urethral discharge. On examination, he also has bilateral conjunctival injection. What is the classic clinical triad of Reactive Arthritis (formerly Reiter's syndrome)?
A.Psoriasis, dactylitis, and enthesitis
B.Aortic regurgitation, pericarditis, and sacroiliitis
C.Urethritis, conjunctivitis, and inflammatory arthritis
D.Uveitis, oral ulcers, and genital pustules
Explanation: Reactive arthritis classically presents with the triad of non-gonococcal urethritis (or cervicitis/enteritis), anterior ocular inflammation (conjunctivitis/uveitis), and asymmetric inflammatory oligoarthritis following a precursor gastrointestinal or genitourinary infection.
10A 60-year-old woman with a 20-year history of seropositive erosive Rheumatoid Arthritis presents with recurrent bacterial pulmonary infections. Examination reveals massive splenomegaly. Full blood count shows: Hb 10.2 g/dL, WBC 1.8 x 10^9/L, Absolute Neutrophil Count (ANC) 0.4 x 10^9/L, and Platelets 160 x 10^9/L. What is the diagnosis, and which malignant complication is this syndrome associated with?
A.Felty Syndrome; increased risk of Non-Hodgkin Lymphoma
B.POEMS Syndrome; increased risk of Multiple Myeloma
C.Adult-onset Still's Disease; increased risk of Acute Myeloid Leukemia
D.Caplan Syndrome; increased risk of Malignant Mesothelioma
Explanation: Felty Syndrome is defined by the triad of long-standing seropositive Rheumatoid Arthritis, splenomegaly, and severe neutropenia (ANC <2.0 x 10^9/L, often <0.5 x 10^9/L). Patients have a markedly increased risk of recurrent pyogenic infections and a 12- to 20-fold increased risk of developing Non-Hodgkin Lymphoma.
About the Cert Rheumatology(SA) Phys Practice Questions
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