100+ Free Cert Rheumatology(SA) Phys Practice Questions

Prepare for the CMSA Sub-specialty Certificate in Rheumatology Cert Rheumatology(SA) Phys — South Africa exam with instant access — no signup required.

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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 Exam

The Cert Rheumatology(SA) Phys is the sub-specialty certificate examination administered by the College of Physicians of the Colleges of Medicine of South Africa. It assesses advanced clinical judgment, diagnostic reasoning, autoantibody and histopathological interpretation, and evidence-based therapeutic management in adult rheumatology.

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: Rheumatoid Arthritis & Spondyloarthropathies (30%), Systemic Lupus Erythematosus, Antiphospholipid Syndrome & Scleroderma (25%), Systemic Vasculitis & Myositis (20%), Crystal Arthropathies, Osteoarthritis & Bone Health (15%), and Biologic Therapies, Immunosuppression & Infection Risks (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 Rheumatology(SA) Phys Exam Content Outline

30%

Rheumatoid Arthritis & Spondyloarthropathies

Pathogenesis, ACR/EULAR classification criteria, autoantibodies (RF, ACPA), extra-articular manifestations, synthetic & biologic DMARD escalation strategies, ankylosing spondylitis, psoriatic arthritis, enteropathic arthritis, and reactive arthritis.

25%

Systemic Lupus Erythematosus, Antiphospholipid Syndrome & Scleroderma

SLE pathobiology, 2019 EULAR/ACR classification criteria, autoantibody panels, lupus nephritis ISN/RPS classification and management, systemic sclerosis (limited vs diffuse), scleroderma renal crisis, pulmonary arterial hypertension, and primary/secondary antiphospholipid syndrome.

20%

Systemic Vasculitis & Myositis

ANCA-associated vasculitides (GPA, MPA, EGPA), large vessel vasculitis (Takayasu, Giant Cell Arteritis), IgA vasculitis, Behcet's disease, polymyositis, dermatomyositis, inclusion body myositis, anti-synthetase syndrome, and immune-mediated necrotizing myopathy.

15%

Crystal Arthropathies, Osteoarthritis & Bone Health

Monosodium urate crystal dynamics, acute gout and urate-lowering therapy guidelines, CPPD / pseudogout, chondrocalcinosis, osteoarthritis phenotype management, osteoporosis FRAX risk assessment, bisphosphonates, denosumab, anabolic therapies, and Paget's disease.

10%

Biologic Therapies, Immunosuppression & Infection Risks

TNF inhibitors, IL-6 receptor antagonists, B-cell depletion, T-cell co-stimulation blockers, JAK inhibitors, pre-biologic latent TB & viral hepatitis screening protocols, opportunistic infection prophylaxis, and vaccination guidelines in immunocompromised rheumatic patients.

How to Pass the Cert Rheumatology(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: Rheumatoid Arthritis & Spondyloarthropathies (30%), Systemic Lupus Erythematosus, Antiphospholipid Syndrome & Scleroderma (25%), Systemic Vasculitis & Myositis (20%), Crystal Arthropathies, Osteoarthritis & Bone Health (15%), and Biologic Therapies, Immunosuppression & Infection Risks (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 Rheumatology(SA) Phys Study Tips from Top Performers

1Master the 2010 ACR/EULAR Rheumatoid Arthritis criteria and 2019 EULAR/ACR SLE classification criteria alongside sub-specialty antibody profiles.

2Understand the ISN/RPS lupus nephritis histopathology classifications and updated EULAR/ERA-EDTA management guidelines.

3Review the clinical trial evidence for ANCA vasculitis induction (RAVE, PEXIVAS, ADVOCATE) and giant cell arteritis (GiACTA).

4Be fluent in pre-biologic screening algorithms for latent tuberculosis and hepatitis B reactivation risk, as well as JAK inhibitor safety profiles.

Frequently Asked Questions

What is the format of the CMSA Cert Rheumatology(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 and passing criteria for the examination?

The examination fee is R24 650. 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).

Who is eligible to take the Cert Rheumatology(SA) Phys exam?

Candidates must hold an FCP(SA) or equivalent specialist qualification in Internal Medicine, be registered with the HPCSA, and have completed accredited rheumatology fellowship training.