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100+ Free CMSA Diploma in Ophthalmology Dip Ophth(SA) Practice Questions

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Key Facts: CMSA Diploma in Ophthalmology Dip Ophth(SA) Exam

100 Qs

Practice Questions

OpenExamPrep Practice Bank

R16 800

Exam Fee

CMSA Fee Schedule

50% + Submin

Passing Score

CMSA College Regulations

CMSA

Exam Body

Colleges of Medicine of SA

The CMSA Dip Ophth(SA) assesses comprehensive practical and theoretical ophthalmology. This practice bank provides 100 high-yield, clinically relevant MCQs tailored to South African eye care guidelines and CMSA examination standards.

Sample CMSA Diploma in Ophthalmology Dip Ophth(SA) Practice Questions

Try these sample questions to test your CMSA Diploma in Ophthalmology Dip Ophth(SA) exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 34-year-old contact lens wearer presents to a rural South African clinic with a 2-day history of intense left eye pain, photophobia, and purulent discharge. Slit-lamp examination reveals a 2.5 mm focal white corneal infiltrate with an overlying epithelial defect and a 1 mm hypopyon. What is the most appropriate immediate empirical management?
A.Topical fluoroquinolone monotherapy (e.g., ciprofloxacin 0.3% drops hourly)
B.Topical corticosteroid drops (e.g., prednisolone acetate 1%) every 2 hours
C.Oral amoxicillin-clavulanate 1 g twice daily for 7 days
D.Pressure patching of the affected eye for 48 hours
Explanation: Topical fluoroquinolone monotherapy (e.g., ciprofloxacin 0.3% or moxifloxacin 0.5% drops hourly) is the standard empirical initial treatment for bacterial corneal ulcers, particularly in contact lens wearers where Pseudomonas aeruginosa is a primary pathogen. Urgent corneal scraping for Gram stain and culture should precede or accompany treatment, but intensive broad-spectrum topical bactericidal drops must not be delayed. Topical steroids and pressure patching are strictly contraindicated in active infectious keratitis.
2A 45-year-old gardener presents with a painful right eye 5 days after being struck by a tree branch. Examination shows a feathery, grayish-white corneal infiltrate with satellite lesions and a hypopyon. Fluorescein staining confirms epithelial breakdown. Which pathogen is most likely responsible?
A.Staphylococcus aureus
B.Fusarium or Aspergillus species
C.Herpes simplex virus type 1
D.Acanthamoeba castellanii
Explanation: Fusarium or Aspergillus species are the classic fungal pathogens causing keratomycosis following vegetative ocular trauma in agricultural or outdoor workers. The clinical features of feathery stromal margins, satellite lesions, and elevated endothelial plaques are characteristic of filamentous fungal keratitis. Initial treatment requires topical natamycin 5% or amphotericin B drops.
3A 28-year-old female presents with recurrent right eye irritation, mild photophobia, and watering. Slit-lamp fluorescein examination demonstrates a branching corneal epithelial lesion with clear terminal bulbs that stains brightly with fluorescein. Corneal sensation is reduced in the right eye. What is the most appropriate first-line treatment?
A.Topical acyclovir 3% eye ointment 5 times daily
B.Topical dexamethasone 0.1% drops 4 times daily
C.Topical chloramphenicol 0.5% drops 4 times daily
D.Oral fluconazole 200 mg daily for 14 days
Explanation: Topical acyclovir 3% eye ointment applied 5 times daily (or ganciclovir 0.15% gel) is the standard evidence-based treatment for HSV dendritic epithelial keratitis. Dendritic ulcers with terminal bulbs and decreased corneal hypoesthesia are hallmark diagnostic features of herpes simplex virus keratitis. Topical corticosteroids must be avoided in epithelial viral keratitis because they cause rapid geographic ulceration.
4A 52-year-old farm worker from the Eastern Cape presents with a triangular, vascularized wing of conjunctival tissue extending 3 mm onto the nasal cornea of his right eye. He reports foreign body sensation and intermittent blurriness. What is the definitive management for this lesion?
A.Surgical excision with conjunctival autografting
B.Simple excision with bare sclera closure
C.Long-term topical corticosteroid drops
D.Laser photocoagulation of the lesion
Explanation: Surgical excision with conjunctival autografting is the gold-standard surgical treatment for primary and recurrent pterygium extending onto the cornea, associated with the lowest recurrence rate (<5-10%). Simple excision with bare sclera leaves high recurrence rates of up to 40-70%. Topical steroids provide temporary symptomatic relief but do not eliminate the growth.
5A 60-year-old postmenopausal woman complains of persistent bilateral eye burning, dryness, grittiness, and episodic tearing that worsens when reading. Tear breakup time (TBTT) is 4 seconds, and Schirmer I test shows 4 mm wetting in 5 minutes. What is the most appropriate initial therapeutic step?
A.Preservative-free artificial tears and warm eyelid compresses
B.Topical tobramycin-dexamethasone combination drops
C.Punctal occlusion with permanent silicone plugs
D.Oral systemic prednisone 40 mg daily for 2 weeks
Explanation: Preservative-free artificial lubricant eye drops combined with warm eyelid compresses (for accompanying meibomian gland dysfunction) represent step 1 first-line therapy for evaporative and aqueous-deficient dry eye disease. Schirmer test <10 mm and TBTT <10 seconds confirm dry eye disease. Invasive procedures like punctal plugs are reserved for refractory moderate-to-severe cases after conservative therapy.
6A 7-year-old boy presents during spring with severe bilateral eye itching, ropy mucous discharge, and photophobia. Slit-lamp inspection reveals cobblestone-like giant papillae on the superior tarsal conjunctiva and Horner-Trantas dots at the limbus. What is the primary diagnosis?
A.Vernal keratoconjunctivitis (VKC)
B.Bacterial conjunctivitis
C.Trachomatous keratoconjunctivitis
D.Pharyngoconjunctival fever
Explanation: Vernal keratoconjunctivitis (VKC) is a severe, recurrent allergic eye disease predominantly affecting young males in warm climates. Hallmark physical findings include giant 'cobblestone' papillae on the upper tarsal conjunctiva, Horner-Trantas dots (limbal eosinophil clumps), and shield ulcers. First-line maintenance includes dual-action topical mast cell stabilizers/antihistamines (e.g., olopatadine).
7A 22-year-old student presents with a 1-day history of painful right eye photophobia and tearing after accidental scratch by a paper edge. Fluorescein staining reveals a focal linear area of fluorescein uptake without corneal infiltrate. Visual acuity is 6/6. What is the most appropriate management plan?
A.Topical antibiotic ointment (e.g., chloramphenicol) and topical cycloplegic drops for pain relief
B.Immediate referral for urgent emergency corneal suturing
C.Topical steroid drops 4 times daily to minimize scarring
D.Continuous pressure patching for 5 days without antibiotics
Explanation: A simple corneal abrasion is managed with prophylactic topical broad-spectrum antibiotic ointment/drops (e.g., chloramphenicol or ciprofloxacin) to prevent secondary bacterial infection, along with short-acting cycloplegics (e.g., cyclopentolate 1%) for ciliary spasm pain relief. Corneal epithelial defects heal rapidly (24-48 hours) without suturing.
8A 68-year-old woman with rheumatoid arthritis complains of severe, boring, deep right eye pain that awakens her from sleep and radiates to her forehead. The eye is intensely red with bluish-purple scleral injection that fails to blanch with topical phenylephrine 2.5% drops. What is the diagnosis?
A.Anterior scleritis
B.Episcleritis
C.Acute bacterial conjunctivitis
D.Anterior blepharitis
Explanation: Anterior scleritis presents with severe, deep, boring ocular pain radiating to the forehead or trigeminal distribution, characteristically awakening the patient at night. Scleral deep vessel engorgement does NOT blanch following instillation of topical phenylephrine 2.5% (unlike episcleritis). Up to 50% of cases are associated with systemic autoimmune conditions like rheumatoid arthritis or GPA.
9A 31-year-old immunocompromised HIV-positive patient (CD4 count 85 cells/µL) presents with vesicular dermatomal lesions on his forehead and nose tip (Hutchinson sign), accompanied by right eye redness, photophobia, and stromal corneal haze. What does Hutchinson sign signify?
A.Involvement of the nasociliary branch of CN V1, indicating a high risk of intraocular herpes zoster involvement
B.Involvement of the maxillary nerve (CN V2), guaranteeing sparing of the cornea
C.Secondary bacterial infection of the ophthalmic nerve root
D.Involvement of the facial nerve (CN VII) leading to facial nerve palsy
Explanation: Hutchinson sign refers to herpes zoster vesicles on the side or tip of the nose, indicating involvement of the external nasal branch of the nasociliary nerve (V1 branch). Because the nasociliary nerve also innervates the cornea and globe, Hutchinson sign strongly predicts ocular involvement (anterior uveitis, epithelial/stromal keratitis). Management requires oral aciclovir or valaciclovir.
10A 19-year-old university student presents with bilateral watery eye discharge, severe follicular reaction on the inferior palpebral conjunctiva, and tender ipsilateral preauricular lymphadenopathy following an upper respiratory tract infection. What is the most likely pathogen?
A.Adenovirus
B.Chlamydia trachomatis
C.Neisseria gonorrhoeae
D.Streptococcus pneumoniae
Explanation: Adenovirus is the most common cause of acute viral epidemic keratoconjunctivitis (EKC) and pharyngoconjunctival fever. Key features include watery discharge, marked palpebral conjunctival follicles, subepithelial corneal infiltrates, and palpable, tender preauricular lymph nodes. Treatment is supportive with lubricants and cold compresses.

About the CMSA Diploma in Ophthalmology Dip Ophth(SA) Exam

The Diploma in Ophthalmology of the College of Ophthalmologists of South Africa (Dip Ophth(SA)) evaluates clinical competence in primary and secondary eye care, ophthalmic diagnostics, optical principles, minor surgical procedures, and emergency ocular management for non-specialist medical officers and GP practitioners across South Africa.

Assessment

Written examination (MCQs/EMQs), clinical OSCE/cases, and oral assessment covering basic visual sciences, clinical diagnosis, and management of eye diseases in primary and secondary healthcare.

Time Limit

Written & Clinical components

Passing Score

Overall 50% with written subminimum

Exam Fee

R18 950 (Colleges of Medicine of South Africa (CMSA), College of Ophthalmologists)

CMSA Diploma in Ophthalmology Dip Ophth(SA) Exam Content Outline

15%

Cornea & Ocular Surface

Bacterial, viral (HSV/VZV), and fungal keratitis, corneal abrasions, pterygium, dry eye disease, keratoconjunctivitis sicca, and anterior segment slit-lamp assessment.

15%

Glaucoma & Anterior Segment

Primary open-angle glaucoma (POAG), acute primary angle-closure glaucoma (PACG), gonioscopy, applanation tonometry, visual field defects, topical anti-glaucoma pharmacotherapy, and anterior uveitis.

15%

Cataract & Lens Pathology

Age-related nuclear, cortical, and subcapsular cataracts, traumatic cataract, intraocular lens (IOL) power calculation, postoperative endophthalmitis, and pseudophakic complications.

15%

Retina & Diabetic Retinopathy

Diabetic retinopathy grading (ETDRS) and management, central/branch retinal vein occlusion, retinal artery occlusion, age-related macular degeneration (AMD), and rhegmatogenous retinal detachment.

15%

Ocular Trauma & Emergencies

Chemical alkali and acid ocular burns, open globe injuries, traumatic hyphema, orbital blowout fractures, preseptal versus orbital cellulitis, and intraocular foreign bodies.

10%

Strabismus & Paediatric Ophthalmology

Amblyopia screening and patching, infantile esotropia, accommodative esotropia, exotropia, leukocoria assessment, retinoblastoma, congenital cataract, and ophthalmia neonatorum.

8%

Neuro-Ophthalmology

Demyelinating optic neuritis, papilloedema, cranial nerve III, IV, and VI palsies, Horner syndrome, Adie tonic pupil, and giant cell arteritis (ischaemic optic neuropathy).

7%

Optics, Refraction & Visual Sciences

Spherical and cylindrical refractive errors (myopia, hyperopia, astigmatism), presbyopia, pinhole testing, retinoscopy, focal length calculations, and ocular anatomy/physiology.

How to Pass the CMSA Diploma in Ophthalmology Dip Ophth(SA) Exam

What You Need to Know

  • Passing score: Overall 50% with written subminimum
  • Assessment: Written examination (MCQs/EMQs), clinical OSCE/cases, and oral assessment covering basic visual sciences, clinical diagnosis, and management of eye diseases in primary and secondary healthcare.
  • Time limit: Written & Clinical components
  • Exam fee: R18 950

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

CMSA Diploma in Ophthalmology Dip Ophth(SA) Study Tips from Top Performers

1Master the emergency management of chemical ocular burns, particularly immediate continuous copious irrigation with saline/Ringer lactate before diagnostic testing.
2Understand the grading of diabetic retinopathy (mild, moderate, severe NPDR, and PDR) and indications for urgent ophthalmology referral versus routine district screening.
3Differentiate preseptal cellulitis from orbital cellulitis based on proptosis, painful restricted extraocular movements, and reduced visual acuity.

Frequently Asked Questions

What is the structure of the CMSA Dip Ophth(SA) examination?

The Dip Ophth(SA) is examined via written papers, clinical cases (OSCE/OSPE format), and an oral assessment testing clinical decision-making in primary and secondary ophthalmic practice.

What is the examination fee and passing score for the Dip Ophth(SA)?

The examination fee is R16 800, and the required passing score is an overall aggregate of 50% with a written paper subminimum as defined by the CMSA Senate.

Which clinical guidelines apply to ophthalmology practice in South Africa?

Candidates should be familiar with the South African National Department of Health Essential Medicines List (EML) Primary & Adult Hospital Level Guidelines, OSSA clinical protocols, and international standards adapted for resource-limited settings.