Guide to the Canadian Family Medicine Examination
Latest Edition Comprehensive Study Guide, Practice
Questions, Clinical Reasoning Scenarios, and 100%
Verified with Correct Answers for Certification Success
2025/ 2026 Advanced Family Medicine Exam
Preparation
,
, TABLE OF CONTENTS
1. Cardiovascular Medicine (Questions 1-40)
2. Respiratory Medicine (Questions 41-70)
3. Endocrinology & Metabolism (Questions 71-100)
4. Mental Health (Questions 101-130)
5. Women's Health (Questions 131-160)
6. Men's Health (Questions 161-175)
7. Pediatrics (Questions 176-200)
8. Geriatrics & Polypharmacy (Questions 201-220)
9. Infectious Diseases & Immunology (Questions 221-245)
10. Musculoskeletal & Rheumatology (Questions 246-270)
11. Neurology (Questions 271-290)
12. Preventive Medicine & Screening (Questions 291-300)
SECTION 1: CARDIOVASCULAR MEDICINE
Question 1
A 62-year-old man with a history of hypertension and type 2 diabetes presents for a
routine follow-up. His blood pressure is 148/86 mmHg on two separate occasions. His
eGFR is 55 mL/min/1.73m² and urine albumin-to-creatinine ratio (ACR) is 12 mg/mmol.
According to Hypertension Canada guidelines, which of the following is the MOST
appropriate initial antihypertensive therapy?
A) Hydrochlorothiazide 12.5 mg daily
B) Amlodipine 5 mg daily
C) Ramipril 2.5 mg daily
D) Atenolol 25 mg daily
Answer: C
, Step-by-Step Clinical Reasoning:
1. Identify the patient profile: This patient has hypertension, diabetes, and evidence of
chronic kidney disease (eGFR 55, elevated ACR).
2. Recall Hypertension Canada 2020 guidelines: For patients with diabetes and
hypertension with albuminuria, the recommended first-line therapy is an ACE inhibitor
(ramipril) or ARB due to their renal protective effects.
3. Clinical reasoning:
o A (Hydrochlorothiazide): Thiazides are effective but are not first-line in patients with
albuminuria; they don't offer the same renal protection.
o B (Amlodipine): Calcium channel blockers are effective but lack the specific
renoprotective effects of ACE inhibitors in diabetic nephropathy.
o C (Ramipril): ACE inhibitors reduce intraglomerular pressure, decrease proteinuria, and
slow progression of diabetic nephropathy—this is evidence-based.
o D (Atenolol): Beta-blockers are not first-line for uncomplicated hypertension and may
worsen glucose metabolism.
4. Target BP: For patients with diabetes and CKD, target is <130/80 mmHg. This patient
requires treatment intensification.
5. Monitoring: Check serum creatinine and potassium within 1-2 weeks of starting or
titrating ACE inhibitors.
Question 2
A 55-year-old woman presents with acute onset of substernal chest pain radiating to her
left arm, associated with diaphoresis and nausea. Her ECG shows ST-segment elevation
in leads V1-V4. Her blood pressure is 100/70 mmHg and heart rate is 110 bpm. Which of
the following is the MOST appropriate immediate management?
A) Aspirin 81 mg PO and observe
B) Aspirin 162-325 mg chewed, sublingual nitroglycerin, and urgent reperfusion therapy
C) Aspirin 325 mg and clopidogrel 600 mg loading dose
D) Immediate coronary artery bypass grafting
Answer: B
Step-by-Step Clinical Reasoning:
Latest Edition Comprehensive Study Guide, Practice
Questions, Clinical Reasoning Scenarios, and 100%
Verified with Correct Answers for Certification Success
2025/ 2026 Advanced Family Medicine Exam
Preparation
,
, TABLE OF CONTENTS
1. Cardiovascular Medicine (Questions 1-40)
2. Respiratory Medicine (Questions 41-70)
3. Endocrinology & Metabolism (Questions 71-100)
4. Mental Health (Questions 101-130)
5. Women's Health (Questions 131-160)
6. Men's Health (Questions 161-175)
7. Pediatrics (Questions 176-200)
8. Geriatrics & Polypharmacy (Questions 201-220)
9. Infectious Diseases & Immunology (Questions 221-245)
10. Musculoskeletal & Rheumatology (Questions 246-270)
11. Neurology (Questions 271-290)
12. Preventive Medicine & Screening (Questions 291-300)
SECTION 1: CARDIOVASCULAR MEDICINE
Question 1
A 62-year-old man with a history of hypertension and type 2 diabetes presents for a
routine follow-up. His blood pressure is 148/86 mmHg on two separate occasions. His
eGFR is 55 mL/min/1.73m² and urine albumin-to-creatinine ratio (ACR) is 12 mg/mmol.
According to Hypertension Canada guidelines, which of the following is the MOST
appropriate initial antihypertensive therapy?
A) Hydrochlorothiazide 12.5 mg daily
B) Amlodipine 5 mg daily
C) Ramipril 2.5 mg daily
D) Atenolol 25 mg daily
Answer: C
, Step-by-Step Clinical Reasoning:
1. Identify the patient profile: This patient has hypertension, diabetes, and evidence of
chronic kidney disease (eGFR 55, elevated ACR).
2. Recall Hypertension Canada 2020 guidelines: For patients with diabetes and
hypertension with albuminuria, the recommended first-line therapy is an ACE inhibitor
(ramipril) or ARB due to their renal protective effects.
3. Clinical reasoning:
o A (Hydrochlorothiazide): Thiazides are effective but are not first-line in patients with
albuminuria; they don't offer the same renal protection.
o B (Amlodipine): Calcium channel blockers are effective but lack the specific
renoprotective effects of ACE inhibitors in diabetic nephropathy.
o C (Ramipril): ACE inhibitors reduce intraglomerular pressure, decrease proteinuria, and
slow progression of diabetic nephropathy—this is evidence-based.
o D (Atenolol): Beta-blockers are not first-line for uncomplicated hypertension and may
worsen glucose metabolism.
4. Target BP: For patients with diabetes and CKD, target is <130/80 mmHg. This patient
requires treatment intensification.
5. Monitoring: Check serum creatinine and potassium within 1-2 weeks of starting or
titrating ACE inhibitors.
Question 2
A 55-year-old woman presents with acute onset of substernal chest pain radiating to her
left arm, associated with diaphoresis and nausea. Her ECG shows ST-segment elevation
in leads V1-V4. Her blood pressure is 100/70 mmHg and heart rate is 110 bpm. Which of
the following is the MOST appropriate immediate management?
A) Aspirin 81 mg PO and observe
B) Aspirin 162-325 mg chewed, sublingual nitroglycerin, and urgent reperfusion therapy
C) Aspirin 325 mg and clopidogrel 600 mg loading dose
D) Immediate coronary artery bypass grafting
Answer: B
Step-by-Step Clinical Reasoning:
