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 Prepara
Question 1: Postpartum Depression
Scenario: A 28-year-old woman presents 6 weeks postpartum with reports of
feeling "overwhelmed," difficulty sleeping even when the baby sleeps, and crying
spells. She says "I don't know why I feel this way—I should be happy." She denies
thoughts of harming herself or the baby.
SAMP Question: What are your initial management steps?
Answer:
1. Screen using validated tool — Edinburgh Postnatal Depression Scale (EPDS)
2. Assess for suicidality — ask directly about thoughts of self-harm or harm to
infant
3. Offer counselling — cognitive-behavioural therapy or interpersonal therapy
4. Consider pharmacotherapy — SSRI (sertraline is preferred during
breastfeeding)
5. Provide psychoeducation — normalize that postpartum depression is
common and treatable
6. Arrange follow-up — reassess in 1-2 weeks
7. Support network — involve partner/family, discuss sleep support
Key Feature: The critical step is distinguishing "baby blues" (resolves by 2 weeks)
from postpartum depression and asking directly about harm to self or infant.
,Question 2: Diabetes Management
Scenario: A 55-year-old man with type 2 diabetes for 8 years on metformin 1000
mg BID presents with HbA1c of 8.2%. He has hypertension (BP 138/86) and his
most recent eGFR is 58 mL/min/1.73m². He is a non-smoker.
SAMP Question: What changes would you make to his management?
Answer:
1. Add SGLT2 inhibitor (e.g., canagliflozin, empagliflozin) for:
o CV/renal protection in patients with established CVD or high risk
o Renoprotective benefits (slows CKD progression)
2. Check renal function — eGFR 58 means SGLT2i may be initiated but
monitor
3. Optimize blood pressure — target ≤130/80 for diabetic patients
4. Consider GLP-1 receptor agonist (liraglutide, semaglutide) — CV benefit
5. Review diet and exercise — reinforce lifestyle modifications
6. Check albuminuria — assess for diabetic kidney disease
7. Recheck HbA1c — in 3 months
Key Feature: Individualized HbA1c targets. SGLT2i and GLP-1 RA are preferred add-
on agents when CV or renal protection is needed.
Question 3: Colorectal Cancer Screening
Scenario: A 52-year-old asymptomatic patient presents for a routine physical. She
has no family history of colorectal cancer or polyps.
SAMP Question: What screening do you recommend?
Answer:
, 1. Offer colorectal cancer screening — age 50-74 is the recommended range
2. Fecal Immunochemical Test (FIT) — every 2 years as primary screening
option
3. Alternative options — colonoscopy every 10 years, flexible sigmoidoscopy
every 5 years
4. Discuss shared decision-making — benefits and limitations of each option
5. Document screening discussion — in the medical record
6. Send FIT kit — with instructions for completion
7. Arrange follow-up — to review results
Key Feature: CTFPHC recommends FIT every 2 years for average-risk individuals
aged 50-74.
Question 4: Acute Asthma Exacerbation
Scenario: A 34-year-old with known asthma presents with increasing shortness of
breath over 24 hours. She is using her salbutamol inhaler every 2 hours. On exam:
RR 26, HR 110, SpO₂ 92% on room air, peak flow 55% of personal best.
SAMP Question: What is your management plan for this patient?
Answer:
1. Assess severity — this is a moderate-to-severe exacerbation (SpO₂ <94%,
PEF 50-75% predicted)
2. Oxygen — target SpO₂ 94-98%
3. Salbutamol — via nebulizer or MDI with spacer: 5 mg nebulized or 4-6 puffs
every 20 minutes for first hour; repeat as needed
4. Ipratropium — add to salbutamol for severe exacerbations
5. Corticosteroids — prednisone 40-50 mg PO daily for 5-7 days
, 6. Consider urgent transfer — if high-risk features present (SpO₂ <90%, silent
chest, confusion)
7. Monitor response — reassess PEF, SpO₂, and symptoms after initial
treatment
Key Feature: The key clinical decision point is recognizing severity and initiating
systemic corticosteroids early—not just bronchodilators.
Question 5: Contraception Counselling
Scenario: A 22-year-old nulliparous woman requests contraception. She has a
history of migraine with aura. She smokes 5 cigarettes daily. BP 118/72, BMI 24.
SAMP Question: Which contraceptive options are appropriate, and which should
be avoided?
Answer:
Contraindicated:
• Combined oral contraceptives (COCs) — contraindicated in patients with
migraine with aura due to increased stroke risk
Appropriate options:
1. Progestin-only pill (POP) — no estrogen-related stroke risk
2. Depot medroxyprogesterone acetate (Depo-Provera) — injection every 12-
13 weeks
3. Progestin implant — etonogestrel or levonorgestrel implant
4. Progestin IUD — LNG-IUS
5. Copper IUD — non-hormonal option
6. Condoms — barrier method
Key Feature: Migraine with aura is a WHO Category 4 condition (absolute
contraindication) for combined hormonal contraception.
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 Prepara
Question 1: Postpartum Depression
Scenario: A 28-year-old woman presents 6 weeks postpartum with reports of
feeling "overwhelmed," difficulty sleeping even when the baby sleeps, and crying
spells. She says "I don't know why I feel this way—I should be happy." She denies
thoughts of harming herself or the baby.
SAMP Question: What are your initial management steps?
Answer:
1. Screen using validated tool — Edinburgh Postnatal Depression Scale (EPDS)
2. Assess for suicidality — ask directly about thoughts of self-harm or harm to
infant
3. Offer counselling — cognitive-behavioural therapy or interpersonal therapy
4. Consider pharmacotherapy — SSRI (sertraline is preferred during
breastfeeding)
5. Provide psychoeducation — normalize that postpartum depression is
common and treatable
6. Arrange follow-up — reassess in 1-2 weeks
7. Support network — involve partner/family, discuss sleep support
Key Feature: The critical step is distinguishing "baby blues" (resolves by 2 weeks)
from postpartum depression and asking directly about harm to self or infant.
,Question 2: Diabetes Management
Scenario: A 55-year-old man with type 2 diabetes for 8 years on metformin 1000
mg BID presents with HbA1c of 8.2%. He has hypertension (BP 138/86) and his
most recent eGFR is 58 mL/min/1.73m². He is a non-smoker.
SAMP Question: What changes would you make to his management?
Answer:
1. Add SGLT2 inhibitor (e.g., canagliflozin, empagliflozin) for:
o CV/renal protection in patients with established CVD or high risk
o Renoprotective benefits (slows CKD progression)
2. Check renal function — eGFR 58 means SGLT2i may be initiated but
monitor
3. Optimize blood pressure — target ≤130/80 for diabetic patients
4. Consider GLP-1 receptor agonist (liraglutide, semaglutide) — CV benefit
5. Review diet and exercise — reinforce lifestyle modifications
6. Check albuminuria — assess for diabetic kidney disease
7. Recheck HbA1c — in 3 months
Key Feature: Individualized HbA1c targets. SGLT2i and GLP-1 RA are preferred add-
on agents when CV or renal protection is needed.
Question 3: Colorectal Cancer Screening
Scenario: A 52-year-old asymptomatic patient presents for a routine physical. She
has no family history of colorectal cancer or polyps.
SAMP Question: What screening do you recommend?
Answer:
, 1. Offer colorectal cancer screening — age 50-74 is the recommended range
2. Fecal Immunochemical Test (FIT) — every 2 years as primary screening
option
3. Alternative options — colonoscopy every 10 years, flexible sigmoidoscopy
every 5 years
4. Discuss shared decision-making — benefits and limitations of each option
5. Document screening discussion — in the medical record
6. Send FIT kit — with instructions for completion
7. Arrange follow-up — to review results
Key Feature: CTFPHC recommends FIT every 2 years for average-risk individuals
aged 50-74.
Question 4: Acute Asthma Exacerbation
Scenario: A 34-year-old with known asthma presents with increasing shortness of
breath over 24 hours. She is using her salbutamol inhaler every 2 hours. On exam:
RR 26, HR 110, SpO₂ 92% on room air, peak flow 55% of personal best.
SAMP Question: What is your management plan for this patient?
Answer:
1. Assess severity — this is a moderate-to-severe exacerbation (SpO₂ <94%,
PEF 50-75% predicted)
2. Oxygen — target SpO₂ 94-98%
3. Salbutamol — via nebulizer or MDI with spacer: 5 mg nebulized or 4-6 puffs
every 20 minutes for first hour; repeat as needed
4. Ipratropium — add to salbutamol for severe exacerbations
5. Corticosteroids — prednisone 40-50 mg PO daily for 5-7 days
, 6. Consider urgent transfer — if high-risk features present (SpO₂ <90%, silent
chest, confusion)
7. Monitor response — reassess PEF, SpO₂, and symptoms after initial
treatment
Key Feature: The key clinical decision point is recognizing severity and initiating
systemic corticosteroids early—not just bronchodilators.
Question 5: Contraception Counselling
Scenario: A 22-year-old nulliparous woman requests contraception. She has a
history of migraine with aura. She smokes 5 cigarettes daily. BP 118/72, BMI 24.
SAMP Question: Which contraceptive options are appropriate, and which should
be avoided?
Answer:
Contraindicated:
• Combined oral contraceptives (COCs) — contraindicated in patients with
migraine with aura due to increased stroke risk
Appropriate options:
1. Progestin-only pill (POP) — no estrogen-related stroke risk
2. Depot medroxyprogesterone acetate (Depo-Provera) — injection every 12-
13 weeks
3. Progestin implant — etonogestrel or levonorgestrel implant
4. Progestin IUD — LNG-IUS
5. Copper IUD — non-hormonal option
6. Condoms — barrier method
Key Feature: Migraine with aura is a WHO Category 4 condition (absolute
contraindication) for combined hormonal contraception.
