GUIDE TO THE CANADIAN FAMILY MEDICINE
EXAMINATION LATEST EDITION COMPREHENSIVE
STUDY GUIDE, PRACTICE QUESTIONS, CLINICAL
REASONING SCENARIOS REAL 130 QUESTIONS
EDITION: 2025/2026 100% VERIFIED WITH
CORRECT ANSWERS & DETAILED RATIONALES
INSTANT DOWNLOAD PDF
CORE DOMAINS COVERED IN THIS EXAM:
• Cardiovascular Medicine: Hypertension, ischemic heart disease, heart
failure, arrhythmias, and lipid management.
• Respiratory Medicine: Asthma, COPD, pneumonia, tuberculosis, and
sleep apnea.
• Endocrinology & Metabolism: Diabetes, thyroid disorders,
osteoporosis, and metabolic syndrome.
• Mental Health: Depression, anxiety, bipolar disorder, schizophrenia,
and substance use disorders.
• Women's Health: Contraception, menopause, breast cancer screening,
and pregnancy-related conditions.
• Men's Health: Prostate health, testosterone deficiency, and erectile
dysfunction.
• Pediatrics: Childhood development, vaccination, common pediatric
illnesses, and adolescent health.
• Geriatrics & Polypharmacy: Frailty, dementia, medication
management, and falls prevention.
• Infectious Diseases & Immunology: Common infections, vaccine-
preventable diseases, and immunocompromised patients.
, • Musculoskeletal & Rheumatology: Osteoarthritis, rheumatoid
arthritis, back pain, and gout.
• Neurology: Stroke, seizures, dementia, headache, and Parkinson's
disease.
• Preventive Medicine & Screening: Cancer screening, cardiovascular
risk assessment, and lifestyle counseling.
SECTION 1: CARDIOVASCULAR MEDICINE (Questions 1-20)
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
Rationale: This patient has hypertension, diabetes, and evidence of chronic
kidney disease (eGFR 55, elevated ACR). According to Hypertension Canada
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. Thiazides do not offer renal protection; beta-
blockers are not first-line and may worsen glucose metabolism.
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
Rationale: This is an acute STEMI (ST-elevation myocardial infarction).
Immediate management includes aspirin (chewed), sublingual nitroglycerin,
and urgent reperfusion therapy (PCI or fibrinolysis). The "door-to-balloon"
time should be <90 minutes. CABG is not the immediate treatment for acute
STEMI.
Question 3: A 68-year-old man with a history of heart failure with
reduced ejection fraction (HFrEF) presents with worsening dyspnea,
orthopnea, and peripheral edema. His ejection fraction is 30%. Which of
the following medication classes has been shown to reduce mortality in
HFrEF?
A. Calcium channel blockers
B. Thiazolidinediones
C. Beta-blockers (e.g., bisoprolol, carvedilol)
D. Non-steroidal anti-inflammatory drugs
Rationale: Beta-blockers (bisoprolol, carvedilol, metoprolol succinate) are
evidence-based therapies that reduce mortality and hospitalizations in HFrEF.
ACE inhibitors/ARBs, ARNIs, and mineralocorticoid receptor antagonists are
also recommended. Calcium channel blockers (non-dihydropyridine) and
NSAIDs are contraindicated or should be used with caution.
Question 4: A 58-year-old woman with hypertension is started on a
thiazide diuretic. Which electrolyte abnormality is MOST commonly
associated with this medication?
A. Hyperkalemia
B. Hypokalemia
C. Hyponatremia
D. Hypercalcemia
, Rationale: Thiazide diuretics cause hypokalemia by increasing potassium
excretion in the distal tubule. They also cause hyponatremia and
hypercalcemia, but hypokalemia is the most common clinically significant
electrolyte abnormality.
Question 5: Which of the following is a Class I indication for statin
therapy according to Canadian guidelines?
A. LDL-C > 2.0 mmol/L in a low-risk patient
B. Clinical atherosclerotic cardiovascular disease (ASCVD)
C. HDL-C < 0.9 mmol/L
D. Triglycerides > 1.7 mmol/L
Rationale: Statins are indicated for secondary prevention in patients with
clinical ASCVD (Class I indication). LDL-C > 2.0 mmol/L in a low-risk patient is
not an automatic indication for statins. HDL-C and triglycerides are not
primary targets.
Question 6: A 72-year-old man presents with a painful, swollen, and
tender right great toe. He reports that the pain started suddenly
overnight. He has a history of hypertension and is on
hydrochlorothiazide. Which of the following is the most likely diagnosis?
A. Osteoarthritis
B. Gout
C. Rheumatoid arthritis
D. Pseudogout
Rationale: Acute gout typically presents with sudden onset of severe pain,
swelling, and redness in the first metatarsophalangeal joint. Risk factors
include thiazide diuretic use. Osteoarthritis is gradual; rheumatoid arthritis is
symmetrical and affects multiple joints; pseudogout typically affects the knee.
Question 7: A patient with atrial fibrillation has a CHADS₂ score of 3.
What is the recommended antithrombotic therapy?
EXAMINATION LATEST EDITION COMPREHENSIVE
STUDY GUIDE, PRACTICE QUESTIONS, CLINICAL
REASONING SCENARIOS REAL 130 QUESTIONS
EDITION: 2025/2026 100% VERIFIED WITH
CORRECT ANSWERS & DETAILED RATIONALES
INSTANT DOWNLOAD PDF
CORE DOMAINS COVERED IN THIS EXAM:
• Cardiovascular Medicine: Hypertension, ischemic heart disease, heart
failure, arrhythmias, and lipid management.
• Respiratory Medicine: Asthma, COPD, pneumonia, tuberculosis, and
sleep apnea.
• Endocrinology & Metabolism: Diabetes, thyroid disorders,
osteoporosis, and metabolic syndrome.
• Mental Health: Depression, anxiety, bipolar disorder, schizophrenia,
and substance use disorders.
• Women's Health: Contraception, menopause, breast cancer screening,
and pregnancy-related conditions.
• Men's Health: Prostate health, testosterone deficiency, and erectile
dysfunction.
• Pediatrics: Childhood development, vaccination, common pediatric
illnesses, and adolescent health.
• Geriatrics & Polypharmacy: Frailty, dementia, medication
management, and falls prevention.
• Infectious Diseases & Immunology: Common infections, vaccine-
preventable diseases, and immunocompromised patients.
, • Musculoskeletal & Rheumatology: Osteoarthritis, rheumatoid
arthritis, back pain, and gout.
• Neurology: Stroke, seizures, dementia, headache, and Parkinson's
disease.
• Preventive Medicine & Screening: Cancer screening, cardiovascular
risk assessment, and lifestyle counseling.
SECTION 1: CARDIOVASCULAR MEDICINE (Questions 1-20)
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
Rationale: This patient has hypertension, diabetes, and evidence of chronic
kidney disease (eGFR 55, elevated ACR). According to Hypertension Canada
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. Thiazides do not offer renal protection; beta-
blockers are not first-line and may worsen glucose metabolism.
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
Rationale: This is an acute STEMI (ST-elevation myocardial infarction).
Immediate management includes aspirin (chewed), sublingual nitroglycerin,
and urgent reperfusion therapy (PCI or fibrinolysis). The "door-to-balloon"
time should be <90 minutes. CABG is not the immediate treatment for acute
STEMI.
Question 3: A 68-year-old man with a history of heart failure with
reduced ejection fraction (HFrEF) presents with worsening dyspnea,
orthopnea, and peripheral edema. His ejection fraction is 30%. Which of
the following medication classes has been shown to reduce mortality in
HFrEF?
A. Calcium channel blockers
B. Thiazolidinediones
C. Beta-blockers (e.g., bisoprolol, carvedilol)
D. Non-steroidal anti-inflammatory drugs
Rationale: Beta-blockers (bisoprolol, carvedilol, metoprolol succinate) are
evidence-based therapies that reduce mortality and hospitalizations in HFrEF.
ACE inhibitors/ARBs, ARNIs, and mineralocorticoid receptor antagonists are
also recommended. Calcium channel blockers (non-dihydropyridine) and
NSAIDs are contraindicated or should be used with caution.
Question 4: A 58-year-old woman with hypertension is started on a
thiazide diuretic. Which electrolyte abnormality is MOST commonly
associated with this medication?
A. Hyperkalemia
B. Hypokalemia
C. Hyponatremia
D. Hypercalcemia
, Rationale: Thiazide diuretics cause hypokalemia by increasing potassium
excretion in the distal tubule. They also cause hyponatremia and
hypercalcemia, but hypokalemia is the most common clinically significant
electrolyte abnormality.
Question 5: Which of the following is a Class I indication for statin
therapy according to Canadian guidelines?
A. LDL-C > 2.0 mmol/L in a low-risk patient
B. Clinical atherosclerotic cardiovascular disease (ASCVD)
C. HDL-C < 0.9 mmol/L
D. Triglycerides > 1.7 mmol/L
Rationale: Statins are indicated for secondary prevention in patients with
clinical ASCVD (Class I indication). LDL-C > 2.0 mmol/L in a low-risk patient is
not an automatic indication for statins. HDL-C and triglycerides are not
primary targets.
Question 6: A 72-year-old man presents with a painful, swollen, and
tender right great toe. He reports that the pain started suddenly
overnight. He has a history of hypertension and is on
hydrochlorothiazide. Which of the following is the most likely diagnosis?
A. Osteoarthritis
B. Gout
C. Rheumatoid arthritis
D. Pseudogout
Rationale: Acute gout typically presents with sudden onset of severe pain,
swelling, and redness in the first metatarsophalangeal joint. Risk factors
include thiazide diuretic use. Osteoarthritis is gradual; rheumatoid arthritis is
symmetrical and affects multiple joints; pseudogout typically affects the knee.
Question 7: A patient with atrial fibrillation has a CHADS₂ score of 3.
What is the recommended antithrombotic therapy?
