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100+ Free CFPC CAC Palliative Care Practice Questions
College of Family Physicians of Canada Certificate of Added Competence in Palliative Care Assessment practice questions are available now; exam metadata is being verified.
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Key Facts: CFPC CAC Palliative Care Exam
CAD $4,445
IPCR total fees (access + assessment, 2025-26)
cfpc.ca IPCR Application Package
6 Domains
CFPC Palliative Priority Topic areas
CFPC Palliative Priority Topics
Bill C-7
Canadian MAiD legal framework assessed
Government of Canada / CFPC
CFPC CAC Palliative Care evaluates advanced family physician competence across 6 core domains: pain management (20%), non-pain symptom control (25%), goals of care (20%), palliative sedation (15%), ethics/MAiD (10%), and psychosocial/grief care (10%). IPCR fees: CAD $373 access + $4,072 assessment (2025-26).
Sample CFPC CAC Palliative Care Practice Questions
Try these sample questions to test your CFPC CAC Palliative Care exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.
1A 68-year-old patient with metastatic prostate cancer receiving oral morphine 60 mg twice daily experiences worsening bone pain with a numerical rating score of 8/10. Pain control is inadequate, but renal function is normal. What is the most appropriate initial adjustment to the oral morphine regimen?
A.Increase oral morphine to 90 mg twice daily and add 15 mg oral morphine as needed every 4 hours for breakthrough pain
B.Discontinue morphine and initiate transdermal fentanyl 50 mcg/hr patch immediately
C.Maintain morphine 60 mg twice daily and add oral meperidine 50 mg every 3 hours for breakthrough pain
D.Switch immediately to oral methadone 20 mg three times daily without dose reduction
Explanation: When escalating regular oral morphine for unmanaged cancer pain, total daily dose is typically increased by 30–50% (here from 120 mg/day to 180 mg/day). Breakthrough medication should be prescribed at 10–15% of the total 24-hour baseline dose (15 mg oral morphine q4h prn).
2A patient with advanced pancreatic cancer taking oral hydromorphone 12 mg every 4 hours requires conversion to a transdermal fentanyl patch due to severe dysphagia. What is the approximate equivalent transdermal fentanyl patch dose?
A.100 mcg/hr
B.25 mcg/hr
C.50 mcg/hr
D.200 mcg/hr
Explanation: Oral hydromorphone 12 mg q4h equals 72 mg/day oral hydromorphone. Using a standard conversion ratio (oral hydromorphone to oral morphine is 1:5, so 72 mg hydromorphone = 360 mg oral morphine/day), 360 mg/day oral morphine converts to a 100 mcg/hr transdermal fentanyl patch (ratio approx 3–4 mg oral morphine/day to 1 mcg/hr fentanyl).
3A 72-year-old female with stage IV non-small cell lung cancer develops severe neuropathic burning pain in an intercostal nerve distribution following thoracic radiation. Which medication is first-line adjuvant therapy for this neuropathic pain component?
A.Gabapentin or pregabalin
B.Acetaminophen
C.High-dose ibuprofen
D.Subcutaneous fentanyl
Explanation: Gabapentinoids (gabapentin or pregabalin) or SNRIs (duloxetine) are first-line adjuvant analgesics for neuropathic cancer pain. Opioids alone are often less effective for pure neuropathic burning or lancinating pain, requiring mechanism-specific adjuvant agents.
4A palliative patient with end-stage renal disease (eGFR 14 mL/min/1.73m²) requires opioid analgesia for severe nociceptive pain. Which opioid regimen is safest to avoid neurotoxic metabolite accumulation?
A.Hydromorphone or fentanyl at reduced doses with extended dosing intervals
B.Morphine sustained-release 30 mg twice daily
C.Codeine 60 mg every 4 hours
D.Meperidine 100 mg every 4 hours
Explanation: Fentanyl and hydromorphone are preferred opioids in severe renal failure. Fentanyl has no active renal metabolites, while hydromorphone-3-glucuronide accumulates significantly less than morphine-6-glucuronide (M6G) and morphine-3-glucuronide (M3G), which cause severe myoclonus, neurotoxicity, and respiratory depression in renal failure.
5A patient with breast cancer and widespread osteolytic bone metastases experiences sharp, localized pain triggered by movement despite stable baseline opioid dosing. What is the most effective adjuvant therapy for somatic bone pain?
A.Bisphosphonates (e.g., intravenous zoledronic acid) or denosumab, combined with short-course corticosteroids
B.Oral baclofen
C.High-dose transdermal buprenorphine alone
D.Inhaled methoxyflurane
Explanation: Bone metastases cause bone pain through osteoclast-mediated bone resorption and inflammatory cytokine release. Bisphosphonates (zoledronic acid) or denosumab, alongside short-course corticosteroids (dexamethasone), effectively inhibit osteoclast activity and reduce bone pain and skeletal-related events.
6A patient receiving high-dose oral morphine for advanced head and neck cancer presents with new-onset myoclonus, hyperalgesia, tactile allodynia, and visual hallucinations. Vital signs and oxygen saturation are normal. What is the underlying pathophysiology and immediate management strategy?
A.Opioid-induced neurotoxicity (OIN) due to metabolite accumulation; rotate to an alternative opioid and increase hydration
B.Acute opioid withdrawal; double the current morphine dose immediately
C.Opioid overdose; administer intravenous naloxone 0.4 mg bolus every 2 minutes
D.Bacterial meningitis; perform an immediate lumbar puncture
Explanation: Opioid-induced neurotoxicity (OIN) is caused by accumulation of active neurotoxic metabolites (such as morphine-3-glucuronide). Features include myoclonus, hyperalgesia, allodynia, delirium, and hallucinations. Management requires rotating to a structurally different opioid (e.g., hydromorphone or fentanyl), dose reduction, and gentle hydration if clinically appropriate.
7When calculating an opioid rotation from oral morphine to oral hydromorphone, what clinical factor warrants applying an automatic 25–50% dose reduction to the calculated equianalgesic dose?
A.Incomplete cross-tolerance between different mu-opioid receptor subtypes
B.Enhanced hepatic first-pass metabolism of hydromorphone
C.Increased renal clearance of hydromorphone metabolites
D.Decreased central nervous system opioid receptor density in cancer patients
Explanation: When rotating between different opioids, incomplete cross-tolerance means the patient is more sensitive to the new opioid than predicted by equianalgesic tables. Therefore, clinicians reduce the calculated equianalgesic dose by 25–50% to ensure safety and prevent overdose.
8What is the recommended first-line pharmacological treatment for opioid-induced constipation (OIC) that fails to respond to oral stimulant laxatives (e.g., sennosides) and osmotic laxatives (e.g., polyethylene glycol)?
A.Peripherally acting mu-opioid receptor antagonists (PAMORAs) such as methylnaltrexone
B.Oral naloxone 40 mg twice daily
C.High-dose bulk-forming psyllium fiber supplements
D.Intravenous neostigmine
Explanation: PAMORAs (e.g., subcutaneous methylnaltrexone or oral naldemedine) selectively block peripheral mu-opioid receptors in the gastrointestinal tract without crossing the blood-brain barrier, reversing opioid-induced constipation without precipitating central withdrawal or compromising analgesia.
9A patient with advanced gastric cancer presents with severe colic abdominal pain due to smooth muscle spasm from partial bowel hypermotility above an obstruction. Which anticholinergic antispasmodic agent is most appropriate?
A.Hyoscine butylbromide (Buscopan)
B.Metoclopramide
C.Domperidone
D.Pilocarpine
Explanation: Hyoscine butylbromide (Buscopan) is a peripherally acting anticholinergic agent that relaxes GI smooth muscle, reducing painful abdominal colic and hyperperistalsis in palliative gastrointestinal conditions and bowel obstruction.
10A patient with metastatic melanoma taking oral transmucosal fentanyl citrate for incident pain reports that pain relief takes 45 minutes to start. Upon assessment, the patient is chewing and swallowing the lozenge rapidly. What instruction should be provided?
A.Place the lozenge against the inner cheek mucosa and allow it to dissolve slowly over 15 minutes without chewing
B.Swallow the lozenge whole with a glass of hot water
C.Crush the lozenge and mix it into applesauce
D.Dissolve the lozenge in liquid and administer sublingually via syringe
Explanation: Transmucosal fentanyl depends on direct absorption across the oral mucosa into the systemic circulation, avoiding hepatic first-pass metabolism and providing rapid onset (10–15 min). Swallowing the drug leads to extensive hepatic first-pass metabolism, reducing bioavailability to ~33% and delaying onset.
About the CFPC CAC Palliative Care Practice Questions
Verified exam format metadata for College of Family Physicians of Canada Certificate of Added Competence in Palliative Care Assessment is pending. The practice questions above remain available while official exam length, timing, passing score, fee, and administrator details are reviewed.