Free Practice Questions for CFPC CAC Palliative Care

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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 review concepts for the CFPC CAC Palliative Care exam. 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 Exam

The CFPC Certificate of Added Competence (CAC) in Palliative Care recognizes family physicians who demonstrate advanced competence in palliative and end-of-life care. Candidates are assessed against CFPC Priority Topics and Key Features covering pain management, symptom control, goals of care, palliative sedation, and Canadian legal/ethical standards including MAiD.

Exam sponsor: College of Family Physicians of Canada (CFPC). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

Summative assessment based on CFPC Priority Topics and Key Features in Palliative Care. Evaluates clinical reasoning in pain management, symptom control, advance care planning, and Canadian end-of-life care standards.

Time Limit

varies-by-route

Passing Score

CFPC Competency Rubric Standard

Exam / Certification Fees

IPCR route: CAD $373 access fee + $4,072 assessment fee (2025-26; confirm on cfpc.ca). Residency route fee varies.

Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Official sources

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

25%

Non-Pain Symptom Control

Dyspnea, nausea, bowel obstruction, delirium, fatigue, and oncologic emergencies.

20%

Pain Management & Opioid Prescribing

Opioid rotation, equianalgesic math, neuropathic pain, bone pain, and side-effect management.

20%

Goals of Care & Communication

Advance care planning, substitute decision-makers in Canada, and SPIKES protocol.

15%

Palliative Sedation & End-of-Life Care

Proportional palliative sedation, refractory symptoms, and active dying care.

10%

Ethics, Legal & MAiD in Canada

Bill C-7 Track 1/Track 2 criteria, safeguards, consent, and capacity evaluation.

10%

Psychosocial & Grief Support

Existential distress, depression, anticipatory grief, and family bereavement care.

Preparing for the CFPC CAC Palliative Care Exam

What You Need to Know

Passing score: CFPC Competency Rubric Standard
Assessment: Summative assessment based on CFPC Priority Topics and Key Features in Palliative Care. Evaluates clinical reasoning in pain management, symptom control, advance care planning, and Canadian end-of-life care standards.
Time limit: varies-by-route
Exam / certification fees: IPCR route: CAD $373 access fee + $4,072 assessment fee (2025-26; confirm on cfpc.ca). Residency route fee varies. Official sources

Using Our Practice Resources

Work through all 100 available questions
Review every answer and explanation
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CFPC CAC Palliative Care: Suggested Study Strategy

1Master equianalgesic opioid conversions (oral morphine to parenteral, hydromorphone, and transdermal fentanyl) and organ-failure adjustments.

2Review Canadian provincial substitute decision-maker (SDM) hierarchies and legal requirements for Medical Assistance in Dying (MAiD) under Bill C-7.

3Memorize mechanism-targeted antiemetic selection (metoclopramide for stasis, haloperidol for chemical, ondansetron for radiation/chemo).

Frequently Asked Questions

What is the CFPC CAC in Palliative Care?

The Certificate of Added Competence (CAC) in Palliative Care is an advanced credential awarded by the College of Family Physicians of Canada (CFPC) to family physicians demonstrating specialized competence in palliative and end-of-life care.

How does CFPC assess competence for the CAC in Palliative Care?

CFPC assesses candidates via two pathways: the Canadian Residency Certification Route (completion of an accredited Category 1 Enhanced Skills residency) or the In-Practice Certification Route (peer and portfolio review demonstrating practice experience against CFPC Priority Topics).

Does this practice bank replace required residency or portfolio work?

No. This practice bank is an English-language MCQ study adaptation designed to help physicians test their clinical knowledge, opioid calculation skills, symptom management algorithms, and Canadian healthcare ethics.