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Episiotomy and Tears Following Delivery

Prophylactic antibiotics significantly reduce the risk of clinically relevant wound complications in women with episiotomies and second-degree tears.

  • True
  • False
Volume 41.3 - Question 15

Metabolic Dysfunction-Associated Steatotic Liver Disease

Which one of the following statements about metabolic dysfunction-associated steatotic liver disease (MASLD) is false?

  • Weight loss of at least 10% is needed to reduce liver fibrosis.
  • Semaglutide has been shown to exert hepatoprotective effects.
  • SGLT2 inhibitors do not have hepatoprotective effects.
  • No liver-directed pharmacotherapies are available for the treatment of MASLD-related cirrhosis.
Volume 41.1 - Question 32

Automated Insulin Delivery

Automated insulin delivery in patients with insulin treated type 2 diabetes is associated with a greater reduction in glycated hemoglobin levels than continuous glucose monitoring alone.

  • True
  • False
Volume 40.6 - Question 28

Steatotic Liver Disease in the Office

Phosphatidylethanol is a biomarker which may identify moderate or heavy alcohol consumption in the past 3 to 4 weeks.

  • True
  • False
Volume 40.5 - Question 29

Steatotic Liver Disease

Weight loss of more than 10% in people who have metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with an improvement in fibrosis.

  • True
  • False
Volume 40.4 - Question 34

Non-Alcoholic Fatty Liver Disease

In patients with Type 2 Diabetes and Non-Alcoholic Fatty Liver Disease, which one of the following statements regarding treatment with oral antidiabetic drugs is false?

  • Thiazolidinediones restore lowered plasma adiponectin levels in patients with nonalcoholic steatohepatitis.
  • Sodium-glucose cotransporter 2 inhibitors might be preferred over other oral antidiabetic drugs with respect to nonalcoholic fatty liver disease regression.
  • Dipeptidyl peptidase-4 (DPP-4) inhibitors are not significantly associated with weight change.
  • DPP-4 inhibitors are significantly associated with a lower incidence of adverse liver-related outcomes when compared with sulfonylureas.
Volume 39.6 - Question 40

Nonalcoholic Fatty Liver Disease

A 35-year-old patient is at your office today because he is experiencing fatigue and right upper abdominal fullness recently. He rarely drinks alcohol and he is wondering if he has nonalcoholic fatty liver disease (NAFLD). 
Volume 36.3 - Question 42

Acute Liver Failure

N-acetylcysteine improves overall survival in the treatment of non-acetaminophen-related acute liver injury. 

  • True
  • False
Volume 36.3 - Question 33

Liver Disease and Diet

In postmenopausal women, there is a statistically significant association between increased sugar-sweetened beverage intake and chronic liver disease mortality. 

  • True
  • False
Volume 39.1 - Question 35

Delivery Planning

Which one of the following statements regarding the Society of Obstetricians and Gynaecologists of Canada recommendations for delivery planning is false?

  • Oral administration of castor oil at term may reduce the need for induction of labour in low risk multiparous individuals.
  • Vaginal intercourse at term increases the rate of spontaneous onset of labour.
  • Delivery can be considered at 39-40 weeks gestation for women with a body mass index of 40 kg/m2 or greater.
  • Cervical length (in cm) has replaced effacement (as a percentage) in the modified Bishop score.
Volume 38.5 - Question 17

Trigger Point Injections for Myofascial Pain

Trigger point injections with bupivacaine in combination with standard therapy for myofascial pain syndrome of the low back are superior to standard therapy alone.

  • True
  • False
Volume 41.4 - Question 30

Weight Regain After Medication Cessation

Cessation of weight management medications is followed by rapid weight regain and reversal of beneficial effects on cardiometabolic markers.

  • True
  • False
Volume 41.4 - Question 24

Semaglutide in MASH

Patients with metabolic-associated steatohepatitis with moderate to advanced fibrosis may have reduction in liver fibrosis with the use of subcutaneous semaglutide of 2.4 mg/week for 72 weeks.

  • True
  • False
Volume 41.4 - Question 22

Hepatitis B Screening

Universal one-time screening of all adults in Canada for hepatitis B is recommended.

  • True
  • False
Volume 41.3 - Question 20

Doula Care

Which one of the following statements about doula care is false?

  • It is associated with more vaginal births after cesarean delivery.
  • It is associated with improved attendance at postpartum visits.
  • It is associated with fewer preterm births.
  • The effect of doula care is not consistent across race.
Volume 41.3 - Question 12

Lubricant Use for Sexual Activity

You are seeing a 27-year-old woman. She has a new sexual partner, and they have been dating for the past two months. When questioning her STI risk, she tells you that she does not use condoms, because of the friction and discomfort they cause during sexual intercourse due to vaginal dryness.
Volume 41.2 - Question 38

Intravenous Tranexamic Acid in Gastrointestinal Bleeding

Which one of the following statements regarding the use of tranexamic acid in adults with gastrointestinal bleeding is false?  

  • It reduces rebleeding rates.  
  • It reduces failure to control bleeding.  
  • It reduces transfusion requirements.  
  • It does not alter mortality.  
Volume 41.2 - Question 21

Adverse Pregnancy Outcome and Risk of Stroke

Women who have an adverse pregnancy outcome (preterm delivery, small for gestational age, preeclampsia, other hypertensive disorders, and gestational diabetes) need early prevention and long-term clinical care to reduce their lifelong risk of stroke.

  • True
  • False
Volume 41.2 - Question 12

Elevated Vitamin B12 Levels

Which one of the following statements about elevated Vitamin B12 levels is false?

  • Less than 5% of individuals have elevated vitamin B12
  • Persistently elevated levels have been associated with an increased incidence of solid cancer, specifically liver, kidney, lung, breast, and gastrointestinal cancers.
  • Patients are at increased risk of hematologic disorders such as chronic myeloid leukemia, polycythemia vera, and myeloproliferative syndromes.
  • A repeat test should be performed to confirm persistent elevation.
Volume 41.1 - Question 29

Transdermal Fentanyl for Chronic Pain

Which one of the following statements about the prescribing of transdermal fentanyl for chronic pain is false?

  • Inappropriate use has been associated with respiratory depression and death.
  • It has been associated with increased patient satisfaction, when used for recommended indications.
  • An enhanced ordering algorithm in EMR, accompanied by pharmacy education, has been shown to reduce inappropriate ordering.
  • Its use is recommended for opioid-naïve patients with acute pain.
Volume 41.1 - Question 24

Cannabis and Psychosis

Which one of the following is not a risk factor for developing psychosis associated with cannabis use?

  • Use of high potency tetrahydrocannabinol (a product with > 10% THC)
  • Frequent use
  • Female sex
  • History of a mental disorder (e.g., bipolar disorder, depression, anxiety)
Volume 41.1 - Question 15

Ferric Derisomaltose vs Iron Sucrose in Pregnancy

When ferric derisomaltose is used for treatment of iron deficiency anemia in pregnancy, as opposed to iron sucrose, which one of the following statements is false?

  • IV infusion times per visit are shorter.
  • Patients treated receive a higher total dose of IV iron.
  • Mean treatment cost per patient per pregnancy is higher.
  • There is a higher incidence of adverse reactions.
Volume 41.1 - Question 10

Trigeminal Neuralgia

A 55-year-old female patient is at your office today complaining of recurrent episodes of left facial pain in the trigeminal nerve area over the past month. Her pain lasts up to 2 minutes and is severe in intensity. She describes the pain as electrical shock-like, shooting, stabbing, and sharp in quality. You have diagnosed her as likely having trigeminal neuralgia.
Volume 40.6 - Question 35

Virtual Yoga for Chronic Low Back Pain

Virtual yoga classes may be an effective treatment option for chronic low back pain.

  • True
  • False
Volume 40.6 - Question 16

Chronic Rhinosinusitis

Which one of the following statements about the diagnosis and management of chronic rhinosinusitis (CRS) is false?

  • The rate of asthma among people with CRS is estimated to be 5 times higher than in the general population.
  • The standard imaging modality is a noncontrast CT scan of the sinuses.
  • Endoscopic sinus surgery is effective for patients who have failed standard medical therapy.
  • Monoclonal antibody therapy is not indicated in patients with severe CRS with nasal polyps.
Volume 40.6 - Question 10

Asthma Prescribing and Carbon Emissions

Which one of the following statements regarding health professionals’ decision-making when choosing which inhaler to prescribe for asthma to reduce carbon emissions is false?

  • Clinicians assume that older patients would be less motivated by environmental concerns.
  • Familiarity is a key factor in inhaler device choice.
  • Clinicians do not consider stigma a barrier to open discussion of environmental considerations.
  • Pharmacy stock is identified as an external constraint that prevents change in practice.
Volume 40.6 - Question 8

Immediate Skin to Skin Contact in Very Preterm Neonates

Which one of the following statements regarding very preterm neonates (born at 28 weeks 0 days to 31 weeks 6 days gestation) who receive two hours of mother-neonate skin to skin contact in the delivery room compared to standard care in the incubator is false?

  • Risk of developmental delay at 2 to 3 years of age is enhanced in the skin to skin contact group.
  • More infants in the skin to skin contact group are breastfed at discharge.
  • The duration of exclusive breastfeeding is longer in the skin to skin contact group.
  • Neurodevelopmental outcomes between the two groups at 3 and 12 months are similar.
Volume 40.6 - Question 4

Statin Use and Risk of Hepatocellular Carcinoma

In patients 40 years or older with chronic liver disease and a baseline Fibrosis-4 (FIB-4) score of 1.3 or higher, statin use is significantly associated with a reduced risk of incident hepatocellular carcinoma.

  • True
  • False
Volume 40.5 - Question 26

Haemophilia

Which one of the following statements about haemophilia is false?

  • In severe cases, symptoms frequently appear between ages 6 to12 months.
  • Joint damage due to bleeding rarely affects small joints.
  • A coagulation screen usually shows an abnormal prothrombin time.
  • Female carriers of haemophilia A tend to have more bleeding episodes compared to non-carriers.
Volume 40.5 - Question 23

Prescribing Physical Activity for Older Adults

Lower volumes of physical activity (between 83 and 166 minutes of moderate activity per week) reduce the risk of morbidity and mortality in older adults.

  • True
  • False
Volume 40.5 - Question 7

Narrative Therapy

Which one of the following statements about narrative interventions in health care is false?

  • They can increase patients’ sense of hope.
  • They can decrease distress.
  • They can be performed across health care settings.
  • They should be performed by a trained psychosocial professional.
Volume 40.4 - Question 35

Transfusion Threshold in Acute Brain Injury

A liberal transfusion threshold, targeting a hemoglobin of 9g/dL compared to a restrictive  strategy targeting a hemoglobin of 7g/dL, was associated with a lower risk of unfavorable neurological outcome at 180 days in patients with acute brain injury.

  • True
  • False
Volume 40.4 - Question 31

Amyloidosis

Which one of the following statements about systemic light chain amyloidosis is false?

  • It commonly causes nephrotic range proteinuria.
  • Cardiac involvement is the leading cause of death.
  • It is associated with multiple myeloma.
  • The five year survival rate is 20%.
Volume 40.4 - Question 29

DRESS

Which one of the following statements about drug reaction with eosinophilia and systemic symptoms is false?

  • The prodromal phase is typically followed by a morbilliform eruption that begins on the trunk.
  • Allopurinol has been associated with the shortest disease latency.
  • Atypical lymphocytosis is the earliest hematologic finding.
  • Systemic glucocorticoids are the mainstay of treatment for induction of remission.
Volume 40.4 - Question 24

Acupuncture for Sciatica

When compared to sham acupuncture, acupuncture resulted in less pain in patients with chronic sciatica from herniated disk.

  • True
  • False
Volume 40.4 - Question 23

Human Strongyloides stercoralis Infection

Which one of the following statements about human Strongyloidiasis is false?

  • Strongyloides stercoralis is a soil-transmitted helminth affecting 30-100 million people worldwide.
  • Autoinfection can result in chronic infection lasting up to 5 years after initial exposure.
  • Hyperinfection occurs mainly in patients who are immunocompromised or immunodeficient.
  • Patients undergoing transplantation should be screened for S. stercoralis.
Volume 40.4 - Question 19

Regulating Professional Ethics in a Context of Technological Change

Which one of the following statements regarding the ethical and regulatory challenges that health professionals face in the context of technological change is false?

  • Most health professional regulators have standards/codes exhorting professionals to be competent in their use of technology.
  • Regulators are uncertain about when they should establish standards, guidance, and/or codes of ethics about technology use.
  • Answering practitioners’ questions about ethical conduct with technology is viewed by regulators to serve the public interest by preventing harm.
  • Regulators have little-to-no governance authority over professionals’ workplaces.
Volume 40.4 - Question 18

Empathic Telephone Conversations

Layperson-delivered, empathy-focused telephone engagement can improve glycemic control for patients with diabetes.

  • True
  • False
Volume 40.4 - Question 17

Hyperemesis Gravidarum

Which one of the following statements about hyperemesis gravidarum is false?

  • Ondansetron is considered safe for use in pregnancy.
  • Daily intravenous treatment in an outpatient setting has been shown to be as effective as hospital admission to resolve dehydration.
  • If intravenous fluid therapy is given, it should include 100 mg of thiamine supplementation daily.
  • Beginning doxylamine succinate and pyridoxine hydrochloride preemptively once pregnancy is confirmed may reduce the overall severity and duration of nausea and vomiting in pregnancy.
Volume 40.4 - Question 13

Oxygenation for Pediatric Procedural Sedation

In pediatric patients, receiving pre-emptive preprocedural oxygenation or procedural oxygenation is associated with having a lower risk of airway, breathing and circulation interventions during sedation compared with patients not receiving procedural oxygenation.

  • True
  • False
Volume 40.4 - Question 7

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