According to the Canadian Paediatric Society (CPS), what vitamin supplement is recommended for all exclusively or partially breastfed infants in Canada?

Vitamin D supplementation of 400 IU/day (up to 800 IU/day in northern communities above 55° latitude during winter) starting at birth until the diet provides a reliable source.

In Alcohol Use Disorder management in Canada, what is the prophylaxis for Wernicke Encephalopathy, and what are the first-line anti-craving medications?

Give parenteral (IV/IM) Thiamine BEFORE or with any glucose-containing fluids to prevent Wernicke encephalopathy (triad: confusion, ophthalmoplegia/nystagmus, ataxia). First-line relapse-prevention medications: Oral Naltrexone (avoid in acute hepatitis/liver failure or opioid use) or Acamprosate (avoid in severe renal impairment CrCl <30 mL/min).

According to the Canadian C-Spine Rule for alert (GCS 15) and stable trauma patients, what are the 3 high-risk factors that mandate cervical spine imaging?

1) Age ≥65 years, 2) Dangerous mechanism (fall ≥1 meter/5 stairs, axial load to head, high-speed MVC >100 km/h/rollover/ejection, motorized recreational vehicle, bicycle collision), or 3) Paresthesias in extremities.

According to the Canadian Cardiovascular Society (CCS) Atrial Fibrillation guidelines, what is the simplified 'CHADS-65' algorithm?

Recommend oral anticoagulation (preferentially a DOAC over warfarin in non-valvular AF) for ALL patients aged ≥65 OR with any single traditional CHADS2 risk factor (Congestive heart failure, Hypertension, Diabetes, prior Stroke/TIA); if age <65 with no CHADS2 factors but vascular disease (CAD/PAD), give aspirin.

In a febrile infant <28 days (neonate) presenting to a Canadian ED, what is the mandatory sepsis workup and empirical antibiotic regimen?

Full septic workup (CBC, blood culture, catheter/suprapubic urinalysis & urine culture, and Lumbar Puncture for CSF analysis/culture) followed by hospitalization and IV Ampicillin + Gentamicin (or Ampicillin + Cefotaxime; add IV Acyclovir if HSV risk/vesicles/seizures/CSF pleocytosis).

What are the criteria for diagnosing Pre-eclampsia per SOGC guidelines?

Blood pressure ≥140/90 mmHg after 20 weeks gestation PLUS either significant proteinuria (≥0.3 g/24h or urinary protein:creatinine ratio ≥30 mg/mmol) OR at least one maternal end-organ dysfunction (severe headache/visual symptoms, elevated AST/ALT + RUQ pain, platelets 90 µmol/L, pulmonary oedema) or uteroplacental dysfunction (fetal growth restriction).

In Canadian Pediatrics, what are the 4 developmental domains and key 12-month vs. 18-month vs. 24-month red flags on the Rourke Baby Record?

12 months: not babbling, not using gestures (pointing/waving), not standing with support. 18 months: not walking independently, fewer than 6–10 single words, lack of joint attention. 24 months: no 2-word meaningful phrases (non-echolalic), loss of any previously acquired speech/social skill at ANY age.

According to CANMAT (Canadian Network for Mood and Anxiety Treatments) guidelines, what are the first-line pharmacotherapies for Bipolar I Acute Mania vs. Bipolar Depression?

Acute Mania: Lithium, Divalproex, or an atypical antipsychotic (Quetiapine, Asenapine, Aripiprazole, Paliperidone, Risperidone, Cariprazine) as monotherapy or combination. Bipolar Depression: Quetiapine, Lurasidone, Lithium, or Lamotrigine (NEVER use antidepressant monotherapy in Bipolar I due to manic switch risk).

According to the Canadian Paediatric Society (CPS), what is the diagnostic rule and first-line antibiotic for Group A Streptococcal (GAS) Pharyngitis in children?

Confirm with Rapid Antigen Detection Test (RADT) and/or throat culture (use Centor/McIsaac score; do NOT test children <3 years as rheumatic fever is rare); treat confirmed GAS with Oral Amoxicillin once daily (50 mg/kg/day, max 1000 mg) or Penicillin V for 10 days.

According to the Canadian Thoracic Society (CTS), what is the preferred reliever therapy for mild asthma when patients have poor adherence to daily controller therapy?

As-needed Budesonide/Formoterol (ICS-LABA) anti-inflammatory reliever therapy rather than SABA monotherapy.

According to the Canadian Paediatric Society (CPS), how is Acute Otitis Media (AOM) managed in an immunocompetent child ≥6 months with mild-to-moderate symptoms vs. severe symptoms?

Watchful waiting for 48 hours with analgesia (ibuprofen/acetaminophen) if child is ≥6 months, non-toxic, temp 48h), or perforated tympanic membrane with purulent otorrhoea.

In the Canadian Syncope Risk Score or San Francisco Syncope Rule ('CHESS'), what features identify high-risk cardiogenic syncope requiring hospital admission/monitoring?

Congestive heart failure history, Hematocrit <30%, abnormal ECG (new arrhythmia, bundle branch block, prolonged QT, Brugada, bifascicular block), Shortness of breath, Systolic BP <90 mmHg, or syncope occurring during exertion or while supine.

In a patient with Cirrhosis and Ascites, how does the Serum-Ascites Albumin Gradient (SAAG) differentiate Portal Hypertension from peritoneal carcinomatosis/TB, and how is Spontaneous Bacterial Peritonitis (SBP) diagnosed?

SAAG = (Serum Albumin) - (Ascitic Fluid Albumin): ≥11 g/L (1.1 g/dL) indicates Portal Hypertension (cirrhosis, heart failure, Budd-Chiari); <11 g/L indicates non-portal causes. SBP is diagnosed when ascitic fluid PMN (neutrophil) count is ≥250 cells/mm³ (treat with IV Ceftriaxone/Cefotaxime + IV Albumin on Day 1 and Day 3).

In Diabetes Canada guidelines, what does the 'ABCDESSS' vascular protection mnemonic stand for?

A1c target ≤7.0% for most; BP 15 yrs, or microvascular/CV disease); Drugs for CV/renal risk reduction (ACEi/ARB, SGLT2i, GLP-1 RA, ASA in secondary prevention); Exercise & Healthy eating; Screening for complications; Smoking cessation; Self-management/stress.

According to SOGC guidelines, when is Rh0(D) Immune Globulin (WinRho) administered to an Rh-negative unsensitized pregnant patient?

Routinely at 28 weeks gestation (300 mcg IM) AND within 72 hours after delivery of an Rh-positive infant (plus after any sensitizing event: miscarriage, ectopic pregnancy, amniocentesis, CVS, ECV, or antepartum bleeding; quantify fetal-maternal haemorrhage with Kleihauer-Betke test).

What are the Ottawa Ankle Rules and Ottawa Knee Rules used to avoid unnecessary radiographs?

Ottawa Ankle: X-ray only if malleolar pain PLUS bony tenderness along the posterior edge/tip of lateral or medial malleolus (distal 6 cm) OR inability to bear weight for 4 steps both immediately and in ED. Ottawa Knee: X-ray if age ≥55, isolated tenderness of patella, tenderness at head of fibula, inability to flex knee to 90°, or inability to bear weight for 4 steps.

Why is honey strictly contraindicated in infants under 12 months of age?

Risk of Infant Botulism caused by ingestion of Clostridium botulinum spores that germinate in the immature infant gut, producing botulinum neurotoxin (blocking presynaptic acetylcholine release → descending flaccid paralysis, constipation, weak cry, 'floppy baby').

How do you manage Acute Angle-Closure Glaucoma in the Emergency Department?

Immediate Ophthalmology consult PLUS rapid IOP lowering using topical Beta-blocker (Timolol), Alpha-2 agonist (Apraclonidine/Brimonidine), Carbonic anhydrase inhibitor (topical Dorzolamide + IV/oral Acetazolamide), topical Pilocarpine (miotic once IOP starts falling), and hyperosmotic IV Mannitol if refractory, followed by definitive Laser Peripheral Iridotomy.

What are the first-line single or single-pill combination antihypertensive classes recommended by Hypertension Canada for uncomplicated hypertension?

Thiazide/thiazide-like diuretics (preferring longer-acting chlorthalidone or indapamide), ACE inhibitors, ARBs, Long-acting dihydropyridine CCBs, or Beta-blockers (beta-blockers are NOT first-line for patients aged ≥60 without another compelling indication).

According to Hypertension Canada guidelines, what are the Automated Office Blood Pressure (AOBP) diagnostic thresholds and treatment targets for Diabetes vs. High-Risk Non-Diabetic patients (SPRINT)?

Diabetes Mellitus: diagnostic threshold ≥130/80 mmHg and treatment target <130/80 mmHg. High-risk cardiovascular patients (SPRINT population): intensive AOBP systolic target <120 mmHg. Standard non-diabetic patients: diagnostic threshold ≥135/85 mmHg (AOBP/HBPM) or ≥140/90 mmHg (non-AOBP), target <140/90 mmHg.

What are the Canadian CT Head Rule criteria for minor head injury (GCS 13–15)?

High risk (for neurosurgical intervention): GCS 3 feet or 5 stairs).

According to Diabetes Canada, when should a patient with Type 1 vs. Type 2 Diabetes begin screening for Diabetic Retinopathy, Nephropathy (ACR + eGFR), and Neuropathy?

Type 1 DM: Start 5 years after diagnosis (once aged ≥15 for retinopathy/neuropathy; post-pubertal and ≥5 yrs duration for nephropathy), then annually. Type 2 DM: Screen immediately AT DIAGNOSIS for retinopathy, nephropathy, and neuropathy, then annually (1–2 yrs for retinopathy if none present).

According to SOGC (Society of Obstetricians and Gynaecologists of Canada) guidelines, what is the two-step preferred screening protocol for Gestational Diabetes Mellitus (GDM) at 24–28 weeks?

Step 1: Non-fasting 50g Glucose Challenge Test (GCT)—if 1h glucose <7.8 mmol/L = normal; if ≥11.1 mmol/L = GDM confirmed directly; if 7.8–11.0 mmol/L → proceed to Step 2: Fasting 75g 2-hour OGTT (GDM if Fasting ≥5.3, 1h ≥10.6, or 2h ≥9.0 mmol/L).

Under Canadian Provincial Mental Health Acts (e.g., Ontario Form 1), what are the criteria for a physician to sign an Application for Psychiatric Assessment (up to 72 hours)?

The physician has personally examined the patient within the past 7 days and has reasonable cause to believe the person has a mental disorder likely to result in serious bodily harm to self, serious bodily harm to another person, or serious physical impairment of the person (the 'Box A' vs. 'Box B' deterioration criteria).

According to Diabetes Canada guidelines, what are the 4 diagnostic criteria for Diabetes Mellitus (requiring confirmation on a repeat test unless unequivocal hyperglycaemic decompensation is present)?

1) Fasting Plasma Glucose (FPG) ≥7.0 mmol/L, 2) HbA1c ≥6.5%, 3) 2-hour Plasma Glucose ≥11.1 mmol/L on a 75g OGTT, or 4) Random PG ≥11.1 mmol/L with classic symptoms (polyuria, polydipsia, unexplained weight loss).

In Obstetrics, what are the 4 manoeuvres in the McRoberts/ALARMER algorithm for Shoulder Dystocia?

Call for help, discourage pushing, never apply fundal pressure: 1) McRoberts manoeuvre (hyperflex maternal thighs onto abdomen), 2) Suprapubic pressure (Rubin I—downward/lateral over fetal anterior shoulder), 3) Internal rotational manoeuvres (Rubin II / Woods corkscrew) or delivery of the posterior arm (Jacquemier), 4) Roll onto all-fours (Gaskin manoeuvre).

What are the DSM-5 / CANMAT diagnostic duration thresholds for Major Depressive Disorder, Persistent Depressive Disorder (Dysthymia), Generalized Anxiety Disorder, and Schizophrenia?

MDD: ≥2 weeks (≥5 of 9 SIGECAPS symptoms including depressed mood or anhedonia). Persistent Depressive Disorder: ≥2 years in adults (≥1 year in children/adolescents). GAD: ≥6 months of excessive worry. Schizophrenia: ≥6 months of continuous disturbance with ≥1 month of active-phase symptoms (compare Schizophreniform: 1 to 6 months; Brief Psychotic Disorder: 1 day to <1 month).

In Opioid Use Disorder (OUD) in Canada (CRISM guidelines), compare Buprenorphine/Naloxone (Suboxone) and Methadone for Opioid Agonist Therapy (OAT).

Buprenorphine/Naloxone is first-line because buprenorphine is a partial mu-opioid receptor agonist with a ceiling effect on respiratory depression (much safer overdose profile), though standard induction requires mild-to-moderate opioid withdrawal first (COWS >12) to avoid precipitated withdrawal (unless micro-dosing/Bernese method is used). Methadone is a full agonist with no withdrawal requirement at initiation but higher risk of overdose and QTc prolongation.

In Canadian Respirology (CTS guidelines), how is Reversible Airflow Obstruction confirmed on spirometry to diagnose Asthma in adults vs. children?

Reduced FEV1/FVC ratio (<0.75–0.80 in adults, <0.80–0.90 in children) AND post-bronchodilator FEV1 increase of ≥12% AND ≥200 mL in adults (or ≥12% in children); if spirometry is normal, a Methacholine Challenge Test (PC20 <4 mg/mL positive) confirms airway hyperresponsiveness.

According to SOGC guidelines, what is the folic acid supplementation dose for Low-Risk vs. Moderate/High-Risk women planning pregnancy?

Low risk: 0.4 mg (400 mcg) daily starting at least 2–3 months before conception and throughout pregnancy/lactation. High risk (prior neural tube defect, personal/partner NTD): 4.0 mg daily starting 3 months pre-conception until 12 weeks gestation, then step down to 0.4–1.0 mg.

In Canadian Gastroenterology (CAG), what is the first-line eradication regimen for Helicobacter pylori infection in Canada (where clarithromycin resistance exceeds 15%)?

14-day Quadruple Therapy: either Bismuth Quadruple Therapy (PBMT: PPI + Bismuth + Metronidazole + Tetracycline) OR Non-Bismuth Concomitant Quadruple Therapy (PAMC: PPI + Amoxicillin + Metronidazole + Clarithromycin) for 14 days.

At what age can whole cow's milk (3.25% homogenized milk) be introduced to infants in Canada, and why must it be delayed until then?

9 to 12 months of age (once the infant is consuming a variety of iron-rich solid foods); earlier introduction causes Iron Deficiency Anaemia due to low bioavailable iron, occult GI blood loss, and displacement of iron-rich foods (limit intake to ≤750 mL/day).

MCCQE Part I Clinical Medicine: Cardiology, Respirology, Gastroenterology, Endocrinology, Psychiatry & Pediatrics (Canadian Guidelines)

High-yield Canadian clinical practice guidelines from Hypertension Canada, CCS, Diabetes Canada, CANMAT, CPS (Canadian Paediatric Society), and SOGC tested on the MCCQE Part I.

Level: basic
Languages: en → en
Cards: 32
Markdown: MCCQE Part I Clinical Medicine: Cardiology, Respirology, Gastroenterology, Endocrinology, Psychiatry & Pediatrics (Canadian Guidelines) (.md)

Flashcards (32)

#	Front (Term / Question)	Back (Definition / Answer)
1	According to the Canadian Paediatric Society (CPS), what vitamin supplement is recommended for all exclusively or partially breastfed infants in Canada?	Vitamin D supplementation of 400 IU/day (up to 800 IU/day in northern communities above 55° latitude during winter) starting at birth until the diet provides a reliable source.
2	In Alcohol Use Disorder management in Canada, what is the prophylaxis for Wernicke Encephalopathy, and what are the first-line anti-craving medications?	Give parenteral (IV/IM) Thiamine BEFORE or with any glucose-containing fluids to prevent Wernicke encephalopathy (triad: confusion, ophthalmoplegia/nystagmus, ataxia). First-line relapse-prevention medications: Oral Naltrexone (avoid in acute hepatitis/liver failure or opioid use) or Acamprosate (avoid in severe renal impairment CrCl <30 mL/min).
3	According to the Canadian C-Spine Rule for alert (GCS 15) and stable trauma patients, what are the 3 high-risk factors that mandate cervical spine imaging?	1) Age ≥65 years, 2) Dangerous mechanism (fall ≥1 meter/5 stairs, axial load to head, high-speed MVC >100 km/h/rollover/ejection, motorized recreational vehicle, bicycle collision), or 3) Paresthesias in extremities.
4	According to the Canadian Cardiovascular Society (CCS) Atrial Fibrillation guidelines, what is the simplified 'CHADS-65' algorithm?	Recommend oral anticoagulation (preferentially a DOAC over warfarin in non-valvular AF) for ALL patients aged ≥65 OR with any single traditional CHADS2 risk factor (Congestive heart failure, Hypertension, Diabetes, prior Stroke/TIA); if age <65 with no CHADS2 factors but vascular disease (CAD/PAD), give aspirin.
5	In a febrile infant <28 days (neonate) presenting to a Canadian ED, what is the mandatory sepsis workup and empirical antibiotic regimen?	Full septic workup (CBC, blood culture, catheter/suprapubic urinalysis & urine culture, and Lumbar Puncture for CSF analysis/culture) followed by hospitalization and IV Ampicillin + Gentamicin (or Ampicillin + Cefotaxime; add IV Acyclovir if HSV risk/vesicles/seizures/CSF pleocytosis).
6	What are the criteria for diagnosing Pre-eclampsia per SOGC guidelines?	Blood pressure ≥140/90 mmHg after 20 weeks gestation PLUS either significant proteinuria (≥0.3 g/24h or urinary protein:creatinine ratio ≥30 mg/mmol) OR at least one maternal end-organ dysfunction (severe headache/visual symptoms, elevated AST/ALT + RUQ pain, platelets <100 × 10⁹/L, creatinine >90 µmol/L, pulmonary oedema) or uteroplacental dysfunction (fetal growth restriction).
7	In Canadian Pediatrics, what are the 4 developmental domains and key 12-month vs. 18-month vs. 24-month red flags on the Rourke Baby Record?	12 months: not babbling, not using gestures (pointing/waving), not standing with support. 18 months: not walking independently, fewer than 6–10 single words, lack of joint attention. 24 months: no 2-word meaningful phrases (non-echolalic), loss of any previously acquired speech/social skill at ANY age.
8	According to CANMAT (Canadian Network for Mood and Anxiety Treatments) guidelines, what are the first-line pharmacotherapies for Bipolar I Acute Mania vs. Bipolar Depression?	Acute Mania: Lithium, Divalproex, or an atypical antipsychotic (Quetiapine, Asenapine, Aripiprazole, Paliperidone, Risperidone, Cariprazine) as monotherapy or combination. Bipolar Depression: Quetiapine, Lurasidone, Lithium, or Lamotrigine (NEVER use antidepressant monotherapy in Bipolar I due to manic switch risk).
9	According to the Canadian Paediatric Society (CPS), what is the diagnostic rule and first-line antibiotic for Group A Streptococcal (GAS) Pharyngitis in children?	Confirm with Rapid Antigen Detection Test (RADT) and/or throat culture (use Centor/McIsaac score; do NOT test children <3 years as rheumatic fever is rare); treat confirmed GAS with Oral Amoxicillin once daily (50 mg/kg/day, max 1000 mg) or Penicillin V for 10 days.
10	According to the Canadian Thoracic Society (CTS), what is the preferred reliever therapy for mild asthma when patients have poor adherence to daily controller therapy?	As-needed Budesonide/Formoterol (ICS-LABA) anti-inflammatory reliever therapy rather than SABA monotherapy.
11	According to the Canadian Paediatric Society (CPS), how is Acute Otitis Media (AOM) managed in an immunocompetent child ≥6 months with mild-to-moderate symptoms vs. severe symptoms?	Watchful waiting for 48 hours with analgesia (ibuprofen/acetaminophen) if child is ≥6 months, non-toxic, temp <39°C, and mild otalgia without perforation/otorrhoea. Treat immediately with High-Dose Amoxicillin (45–90 mg/kg/day) if <6 months, severe symptoms (temp ≥39°C, moderate-severe otalgia >48h), or perforated tympanic membrane with purulent otorrhoea.
12	In the Canadian Syncope Risk Score or San Francisco Syncope Rule ('CHESS'), what features identify high-risk cardiogenic syncope requiring hospital admission/monitoring?	Congestive heart failure history, Hematocrit <30%, abnormal ECG (new arrhythmia, bundle branch block, prolonged QT, Brugada, bifascicular block), Shortness of breath, Systolic BP <90 mmHg, or syncope occurring during exertion or while supine.
13	In a patient with Cirrhosis and Ascites, how does the Serum-Ascites Albumin Gradient (SAAG) differentiate Portal Hypertension from peritoneal carcinomatosis/TB, and how is Spontaneous Bacterial Peritonitis (SBP) diagnosed?	SAAG = (Serum Albumin) - (Ascitic Fluid Albumin): ≥11 g/L (1.1 g/dL) indicates Portal Hypertension (cirrhosis, heart failure, Budd-Chiari); <11 g/L indicates non-portal causes. SBP is diagnosed when ascitic fluid PMN (neutrophil) count is ≥250 cells/mm³ (treat with IV Ceftriaxone/Cefotaxime + IV Albumin on Day 1 and Day 3).
14	In Diabetes Canada guidelines, what does the 'ABCDESSS' vascular protection mnemonic stand for?	A1c target ≤7.0% for most; BP <130/80 mmHg (ACEi/ARB); Cholesterol (statin for all age ≥40, or ≥30 with DM >15 yrs, or microvascular/CV disease); Drugs for CV/renal risk reduction (ACEi/ARB, SGLT2i, GLP-1 RA, ASA in secondary prevention); Exercise & Healthy eating; Screening for complications; Smoking cessation; Self-management/stress.
15	According to SOGC guidelines, when is Rh0(D) Immune Globulin (WinRho) administered to an Rh-negative unsensitized pregnant patient?	Routinely at 28 weeks gestation (300 mcg IM) AND within 72 hours after delivery of an Rh-positive infant (plus after any sensitizing event: miscarriage, ectopic pregnancy, amniocentesis, CVS, ECV, or antepartum bleeding; quantify fetal-maternal haemorrhage with Kleihauer-Betke test).
16	What are the Ottawa Ankle Rules and Ottawa Knee Rules used to avoid unnecessary radiographs?	Ottawa Ankle: X-ray only if malleolar pain PLUS bony tenderness along the posterior edge/tip of lateral or medial malleolus (distal 6 cm) OR inability to bear weight for 4 steps both immediately and in ED. Ottawa Knee: X-ray if age ≥55, isolated tenderness of patella, tenderness at head of fibula, inability to flex knee to 90°, or inability to bear weight for 4 steps.
17	Why is honey strictly contraindicated in infants under 12 months of age?	Risk of Infant Botulism caused by ingestion of Clostridium botulinum spores that germinate in the immature infant gut, producing botulinum neurotoxin (blocking presynaptic acetylcholine release → descending flaccid paralysis, constipation, weak cry, 'floppy baby').
18	How do you manage Acute Angle-Closure Glaucoma in the Emergency Department?	Immediate Ophthalmology consult PLUS rapid IOP lowering using topical Beta-blocker (Timolol), Alpha-2 agonist (Apraclonidine/Brimonidine), Carbonic anhydrase inhibitor (topical Dorzolamide + IV/oral Acetazolamide), topical Pilocarpine (miotic once IOP starts falling), and hyperosmotic IV Mannitol if refractory, followed by definitive Laser Peripheral Iridotomy.
19	What are the first-line single or single-pill combination antihypertensive classes recommended by Hypertension Canada for uncomplicated hypertension?	Thiazide/thiazide-like diuretics (preferring longer-acting chlorthalidone or indapamide), ACE inhibitors, ARBs, Long-acting dihydropyridine CCBs, or Beta-blockers (beta-blockers are NOT first-line for patients aged ≥60 without another compelling indication).
20	According to Hypertension Canada guidelines, what are the Automated Office Blood Pressure (AOBP) diagnostic thresholds and treatment targets for Diabetes vs. High-Risk Non-Diabetic patients (SPRINT)?	Diabetes Mellitus: diagnostic threshold ≥130/80 mmHg and treatment target <130/80 mmHg. High-risk cardiovascular patients (SPRINT population): intensive AOBP systolic target <120 mmHg. Standard non-diabetic patients: diagnostic threshold ≥135/85 mmHg (AOBP/HBPM) or ≥140/90 mmHg (non-AOBP), target <140/90 mmHg.
21	What are the Canadian CT Head Rule criteria for minor head injury (GCS 13–15)?	High risk (for neurosurgical intervention): GCS <15 at 2h post-injury, suspected open/depressed skull fracture, any sign of basal skull fracture, ≥2 episodes of vomiting, or age ≥65. Medium risk (for brain injury on CT): retrograde amnesia ≥30 min, or dangerous mechanism (pedestrian struck, ejected from vehicle, fall >3 feet or 5 stairs).
22	According to Diabetes Canada, when should a patient with Type 1 vs. Type 2 Diabetes begin screening for Diabetic Retinopathy, Nephropathy (ACR + eGFR), and Neuropathy?	Type 1 DM: Start 5 years after diagnosis (once aged ≥15 for retinopathy/neuropathy; post-pubertal and ≥5 yrs duration for nephropathy), then annually. Type 2 DM: Screen immediately AT DIAGNOSIS for retinopathy, nephropathy, and neuropathy, then annually (1–2 yrs for retinopathy if none present).
23	According to SOGC (Society of Obstetricians and Gynaecologists of Canada) guidelines, what is the two-step preferred screening protocol for Gestational Diabetes Mellitus (GDM) at 24–28 weeks?	Step 1: Non-fasting 50g Glucose Challenge Test (GCT)—if 1h glucose <7.8 mmol/L = normal; if ≥11.1 mmol/L = GDM confirmed directly; if 7.8–11.0 mmol/L → proceed to Step 2: Fasting 75g 2-hour OGTT (GDM if Fasting ≥5.3, 1h ≥10.6, or 2h ≥9.0 mmol/L).
24	Under Canadian Provincial Mental Health Acts (e.g., Ontario Form 1), what are the criteria for a physician to sign an Application for Psychiatric Assessment (up to 72 hours)?	The physician has personally examined the patient within the past 7 days and has reasonable cause to believe the person has a mental disorder likely to result in serious bodily harm to self, serious bodily harm to another person, or serious physical impairment of the person (the 'Box A' vs. 'Box B' deterioration criteria).
25	According to Diabetes Canada guidelines, what are the 4 diagnostic criteria for Diabetes Mellitus (requiring confirmation on a repeat test unless unequivocal hyperglycaemic decompensation is present)?	1) Fasting Plasma Glucose (FPG) ≥7.0 mmol/L, 2) HbA1c ≥6.5%, 3) 2-hour Plasma Glucose ≥11.1 mmol/L on a 75g OGTT, or 4) Random PG ≥11.1 mmol/L with classic symptoms (polyuria, polydipsia, unexplained weight loss).
26	In Obstetrics, what are the 4 manoeuvres in the McRoberts/ALARMER algorithm for Shoulder Dystocia?	Call for help, discourage pushing, never apply fundal pressure: 1) McRoberts manoeuvre (hyperflex maternal thighs onto abdomen), 2) Suprapubic pressure (Rubin I—downward/lateral over fetal anterior shoulder), 3) Internal rotational manoeuvres (Rubin II / Woods corkscrew) or delivery of the posterior arm (Jacquemier), 4) Roll onto all-fours (Gaskin manoeuvre).
27	What are the DSM-5 / CANMAT diagnostic duration thresholds for Major Depressive Disorder, Persistent Depressive Disorder (Dysthymia), Generalized Anxiety Disorder, and Schizophrenia?	MDD: ≥2 weeks (≥5 of 9 SIGECAPS symptoms including depressed mood or anhedonia). Persistent Depressive Disorder: ≥2 years in adults (≥1 year in children/adolescents). GAD: ≥6 months of excessive worry. Schizophrenia: ≥6 months of continuous disturbance with ≥1 month of active-phase symptoms (compare Schizophreniform: 1 to 6 months; Brief Psychotic Disorder: 1 day to <1 month).
28	In Opioid Use Disorder (OUD) in Canada (CRISM guidelines), compare Buprenorphine/Naloxone (Suboxone) and Methadone for Opioid Agonist Therapy (OAT).	Buprenorphine/Naloxone is first-line because buprenorphine is a partial mu-opioid receptor agonist with a ceiling effect on respiratory depression (much safer overdose profile), though standard induction requires mild-to-moderate opioid withdrawal first (COWS >12) to avoid precipitated withdrawal (unless micro-dosing/Bernese method is used). Methadone is a full agonist with no withdrawal requirement at initiation but higher risk of overdose and QTc prolongation.
29	In Canadian Respirology (CTS guidelines), how is Reversible Airflow Obstruction confirmed on spirometry to diagnose Asthma in adults vs. children?	Reduced FEV1/FVC ratio (<0.75–0.80 in adults, <0.80–0.90 in children) AND post-bronchodilator FEV1 increase of ≥12% AND ≥200 mL in adults (or ≥12% in children); if spirometry is normal, a Methacholine Challenge Test (PC20 <4 mg/mL positive) confirms airway hyperresponsiveness.
30	According to SOGC guidelines, what is the folic acid supplementation dose for Low-Risk vs. Moderate/High-Risk women planning pregnancy?	Low risk: 0.4 mg (400 mcg) daily starting at least 2–3 months before conception and throughout pregnancy/lactation. High risk (prior neural tube defect, personal/partner NTD): 4.0 mg daily starting 3 months pre-conception until 12 weeks gestation, then step down to 0.4–1.0 mg.
31	In Canadian Gastroenterology (CAG), what is the first-line eradication regimen for Helicobacter pylori infection in Canada (where clarithromycin resistance exceeds 15%)?	14-day Quadruple Therapy: either Bismuth Quadruple Therapy (PBMT: PPI + Bismuth + Metronidazole + Tetracycline) OR Non-Bismuth Concomitant Quadruple Therapy (PAMC: PPI + Amoxicillin + Metronidazole + Clarithromycin) for 14 days.
32	At what age can whole cow's milk (3.25% homogenized milk) be introduced to infants in Canada, and why must it be delayed until then?	9 to 12 months of age (once the infant is consuming a variety of iron-rich solid foods); earlier introduction causes Iron Deficiency Anaemia due to low bioavailable iron, occult GI blood loss, and displacement of iron-rich foods (limit intake to ≤750 mL/day).