NAC OSCE Patient Management & Treatment 2 — Questions and Answers
Question 1: A 2-year-old child presents with a first febrile seizure lasting 3 minutes that has now resolved. The child is alert and examination is normal. According to CPS guidelines, what is the MOST appropriate next step?
- Reassure parents, educate about fever management, and discharge — routine EEG and neuroimaging are NOT indicated for simple febrile seizures (Correct answer)
- Admit for 24-hour EEG monitoring
- Start prophylactic antiepileptics
- Urgent CT head and lumbar puncture
Correct answer: Reassure parents, educate about fever management, and discharge — routine EEG and neuroimaging are NOT indicated for simple febrile seizures
CPS guidelines state that simple febrile seizures (brief, generalised, no recurrence within 24 hours) do not require EEG, neuroimaging, or prophylactic anticonvulsants; parental education and fever management are sufficient.
Question 2: According to the SOGC, at what gestational age is the combined first-trimester prenatal screening (nuchal translucency + PAPP-A + free β-hCG) performed?
- 11+0 to 13+6 weeks gestation (Correct answer)
- 15-18 weeks gestation
- 8-10 weeks gestation
- 20-22 weeks gestation
Correct answer: 11+0 to 13+6 weeks gestation
SOGC guidelines specify combined first-trimester screening is performed between 11+0 and 13+6 weeks when nuchal translucency measurement is technically optimal.
Question 3: A 72-year-old patient is discharged after an acute STEMI treated with primary PCI. According to CCS guidelines, which medications should be prescribed at discharge?
- Dual antiplatelet therapy (aspirin + P2Y12 inhibitor), high-intensity statin, ACE inhibitor or ARB, and beta-blocker (Correct answer)
- Aspirin alone and a statin
- Warfarin, aspirin, and a statin only
- Beta-blocker and diuretic only
Correct answer: Dual antiplatelet therapy (aspirin + P2Y12 inhibitor), high-intensity statin, ACE inhibitor or ARB, and beta-blocker
CCS post-MI guidelines recommend DAPT (aspirin + ticagrelor or prasugrel), high-intensity statin, ACE inhibitor/ARB (especially if EF <40%), and beta-blocker as standard post-STEMI secondary prevention.
Question 4: A 55-year-old woman is newly diagnosed with stage 2 breast cancer (ER+/PR+/HER2-). She undergoes lumpectomy. According to Canadian Cancer Society standards, which adjuvant therapy is indicated?
- Adjuvant radiotherapy to the breast plus 5-10 years of endocrine therapy (tamoxifen or aromatase inhibitor) (Correct answer)
- Chemotherapy alone
- No further treatment after clear surgical margins
- Trastuzumab as targeted therapy
Correct answer: Adjuvant radiotherapy to the breast plus 5-10 years of endocrine therapy (tamoxifen or aromatase inhibitor)
For hormone receptor-positive early breast cancer after breast-conserving surgery, adjuvant breast radiotherapy reduces local recurrence and endocrine therapy for 5-10 years reduces systemic recurrence, per Cancer Care Ontario and Canadian guidelines.
Question 5: According to the Canadian Immunization Guide, which vaccine is recommended at 2, 4, and 6 months of age in the standard Ontario childhood immunization schedule?
- DTaP-IPV-Hib-HB (hexavalent vaccine) plus PCV13 and Rotavirus (Correct answer)
- MMR and Varicella at 2 months
- Meningococcal C vaccine only at 2 and 4 months
- HPV vaccine at 6 months
Correct answer: DTaP-IPV-Hib-HB (hexavalent vaccine) plus PCV13 and Rotavirus
Ontario's immunization schedule at 2, 4, and 6 months includes the hexavalent vaccine (DTaP-IPV-Hib-HB), pneumococcal conjugate (PCV13), and rotavirus oral vaccine, consistent with the Canadian Immunization Guide.
Question 6: A patient with opioid use disorder is stable on buprenorphine/naloxone (Suboxone). According to Canadian guidelines on opioid use disorder, what is the recommended approach to long-term maintenance?
- Continue indefinitely with regular reassessment; tapering should only be considered if the patient is stable and requests it (Correct answer)
- Taper and discontinue within 6 months of stabilisation
- Switch to methadone after 12 months
- Reduce to lowest dose as quickly as possible
Correct answer: Continue indefinitely with regular reassessment; tapering should only be considered if the patient is stable and requests it
The National Opioid Use Disorder guideline and CRISM (Canadian Research Initiative in Substance Misuse) recommend indefinite maintenance on buprenorphine/naloxone for OUD as it reduces mortality, with tapering only at patient request after prolonged stability.
NAC OSCE Patient Management & Treatment 2
A 2-year-old child presents with a first febrile seizure lasting 3 minutes that has now resolved.
The child is alert and examination is normal.
According to CPS guidelines, what is the MOST appropriate next step?