NAC OSCE Patient Management & Treatment — Questions and Answers
Question 1: According to Diabetes Canada 2023 guidelines, which medication should be added first-line alongside metformin in a patient with type 2 diabetes and established cardiovascular disease?
- An SGLT2 inhibitor (e.g., empagliflozin) or GLP-1 receptor agonist with proven CV benefit (Correct answer)
- Sulfonylurea (e.g., glyburide)
- DPP-4 inhibitor (e.g., sitagliptin)
- Insulin glargine
Correct answer: An SGLT2 inhibitor (e.g., empagliflozin) or GLP-1 receptor agonist with proven CV benefit
Diabetes Canada 2023 guidelines recommend SGLT2 inhibitors or GLP-1 receptor agonists as preferred second agents in T2DM with established ASCVD due to demonstrated cardiovascular and renal benefits.
Question 2: A 6-year-old child weighing 20 kg presents to a Canadian emergency department with moderate croup (Westley score 3-5). What is the standard treatment?
- Oral dexamethasone 0.6 mg/kg (single dose) with nebulised epinephrine for moderate cases (Correct answer)
- Inhaled budesonide only
- IV methylprednisolone and admission
- Oral prednisolone 1 mg/kg for 5 days
Correct answer: Oral dexamethasone 0.6 mg/kg (single dose) with nebulised epinephrine for moderate cases
Canadian paediatric guidelines recommend oral or IM dexamethasone 0.6 mg/kg (single dose) for croup; nebulised racemic or L-epinephrine is added for moderate-to-severe cases with stridor at rest.
Question 3: According to the Canadian Hypertension Education Program (CHEP/Hypertension Canada), what is the target blood pressure for a non-diabetic adult with hypertension and no other comorbidities?
- <130/80 mmHg for most patients, and <120 mmHg systolic in high-risk patients (Correct answer)
- <140/90 mmHg for all patients without exception
- <150/90 mmHg for patients over 60
- <135/85 mmHg by home monitoring only
Correct answer: <130/80 mmHg for most patients, and <120 mmHg systolic in high-risk patients
Hypertension Canada 2020+ guidelines recommend a target of <130/80 mmHg for most adults and <120 mmHg systolic for high-risk patients (e.g., established CVD, CKD, diabetes with target organ damage).
Question 4: A 35-year-old pregnant woman at 36 weeks has a group B Streptococcus (GBS)-positive vaginal/rectal swab. According to SOGC guidelines, what is the appropriate management during labour?
- Intrapartum IV penicillin G starting at onset of active labour or rupture of membranes (Correct answer)
- Oral amoxicillin during the third trimester
- No treatment required as GBS is a normal commensal
- Caesarean section to prevent neonatal infection
Correct answer: Intrapartum IV penicillin G starting at onset of active labour or rupture of membranes
SOGC guidelines recommend intrapartum IV penicillin G (or ampicillin) as prophylaxis for GBS-positive mothers to prevent early-onset neonatal GBS disease; antenatal oral antibiotics do not reliably eliminate carriage.
Question 5: A 70-year-old patient with non-valvular atrial fibrillation has a CHA₂DS₂-VASc score of 3. According to CCS guidelines, what anticoagulation is recommended?
- A direct oral anticoagulant (DOAC), preferably over warfarin (Correct answer)
- Aspirin 81 mg daily
- No anticoagulation — the risk is too high in elderly patients
- Warfarin with target INR 2.0-3.0 as first choice
Correct answer: A direct oral anticoagulant (DOAC), preferably over warfarin
CCS Atrial Fibrillation guidelines recommend DOACs over warfarin for stroke prevention in non-valvular AF when CHA₂DS₂-VASc ≥2 in males or ≥3 in females due to superior efficacy and safety profiles.
Question 6: According to Canadian pain management principles and the National Opioid Use Disorder Guideline, what is the MOST appropriate first-line approach for chronic non-cancer low back pain?
- Non-pharmacological therapies (exercise, CBT, physiotherapy) with NSAIDs as first pharmacological option; opioids are NOT first-line (Correct answer)
- Long-acting opioids as first-line due to superior analgesia
- Immediate referral to surgery
- Gabapentin as first-line monotherapy
Correct answer: Non-pharmacological therapies (exercise, CBT, physiotherapy) with NSAIDs as first pharmacological option; opioids are NOT first-line
Canadian guidelines and the National Pain Centre recommend non-pharmacological therapies first; NSAIDs are first-line pharmacotherapy for low back pain, and opioids should only be considered after other treatments have failed, given Canada's opioid crisis.
NAC OSCE Patient Management & Treatment
According to Diabetes Canada 2023 guidelines, which medication should be added first-line alongside metformin in a patient with type 2 diabetes and established cardiovascular disease?