NAC OSCE Patient Management & Treatment

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?

Accepted Answer

An SGLT2 inhibitor (e.g., empagliflozin) or GLP-1 receptor agonist with proven CV benefit

Answer

Sulfonylurea (e.g., glyburide)

Answer

DPP-4 inhibitor (e.g., sitagliptin)

Answer

Insulin glargine

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?

Accepted Answer

Oral dexamethasone 0.6 mg/kg (single dose) with nebulised epinephrine for moderate cases

Answer

Inhaled budesonide only

Answer

IV methylprednisolone and admission

Answer

Oral prednisolone 1 mg/kg for 5 days

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?

Accepted Answer

<130/80 mmHg for most patients, and <120 mmHg systolic in high-risk patients

Answer

<140/90 mmHg for all patients without exception

Answer

<150/90 mmHg for patients over 60

Answer

<135/85 mmHg by home monitoring only

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?

Accepted Answer

Intrapartum IV penicillin G starting at onset of active labour or rupture of membranes

Answer

Oral amoxicillin during the third trimester

Answer

No treatment required as GBS is a normal commensal

Answer

Caesarean section to prevent neonatal infection

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?

Accepted Answer

A direct oral anticoagulant (DOAC), preferably over warfarin

Answer

Aspirin 81 mg daily

Answer

No anticoagulation — the risk is too high in elderly patients

Answer

Warfarin with target INR 2.0-3.0 as first choice

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?

Accepted Answer

Non-pharmacological therapies (exercise, CBT, physiotherapy) with NSAIDs as first pharmacological option; opioids are NOT first-line

Answer

Long-acting opioids as first-line due to superior analgesia

Answer

Immediate referral to surgery

Answer

Gabapentin as first-line monotherapy