CCFP priority topic 20 of 105
Crisis on the CCFP exam
8 key features, the mistakes that cost marks, and a practice question.
Checked by a Canadian family physician, MD, CCFP. Updated October 20, 2026.
What the exam tests
Key features
The CFPC’s 8 key features for Crisis. Each one below has how the exam asks it, the common mistakes and the approach.
Practice question
Try one before you read
A real case from the bank, in the new short-menu format. Answer it first. Then read the key features.
Key feature 1 of 8
The walk-in in crisis
Make time for an upset patient who walks in, and let talking calm them.
CFPC skill Selectivity, communication, patient-centred approach, clinical reasoningPhase Hypothesis generation, history, treatment
On the exam
A man walks in unbooked, crying and smelling of alcohol after losing his savings. Expect one best answer.
Pick the first thing to do.
Common mistakes
Sending him home until he is sober, or booking him next week. Handing him a depression form or telling him to calm down also delays the talk he needs.
Approach
- See him today. Find a quiet room and enough time, even on a full day.
- Name what you see: "You look very upset. Tell me what happened."
- Let the story come out before you ask checklist questions. A review of systems tells him his story is not wanted.
- Do not order him to calm down. Listening settles a person; commands stir him up.
- Skip false comfort. You cannot promise how things will turn out, and he will stop trusting you if it goes wrong.
- Alcohol on the breath raises his risk. It is a reason to keep him, not to send him away.
Key feature 2 of 8
Support and limits
Build support from people close by and local services, agree on next steps, and hold professional limits.
CFPC skill Clinical reasoning, patient-centred approach, selectivity, communication, professionalismPhase History, treatment, referral, follow-up, hypothesis generation
On the exam
A mother with postpartum depression says nights are hardest and asks for your cell number. Expect a short menu (pick several from a list).
Pick the parts of her support plan.
Common mistakes
Giving her your own number or night visits. It feels kind, but it crosses a professional line and cannot last. A review in four weeks is too far away.
Approach
- Ask who can help now: a partner, family, friends, a faith group. Ask what got her through hard times before.
- Offer local help: a counsellor, a crisis line, a public health nurse or a peer group.
- Agree on the next visit together. In a crisis, that means days, not weeks.
- Tell her who to call at night: the clinic's on-call service, a crisis line or emergency services.
- Hold the line: no lending money, no gifts, no personal phone, no special after-hours visits. These feel helpful today and harm the care later.
Key feature 3 of 8
Safety first
Check whether the patient or anyone near them is in danger, and respond.
CFPC skill Clinical reasoning, patient-centred approach, selectivityPhase Diagnosis, history, treatment, follow-up
On the exam
A man in crisis after a money loss has rifles at home and a stock of pills. Expect a short menu (pick several from a list), then one best answer.
Pick the danger cues, then tonight's first step.
Common mistakes
Treating his shame, lost sleep or anger at the bank as the danger sign. Or dealing with the pills before the rifles: firearms are far more lethal.
Approach
- Ask directly about thoughts of suicide and of hurting someone else. Ask about a plan, the means and intent.
- Ask about firearms at home every time.
- Ask who else is caught up in the crisis: children, a partner, an older parent, anyone he cares for.
- Change what can change tonight. Get firearms out of the home first, then extra pills.
- The loss itself and his drinking matter, but neither can be fixed tonight.
- If he cannot be made safe in the office, arrange safe transport to the emergency department. Do not let him go alone.
| What the patient says | What it means | What to do |
|---|---|---|
| Shame, worry, poor sleep, anger at a company | Expected distress after a loss | Support and a plan; keep asking about safety |
| Names a person, a plan or a weapon | Possible danger to self or others | Ask about intent and means; act tonight |
| Unwanted, horrifying thoughts of harming a baby that the patient knows are wrong and fears | Likely intrusive thoughts (obsessions), not intent | Treat the illness and arrange support; not by itself grounds to report |
| Voices or false beliefs after a birth | Possible postpartum psychosis | Same-day emergency psychiatric care |
Key feature 4 of 8
Drugs in a crisis
Use calming or sleep drugs only where they truly help, and choose them with care.
CFPC skill Clinical reasoning, selectivityPhase Diagnosis, treatmentSources Health Canada, Choosing Wisely Canada
On the exam
A man in crisis takes lorazepam at bedtime, drinks most nights and wants a stronger sleeping pill. Expect one best answer.
Pick the safest drug plan.
Common mistakes
Doubling his lorazepam or switching to zopiclone: with alcohol, both can kill. Low-dose quetiapine for sleep is wrong too; antipsychotics are not a routine sleep drug.
Approach
- Most stress reactions need no drug. The lorazepam label says everyday stress usually does not need an anxiety drug.
- Ask about alcohol and other drugs first. Benzodiazepines and zopiclone taken with alcohol can lead to overdose or death.
- If you prescribe, use the lowest dose for the shortest time. Start lorazepam with no more than a week's supply and no automatic renewals.
- Zopiclone is for short use, usually 7 to 10 days. Never give more than a month's supply.
- Do not routinely use an antipsychotic such as quetiapine for sleep problems with no other cause. Try sleep habits and behaviour changes first.
- Plan the stop when you start. Review any sedative begun in a crisis before renewing it, and taper rather than stop suddenly.
- Mild low mood after a loss does not need an antidepressant first. Offer talk therapy and support, and check for suicide risk.
| Drug | Limit | Know this |
|---|---|---|
| Lorazepam | Short courses. First supply one week at most, no automatic renewals. | With alcohol: overdose or death. Taper; do not stop suddenly. |
| Zopiclone | Usually 7 to 10 days. No more than a month's supply. | Same alcohol warning as benzodiazepines. Can cause sleep-walking or sleep-driving. |
| Quetiapine or another antipsychotic | Not routinely for insomnia | Weight gain and metabolic harm, even at low doses. |
Key feature 5 of 8
How they cope
Ask how the patient is getting through it, including drinking, drugs, gambling or violence.
CFPC skill Clinical reasoning, professionalismPhase History
On the exam
A man in crisis after a job loss says he copes by staying in bed. Expect a short menu (pick several from a list).
Pick the coping habits to ask about.
Common mistakes
Stopping at alcohol and missing gambling, other drugs or violence at home. Or judging him, so he hides the rest.
Approach
- Ask about alcohol, cannabis and other drugs. Ask how much has changed since the crisis began.
- Ask about gambling, spending, eating too much or too little, and risky sex.
- Ask about anger and violence at home. Ask whether anyone is afraid of him.
- Ask about pulling away: staying in bed, missing work, cutting off friends.
- Make it easy to answer: "Many people drink more at times like this. Has that happened to you?"
- Link each habit to the plan. Nightly drinking raises tonight's risk and changes any drug choice.
Key feature 6 of 8
Clinic readiness
Plan with your whole clinic team for sudden emergencies, clinical or not.
CFPC skill ProfessionalismPhase Hypothesis generation, treatment
On the exam
Your clinic writes an emergency plan after a patient collapsed at the front desk. Expect a short menu (pick several from a list).
Pick what the plan must include.
Common mistakes
A plan written by the doctors alone, or one for medical events only. Front desk staff meet the angry patient, the fire or the power cut first.
Approach
- Write the plan with everyone: doctors, nurses and front desk staff.
- Cover medical events: collapse, seizure, a severe allergic reaction.
- Cover non-medical events: a violent person, fire, flood, a power or computer outage, an outbreak.
- Check the emergency kit and drugs on a schedule. Everyone should know where the defibrillator is.
- Run drills. Decide ahead who calls 911, who brings the kit and who leads.
- Plan how patients will still reach care if the clinic must close.
Key feature 7 of 8
Emergency in the clinic
When a sudden emergency strikes, stay steady, use what is on hand, and get help.
CFPC skill Professionalism, clinical reasoning, selectivity, communicationPhase History, treatment, referral
On the exam
A patient has a seizure in your clinic waiting area. Expect a short menu (pick several from a list) of first steps.
Pick the first steps.
Common mistakes
Rushing in alone, or trying a full hospital work-up in the clinic. Call for help early, stabilize with what you have, then transfer.
Approach
- Stay calm. Speak slowly and give clear, short tasks.
- Check the scene: is it safe, and what people and kit are here?
- Call for help early. Name the person and the job: "You, call 911."
- Do what your setting allows: airway, breathing, circulation, protection from injury. Transfer for what it does not.
- In a seizure, turn the patient on the side, time it, and put nothing in the mouth.
- Afterwards, debrief with the team and fix what went wrong.
Key feature 8 of 8
Past trauma
Spot signs of past trauma in any patient, and avoid hurting them again in care.
CFPC skill Clinical reasoning, patient-centred approachPhase Hypothesis generation, diagnosis, treatment
On the exam
A woman tenses, goes quiet and stares away as you begin a pelvic exam. Expect one best answer.
Pick the best next step.
Common mistakes
Pressing on to finish the exam, or not noticing the change. Silence, freezing, anger and missed visits can all be signs of past trauma.
Approach
- Assume any patient may have past trauma. You do not need the story to change how you give care.
- Watch for signs: freezing, going quiet, tears, anger, missed visits, many vague complaints.
- Stop when she shows distress. Name it gently and offer to pause or carry on.
- Explain each step before you do it. Ask before you touch.
- Give her control: a support person in the room, a way to say stop, a choice of gown or position.
- Never push for the trauma story. Offer help to talk about it later if she wants.
Flashcards
Answer it first, then check.
KF 1An unbooked man is crying and smells of alcohol. See him now or later?
Now. Alcohol raises his risk, so sending him away is the most dangerous choice.
KF 3He has rifles at home and a stock of lorazepam. What goes first?
The rifles. Firearms are far more lethal. Deal with the extra pills next.
KF 4He drinks most nights and wants a stronger sleeping pill. Why not?
Benzodiazepines and zopiclone taken with alcohol can cause overdose or death. Source: Health Canada
KF 4Is low-dose quetiapine a good sleep aid for a patient in crisis?
No. Even low doses cause weight gain and metabolic harm. Try sleep habits and behaviour changes first. Source: Choosing Wisely Canada
KF 4You start lorazepam in a crisis. How much do you give at first?
No more than a week's supply, with no automatic renewals. Plan the taper from the start. Source: Health Canada
KF 2A patient in crisis asks for your cell number for bad nights. What do you do?
Decline kindly. Give the clinic's after-hours line and a crisis line, and book a visit within days.
KF 8A patient freezes and goes quiet during a pelvic exam. What next?
Stop. Name what you see gently. Offer to pause or carry on, and let the patient choose.
KF 6Who should help write the clinic's emergency plan?
Everyone: doctors, nurses and front desk staff. Plan for medical and non-medical events, then drill it.
FAQ
Is there a Canadian guideline for crisis care?
No single one. The exam tests your approach: see the patient now, listen, check safety, build support and plan the next visit. Drug labels guide any sedative you choose.
Should every patient in crisis go to the emergency department?
No. Many can be helped in the office with a safety check, support and a visit within days. Send them when the danger cannot be made safe today.
Do I ask about suicide if the patient does not raise it?
Yes. Ask every patient in crisis about thoughts of suicide and of hurting anyone else. Ask about a plan and the means, including firearms. Then ask who else is at risk.
Can I prescribe anything at all in a crisis?
Sometimes, with care. Check alcohol use first. Use the lowest dose, a small supply for a short time, and plan the stop on day one. Most patients need talk and support, not pills.
Sources
Written from the CFPC Assessment Objectives and Canadian guidelines first. Checked by a Canadian family physician, MD, CCFP.
Last reviewed October 20, 2026For exam study. Not advice for a patient in front of you.
- Assessment Objectives for Certification in Family Medicine, 2nd editionCollege of Family Physicians of Canada · 2020
- Drug Product DatabaseHealth Canada
- Choosing Wisely recommendationsChoosing Wisely Canada