CCFP priority topic 29 of 105
Disability on the CCFP exam
7 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 7 key features for Disability. 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 7
Is it a disability?
Decide whether a change in what a patient does is a real loss for that person.
CFPC skill Patient-centred approach, clinical reasoningPhase Diagnosis
On the exam
A teen boy with depression has left a team, his lessons and a community group. Expect a short menu (pick several from a list).
Pick the changes that are real losses.
Common mistakes
Calling every dropped activity withdrawal. He left a team that did not fit, lessons his mother chose, and a group he outgrew. Gaming with friends is contact kept.
Approach
- Ask what the patient did before, what has changed, and what each change costs them.
- A change counts as a loss when it blocks a role the patient values: school, work, caring for others, friends.
- A choice is not a restriction. Ask why each activity stopped before you call it withdrawal.
- Note what still works. It shows the strengths to build on.
- In a baby born early, judge skills by corrected age: age from birth minus the weeks born early.
- Ask about the patient's own goals. The same change can be a disability for one person and not for another.
| Change | Why it stopped | Real loss? |
|---|---|---|
| Left a sports team | The team did not fit; he now plays in a league he enjoys | No: he still plays |
| Quit lessons | His mother chose them, not him | No |
| Misses most school days | Fear of what happens at school | Yes: it blocks a key role |
| Evenings gaming online | He plays with friends | No: contact is kept |
Key feature 2 of 7
Older adults at risk
Keep checking older patients, visit after visit, for what could cost them their independence.
CFPC skill Clinical reasoningPhase History, hypothesis generationSources Choosing Wisely Canada
On the exam
An 82-year-old who takes a nightly sleeping pill comes for a blood pressure check and mentions a stumble last week. Expect a short menu (pick several from a list).
Pick the risks to ask about today.
Common mistakes
Treating only the blood pressure because the visit was booked for it, or screening once and never again. Missing a sleeping pill as a cause of falls costs marks too.
Approach
- Ask about falls at each visit: a fall, a near fall, a fear of falling.
- Check eyesight, hearing, memory, mood, walking and balance. Ask which daily tasks have become hard.
- Review every medicine, including ones bought without a prescription. Many medicines in older adults add to falls, confusion and loss of function.
- Do not start sedatives such as lorazepam or other sleeping pills as a first choice for sleep, agitation or delirium. They raise the risk of falls and hip fracture.
- Avoid physical restraints for confusion or agitation. They bring pressure sores, pneumonia, injury and more agitation.
- Ask who helps at home, and whether that helper is coping.
- Check again after an illness, a new medicine or a hospital stay. Risk changes over time.
Key feature 3 of 7
Look for it in long illness
In a patient with a long-term physical or mental illness, look for lost function and name it.
CFPC skill Clinical reasoning, patient-centred approachPhase Diagnosis, hypothesis generation
On the exam
A teen boy's depression score has fallen from 19 to 8, yet he misses most school days. Expect a short menu (pick several from a list).
Pick what to assess at this visit.
Common mistakes
Repeating the depression score, checking adherence, or asking about sleep and appetite. Each measures symptoms again. None shows what he can and cannot do.
Approach
- Track function as well as symptoms: school or work, self-care, friends, family roles.
- A falling symptom score does not mean function is back. Ask what the patient did this week.
- Ask what keeps the patient from each role. The barrier may sit at school, work or home, not in the illness.
- In joint disease, multiple sclerosis or low mood, ask about daily tasks at each review, not only pain or mood.
- Before testing for a second disorder, find out what keeps the patient from the role.
- A child with one disability can develop another, so keep checking hearing, vision and development at each review.
| Condition | Measures symptoms | Measures function |
|---|---|---|
| Depression | Questionnaire score, sleep, appetite | Days at school or work, friends seen, tasks done |
| Joint disease | Pain score, swollen joints | Walking, dressing, gripping, job tasks |
| Cerebral palsy in a baby | Muscle tone, reflexes | Sitting, reaching, hearing and feeding, judged by corrected age |
Key feature 4 of 7
The whole picture
In a patient living with a disability, ask about the body, mood and social life, including money, work and family.
CFPC skill Patient-centred approachPhase History
On the exam
A 10-month-old girl with cerebral palsy, born 12 weeks early; her father is deployed. Expect a short menu (pick several from a list).
Pick what to ask about the child and family.
Common mistakes
A full birth, family and prenatal history. Her cause is known, so the answers change nothing today. Screen time and safe sleep are routine advice, but they are not what this question asks about.
Approach
- Body: what the patient can do, such as moving, eating, seeing, hearing and self-care.
- Mood: how the patient and each family member are coping.
- Money and work: lost income, leave, and the cost of care, travel and equipment.
- Family: who gives the care, who gives the carer a break, and who is away.
- Getting there: transport, distance to therapy, and which visits were missed and why.
- In a teen, ask the teen directly, not only through a parent or a teacher.
- Skip history that cannot change today's care, such as the cause of a condition already known.
Key feature 5 of 7
A plan with many parts
Build a plan with several parts that limits the harm a disability does and keeps function from slipping.
CFPC skill Patient-centred approach, professionalismPhase TreatmentSources Choosing Wisely Canada
On the exam
A baby girl with cerebral palsy cries at splint fittings. Her father is deployed, her mother works and is worn out, and therapy means long taxi trips. Expect one best answer.
Pick the plan that removes each barrier.
Common mistakes
Stopping the splints, pausing therapy until her father is home, or a leave note for her mother as the whole plan. Tears usually mean a poor fit, gaps cost practice, and leave alone fixes no barrier and costs income.
Approach
- Splints that hurt go back to the splint maker (orthotist) to fix the fit. Do not stop them without a review.
- Therapy too far away: offer virtual visits where they serve as well and the family prefers them, plus a home program.
- A worn-out carer needs respite: planned breaks, with practical help at home.
- Link the family to local services and funding programs for travel and equipment.
- In a teen whose school uses the wrong name, fix the barrier itself: the name on the records, a private place to change, someone to sit with at lunch.
- Keep the patient in each role. For a teen, shorter days and dropped classes shrink life further.
| Barrier | Tempting answer | Better fix |
|---|---|---|
| Splints bring tears | Stop them | The orthotist checks the fit |
| Long trips to therapy | Wait, or add more visits | Virtual visits and a home program |
| Tired carer, alone | A note for leave from work | Respite and help at home |
| Teen called by the wrong name at school | Shorter days, skip gym | Fix the name on records; a private place to change |
Key feature 6 of 7
Prevent it
In people likely to lose function, act early to protect it before any loss.
CFPC skill Clinical reasoning, patient-centred approachPhase TreatmentSources Choosing Wisely Canada
On the exam
A warehouse worker with low back pain and no red flags asks for rest and an X-ray. Expect a short menu (pick several from a list).
Pick the advice that protects function.
Common mistakes
Bed rest, imaging without red flags, or opioids for comfort. Each can stretch out disability. Doing nothing about the job is wrong too.
Approach
- Low back pain without red flags needs no imaging. Most episodes are harmless and settle on their own.
- Recommend exercise for joint wear (osteoarthritis) and long-term low back pain. It brings real pain relief.
- Avoid long-term opioids for chronic pain. Before any opioid, check side effects, work duties and whether the patient can drive safely. Higher doses go with longer disability.
- After a concussion, rest 24 to 48 hours at most. Then build activity back step by step.
- In physical jobs, ask about lifting and posture. Suggest changes to tasks or hours that keep the worker on the job.
- With a mental health condition, start counselling early. Help the patient stay connected to work, school and friends.
Key feature 7 of 7
Leave is not the plan
When a condition limits function, treat it fully; a break from work or school is one piece at most.
CFPC skill Clinical reasoning, patient-centred approachPhase TreatmentSources Choosing Wisely Canada
On the exam
A teen boy's mood is better on treatment, but he avoids school. His mother asks for a note to keep him home for the term. Expect one best answer.
Pick the best next step.
Common mistakes
Writing the note because the mother asks and he has depression. Raising the dose is wrong too: his mood has responded, and school is what keeps him home.
Approach
- Support absence only when it is medically needed. Time away from work is linked to worse health, slower recovery and longer disability.
- When an employer or insurer asks, describe what the patient can do. List limits only when truly needed, and make each one specific.
- Name the barrier first: a task, a person or a place. Then plan how to fix it.
- If leave is needed, set an end date and a plan for the return.
- Keep the patient connected to classmates, co-workers and daily routines.
- Treat the condition alongside the return, not instead of it.
Flashcards
Answer it first, then check.
KF 1A teen quit lessons his mother chose. Is that a loss of function?
No. Giving up something he did not value is not a restriction. Ask why each activity stopped.
KF 1A baby born 12 weeks early is now 10 months old. Which age do you judge her by?
Her corrected age: about 7 months. Subtract the weeks born early from her age since birth.
KF 2An 80-year-old asks for a sleeping pill. What harm worries you most?
Falls and hip fracture. Sleeping pills are not a first choice for sleep in older adults; start with non-drug help. Source: Choosing Wisely Canada
KF 3His depression score fell from 19 to 8, but he misses most school days. What next?
Ask what keeps him from school. The score tracks his mood, not what he can do.
KF 4A tired mother of a baby with cerebral palsy. Name three things to ask her.
Any three: transport, money and work, help at home, her own mood, who else gives care.
KF 5A baby cries at every splint fitting. Do you stop the splints?
No. Tears usually mean a poor fit. Send the splints back to the orthotist to adjust.
KF 6Low back pain in a warehouse worker, with no red flags. Does the worker need an X-ray?
No. Most low back pain is harmless and settles on its own. Imaging without red flags does not help. Source: Choosing Wisely Canada
KF 7An employer asks you to list a patient's limits. What do you write?
What the patient can do. Add limits only when medically needed, and make each one specific. Source: Choosing Wisely Canada
FAQ
Is there a Canadian guideline on disability?
No single one covers this topic. The exam marks a method: judge each loss against the patient's own roles, ask about every part of life, and build a plan beyond leave.
Do I need a disability scale or questionnaire?
No tool earns marks by itself. Ask what the patient did before, what they do now, and what stands in the way. A symptom score does not measure function.
When is a note for leave the right answer?
When the condition truly stops the patient from doing the work, or the work would cause harm. Even then, give an end date, name the barriers, and plan the return.
Does disability only mean physical limits?
No. Mood, memory, hearing, money and relationships all count. A teen who cannot face school has a disability, even when the body works well.
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
- Choosing Wisely recommendationsChoosing Wisely Canada