CCFP priority topic 43 of 105
Gender Specific Issues on the CCFP exam
5 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 5 key features for Gender Specific Issues. 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 5
Same disease, other face
Keep a wide list of causes when a disease may look different in women and in men.
CFPC skill Clinical reasoningPhase Hypothesis generation
On the exam
A woman of 71 gets upper belly burning pushing a wheelchair uphill. Expect a short menu (pick several from a list), then one best answer.
Pick the questions that test for angina.
Common mistakes
Calling it reflux because an antacid helped, or stress because caregiving is hard. Neither comes on with effort and stops with rest. Antacid relief does not rule out the heart.
Approach
- Ask what brings it on and what ends it. Discomfort with effort that eases within minutes of rest is angina until shown otherwise.
- In women, angina may feel like burning or pressure, or pain in the upper belly, jaw or back. It may show as breathlessness or tiredness on effort.
- Relief with an antacid does not separate the heart from the esophagus.
- A normal resting ECG (heart tracing) does not rule out angina.
- A troponin blood test looks for a heart attack happening now. A normal result does not rule out stable angina.
- Turn it around for men. Depression in a man may show as anger, irritability, more drinking or overwork. Ask about mood and suicide directly.
| Condition | Often missed in | How it may show |
|---|---|---|
| Angina | Women | Burning, upper belly, jaw or back pain, breathlessness or tiredness, each on effort |
| Depression | Men | Anger, irritability, more drinking, risk-taking, overwork, body pain |
| Osteoporosis | Men | A fracture after a fall from standing height |
Key feature 2 of 5
Abuse at home
In a woman with any health problem, think about whether abuse by a partner plays a part.
CFPC skill Clinical reasoningPhase Hypothesis generation, history
On the exam
A woman with headaches and poor sleep says her partner shoved her. Expect a short menu (pick several from a list) of questions.
Pick the questions that measure her danger.
Common mistakes
Asking first about her psychiatric history, or whether she will call the police. Neither measures her danger tonight. Couples counselling is wrong too while abuse and fear go on.
Approach
- Think of abuse with headaches, poor sleep, low mood or pelvic pain. Also think of it with injuries that do not fit the story, missed visits, or a partner who will not leave.
- Ask with her alone. Use a plain question: has anyone at home hurt you, threatened you or made you afraid?
- If she says yes, believe her. Ask about danger: is it getting worse, has the partner choked her, are there weapons, threats to kill, a recent separation?
- Make a safety plan with her: where to go, who to call, a bag ready, the children's safety. Give shelter and crisis line contacts.
- Write down her words and her injuries clearly. For an adult, reporting to police is her choice. Know your province's duty to report a child at risk.
- Name the trauma reaction right. Months of nightmares, avoidance and startle after an assault point to post-traumatic stress disorder (PTSD), not an adjustment disorder.
Key feature 3 of 5
Roles and strain
When stress drives the symptoms, ask how the patient is juggling work, home and partner.
CFPC skill Patient-centred approach, clinical reasoningPhase Hypothesis generation, historySources Choosing Wisely Canada
On the exam
A woman of 38 has daily headaches and broken sleep since her promotion and her partner's job loss. Expect a short menu (pick several from a list).
Pick the questions about her roles and load.
Common mistakes
Chasing screen time, eye strain or food triggers. None explains daily headaches that began with the upheaval. Asking only about his job loss misses how her own load changed.
Approach
- Ask who does what now: paid work, housework, child care, caring for a parent, money.
- Ask what changed, and when. Match the start of the symptoms to the change.
- Ask how she and her partner are getting on, and whether she feels safe at home. Strain between partners can hide abuse.
- Ask men the same questions. A man who lost his job, or works two jobs, may show strain as pain, poor sleep or drinking.
- In a caregiver, ask about the caregiver's own load and health. The sick partner's chart does not explain the caregiver's symptoms.
- Treat stress-related insomnia with sleep habits and behavioural steps first. Do not routinely use antipsychotics for insomnia. In older adults, sleeping pills are not the first choice.
Key feature 4 of 5
Intimate exams
Set up office habits so intimate exams feel safe and the patient stays in control.
CFPC skill ProfessionalismPhase PhysicalSources Choosing Wisely Canada
On the exam
A woman who was assaulted is anxious about an overdue Pap test. Expect a short menu (pick several from a list) of office steps.
Pick the steps that give her control.
Common mistakes
Pressing on once the exam has started, or using her relative as the chaperone. Doing a Pap she does not need, such as at 72 after normal results, is wrong too.
Approach
- Make it written office policy. Train staff who act as chaperones.
- Offer a chaperone for breast, pelvic, genital or rectal exams. Note the offer and the answer in the chart. Know your college's standard.
- Explain each step and why before you start. Get consent, and check again if the exam changes.
- Give privacy to undress and a gown or drape. Uncover only the part you examine.
- Offer choices: the position, who is in the room, a smaller speculum, or another day.
- Stop at once if the patient asks or shows distress. Go on only if the patient agrees again.
- Skip intimate exams that do not help. No cervical screening under 25 or over 69, or after a hysterectomy for a benign cause. No routine pelvic exam to screen for ovarian cancer.
Key feature 5 of 5
Bias in the evidence
Check whether a study's results fit your patient when its subjects lean to one sex.
CFPC skill Clinical reasoning, professionalismPhase Hypothesis generationSources Health Canada
On the exam
A woman with coronary disease takes ASA and daily ibuprofen. A friend says ASA fails in women. Expect one best answer.
Pick the best change to her medicines.
Common mistakes
Stopping ASA because a trial in healthy women found no fewer heart attacks. She already has coronary disease. Switching to clopidogrel misses the real problem: the ibuprofen.
Approach
- Ask who was studied: sex, age, and healthy or already ill. A result in one group may not fit another.
- Keep prevention types apart. A result in people with no heart disease does not transfer to someone who has it.
- ASA (acetylsalicylic acid) after a heart attack or unstable angina lowers illness and death. In people with no heart disease, it does not lower heart deaths or first strokes.
- Ibuprofen can block low-dose ASA's effect on platelets. Review whether daily ibuprofen is needed. If it stays, take it at least 1 hour after and 11 hours before immediate-release ASA. Enteric-coated ASA is not advised with regular ibuprofen.
- Doses can differ by sex. Women clear zolpidem more slowly, so start women at 5 mg. Men start at 5 or 10 mg. From 65, 5 mg for everyone.
- Ask about morning grogginess. In some people, higher morning blood levels after 10 mg raise the risk of impaired driving next day. Take it only with 7 to 8 hours left in bed.
| Drug | What the label says | What you do |
|---|---|---|
| Zolpidem | Women clear it more slowly. Start women at 5 mg, men at 5 or 10 mg. From 65, 5 mg for all. No more than 10 mg a night. | Ask about morning grogginess and driving. |
| ASA, no heart disease yet | Fewer first non-fatal heart attacks, but no fewer heart deaths or first strokes. More bleeding. | Weigh benefit against bleeding for each person. |
| ASA, known coronary disease | Lowers illness and death after a heart attack or unstable angina. | Keep it. A trial in healthy women does not change this. |
| ASA with ibuprofen | Ibuprofen can blunt ASA's effect on platelets. | Review the ibuprofen. Time the doses if it must stay. |
Flashcards
Answer it first, then check.
KF 1Burning in her upper belly comes when she pushes uphill and stops with rest. What is it?
Angina until shown otherwise. An antacid that helps does not rule out the heart.
KF 1A man of 45 is irritable, drinking more and working late. What do you ask about?
Mood and suicide. In men, depression often shows as anger, drinking or overwork, as well as or instead of sadness.
KF 2She says her partner choked her last month. Why does that matter today?
Choking is a strong sign of danger. Measure her risk and make a safety plan before she leaves.
KF 3Her daily headaches began with her promotion and her partner's job loss. What do you ask?
Who does what at home and work now, how they are getting on, and whether she feels safe.
KF 4The patient asks you to stop halfway through a pelvic exam. What do you do?
Stop at once. Check in, and go on only if the patient agrees again.
KF 4A woman of 72 with normal past results asks for a Pap test. Is it needed?
No. Choosing Wisely Canada advises against cervical screening after 69. Source: Choosing Wisely Canada
KF 5A woman of 40 starts zolpidem. What is her starting dose?
5 mg at bedtime, with 7 to 8 hours left in bed. Women clear it more slowly than men. Source: Health Canada
KF 5She takes ASA for coronary disease and ibuprofen every day. What is the problem?
Ibuprofen can block ASA's effect on platelets. Daily use may make the ASA less protective. Source: Health Canada
FAQ
Is there a Canadian guideline for this topic?
No single one covers it. The exam marks habits. Think of how each sex may present, ask about abuse and home load, protect patients in intimate exams, and check who a study included.
Should I ask every woman about abuse?
Ask whenever the story fits: injuries that do not match, headaches, poor sleep, low mood, pelvic pain or a controlling partner. Always ask with her alone, never with the partner present.
Does cervical screening start at 21 or 25?
Sources differ. Choosing Wisely Canada's family medicine list says do not screen under 25. Its 2021 gynecology list says start at 21. Follow your own province's screening program.
Is ASA a poor choice for women?
No. For a woman with known coronary disease, ASA lowers illness and death. The doubt is about people with no heart disease, where benefit is small and bleeding is real.
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
- Drug Product DatabaseHealth Canada