CCFP priority topic 67 of 105
Multiple Medical Problems on the CCFP exam
6 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 6 key features for Multiple Medical Problems. 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 6
Today's main reason
When a patient brings many concerns, find out which one brought them in today.
CFPC skill Selectivity, clinical reasoningPhase History
On the exam
A home visit: a tube-fed boy with cerebral palsy, and his mother's five concerns. Expect a short menu (pick several from a list).
Pick what to ask first.
Common mistakes
Redoing settled history: the cause of his cerebral palsy, his milestones, his controlled seizures. Or chasing one item, like celiac disease, before the family's priority is known.
Approach
- Get the whole list first. Keep asking “Anything else?” until there is nothing more.
- Ask which concern matters most today, and why now. Ask what they fear it might be.
- Ask the patient as well as the caregiver. A child, or a resident in long-term care, has a view too.
- Ask what has changed. A new symptom or a new pattern outranks an old, stable problem.
- Skip a full review of diagnoses that are settled and controlled. It spends time and ranks nothing.
- Hold health upkeep, like teeth or vaccines, until you know the priority.
Key feature 2 of 6
A shared agenda
Rank the problems with the patient so you both agree on today's plan.
CFPC skill Patient-centred approachPhase TreatmentSources Choosing Wisely Canada
On the exam
A 15-minute visit, and the mother and her son want different problems fixed first. Expect one best answer.
Choose how to set today's agenda.
Common mistakes
Following only the mother's list, ranking it yourself, or racing through all five in 15 minutes. Referring just because it looks complex is wrong too.
Approach
- Say the list back, and say how much time you have.
- Ask each person, child and parent, which item matters most to them.
- Add your own view. Anything urgent or unsafe goes first, and say why.
- Agree on one or two items for today. Book a visit soon for the rest, and write the plan down.
- Keep the coordination in family practice. Refer for a clear question a specialist must answer, not for complexity.
- In older adults, talk about goals and the expected course of illness before you order tests.
Key feature 3 of 6
What lies beneath
When complaints pile up, think of low mood, worry or abuse, and keep checking for disease.
CFPC skill Clinical reasoningPhase Hypothesis generationSources Choosing Wisely Canada
On the exam
A boy has headaches, stomach aches and new bedwetting, worse on school mornings. Expect a short menu (pick several from a list).
Pick the likely causes to explore.
Common mistakes
Chasing a brain tumour, celiac disease or diabetes when his exam and urine dipstick are normal. Calling it anxiety and ending the search is wrong too.
Approach
- Many symptoms, in many body systems or over many visits: think of anxiety, depression and abuse.
- Look at the pattern. Symptoms worse on school mornings and better at weekends point to stress at school or home.
- Ask about bullying, stress and harm at home. See a child or teen alone for part of the visit.
- Ask about alcohol and drugs, and how often pain medicines are taken.
- In adults with migraine, acetaminophen or anti-inflammatory pills on 15 or more days a month risk medication overuse headache. For triptans, opioids or combination pills, it is 10 or more days.
- Keep checking for disease. A new sign, or a change in the pattern, reopens the work-up.
| Clue in the case | Makes less likely |
|---|---|
| Gone on weekends and holidays, back on school days | Brain tumour, celiac disease |
| Neurological exam at the child's usual baseline | Brain tumour |
| Weight still on the usual growth line | Celiac disease |
| Urine dipstick normal, with no glucose | Diabetes, urine infection |
Key feature 4 of 6
Mood in chronic illness
Patients with several chronic conditions are prone to depression, so check for it over time.
CFPC skill Clinical reasoningPhase Hypothesis generation, historySources Canadian Task Force on Preventive Health Care
On the exam
A teen with asthma and epilepsy, well at a routine visit with his mother, after past school refusal. Expect a short menu (pick several from a list).
Pick how and when to check mood.
Common mistakes
Relying on his mother's report, or asking only when he seems unwell. Waiting until he is older, or until school refusal returns, lets depression take hold.
Approach
- Chronic illness raises the risk of depression. Ask about mood at regular visits, not only when the patient seems unwell.
- See a teen alone for part of each visit. Parents often miss sadness and worry.
- Ask about sleep, energy, interest, school or work, and thoughts of self-harm or suicide.
- In teens, depression may show as falling grades, irritability or lost interest, before any school refusal.
- For adults, the Canadian Task Force (2025) advises against screening everyone with a scored questionnaire. It still asks you to ask about well-being and watch for signs.
- Asking about mood is not a scored screen. Any clue gets a full assessment, including suicide risk, at that visit.
Key feature 5 of 6
Medicine review
Review the whole treatment plan often to cut drugs, avoid interactions and keep choices current.
CFPC skill Clinical reasoningPhase Treatment, follow-upSources Choosing Wisely Canada, Health Canada
On the exam
A teenage girl on carbamazepine and propranolol has worse asthma and wants the pill. Expect one best answer, then a short menu (pick several from a list).
Pick the drug change, then a safe method.
Common mistakes
Adding an inhaler for wheeze that propranolol caused, raising its dose, or adding a second migraine preventive. Choosing the pill without checking carbamazepine is wrong too.
Approach
- Review every medicine at refills, and when the condition, the goals of care or the care setting changes.
- For each drug, ask: is there still a reason, and do the benefits still outweigh the harms?
- A new symptom after a new drug: suspect the drug. Stop, switch or lower it before adding another to treat it.
- Propranolol is contraindicated in asthma and bronchospasm (narrowed airways). More inhaler does not fix the cause.
- Carbamazepine lowers the levels of many drugs, including hormonal birth control and warfarin. Advise a non-hormonal method while on it. Keep using effective birth control for 2 weeks after the last dose.
- Before any new prescription, check the full medicine list. In older adults, avoid a benzodiazepine or sedative as first choice for sleep, agitation or delirium.
| Problem | Example | What to do |
|---|---|---|
| One drug treating another's harm | Worse wheeze after propranolol, met with more inhaler | Stop or switch the cause first |
| Interaction | Carbamazepine with the pill, patch or implant | Advise a non-hormonal method |
| No reason left | Long-term proton pump inhibitor (acid pill) with no ongoing need | Lower, taper, stop, or use only as needed |
| Target too tight | Older adult with several conditions, on drugs that cause lows, aiming for A1c (average blood sugar) below 7.5% | Ease the target and the drug |
Key feature 6 of 6
Fair limits on visits
When visits keep coming for symptoms that do not change, put fair bounds on them.
CFPC skill Patient-centred approach, professionalismPhase Treatment, follow-up
On the exam
A man with several chronic conditions books weekly for the same pain, and the work-up is done. Expect one best answer.
Choose how to manage his visits.
Common mistakes
A new test or referral at each visit for symptoms that have not changed. Ending his care, or refusing to see him, is wrong too.
Approach
- First check that nothing has changed. A new symptom or sign gets assessed.
- Offer booked visits at a set interval, rather than a visit each time symptoms flare.
- Agree on how long each visit runs, and on one or two concerns per visit.
- Say which new signs should bring the patient in sooner.
- Frame limits as part of good care, not as a penalty. Keep one clinician as the main contact.
- Write the plan in the chart so the whole team follows it.
Flashcards
Answer it first, then check.
KF 1A mother lists five concerns at a home visit. What do you ask before any detail?
Is that everything, and which concern matters most today, and why now?
KF 2The parent and the child want different problems fixed first. How do you set the agenda?
Ask each their top item, add any urgent one, and agree on one or two. Book the rest.
KF 3A child's headaches and stomach aches ease every weekend. What do you ask about?
School and home: stress, bullying, worry and harm. Keep checking for disease as well.
KF 4A teen with asthma and epilepsy seems well. How often do you ask about mood?
At each regular visit, partly alone with the teen. Chronic illness keeps the risk raised.
KF 4Should every adult get a scored depression questionnaire?
No. The Canadian Task Force advises against it, even at higher risk. Ask about well-being and watch for signs. Source: Canadian Task Force on Preventive Health Care
KF 5Her asthma got worse six weeks after propranolol started. What is the next step?
Stop or switch the propranolol. It is contraindicated in asthma, and more inhaler treats one drug's harm with another. Source: Health Canada, Choosing Wisely Canada
KF 5She takes carbamazepine and asks for the pill. What do you advise?
A non-hormonal method. Carbamazepine lowers hormone levels and makes hormonal birth control less reliable. Source: Health Canada
KF 6He books every week for the same pain, and the work-up is done. What do you offer?
Booked visits at a set interval and length, and clear signs that should bring him in sooner.
FAQ
Is there a Canadian guideline for this topic?
No single one covers it. The exam marks a method: find today's reason, agree on an agenda, think of mood and abuse, review medicines, and set fair limits.
Does thinking of anxiety or depression mean I stop testing?
No. Keep looking for disease that fits the findings. But do not chase each symptom with a test. Let red flags and a change in the pattern lead you.
Is putting limits on visits unkind or unprofessional?
Not when it serves the patient's care. Keep seeing them on a set schedule, say what should bring them in sooner, and never use limits to push them away.
When should I refer a patient with many problems?
When a clear question needs a specialist's answer. Complexity alone is not a reason. Family practice keeps the coordination. A referral without a clear question adds waits and visits.
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
- Published prevention guidelinesCanadian Task Force on Preventive Health Care
- Drug Product DatabaseHealth Canada