CCFP priority topic 81 of 105
Rape/Sexual Assault 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 Rape/Sexual Assault. 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
Care without a kit
Give full medical care after a sexual assault, whether or not the patient wants a forensic kit.
CFPC skill Clinical reasoning, professionalismPhase TreatmentSources Health Canada
On the exam
A woman arrives hours after an assault, unsure about police and wanting to go home. Expect a short menu (pick several from a list).
Pick what she needs tonight.
Common mistakes
Waiting until she decides about police, or sending her home with a sedative. Calling police without her consent is wrong too: a competent adult decides.
Approach
- Medical care does not wait on the legal decision. Offer it whether or not she wants a kit or a police report.
- Treat injuries first. Then offer pregnancy prevention, sexually transmitted infection (STI) care, and HIV and hepatitis B assessment.
- Offer emergency contraception now. Levonorgestrel is for use within 72 hours and works best in the first 24. Each day of delay lowers its effect.
- A competent adult decides whether to report. Calling police without her consent breaks confidentiality.
- Do not sedate her to calm her before time-sensitive care. A sedative treats the distress, not the exposure.
- Book follow-up for injuries, test results and how she is coping.
Key feature 2 of 7
Same care, any setting
Bring the emergency-room approach to assault care into the office and every other clinic.
CFPC skill Clinical reasoningPhase TreatmentSources Health Canada, Public Health Agency of Canada, Society of Obstetricians and Gynaecologists of Canada
On the exam
A patient tells you in the office about an assault four days ago. Expect a short menu (pick several from a list) of what to offer.
Pick what to offer at this visit.
Common mistakes
Deciding nothing is left to offer because 72 hours have passed. Ulipristal still works up to 5 days, and testing and counselling have no deadline.
Approach
- Run the same four steps as in emergency: a medical check, pregnancy prevention, STI care and counselling.
- Ulipristal 30 mg works up to 120 hours (5 days) after the assault. Levonorgestrel is for use within 72 hours.
- A copper intrauterine device (IUD) is the most effective option. It can go in up to 7 days after the assault and also gives ongoing contraception.
- Do a pregnancy test first if the patient may already be pregnant from earlier sex.
- Emergency contraception does not protect against STIs or HIV.
- Test for STIs. If you suspect one, screen for the others too: they share risks, and co-infection is common.
- Check for pregnancy if the next period is more than 7 days late.
| Levonorgestrel 1.5 mg | Ulipristal 30 mg | |
|---|---|---|
| Use within | 72 hours. Works best in the first 24. | 120 hours (5 days) |
| Take it | As soon as possible | As soon as possible |
| Afterwards | Avoid sex or use another method until the next period | Start a hormonal method no sooner than 5 days later. Condoms until the next period. |
| Watch for | Pregnancy already present: test first | Some drugs speed its breakdown (enzyme inducers): do not combine |
Key feature 3 of 7
What to chart
Record what you find and what care needs; leave out second-hand accounts.
CFPC skill Clinical reasoning, professionalismPhase History
On the exam
A mother brings her toddler after a call from the daycare about abuse. Expect a short menu (pick several from a list) of what to chart.
Pick what belongs in the chart.
Common mistakes
Writing down the mother's theory about who did it, or what others say is on videos you have not seen. Calling a diaper rash proof of abuse is wrong too.
Approach
- Chart what you saw on exam and what you were told directly, in plain words.
- When a patient tells you what happened, write it in their words, not your summary.
- Leave out second-hand claims: rumours, a parent's theory about who did it, things you have not seen.
- Chart a caregiver's report as theirs ('mother reports …'). Leave out their guesses about who did it.
- Describe findings, not conclusions. Whether abuse happened is for the investigation to decide.
- A normal genital exam neither proves nor rules out abuse. Abused children often have no injury.
- A bright red diaper rash that spares the skin creases is irritant diaper rash, not a sign of abuse.
Key feature 4 of 7
HIV and hepatitis B
Decide whether each patient needs HIV or hepatitis B prevention, on top of the other preventive care.
CFPC skill Clinical reasoningPhase Hypothesis generation, diagnosisSources Health Canada, Public Health Agency of Canada 2022, CMAJ 2025
On the exam
A woman assaulted last night had hepatitis B vaccine, with antibody of 10 IU/L or more on a test last year. Expect one best answer for hepatitis B, then a short menu (pick several from a list) for HIV.
Pick the hepatitis B and HIV plan.
Common mistakes
Giving immune globulin to a documented vaccine responder. Waiting for proof of exposure before HIV prophylaxis (preventive HIV medicine) is wrong too.
Approach
- Ask about hepatitis B vaccine and look for a documented antibody response.
- Immune globulin (ready-made antibody, given as a shot) is not needed if antibody is 10 IU/L (international units per litre) or more.
- The test must be from the past 24 months, or done within 48 hours.
- Never vaccinated: start the vaccine series now. Add hepatitis B immune globulin when the assailant is known to have hepatitis B.
- If her results or the assailant's are not back within 48 hours, treat it as a possible exposure.
- HIV is a separate decision. Offer HIV prophylaxis unless the assailant is unlikely to carry HIV that can pass on.
- Start HIV prophylaxis as soon as possible, up to 72 hours after the assault. Never delay it to confirm the exposure.
Key feature 5 of 7
Support for everyone
Offer counselling to the assaulted person and to the people around them, who are harmed too.
CFPC skill Clinical reasoningPhase Treatment
On the exam
A toddler's parents, days after abuse at daycare came to light. The mother cannot sleep. Expect a short menu (pick several from a list).
Pick who needs support and how.
Common mistakes
Focusing on the child alone, or giving the mother a sleeping pill. Waiting for the court case to end is wrong too: counselling runs alongside an investigation.
Approach
- Ask each person close to the patient how they are coping: parents, partner, friends.
- Offer them counselling in their own right, not only as helpers.
- Do not hold support back for court. Counsellors work alongside investigations.
- A sleeping pill treats one symptom. Offer support for the whole reaction.
- If a parent is struggling to function, make the referral yourself. Do not leave it to them.
- Ask about the other parent too, even if only one came to the visit.
Key feature 6 of 7
Ask again later
At later visits, check again whether counselling is needed, even if it was turned down.
CFPC skill Clinical reasoningPhase Treatment, follow-up
On the exam
Weeks later, the child is thriving. The father avoids the subject and the mother is worse. Expect a short menu (pick several from a list).
Pick what to do at this follow-up.
Common mistakes
Taking the child's good results as the end of it, or the father's avoidance as coping. Sending a thriving, preverbal child to therapy misses who is struggling.
Approach
- Book follow-up. At each visit, ask about mood, sleep and daily function.
- Avoidance is a sign of distress, not coping. Ask about it directly.
- Good news for the patient does not settle the family's distress.
- Offer counselling again, even if it was declined before. Needs change over time.
- Aim help at the people who show harm now.
- Ask those affected about low mood, worry and thoughts of suicide.
Key feature 7 of 7
Assault not yet told
Think of a sexual assault the patient has not mentioned when low mood, worry or unexplained body symptoms appear.
CFPC skill Clinical reasoningPhase Hypothesis generation, history
On the exam
A woman has a fast pulse, poor sleep and dread since the weekend. Tests are normal. Expect a short menu (pick several from a list).
Pick what to ask her about.
Common mistakes
Chasing a heart, lung or thyroid cause, or a sleep disorder, when tests are normal and it all began two days ago. Ask what happened that weekend.
Approach
- When worry, low mood or body symptoms start suddenly, ask what happened just before.
- Ask in private, with no partner or family member in the room.
- Ask plainly: has anyone touched you or forced sex on you without your consent?
- Normal tests and a clear start date point away from a medical cause.
- Do not label it panic or a sleep disorder before you ask.
- If the patient tells you, switch to assault care. Time since the assault decides what can still be offered.
Flashcards
Answer it first, then check.
KF 1She wants no police and no kit. What care do you still offer?
All of it: injury care, emergency contraception, STI care, HIV and hepatitis B assessment, and support.
KF 2The assault was four days ago. Which emergency contraceptive pill works best now?
Ulipristal 30 mg. It is approved for up to 120 hours and works better than levonorgestrel on days 4 and 5. Source: Health Canada, Society of Obstetricians and Gynaecologists of Canada
KF 2She took ulipristal today and wants the pill. When can she start?
No sooner than 5 days later. She uses condoms until her next period. Source: Health Canada
KF 3A mother names a teenager she thinks abused her child. Does it go in the chart?
No. It is a second-hand claim. Chart what you saw and what you were told directly.
KF 4Her hepatitis B antibody was 10 IU/L or more on a test last year. Does she need immune globulin?
No. A level of 10 IU/L or more within 24 months means no immune globulin. HIV is still separate. Source: Health Canada
KF 4Do bruises on her arms raise her HIV risk?
No. Risk depends on semen or blood on the mouth, vagina or anus, and rises with tears there.
KF 5The child is thriving, but the parents cannot sleep. Who needs counselling?
The parents. People close to an assaulted person are affected and need support too.
KF 7New fast pulse, dread and poor sleep, with a normal heart tracing and thyroid test. What do you ask?
What happened just before it began, including any sexual assault. Ask in private.
FAQ
Does the exam expect me to know the steps of a forensic kit?
Not as the main point. The exam rewards medical care that does not depend on the kit. Care goes ahead whether or not the patient wants a kit or police.
Do I have to report an adult's assault to police?
No. A competent adult decides whether to report. Telling police without consent breaks confidentiality. A child is different: suspected abuse of a child must be reported to child protection services.
Is emergency contraception still worth giving after three days?
Yes. Ulipristal is approved for up to 120 hours (5 days). Levonorgestrel is approved for 72 hours. A copper intrauterine device (IUD) works up to 7 days and is the most effective.
Which hepatitis B antibody result means no immune globulin?
10 IU/L (international units per litre) or more on a test in the past 24 months, or on one done within 48 hours. With an older result, recheck the level now.
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
- STBBI screening and diagnostic testingPublic Health Agency of Canada
- SOGC guidelines and JOGCSociety of Obstetricians and Gynaecologists of Canada
- Hepatitis B vaccines: Canadian Immunization GuidePublic Health Agency of Canada · 2022
- Canadian guideline on HIV pre- and postexposure prophylaxis: 2025 updateCMAJ · 2025