CCFP priority topic 91 of 105
Smoking Cessation on the CCFP exam
3 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 3 key features for Smoking Cessation. 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 3
Ask everyone, every time
Ask every patient about tobacco at each visit and record it, because habits change.
CFPC skill Clinical reasoningPhase Hypothesis generation, follow-upSources Canadian Task Force on Preventive Health Care, Health Canada
On the exam
A drowsy man on clozapine who quit smoking last week. Expect a short menu (pick several from a list).
Pick the history and the test that matter.
Common mistakes
Asking about menthol or “light” brands, or ordering a chest X-ray. None changes the plan. The real miss: he stopped smoking last week.
Approach
- Ask every patient whether they smoke, and record it. Ask again at later visits: people quit, and people start again.
- Ages 5 to 18: ask the child or a parent about tobacco, then give brief advice of up to 5 minutes. Do it at a suitable visit, such as a checkup or a vaccine visit.
- A child with repeated ear infections or wheeze: ask who smokes at home and in the car.
- Ask what changes the plan: how much the patient smokes, past quit attempts, and interest in quitting. Brand and strength change nothing.
- Tobacco smoke speeds up clozapine breakdown. Stopping smoking, or switching to vaping, can raise the level. Check a clozapine level and watch for side effects.
- Starting to smoke again lowers the clozapine level. Keep asking about smoking at every review.
- A chest X-ray does not screen for lung cancer. Low-dose CT is for ages 55 to 74 with 30 pack-years or more (packs a day times years smoked), who smoke or quit under 15 years ago.
Key feature 2 of 3
Gains and readiness
Talk with each smoker about what stopping or cutting down would gain, and recheck their readiness often.
CFPC skill Clinical reasoning, patient-centred approachPhase Treatment, history, follow-upSources Canadian Task Force on Preventive Health Care, Health Canada
On the exam
A 47-year-old man on clozapine who smokes comes for a refill. Expect a short menu (pick several from a list).
Pick what to ask and say today.
Common mistakes
Waiting for his psychiatrist to clear him before raising quitting. Or taking a family cancer history. Neither changes his interest or what you offer today.
Approach
- Advise every person who smokes to stop. Then offer at least one proven option.
- Make it a shared choice. Lay out the options to inform, not to push one.
- Tie the gain to what matters to the patient: breathing, money, children, a health goal.
- Ask how ready the patient is, what got in the way before, and what help they want.
- Not ready today? Record it and ask again next visit. You need not cover every option each time.
- Expect several attempts. After a relapse, start again without blame.
- Mental illness is no reason to delay the talk. Once a quit date is set, plan clozapine level checks with the prescriber.
Key feature 3 of 3
Medicine plus support
When a smoker wants to stop, recommend medicine and behavioural help together, with follow-up.
CFPC skill Clinical reasoning, communicationPhase Treatment, follow-upSources Canadian Task Force on Preventive Health Care, Health Canada
On the exam
A man with schizophrenia on clozapine is ready to stop smoking. Expect one best answer for the plan.
Pick the best quit plan.
Common mistakes
Bupropion: it lowers the seizure threshold, as clozapine does. Medicine alone, or counselling alone, is one strategy. Vaping first skips the proven options.
Approach
- Offer medicine and behavioural support together. The Task Force backs the pair strongly.
- Medicines: nicotine replacement, varenicline, bupropion or cytisine. Choose with the patient.
- Support: brief advice, counselling alone or in a group, text messages, or self-help material. Online programs only with added support.
- Bupropion: not with a seizure disorder or past seizure, another bupropion product, or bulimia or anorexia, now or in the past. Take extreme care with drugs that lower the seizure threshold, such as antipsychotics.
- Mental illness does not change the advice. It covers adults who smoke, except during pregnancy or breastfeeding.
- E-cigarettes: the Task Force suggests against them, unless other options failed, were refused, or the patient strongly prefers them. Warn that long-term safety is unknown.
| Option | Task Force advice | Know this |
|---|---|---|
| Medicine plus behavioural support | Recommend (strong) | Most trials (52), low certainty. Choose with the patient. |
| Medicine: nicotine replacement, varenicline, bupropion, cytisine | Recommend (strong) | Nicotine replacement: small rise in palpitations or chest pain. Varenicline: small rise in side effects. |
| Behavioural: advice, counselling, texts, self-help | Recommend (strong) | Little to no harm. |
| E-cigarettes | Suggest against (conditional) | Only after other options fail or are refused, or by strong preference. |
| Acupuncture, hypnosis, laser, St. John's wort | Recommend against (strong) | Do not offer. |
Flashcards
Answer it first, then check.
KF 1A man on clozapine quit smoking 10 days ago and is now drowsy. First test?
A clozapine level. Smoke speeds clozapine breakdown, so quitting can raise the level. Source: Health Canada
KF 1A 31-year-old smoker with no symptoms asks for a chest X-ray to screen for lung cancer. Your answer?
No. A chest X-ray does not screen for lung cancer. Low-dose CT starts at 55, with 30 pack-years. Source: Canadian Task Force on Preventive Health Care
KF 1A 12-year-old comes in for a vaccine. Do you ask about tobacco?
Yes. Ask the child or a parent, then give brief advice. This covers ages 5 to 18. Source: Canadian Task Force on Preventive Health Care
KF 2A smoker says she is not ready to quit. What do you do?
Advise quitting and offer an option. Record her answer, and ask again next visit. Source: Canadian Task Force on Preventive Health Care
KF 3Which medicines does the Task Force recommend for quitting?
Nicotine replacement, varenicline, bupropion and cytisine. Pair them with behavioural support. Source: Canadian Task Force on Preventive Health Care
KF 3How do you start bupropion to quit smoking?
150 mg once a day for 3 days, then twice a day. Quit in week 2. Treat 7 to 12 weeks. Source: Health Canada
KF 3When can an e-cigarette be part of the quit plan?
After other options fail or are refused, or by strong preference. Warn that long-term safety is unknown. Source: Canadian Task Force on Preventive Health Care
FAQ
Which guideline does the exam follow for quitting?
The CFPC names none. The Canadian Task Force advice from 2025 fits the key features: encourage every smoker to stop, and offer behavioural support, medicine, or both together.
Should I suggest vaping to help a patient quit?
Not first. The Task Force suggests against it unless other options failed or were refused, or the patient strongly prefers it. Warn that long-term safety is unknown and nicotine dependence goes on.
Does the Task Force advice cover teens and pregnancy?
The 2025 advice covers adults 18 and over, but not during pregnancy or breastfeeding. For ages 5 to 18, the 2017 advice is to ask about tobacco and give brief advice.
When does a pack-year count matter?
For lung cancer screening at ages 55 to 74. A pack-year is packs a day times years smoked. In a younger smoker it changes nothing about the quit plan.
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
- Published prevention guidelinesCanadian Task Force on Preventive Health Care
- Drug Product DatabaseHealth Canada