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Nicotine dependence — MCCQE Part 1 MCQ

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ModerateSubstance UseNicotine dependenceMCCQE Part 1

A 58-year-old smoker with COPD wants to quit and has failed unaided attempts but is willing to use medication. Which of the following is the most appropriate next step?

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Correct answer: D — Offer behavioural counselling plus pharmacotherapy such as varenicline or nicotine replacement

Offer behavioural counselling plus pharmacotherapy such as varenicline or nicotine replacement is the single best answer because the age, timing, examination findings and investigations in the vignette fit Nicotine dependence better than the alternatives. The most tempting distractor is less appropriate because it either treats a neighbouring presentation, delays a time-critical intervention, or ignores a key discriminator in the stem. The remaining options are suboptimal because they would miss the diagnosis, use an investigation or treatment in the wrong sequence, or fail to address safety and follow-up. Canadian practice should be anchored to Canadian smoking cessation guideline, with attention to acuity, safety-netting and local provincial pathways.

Reference: Canadian smoking cessation guideline