• Dr. Leah Feldman MD CM CCFP

Are You Feeling The Pressure Of The CCFP Exam?


SNAP SAMP (Answers Below):

​A 24 year-old female presents to you with a blood pressure of 150/90…

  1. Name 4 causes of secondary hypertension

  2. Assuming you diagnose new hypertension in this patient, what initial investigations would you order for this patient (name at least 5)?

  3. Name 1 CLASS of medication that you should avoid in this patient

  4. Name 2 examples of hypertensive emergency

Hypertension is a NEED-TO-KNOW TOPIC

Here are some tips to remember:

  • DO screen all patients at all appropriate visits

  • Automated cuffs are BETTER than your manual skills (NEW in the CHEP guidelines)

  • DO NOT use ACEi as first line therapy in Black patients with uncomplicated HTN

  • DO NOT use beta-blockers in patients >60 with uncomplicated HTN

  • On a SOO, always ask about medication compliance and educate the patient on how to check their BP at home

KNOW YOUR TARGETS!

<140/90 for uncomplicated patients

<130/80 for DM or CVD

<140/90 for renal patients (who are non-diabetic)

<150 SBP in patients over 80

Remember your lifestyle modifications! Can you list FIVE without looking?

  • Decrease Sodium (reduce by 1800mg/day)

  • Lose weight (4.5kg)

  • Reduce Alcohol (by 2.7 drinks/day)

  • Exercise! (150min/week)

  • Change that diet (DASH = Dietary Approaches to Stop Hypertension)

The CHEP guidelines are Canada’s hypertension guideline, so make sure to review these guidelines carefully before your exam!

A 24 year old female presents to you with a blood pressure of 150/90…

  1. Name 4 causes of secondary hypertension

  • Obstructive Sleep Apnea

  • Hyperaldosteronism

  • Pheochromocytoma

  • Renal Artery Stenosis

  • Hyperthyroidism

  • Cushings Syndrome

  • Don’t forget that medications such as OCP and NSAIDS can raise BP, so definitely ask about them on a SOO

  1. Assuming you diagnose this patient appropriately with new hypertension, what initial investigations would you order?

  • BETA HCG! Although this is not part of the initial workup for hypertension, if this patient is pregnant, it changes the way we will manage her!

  • Urinalysis

  • Potassium (remember, “electrolytes” alone isn’t specific enough according to the CCFP)

  • Sodium

  • Creatinine

  • Fasting Blood Glucose / Or Glycated Hemoglobin A1c (remember, “glucose” alone might not be specific enough!)

  • Serum Total Cholesterol (remember, do not write “lipid profile” and new for 2016, you no longer need to ask your patients to fast!)

  • Low-Density Lipoprotein

  • High-Density Lipoprotein

  • Triglycerides

  • Non-HDL cholesterol

  • 12-lead electrocardiography

  • Urinary Albumin excretion (if diabetic)

  1. Name 1 CLASS of medication that you should avoid in this patient.

  • AVOID ACEi (in case she is pregnant)

  1. Name 2 examples of Hypertensive emergency

  • Pre-eclampsia

  • Acute ischemic stroke

  • Acute kidney injury

  • Acute coronary syndrome

  • Acute aortic dissection

Source: http://www.cfpc.ca/uploadedFiles/Education/Certification_in_Family_Medicine_Examination/SAMPS%20instructions%20-%20Eng.pdf

CHEP 2016 Guidelines

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