• 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


<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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The only Canada-Wide CCFP exam course - created by two Family Doctors who wished this existed when we were residents, and are on a mission to help CCFP exam candidates. Disclosures: The Review Course founders have no conflicting commercial interests. As is the case with any private events hosted on a university campus or hospital, this event is not affiliated with nor endorsed by the host venues. Our materials are peer-reviewed and prepared by Canadian physicians; we do not guarantee that our preparation materials are representative of any Canadian examination and we do not provide questions from any other examination nor are they intended as medical advice. The College of Family Physicians of Canada does not affiliate with nor endorse any exam preparation course.