STUDY TIPS FROM THE REVIEW COURSE

Are You Feeling The Pressure Of The CCFP Exam?

September 26, 2017

 

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
       

  2. 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)
       

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

    • AVOID ACEi (in case she is pregnant)
       

  4. 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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