Thank you to all our participants who virtually attended the Family Medicine Exam Prep Course in the fall. We are excited to see so many of you join our spring classes. Several of you have requested we continue to post more practice SAMPs, so here you go!

Just a reminder… pay attention to the questions. Here are our general tips one more time:

1. Pay attention to the questions. Look carefully at how many items you are being asked to list. If the question asks for five items, you will not get more marks if you list eight items; the examiner will look at the first five and allocate marks only for the first five answers – so be careful. On a SAMP, if it is not clearly stated how many items you should list, look at the amount of points/marks being allocated for the question to get an idea of how many answers the examiner may be anticipating you write down.

2. Do not write lengthy answers. Most questions can be answered in 10 words or less!

3. Be specific when writing down investigations (hemoglobin instead of CBC; CT abdomen instead of CT).

4. Remember that trade names and generic names are both acceptable when writing down medications.

5. For more helpful tips, you can refer to CCFP’s SAMP instructions by clicking here.

SAMP

Shorty Attention is an 18-year-old male who comes to your office. He endorses more than 6 symptoms of ADHD and he is concerned both his academic and athletic life are being affected. His symptoms date back to at least the age of 6 (from what he can remember) but he managed to do well in school.
Now that he is in university, his symptoms are preventing him from concentrating and his grades are suffering. He is requesting medication to help him focus. (16 points)

1. Can a diagnosis of ADHD be made? (1 point)

• • Yes, it is sufficient to demonstrate that symptoms were present before the age of 12 even if the impairment was delayed. You must still complete clinical interviews and use validated rating scales and rule out ADHD-mimics.

2. True or false: ADHD is the most inheritable mental health disorder. (1 point)

• • True. Children of individuals with ADHD are more than 50% likely to develop ADHD themselves.

3. True or false: CADDRA and CPS have stated that the diagnosis and management of ADHD should be done by physicians who specialize in pediatric ADHD. (1 point)

• • False. CADDRA, CPS, AAP have all stated that the diagnosis and management of ADHD are within the scope of practice of family physicians.

4. How is the diagnosis of ADHD made? (4 points)

• • A patient must meet the diagnostic criteria in the DSM-5 and demonstrate:
    • at least 6 symptoms of inattention, hyperactivity or both
    • symptoms must cause functional impairment
    • symptoms must have been present before the age of 12
    • symptoms must be present in 2 or more settings

5. List 3 common mental health comorbidities that coexist with ADHD. (3 points)

• • Anxiety
  • Depression
  • ODD
  • ASD
  • Learning Disorder
  • Intellectual Disability

6. What is the recommended first-line therapy for preschool-aged patients? (1 point)

• • Behavioural modification therapy

7. Before starting stimulant medication, what must you screen for in all patients with ADHD? (1 point)

• • Screen for risk factors for sudden cardiac death

8. List 2 side-effects of stimulant medication. (2 points)

• • Mild elevation in BP
  • Appetite loss
  • Abdominal pain
  • Headaches
  • Anxiety
  • Insomnia
  • Reduced height velocity (after prolonged use)

9. What should you monitor at follow-up visits in patients taking stimulant medication? List 2 physical assessments. (2 points)

• • Height
  • Weight
  • BP
  • Heart rate