Thank you to all our participants who attended the Family Medicine Exam Prep Course in Hamilton. We are excited to see so many of you join our fall 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

A 43-year-old female, G1P0, comes into your office. She recently took a home pregnancy test and it was positive. You confirm her pregnancy with a serum BHCG and an US. She has a history of Hypertension and her BMI is 30. She would like to discuss prenatal care with you. (18 points)

1. How much folic acid should a woman take who has a low risk for neural tube defects (NTD)? (1 point)

• • 0.4 mg

2. List 3 factors that would increase a woman’s risk of having a fetus with NTD? (3 points)

• • Folate sensitive issues (e.g. heart defects, cleft palate, etc.)
  • Family history of NTD in 1st/2nd degree relative
  • Type I/Type II DM
  • Anti-seizure medications
  • GI malabsorption (e.g. Gastric bypass, Crohn’s disease, Celiac, etc.)
  • Alcohol abuse
  • BMI 30 or higher

3. How much folic acid should a woman with a medium risk for NTD take preconception? (1 point)

• • ≥ 1.0 mg (start taking 3 months before conception)

4. List 1 factor that would be considered high risk for NTD? (1 point)

• • Personal history of NTD in either partner
  • History of a previous NTD pregnancy in either partner

5. How much folic acid should a woman with a high risk for NTD take preconception? (1 point)

• • ≥ 4.0 mg (start taking 3 months before conception)

6. List 5 foods you would advise against eating in a woman who is pregnant to reduce her risk of Listeria. (5 points)

• • Raw or undercooked meat
  • Poultry
  • Seafood (including sushi and oysters)
  • Sprouts
  • Undercooked eggs
  • Soft, semi-soft and blue-veined cheeses
  • Deli meats/meat spreads
  • Unpasteurized foods (e.g. dairy, fruit juices, cider, etc.)

7. List 1 food with high mercury content that you would advise against consuming while pregnant. (1 point)

• • Shark
  • Swordfish
  • Marlin
  • Orange roughy
  • Fresh or frozen tuna

8. List 3 risks associated with maternal obesity in pregnancy. (3 points)

• • Pregnancy loss
  • Stillbirth
  • LGA or SGA
  • Poor placental function
  • Diabetes/GDM
  • HTN
  • Preeclampsia
  • Preterm labour
  • Fetal malformations

9. When should you screen for gestational diabetes for an otherwise healthy G1P0? (1 point)

• • 24-28 weeks

10. In women who are Rh negative, what complication can the fetus develop if the mother is not given Rhogam? (1 point)

• • Hemolytic anemia in the fetus