We are excited to see so many of you join our spring FMEP courses. 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.

We wanted to go over an important but less commonly discussed topic – Spontaneous Coronary Artery Dissection (SCAD).

Doc, do you know what SCAD is? (12 points)

1. What is SCAD? (1 point)

• • A spontaneous non-atherosclerotic separation of the coronary artery wall (between intimate, media or adventitia) causing intramural hematoma in the false lumen, with or w/o an intimal tear

2. Who is most affected by this condition? (1 point)

• • Caucasian women aged 45-55 are most commonly affected

3. List five predisposing causes of SCAD. (5 points)

• • Fibromuscular dysplasia
    
  • Pregnancy
    
  • Connective tissue disorder (e.g., Marfan’s syndrome, Ehler-Danlos Syndrome)
    
  • Systemic Inflammatory disease (e.g., Crohn’s, giant cell arteritis)
    
  • Hormonal therapy (OCP, corticosteroids)
    
  • Coronary artery Spasm
    
  • Idiopathic
    
  • Precipitating stressors (emotional stress, unusually intense physical stress, etc.)
    

4. What medications should patients be on POST-SCAD? (2 points)

• • Aspirin
    
  • Beta-blocker (reduced arterial shear stress)
    
  • +/- Clopidogrel
    
  • +/- ACE inhibitors
    
  • +/- Statins
    
  • +/- Nitrates and/or CCB
    

5. What strategies apart from medications can you implement to reduce the recurrence of SCAD? (3 points)

• • Reduced emotional stress: psychosocial support, peer group support
  • Reduce physical stress: avoid heavy weight lifting (<30-50 pounds), avoid competitive sports, participate in cardiac rehab
  • Avoid pregnancy
  • Avoid coughing, retching