We are excited to see so many of you join our fall 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.

SAMP

Elizabeth Holmes is a 41 year old female presenting with her first pregnancy. She has a history of systemic lupus erythematosus, chronic kidney disease (her last eGFR was 49), prediabetes, and class II obesity. She takes Perindopril 8mg. She smoked half a pack per day but stopped as soon as she found out she is pregnant. She is currently 6 weeks pregnant. She tells you she is concerned about preeclampsia as her sister just underwent an emergency c-section due to eclampsia. (16 points)

1. What are Elizabeth’s risk factors for preeclampsia? List 5. (5 points)

• • Obesity
  • First pregnancy
  • Age ≥ 35
  • BMI > 30
  • Family history of preeclampsia
  • Chronic hypertension
  • Chronic kidney disease
  • Autoimmune disease

2. Would you start aspirin for her? (1 point)

• • Yes

3. If you answered yes to the above question, at how many weeks would you initiate aspirin? (1 point)

• • At 12 weeks and before 16 weeks

4. What dose of aspirin would you recommend of aspirin for women at higher risk for preeclampsia? (1 point)

• • 160-162 mg/day

5. List 5 complications to the mother associated with preeclampsia. (5 points)

• • Eclamptic seizures
  • Cerebrovascular accident
  • Cardiovascular disease
  • Pulmonary edema and ARDS
  • Placental abruption
  • Renal failure
  • Liver failure (HELLP)
  • DIC
  • Death

6. List 3 complications to the fetus associated with preeclampsia. (3 points)

• • Pre-term birth
  • Intrauterine growth retardation
  • Developmental delay
  • Still-birth

References:

Jain, V., & Bujold, E. (2023). Screening for preeclampsia risk and prophylaxis with acetylsalicylic acid. Canadian Medical Association Journal, 195(45), E1557-E1558. https://doi.org/10.1503/cmaj.230620

Kaufmann, P., Black, S., & Huppertz, B. (2003). Endovascular trophoblast invasion: Implications for the pathogenesis of intrauterine growth retardation and preeclampsia. Biology of Reproduction, 69(1), 1-7. https://doi.org/10.1095/biolreprod.102.014977