CCFP Pre-Course Activity: SAMP Practice Review (2026)

Mrs. Backed Up, a 55-year-old woman, presents to your clinic complaining of constipation over several weeks. She has experienced intermittent constipation throughout her adult life. Her bowel pattern until recently consisted of a soft, brown, well-formed bowel movement every 2 days. Now, her stool is firm, small, round, and difficult to pass. She has been taking acetaminophen with codeine (Tylenol #3) nightly for a sprained ankle sustained one month ago. She also takes amlodipine and levothyroxine. Her last TSH, done one year ago, was normal. 

1. Which of the following features would be considered red flags that should be specifically asked about in a patient presenting with a change in bowel habits? 

Select ALL that apply. Answers: B, E, F, G, M, N 

a. Bloating 

b. Rectal bleeding/hematochezia/melena 

c. Hair loss 

d. Constipation alternating with diarrhea 

e. Family history of colon cancer 

f. Unintentional weight loss 

g. Anorexia and loss of appetite 

h. Palpitations 

i. Excessive flatulence 

j. Heartburn 

k. Cold intolerance 

l. Urinary frequency 

m. Night sweats 

n. Nocturnal bowel movements 

 

2. Given that this patient takes levothyroxine for a thyroid condition, which of the following groups of symptoms would be most relevant to ask about to assess for undertreated hypothyroidism as a secondary cause of constipation? 

Select ONE correct answer. Answer: B 

a. Heat intolerance, tremor, diarrhea, palpitations 

b. Cold intolerance, hair loss, dry skin, depression 

c. Polyuria, polydipsia, polyphagia, blurred vision 

d. Dyspnea, orthopnea, peripheral edema, chest pain 

 

3. Which of the following first-line measures is MOST appropriate to recommend to help Mrs. Backed Up return to her usual bowel pattern? 

Select ALL that apply. Answer: B, D, F, I 

a. Start a low-residue diet 

b. Increase physical activity 

c. Increase dairy intake 

d. Increase oral fibre intake 25-30g per day 

e. Increase oral fluid intake to 1L per day 

f. Reduce acetaminophen #3 use 

g. Increase levothyroxine 

h. Initiate a high-protein diet 

i. Establish a regular toileting routine 

j. Taper amlodipine 

k. Instruct on pelvic floor biofeedback 

l. Eliminate dietary fat  

 

4. For each class of constipation medication listed below, select one example medication from the corresponding list: 

Answers: 

a. Lubricant: Mineral Oil 

b. Stool Softener: Docusate (Colace) 

c. Stimulant Laxative: any of Senna, Bisacodyl, Castor oil 

d. Bulk forming laxative: Psyllium husks (Metamucil) 

e. Osmotic laxative: any of Lactulose, Magnesium salts, Sorbitol, PEG, Phosphate enema (rectal osmotic laxative) 

 

Mrs. Backed Up applies your suggestions for lifestyle change and her bowel function reverts to normal. Two years later, she presents for her periodic health exam. Her bowel movements are regular and soft. She denies weight loss, fatigue, or constitutional symptoms. She has maintained the dietary changes that she started two years ago. You offer her screening for colon cancer. 

 

5. If she was adopted and does not know her family history, what one investigation do you order for colon cancer screening? 

Select ONE correct answer. Answer: A 

a. Fecal immunochemical test (FIT) 

b. Carcinoembryonic antigen (CEA) 

c. Complete blood count (CBC) 

d. Colonoscopy  

 

6. How often do you recommend this screening test be repeated? 

Select ONE correct answer. Answer: B 

a. Every 6 months 

b. Every 1–2 years 

c. Every 3 years 

d. Every 5 years 

e. Once only (no repeat needed)
 

7. If the result of the above screening test is positive, what is your next course of action? 

Select ONE correct answer. Answer: D 

a. Repeat the fecal immunochemical test in 6 months 

b. Order an abdominal ultrasound 

c. Order a CT colonography 

d. Refer for colonoscopy 

e. Order a barium enema

Mr Key is a 34 year old healthy patient of yours who is travelling to Thailand in 3 months and he states he will be an area where malaria is prevalent.  He comes to you for travel counselling.

1. What are THREE non-pharmacologic strategies to protect against malaria? (3 points)

• Insect repellents containing DEET (30% DEET recommended)
• Use treated bed nets/sleep tents
• Wear clothes that cover exposed skin

2. Name FOUR pharmacologic agents that can be taken to protect against malaria? (4 points)

• Atovaquone/proguanil (Malarone)
• Chloroquine/quinine
• Mefloquine (Larium)
• Doxycycline

3. Mr. Key is fair-skinned and burns easily. What medication would you prefer to avoid in him? (1 point)

• Doxycycline

4. Mr. Key reports that he has had periods of time in his life when he required treatment for depression and suicidal ideation. Which medication would you avoid prescribing to him? (1 point)

• Mefloquine/larium

5. Mr. Key returns to your office 2 weeks after his trip presenting with fever of unknown origin. When you ask him if he completed the prophylactic medication you had prescribed, he states he forgot to take it.  What investigation will confirm your suspected diagnosis of malaria? (1 point)

• Thick and thin blood smear (also acceptable: Giemsa stain)

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Source: Therapeutic Choices 6^th edition

Mrs. Smith, age 56, is a teacher who presents at your office complaining of a sore throat. She describes a sudden onset of symptoms, beginning with some throat fullness this morning that progressed to more discomfort. She also notes that her lips feel a bit "puffy." A slight dry cough started about a week ago. She denies any fever. 

 

Her past medical history is significant for polycythemia vera, gastroesophageal reflux disease, and hypertension diagnosed two weeks ago. Her medications include hydroxyurea, esomeprazole, and lisinopril (started two weeks ago). 

 

Physical examination reveals a temperature of 37°C. The posterior oropharynx, floor of the mouth, and soft palate appear quite edematous and slightly inflamed with no exudate. Her tongue is also slightly swollen. Blood pressure is 120/80 mmHg, heart rate is 90 bpm, respiratory rate is 16/min, and oxygen saturation is 99%. 

 

1. What is the most likely diagnosis? 

Select ONE correct answer. Answer: B 

a. Peritonsillar abscess 

b. Angioedema 

c. Infectious mononucleosis 

d. Allergic contact stomatitis 

e. Ludwig's angina 

f. Epiglottitis 

g. Streptococcal pharyngitis 

h. Anaphylaxis 

 

2. What is the most likely cause of the diagnosis identified in Question 1? 

Select ONE correct answer. Answer: C 

a. Hydroxyurea hypersensitivity 

b. Esomeprazole allergy 

c. Lisinopril use 

d. Viral upper respiratory tract infection 

e. Hereditary C1-esterase inhibitor deficiency
 

3. Which of the following is the most appropriate initial management plan for Mrs. Smith? 

Select ONE correct answer. Answer: A 

a. Discontinue lisinopril 

b. Decrease lisinopril to half dose and then slowly increase once tolerated 

c. Administer intramuscular epinephrine 

d. Send her to the Emergency Department 

e. Prescribe corticosteroids 

 

4. According to Canadian guidelines, which of the following antihypertensive classes is contraindicated as a replacement for lisinopril in Mrs. Smith? 

Select ONE correct answer. Answer: C 

a. Calcium channel blockers (e.g., amlodipine)

b. Thiazide diuretics (e.g., hydrochlorothiazide) 

c. Angiotensin receptor blockers (e.g., valsartan) 

d. Beta-blockers (e.g., bisoprolol) 

e. Direct renin inhibitors (e.g., aliskiren)  

 

5. You counsel Mrs. Smith about the possible symptom resolution. 

Select ALL that apply. Answer: B and C 

a. Symptoms always resolve within 6 hours of drug discontinuation 

b. Symptoms typically resolve within 24–72 hours 

c. ACE inhibitor–induced angioedema can recur for weeks to months after discontinuation 

d. No need to seek emergency care if symptoms recur, as the issue has been diagnosed 

e. Symptoms could persist indefinitely unless treated 

f. Symptoms will resolve immediately upon drug discontinuation 

g. Symptoms can worsen for 2 weeks before improving  

 

6. Which of the following features, if present, would necessitate immediate administration of intramuscular epinephrine and transfer to the emergency department? 

Select ALL that apply. Answers: B and D 

a. Lip swelling alone without dyspnea 

b. Stridor 

c. Mild tongue edema with normal oxygen saturation 

d. Hypotension with tachycardia 

e. Dry cough 

 

7. Mrs. Smith's hypertension still requires treatment. According to Hypertension Canada guidelines, which of the following would be the most appropriate first-line replacement antihypertensive for a patient with uncomplicated hypertension? 

Select ONE correct answer. Answer: C 

a. Hydralazine 

b. Clonidine 

c. Amlodipine 

d. Prazosin 

e. Spironolactone  

 

8. Before discharging Mrs. Smith from the office, which of the following patient education points is MOST important to communicate? 

Select ONE correct answer. Answer: B  

a. She may retry lisinopril at a lower dose in 6 months 

b. She should inform all future healthcare providers that she has had ACE inhibitor–induced angioedema, and this should be documented as a drug allergy/adverse reaction 

c. She should take daily antihistamines indefinitely to prevent recurrence 

d. She should avoid all antihypertensive medications permanently 

e. ACE inhibitor–induced angioedema only occurs once and will not recur  

A 20-year old competitive female basketball player presents with a knee injury.  She was playing basketball the evening before and injured her knee while attempting a rapid pivot.  Her knee gave out and she heard a pop.  She required help to leave the playing surface and did not return to the game. Her knee started to swell within an hour.

1. What diagnosis do you suspect? (1 point)

Anterior Cruciate Ligament (ACL) injury.

2. List THREE points from the history which support this diagnosis. (3 points)

• pivot mechanism, non-contact mechanism
• heard a pop
• early/immediate swelling
• unable to continue playing
• knee buckled/gave way

3. Name TWO maneuvers on physical exam which test for this condition. (2 points)

• Anterior drawer test
• Lachman test
• Pivot shift test

Two weeks later, she tells you that the swelling is improving but that she “doesn’t trust” the knee, feeling as if it will give out on her.  In fact, there has been one episode of painless buckling.  Your physical exam confirms the diagnosis.

4. What are the indications for surgical repair in this patient? (3 points)

• interest in continuing in basketball
• instability
• occupational need for ACL-stabilized knee
• age

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A 66-year-old woman presents for an office visit after slipping on ice and falling onto her back. She complains of lower back pain but denies leg weakness, numbness, or bowel/bladder symptoms. She is a smoker, weighs 58 kg, is postmenopausal, and has celiac disease. She takes only a multivitamin and is otherwise healthy. 

1. Which of the following is NOT an established independent risk factor for osteoporosis? 

Select ONE correct answer. Answer: D 

a. Current cigarette smoking 

b. Body weight <60 kg 

c. Untreated celiac disease with malabsorption 

d. Obesity (BMI >35 kg/m²)  

e. Previous fragility fracture after age 50    

  

2. Which combination of clinical features in this patient places her at the highest risk for osteoporosis? 

Select ONE correct answer. Answer: A 

a. Age >65 years, smoking, postmenopausal status, low body weight, celiac disease  

b. Smoking, obesity, diabetes mellitus, hypertension, female sex 

c. Age >65 years, obesity, hypothyroidism, dyslipidemia, low physical activity 

d. Female sex, chronic kidney disease, smoking, obesity, hyperuricemia 

  

3. Which physical examination finding is most suggestive of a prior vertebral compression fracture related to osteoporosis? 

Select ONE correct answer. Answer: B 

a. Loss of lumbar lordosis with scoliosis 

b. Thoracic kyphosis associated with measurable height loss  

c. Bilateral lower limb edema 

d. Hypermobile joints with pes planus 

e. Tender enlargement of the thyroid gland  

 

4. Which of the following is LEAST useful as part of the routine physical assessment of a patient suspected of having osteoporosis? 

Select ONE correct answer. Answer: E 

a. Measurement of current height and comparison with previous adult height 

b. Assessment of occiput-to-wall distance 

c. Timed Up and Go (TUG) test 

d. Measurement of rib-to-pelvis distance 

e. Measurement of mid-arm circumference 

 

5. According to WHO diagnostic criteria, osteoporosis is defined by a DXA T-score of: 

Select ONE correct answer. Answer: D 

a. ≤ –1.0 at any skeletal site 

b. < –1.5 at the lumbar spine only 

c. ≤ –2.0 at the femoral neck 

d. ≤ –2.5 at the lumbar spine, total hip, or femoral neck  

e. ≤ –3.0 regardless of fracture history 

 

6. Which laboratory investigation is LEAST helpful in the routine evaluation for secondary osteoporosis in this patient? 

Select ONE correct answer. Answer: D 

a. Serum calcium 

b. Thyroid-stimulating hormone (TSH) 

c. Serum protein electrophoresis 

d. Lipid profile 

e. 25-hydroxyvitamin D 

 

7. Which of the following laboratory panels is most appropriate as an initial evaluation for secondary causes of osteoporosis? 

Select ONE correct answer. Answer: A 

a. CBC, calcium, creatinine, alkaline phosphatase, TSH, 25-hydroxyvitamin D 

b. Troponin, BNP, CK, D-dimer, CRP 

c. Ferritin, vitamin B12, folate, magnesium, uric acid 

d. Lipase, bilirubin, INR, LDH, ESR 

e. ANA, rheumatoid factor, anti-CCP, complement levels, CK 

 

8. Which combination of non-pharmacologic interventions has the strongest evidence for reducing fracture risk in patients with osteoporosis? 

Select ONE correct answer. Answer: B 

a. Bed rest, high-protein diet, avoidance of exercise 

b. Smoking cessation, weight-bearing and resistance exercise, balance training, and fall prevention  

c. High-dose vitamin C supplementation and aerobic exercise only 

d. Swimming alone combined with caffeine restriction 

e. Elimination of dairy products and prolonged back bracing 

 

9. For a woman over age 50 with osteoporosis, the recommended total daily elemental calcium intake (diet plus supplements) is: 

Select ONE correct answer. Answer: D 

a. 600 mg/day 

b. 800 mg/day 

c. 1,000 mg/day 

d. 1,200 mg/day  

e. 2,000 mg/day 

 

10. If this patient’s FRAX/CAROC assessment demonstrates a high 10-year fracture risk, which of the following would generally be considered first-line pharmacologic therapy, assuming no contraindications? 

Select ONE correct answer. Answer: A 

a. Oral bisphosphonate therapy  

b. Hormone replacement therapy regardless of age 

c. Calcitonin nasal spray as monotherapy 

d .Long-term systemic glucocorticoids 

e. Vitamin D supplementation alone 

 

11. Which of the following is NOT an approved pharmacologic class for the treatment of osteoporosis? 

Select ONE correct answer. Answer: E 

a. Bisphosphonates 

b. Selective estrogen receptor modulators (SERMs) 

c. RANK ligand inhibitors 

d. Parathyroid hormone analogues 

e. Sodium-glucose cotransporter-2 (SGLT2) inhibitors 

 

12. Which medication acts by binding RANK ligand, thereby inhibiting osteoclast formation and activity? 

Select ONE correct answer. Answer: D 

a. Zoledronic acid 

b. Raloxifene 

c. Teriparatide 

d. Denosumab  

e.Romosozumab 

Elizabeth Drolet visits you in your office for a discussion about breast cancer screening.  She is a healthy, non-smoking 51 year-old woman with no family history of breast cancer.  Her BMI is normal.  She has not had a mammogram.

1. Is Ms. Drolet at high, average, or low risk of contracting breast cancer? (1 point)

• Average risk

2. If you recommend mammography for this woman, how often should she be screened? (1 point)

• Every 1-2 years

3. In counseling Ms. Drolet, what pros and cons of screening would you discuss? Name FOUR. (4 points)

• May find a false positive
• May undergo an invasive testing to prove false positive
• Relatively small reductions in mortality
• Might permit surgery at earlier stage thus permitting less invasive procedure
• Risk of mastectomy higher among screened woman
• Accumulated radiation of mammogram is considered safe

5. Name FIVE qualities of a good screening test? (5 points)

• Acceptable to those eligible
• Inexpensive/reasonable in cost
• High sensitivity: bulk of those with the disease should test positive
• High specificity: bulk of those without the disease should test negative
• Safe to administer
• Lead to improved health outcomes/reduced mortality
• Capable to detecting disease in pre-clinical state
• Be widely available

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Mrs. A. brings in her 12-month-old daughter, Madelyn, to your clinic. She states Madelyn has had a cold for the past 3 days and has been increasingly "fussy" over the past 24 hours. She is not feeding as well and is crying more often. Mrs. A. has also observed the baby pulling at her right ear. Madelyn has been sleeping poorly. This morning she had an axillary temperature of 39.6°C. 

 

1.Which of the following examination findings would be most consistent with a diagnosis of Acute Otitis Media (AOM)? 

Select ALL that apply. Answer: B, C, D, G 

a. Pearly white, translucent tympanic membrane with visible bony landmarks 

b. Loss of bony landmarks 

c. Air-fluid levels behind the tympanic membrane 

d. Immobile tympanic membrane on pneumatic otoscopy 

e. Retracted tympanic membrane with prominent bony landmarks 

f. Presence of fluid in the external ear canal with an intact tympanic membrane 

g. Bulging, discoloured tympanic membrane 

 

2. You perform an otoscopic examination on Madelyn's right ear. which of the following visual findings is the most specific indicator of an acute bacterial infection (AOM) rather than a simple viral otitis media with effusion? 

Select ONE correct answer. Answer: B 

a. Erythema of the tympanic membrane without structural changes 

b. Severe bulging of the tympanic membrane 

c. Visible white patches restricted to the surface of the pars tensa 

d. Increased mobility of the tympanic membrane on pneumatic otoscopy 

 

3. Which of the following are recognized risk factors for the development of AOM? 

Select ALL that apply. Answer: B, E, F 

a. Female sex 

b. Daycare attendance 

c. Exclusive breastfeeding 

d. Living in a rural setting 

e. Thumb sucking 

f. Exposure to parental secondhand cigarette smoke  

 

4. Which of the following are among the major bacterial pathogens responsible for AOM? 

Select ALL that apply. Answer: B, D, G 

a. Staphylococcus aureus 

b. Treptococcus pneumoniae 

c. Pseudomonas aeruginosa 

d. Haemophilus influenzae 

e. Group A Streptococcus 

f. Escherichia coli 

g. Moraxella catarrhalis 

 

5. Madelyn has an intact tympanic membrane with evidence of acute otitis media on exam. She has not received antibiotics before.  

a) If you decided to treat Madelyn with antibiotics, which of the following represents the correct first-line agent for an uncomplicated case of AOM? 

Select ONE correct answer.  Answer: B 

a. Azithromycin 

b. Amoxicillin 

c. Cefuroxime 

d. Amoxicillin-clavulanate 

e. Cefprozil 

 

b) What is the appropriate duration of the above treatment for Madelyn?  

Select ONE correct answer. Answer: D 

a. 3 days 

b. 5 days 

c. 7 days 

d. 10 days 

 

6. If Madelyn fails to improve after 2-3 days of first-line treatment, which would be the next appropriate second-line antimicrobial agents for acute otitis media? 

Select ONE correct answer. Answer: D  

a. Ciprofloxacin 

b. Cefprozil 

c. Metronidazole 

d. Amoxicillin-clavulanate 

e. Trimethoprim-sulfamethoxazole 

f. Clindamycin 

 

7. Which of the following best describes the "Watchful Waiting" approach in the management of AOM? 

Select ALL that apply. Answer: B, C, D, G 

a. Prescribing a prophylactic antibiotic at a reduced dose for 48 hours 

b. Deferring antibiotic therapy for 24-48 hours 

c. Treating with analgesia if needed 

d. Explaining the management plan with caregivers so decision-making can be shared 

e. Administering a single dose of intramuscular ceftriaxone and reassessing in 48 hours 

f. Delay all treatment, including antipyretics, to properly assess how severe the AOM is 

g. Provide an antimicrobial prescription to be filled if the child does not improve after 24-48 hours 

 

8. Which of the following are criteria where the "Watchful Waiting" approach would be appropriate? 

Select ALL that apply. Answers: A, C, D, E 

a. Age older than 6 months 

b. Unilateral AOM with otorrhea 

c. Mild signs and symptoms with a non-toxic appearance 

d. Fever of 38°C 

e. Reliable parents/caregivers who can ensure follow-up 

f. Recent URTI 

A healthy 45 year-old Caucasian man presents for his periodic health exam.   His father suffers from hemochromatosis and your patient asks about his risk of acquiring this problem.

1. What is the inheritance pattern of familial hemochromatosis? (1 point)

• Autosomal recessive

2. Patients originating from which part of the world are at highest risk? (1 point)

• Northern European descent

3. What is the mechanism by which familial hemochromatosis causes iron overload? (2 points)

• Regulation of iron absorption in the GI tract is defective
• Accelerated iron absorption, exceeding physiological requirements
• Excess iron is subsequently deposited in the tissues.

4. What is the most common presentation of hemochromatosis? Name TWO. (2 points)

• Asymptomatic
• Fatigue
• Arthralgia
• Incidental elevated ferritin
• Development of bronze diabetes

5. Name FIVE clinical conditions that can result from familial hemochromatosis. (5 points)

• Adult onset diabetes/DM II
• Arthritis
• Cardiomyopathy
• Congestive heart failure
• Hepatomegaly
• Cirrhosis
• Hepatocellular carcinoma
• Increased skin pigmentation
• Elevated liver enzymes/hepatitis
• Hypogonadism/infertility

6. What lab tests would you consider for a patient suspected of having this condition, name TWO? (2 points)

• Ferritin level
• Total Iron Binding Capacity 
• Transferrin saturation (or percent saturation of TIBC)
• Liver enzymes such as ALT
• Blood sugar 
• HFE genetic testing

7. What ONE investigation could you offer your patient to confirm the diagnosis? (1 point)

• Genetic testing/chromosomal testing
• Liver biopsy

8. What is the treatment for hemochromatosis? (1 point)

• Phlebotomy

9. Which test would you use to monitor your patient’s progress through therapy? (1 point)

• Ferritin

10. What other specific conditions might lead to elevation in the value of this test? Name THREE. (3 points)

• Rheumatoid arthritis
• Hepatitis/liver disease
• Systemic lupus erythematosus
• Infection
• Cancer/lymphoma
• High iron diet/over-supplementation
• Hyperthyroidism
• Still’s disease
• Haemolytic anemias
• Thalassemia
• Alcoholism
• Recurrent blood transfusion

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Mrs. H.T., a 55-year-old woman with essential hypertension, was previously well controlled on a thiazide diuretic and lifestyle modification. Her blood pressure has gradually increased to 154/96 mmHg despite continued exercise, weight loss, and dietary improvement. Multiple properly measured home readings average in the 150s/90s. There is no history of diabetes, chronic kidney disease, coronary artery disease, or heart failure. 

 

1.Which of the following are considered first-line antihypertensive drug classes for uncomplicated hypertension according to current Canadian guidelines? 

Select ALL that apply. Answer: A, C, D, G 

a. Angiotensin-converting enzyme (ACE) inhibitors 

b. Alpha – blockers 

c. Long-acting dihydropyridine calcium channel blockers 

d. Thiazide or thiazide-like diuretics 

e. Mineralocorticoid receptor antagonists (e.g., spironolactone) 

f. Loop diuretics 

g. Angiotensin receptor blockers (ARBs) 

h. Beta-blockers in patients older than 60 years without compelling indications 

i. Direct renin inhibitors (e.g., aliskiren) 

j. Centrally acting alpha-2 agonists (e.g., clonidine) 

 

2. Two weeks after initiating an ACE inhibitor, which investigations should routinely be repeated? 

Select ALL that apply. Answer: A, B, E 

a. Serum creatinine 

b. Estimated glomerular filtration rate (eGFR) 

c. Liver function tests 

d. Serum sodium 

e. Serum potassium 

f. Complete blood count 

g. Urine albumin-to-creatinine ratio 

h. Serum bicarbonate  

 

3. According to Hypertension Canada, what is the recommended target home blood pressure for patients with heart failure? 

Select ONE correct answer. Answer: D 

a. <140/90 mmHg 

b. <135/85 mmHg 

c. <130/80 mmHg 

d. <120/80 mmHg 

e. <110/70 mmHg 

  

4. Which instructions are appropriate to ensure accurate home blood pressure measurement? 

Select ALL that apply. Answer: A, B, D, E, F, G, J 

a. Rest quietly for at least 5 minutes before measuring 

b. Empty the bladder before measurement if needed 

c. Measure immediately after climbing stairs 

d. Sit with the back supported 

e. Keep both feet flat on the floor without crossing the legs 

f. Support the arm at heart level 

g. Avoid caffeine, nicotine, and vigorous exercise for at least 30 minutes beforehand 

h. Talk as little as possible during the measurement 

i. Measure over clothing if the sleeve is thin 

j. Take two readings one minute apart and record the average  

 

5. Her HbA1c returns at 7.4%, confirming type 2 diabetes mellitus. According to Canadian guidelines, what is the recommended office blood pressure target? 

Select ONE correct answer. Answer: C 

a. <140/90 mmHg 

b. <135/85 mmHg 

c. <130/80 mmHg 

d. <120/80 mmHg 

e. <125/75 mmHg  

 

6. According to Hypertension Canada, what is the recommended daily sodium intake for adults with hypertension? 

Select ONE correct answer. Answer: C 

a. Less than 3,500 mg/day 

b. Less than 2,500 mg/day 

c. Less than 2,000 mg/day 

d. Less than 1,500 mg/day 

e. Sodium restriction has not been shown to reduce blood pressure

 

7. Which lifestyle interventions have been shown to reduce blood pressure in adults with hypertension? 

Select ALL that apply. Answer: A, B, C, D, F, G, I 

a. Weight reduction in overweight or obese individuals 

b. DASH dietary pattern 

c. Restricting dietary sodium 

d. Regular aerobic exercise (150 minutes/week or more) 

e. Drinking diet soda 

f. Limiting alcohol consumption to recommended levels 

g. Smoking cessation to reduce overall cardiovascular risk 

h. Potassium supplementation regardless of kidney function 

i. Stress-reduction interventions (e.g., mindfulness or cognitive behavioural therapy) may provide modest BP reduction 

j. Increasing dietary protein while maintaining a high sodium intake 

A 58 year-old man presents to your local emergency department with a one-day history of confusion. He has no history of head trauma, no alcohol use and he has no fever. Serum calcium is found to be severely high.

1. List FOUR symptoms of hypercalcemia. (4 points)

• Mental status change - confusion
• Abdominal pain
• Nausea
• Vomiting
• Fatigue
• Renal colic
• Dehydration
• Polyuria
• Constipation

2. List TWO acute treatments of hypercalcemia. (2 points)

• Hydration with normal saline
• Furosemide (Lasix) IV
• Calcitonin 
• Bisphosphate

3. List TWO important causes of hypercalcemia. (2 points)

• Malignancy
• Hyperparathyroidism

4. List THREE blood tests you would order next to help determine the severity and cause of the hypercalcemia. (3 points)

• Albumin
• Parathyroid hormone
• Serum phosphate
• Vitamin D level

5. What are TWO potentially life threatening consequences of hypercalcemia? (2 points)

• Dehydration/volume depletion from polyuria
• Cardiac arrhythmias