Falls, Pills, and Perils

We are excited to see so many of you join our FMEP courses. Several of you have requested we continue to post more practice SAMPs, so here you go!

SAMP

An 83-year-old woman presents with recurrent falls. Medications: lorazepam 1 mg HS, metoprolol, amlodipine, sertraline, omeprazole, and OTC diphenhydramine for sleep. (8 points)

1. Most significant contributor to fall risk? (1 point)
   1. Amlodipine
   2. Sertraline
   3. Metoprolol
   4. Lorazepam
   5. Omeprazole

   Answer: D

2. Which OTC medication should be stopped first? (1 point)
   1. Multivitamin
   2. Diphenhydramine
   3. Calcium
   4. Vitamin D
   5. Magnesium

   Answer: B

3. Best next step to reduce fall risk? (1 point)
   1. Increase omeprazole dose
   2. Switch lorazepam to long-acting benzo
   3. Gradually taper off lorazepam
   4. Add melatonin 10 mg
   5. Stop metoprolol

   Answer: C

4. Which adverse effect is most associated with diphenhydramine in geriatric patients? (1 point)
   1. Hypertensive crisis
   2. Bradycardia
   3. Anticholinergic toxicity
   4. Hepatotoxicity
   5. Renal impairment

   Answer: C

5. Which interventions reduce fall risk? Select all that apply. (4 points)
   1. Home hazard assessment
   2. Strength and balance training
   3. Vitamin D optimization
   4. Routine CT head screening
   5. Polypharmacy reduction

   Answer: A, B, C, E

Headaches That Hide

We are excited to see so many of you join our FMEP courses. Several of you have requested we continue to post more practice SAMPs, so here you go!

SAMP

A 27-year-old woman presents with headaches occurring 10 days per month. Unilateral throbbing with photophobia, worsened by movement. No neurological deficits. (8 points)

1. Most likely diagnosis? (1 point)
   1. Cluster headache
   2. Migraine without aura
   3. Tension-type headache
   4. Medication-overuse headache
   5. Temporal arteritis

   Answer: B

2. Best first-line acute treatment? (1 point)
   1. Opioids
   2. Triptans
   3. Amitriptyline
   4. Verapamil
   5. Acetazolamide

   Answer: B

3. Which is an indication for migraine prophylaxis? (1 point)
   1. 1 headache/month requiring bed rest
   2. 2 headaches/month relieved by NSAIDs
   3. ≥4 disabling headaches/month
   4. Patient request
   5. Headache triggered by chocolate

   Answer: C

4. Effective prophylactic options include: Select all that apply. (4 points)
   1. Propranolol
   2. Topiramate
   3. CGRP monoclonal antibodies
   4. Oxycodone
   5. Onabotulinum toxin A (if chronic)

   Answer: A, B, C, E

5. Which red-flag feature warrants urgent imaging? (1 point)
   1. Mild nausea
   2. Photophobia
   3. Thunderclap onset
   4. Family history of migraine
   5. Menstruation-related attacks

   Answer: C

The Thyroid Puzzle

We are excited to see so many of you join our FMEP courses. Several of you have requested we continue to post more practice SAMPs, so here you go!

SAMP

A 55-year-old woman presents with fatigue, weight gain, and constipation. TSH is 12 mIU/L, free T4 low-normal. (8 points)

1. Most likely diagnosis? (1 point)
   1. Subclinical hypothyroidism
   2. Overt hypothyroidism
   3. Hyperthyroidism
   4. Euthyroid sick syndrome
   5. Thyroid nodule

   Answer: B

2. Best initial management? (1 point)
   1. Observation only
   2. Start levothyroxine
   3. Methimazole
   4. Radioactive iodine
   5. High-dose iodine supplementation

   Answer: B

3. Which factor increases levothyroxine requirements? (1 point)
   1. Pregnancy
   2. Sedentary lifestyle
   3. Vitamin D supplementation
   4. Aging
   5. High-fibre diet

   Answer: A

4. Which medications interfere with levothyroxine absorption? Select all that apply. (4 points)
   1. Calcium
   2. Iron
   3. Bisphosphonates
   4. Proton pump inhibitors
   5. Metformin

   Answer: A, B, C, D

5. Target TSH after treatment? (1 point)
   1. <0.1 mIU/L
   2. Within normal range for age
   3. >10 mIU/L
   4. Suppressed below normal
   5. No need to monitor

   Answer: B

Your Study Plan, Simplified 📅

The CCFP exam is quickly approaching, and the FMEP Course is here to help! We know you are juggling many responsibilities, so we made a study calendar to help keep you on track.

Click here to see the calendar.

The Case of the Persistent Cough

We are excited to see so many of you join our FMEP courses. Several of you have requested we continue to post more practice SAMPs, so here you go!

SAMP

A 48-year-old non-smoking woman presents with an 8-month history of chronic cough. She notes it started at the same time she was diagnosed with hypertension and started on medication. There has been no fever, weight loss, or hemoptysis. She reports occasional heartburn and seasonal allergies. Medications: ramipril, cetirizine PRN. Chest X-ray is normal. (7 points)

1. Most likely diagnosis? (1 point)
   1. ACE-inhibitor-related cough
   2. Non-asthmatic eosinophilic bronchitis
   3. Cough-variant asthma
   4. Gastroesophageal reflux disease (GERD)
   5. Upper-airway cough syndrome (UACS)

   Answer: A

2. Next best step in management? (1 point)
   1. Methacholine challenge test
   2. Switch ramipril to an ARB
   3. Start high-dose ICS
   4. Start PPI trial
   5. Order sinus CT

   Answer: B

3. Which feature least supports cough-variant asthma? (1 point)
   1. Normal spirometry
   2. Response to bronchodilators
   3. Positive methacholine challenge
   4. Eosinophilia in sputum
   5. No history of wheeze

   Answer: A

4. Which is true regarding chronic cough work-up? Select all that apply. (3 points)
   1. ACE inhibitors can cause cough months after initiation
   2. GERD-related cough requires daily heartburn to be likely
   3. Normal chest X-ray rules out chronic sinusitis
   4. UACS can present without rhinorrhea
   5. Trial therapies are acceptable diagnostic tools

   Answer: A, D, E

5. Which medication is least likely to help ACE-I cough? (1 point)
   1. ARB substitution
   2. Inhaled corticosteroid
   3. Cough suppressants
   4. Switching to another ACE-I
   5. Discontinuing ACE-I

   Answer: D

Under Pressure: Recognizing and Managing Eustachian Tube Dysfunction in Primary Care

We are excited to see so many of you join our 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:

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A Lifelong Journey: Managing Adult Cerebral Palsy

We are excited to see so many of you join our 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:

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High Stakes: The Rising Potency of Cannabis and Its Mental Health Risks

We are excited to see so many of you join our 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:

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GLP-1 RAs and Reproductive Health: Balancing Benefits, Risks, and Timing

We are excited to see so many of you join our 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:

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The Hidden Deficiency: Copper’s Crucial Role in Blood, Brain, and Beyond

We are excited to see so many of you join our 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:

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