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 54-year-old man presents with intermittent chest pain for 3 months, lasting 10 minutes, precipitated by climbing stairs, relieved by rest. Risk factors: diabetes, hypertension, dyslipidemia. Resting ECG: normal. (8 points)

1. Most likely diagnosis? (1 point)
   1. Stable angina
   2. Unstable angina
   3. Atypical GERD
   4. Costochondritis
   5. Panic attacks

   Answer: A

2. Best initial investigation? (1 point)
   1. Troponin (urgent)
   2. Exercise stress test
   3. Coronary CT angiography
   4. Holter monitoring
   5. D-dimer

   Answer: B

3. Which medication should be initiated for long-term risk reduction? (1 point)
   1. Aspirin
   2. Nitroglycerin patch
   3. Ibuprofen
   4. Digoxin
   5. Clopidogrel (monotherapy)

   Answer: A

4. Which finding reclassifies his chest pain as unstable angina? (1 point)
   1. Pain relieved by rest
   2. Pain only with heavy exertion
   3. Increasing frequency over 3 months
   4. Pain associated with diaphoresis
   5. Pain reproducible on palpation

   Answer: C

5. Evidence-based treatment for stable angina includes. Select all that apply. (4 points)
   1. Beta-blocker
   2. Long-acting nitrate (if symptoms persist)
   3. Calcium-channel blocker
   4. High-intensity statin
   5. Oral corticosteroids

   Answer: A, B, C, D