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

Roger Smith is a 73 year old male who has been a patient of yours for the past 15 years. His medical history is significant for hyperlipidemia and hypertension. He takes Candesartan and Rosuvastatin. He enjoys playing squash, running, and works as a lawyer. His wife passed away last year from breast cancer. He has a good relationship with his two sons and daughters. He smoked a pack per day from the age of 25 to 45 and then quit. He drinks socially. He comes regularly for his preventative care visits; on this visit, he reports that his pants have been hanging loosely on him and he estimates that he has lost 40 to 50 pounds unintentionally. (14 points)

1. What is your differential diagnosis for unintentional weight loss? (5 points)

• • Celiac disease
  • Inflammatory bowel disease
  • Peptic ulcer disease
  • Hyperthyroidism
  • Diabetes
  • Stroke
  • Dementia
  • Parkinson’s disease
  • HIV, TB, HCV, helminthic infection
  • Depression/eating disorders
  • End-stage renal disease
  • Chronic obstructive pulmonary disease
  • Congestive heart failure
  • Malignancy
  • Nutritional deficiency
  • Note: Many answers may be correct here. Be specific!

2. What lab investigations would you consider ordering for someone presenting with unintentional weight loss? (5 points)

• • Hb
  • WBC
  • TSH
  • Hba1c
  • Na, K+
  • Creatinine
  • Calcium
  • CRP, LDH
  • AST, ALT, ALP, albumin
  • Urinalysis

3. What two imaging tests would you consider ordering? (2 points)

• • Chest x-ray
  • Abdominal ultrasound
  • CT chest/abdomen/pelvis
  • Note: There are others but these would be reasonable first tests.

4. List one antidepressant that can boost appetite. (1 point)

• • Mirtazapine

5. True or false: No organic etiology is identified in up to 25% of cases of unintentional weight loss. (1 point)

• • True