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

Mr. Nuch Rig, a 56-year-old male comes to see you regarding ongoing headaches. He tells you that the headaches are usually one-sided and can last up to 12 hours. When he gets the headache he goes into a dark, quiet room as light and sound often worsen his symptoms. His medical history is significant for hypertension and he is a current smoker. He works as a security guard and often does shift work. (16 points)

1. What is one first-line medication for acute migraines? (1 point)

• • Ibuprofen
  • Aspirin
  • Acetaminophen
  • Naproxen

2. What are two first-line medications for migraine prophylaxis? (2 points)

• • Propranolol
  • Metoprolol
  • Nadolol
  • Amitriptyline
  • Nortriptyline

3. What are three non-pharmacologic measures to help with reducing migraine headaches that you can discuss with your patient? (3 points)

• • Manage stress
  • Avoid excessive caffeine consumption
  • Exercise
  • Avoid irregular or skipped meals
  • Healthy weight
  • Appropriate sleep patterns

4. Name three physical exam maneuvers you would want to include for a patient who is presenting with a headache. (3 points)

• • Temperature
  • Blood pressure
  • Cranial nerves (fundoscopy, pupils, eye movements, visual fields, evaluation of facial movements for asymmetry, and weakness)
  • Power exam – assessment for unilateral limb weakness
  • Reflexes
  • Coordination
  • Gait
  • Neck examination (posture and range of motion)
  • Palpation for muscle tender points

5. List four red flags for headaches. (4 points)

• • Thunderclap onset
  • Fever and meningismus
  • Papilledema with focal signs or reduced level of consciousness
  • Acute glaucoma
  • An elderly patient with a new headache with cognitive change
  • A new headache in a patient with risk factors for HIV infection or cancer
  • Unexplained focal signs
  • Onset after age 50
  • Jaw symptoms or claudication
  • Vision changes

6. What is one first-line medication for tension headaches? (1 point)

• • Ibuprofen
  • Aspirin
  • Acetaminophen
  • Naproxen

7. What are two medications for tension headache prophylaxis? (2 points)

• • Amitriptyline
  • Nortriptyline
  • Mirtazapine
  • Venlafaxine