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

Mrs. Orthopn Eay, a 77 year old female, presents to your office with a new onset of bilateral leg edema and shortness of breath on exertion. She notes that over the last 2 months she has had to sleep with 2 pillows as she is increasingly short of breath at night. She denies any chest pain, fevers, shortness of breath at reset. She is currently taking a multivitamin and Acetaminophen 1-2 times a week for knee osteoarthritis. She smokes 3 cigarettes a day and drinks 2 bottles of wine per week. She works as a bookkeeper and lives a sedentary lifestyle. She has no known drug allergies. Her vitals are: T 36.8, HR 76 and regular, BP 132/88, SP02 99 % on room air. (21 points)

1. What three non-laboratory investigations would you consider ordering for her? (3 points)

• • Chest x-ray
  • ECG
  • ECHO

2. What three laboratory investigations would you consider ordering for her? (3 points)

• • Hemoglobin
  • Creatinine
  • Blood urea nitrogen
  • Glucose
  • Sodium
  • Potassium
  • Troponin
  • Brain natriuretic peptide

3. She undergoes an ECHO and the ejection fraction is 30%. What three classes of medication would you consider offering to her to reduce mortality? (3 points)

• • Angiotensin-converting enzyme inhibitor (or an angiotensin receptor blocker if unable to tolerate ACE inhibitors)
  • Beta-blocker
  • Mineralocorticoid receptor antagonist
  • Angiotensin receptor-neprilysin inhibitor (ARNI)
  • Ivabradine

4. What laboratory investigations would you order for monitoring, specifically related to the medications you started in the question above? (2 points)

• • Potassium
  • Sodium
  • Creatinine/Egfr

5. What three non-pharmacologic management options would you counsel her on in the setting of heart failure? (3 points)

• • Exercise (as long as there is no unstable ischemia, uncontrolled: heart failure, hypertension, arrhythmia, severe and symptomatic valvular disease)
  • Diet changes (salt reduction, fluid restriction <2L/day)
  • Smoking cessation
  • Reduce alcohol consumption
  • Cardiac rehabilitation
  • Daily weights

6. What are five risk factors for heart failure? (5 points)

• • Older age
  • Male sex
  • Heavy alcohol use
  • Smoking
  • Physical inactivity
  • Coronary artery disease
  • Hypertension
  • Valvular heart disease
  • Arrhythmia
  • Diabetes Mellitus
  • Dyslipidemia
  • Obesity
  • Chemotherapy
  • Radiation therapy
  • Family or personal history of cardiomyopathy

7. What two vaccines would you like to offer her to reduce her risk of future congestive heart failure exacerbations? (2 points)

• • Pneumonia vaccine (Pneumovax-23, Prevnar-13)
  • Influenza
  • COVID-19 vaccine