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

You are working in the ER in a rural hospital. A 56 year old male comes in with fatigue and a fever. He is currently undergoing chemotherapy for gliosarcoma which was diagnosed 2 months ago. He appears unwell. His temperature is 38.6°C, HR is 106, and BP is 134/78. He is on room air and saturation is 98%. (8 points)

1. What is febrile neutropenia? (1 point)

• • Febrile neutropenia is defined as an oral temperature of > 38.3°C or a sustained temperature of 38°C or higher for at least 1 hour WITH an absolute neutrophil count of 1.0 × 109/L or less

2. What four investigations would you consider ordering? (4 points)

• • HgB
  • WBC including differential
  • Platelets
  • Creatinine
  • BUN
  • Na, K
  • AST
  • ALT
  • Total Bilirubin
  • Blood cultures
  • Urine culture
  • Peripheral blood smear
  • Viral culture
  • CXR (if there are respiratory symptoms)
  • Note: There are many answers here. BE SPECIFIC!

3. True or false: Only 20-30% of patients with febrile neutropenia have an identifiable cause. (1 point)

• • True

4. True or false: Rectal examinations should be performed to rule out mucositis. (1 point)

• • False. There is an increased risk of bacteremia.

5. True or false: Chest X-rays may be normal in neutropenic patients as they may not be able to mount an inflammatory response. (1 point)

• • True

Helpful CFP Resource:
https://www.cfp.ca/content/cfp/69/1/28.full.pdf