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

A 42-year-old female presents with a history of unintentional weight loss; she has lost 20lbs over the past three months. She recently immigrated from India where she used to be a marathon runner but has stopped running due to significant fatigue that has become progressively worse over the past six months. She admits to significant nausea most days and has muscle and joint pain. She has been trying to snack on chips and crackers as she has developed a craving for salty food. She also noticed a hyperpigmented rash on her face that looks like this: (12 points)

1. What is the likely diagnosis? (1 point)

• • Addison’s disease

2. What is the underlying pathophysiology of the above condition? (1 point)

• • It is a disease characterized by the destruction of the adrenal cortex leading to adrenocortical insufficiency (eliminates glucocorticoid and mineralocorticoid function)

3. What two tests would you consider ordering first to assess for adrenocortical insufficiency? (2 points)

• • Morning serum cortisol concentration
  • A Rapid ACTH stimulation test

4. What is the most common cause of Addison’s disease worldwide? (1 point)

• • TB

5. List three other possible causes of adrenal destruction that can lead to Addison’s disease? (3 points)

• • Autoimmune adrenalitis
  • Non-TB Infections (e.g. Fungal infection, CMV infection, etc.)
  • Adrenal hemorrhage
  • Infiltrating disease (e.g. amyloidosis)
  • Iatrogenic causes (e.g. Taking glucocorticoids for a long time, surgical removal of adrenal glands)
  • Cancer

6. List three common autoimmune conditions associated with Addison’s disease? (3 points)

• • Vitiligo
  • Type 1 diabetes
  • Hypothyroidism

7. What is the difference between primary and secondary adrenal insufficiency? (1 point)

• • Primary adrenal insufficiency is secondary to a malfunction of the adrenal cortex. Secondary adrenal insufficiency is secondary to a malfunction of the pituitary gland that produces hormones that help the adrenal cortex work.

Image by DermNet NZ, https://dermnetnz.org/

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