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. Wes Jet comes to your office asking about his upcoming travel plans. He is hoping to book a trip to Chile and climb the Andes mountains and then fly to the Dominican to an all-inclusive resort after that. He will travel once the restrictions have been lifted. He has a number of questions about travel. (14 points)

1. He heard about malaria prophylaxis. You counsel him on the areas where malaria is endemic. What are three medications that can be used for malaria prophylaxis in adults? (3 points)

• • Atovaquone-Proguanil (malarone)
  • Doxycycline
  • Chloroquine
  • Mefloquine (less favourable option due to adverse effects)
  • Hydroxychloroquine
  • Primaquine

2. Apart from routine vaccines, what are three travel vaccines you could offer any traveller? (3 points)

• • Oral cholera vaccine (not routinely recommended but many patients ask about this! – evidence is poor in preventing traveller’s diarrhea compared to placebo)
  • Influenza (during the flu season)
  • Hepatitis A
  • Hepatitis B
  • Typhoid fever
  • Tick-borne encephalitis (this vaccine is only available in countries where the disease is present)
  • TB BCG vaccine (variable efficacy in preventing TB in adults and is of very limited use in travellers – you could consider this in long-term travellers visiting regions where TB is highly endemic)
  • Yellow fever
  • Monovalent and Quadrivalent Meningococcal vaccine
  • Japanese encephalitis vaccine
  • Rabies vaccine

3. What are two ways to help reduce the risk of high-altitude illness? (2 points)

• • Avoid overexertion and alcohol
  • Stay hydrated
  • Ascend as slowly as possible
  • The sleeping elevation is particularly important and should be increased gradually (< 500 m/d with an extra day allowed for acclimatization every 1000 m)
  • Ascend to 2500-3000 m over 2 days if possible
  • Consider prophylaxis if at moderate to high risk of high-altitude sickness
  • Consider keeping a prescription of Acetazolamide and this can be taken at the first sign of symptoms

4. What would you like to counsel Mr. Wes Jet on to help reduce the risk of travellers’ diarrhea? (3 points)

• • Eat foods that are fully cooked and still hot (avoid raw meats and fish/shellfish)
  • Wash fruits and vegetables in safe water and peel them yourself
  • Avoid food from street vendors
  • Drink water that has been boiled/disinfected
  • Use ice from disinfected and/or bottled water
  • Brush your teeth with bottled or purified water
  • Wash your hands with either soap or hand sanitizer

5. How would you manage traveller’s diarrhea? (3 points)

• • Oral rehydration (e.g., Gastrolyte, clear fluids, dilute fruit juice, soup with salt, etc.)
  • Loperamide or bismuth subsalicylate (do not use in cases of severe abdominal pain, or bloody diarrhea – this could be indicative of invasive colitis, and be associated with adverse outcomes like toxic megacolon and intestinal perforation)
  • Consider antibiotics for moderate to severe diarrhea (e.g., ciprofloxacin, levofloxacin, azithromycin, rifaximin, bismuth, and loperamide)

Helpful Resources:
Traveler’s diarrhea (2019): https://www.cfp.ca/content/cfp/65/7/483.full.pdf 
FMEP Traveller’s Diarrhea (2019): https://familymedexamprep.com/on-a-soo-lets-talk-about-poo/
Treatment and prevention of traveler’s diarrhea (2015): https://www.cfp.ca/content/cfp/61/11/976.full.pdf
Travel medicine (2014): https://www.cfp.ca/content/cfp/60/12/1091.full.pdf