We are excited to see so many of you join our FMEP courses. Several of you have requested we continue to post more practice SAMPs, so here you go!

SAMP

Lucas is a 9-year-old boy who presents to the clinic in early October with a three-day history of worsening coughing, chest tightness, and wheezing. His symptoms have become more troublesome at night, waking him several times due to shortness of breath and coughing fits. Yesterday, he left his soccer game early because he “couldn’t breathe properly” during running. He has been using his blue inhaler frequently, approximately 4-5 times per day, but is currently without his spacer, which he usually leaves at school. He has no fever, but does have known seasonal allergies. On exam, Lucas is sitting in a slightly forward position, taking visible extra effort to breathe. He speaks in short phrases rather than full sentences and has widespread expiratory wheezing on auscultation. (10 points)

1. List two signs of severe asthma. (2 points)

   Answer: Accessory muscle use, O2 sat <92%, difficulty speaking full sentences, marked wheeze (any two)

2. What initial medication should be administered in the clinic? (1 point)

   Answer: Short–acting beta–agonist (e.g., salbutamol)

3. Provide the dose and route of this medication. (1 point)

   Answer: 2–4 puffs via spacer OR 2.5 mg by nebulizer

4. State one indication for systemic steroids in this case. (1 point)

   Answer: Moderate–severe symptoms or multiple SABA doses required

5. Prescribe one appropriate oral steroid and dose. (1 point)

   Answer: Prednisone 1–2 mg/kg/day (max 40–50 mg) for 3–5 days

6. Identify one test to assess severity in the clinic. (1 point)

   Answer: Peak flow measurement or spirometry, where possible

7. List two components of asthma education. (2 points)

   Answer: Trigger avoidance, inhaler/spacer technique review, provide action plan (any two)

8. When should follow–up occur? (1 point)

   Answer: Follow–up in 2–3 days or sooner if worsening