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

Ms. Chal Obreath is a 51 year old woman who presents to your office with worsening shortness of breath and wheezing over the past year. She denies chest pain, palpitations, orthopnea, paroxysmal nocturnal dyspnea and leg edema. There have been no reported fevers. She is an ex-smoker and quit 20 years ago (10 pack-year smoking history). She has seen a cardiologist who performed an extensive workup and did not feel her symptoms were attributable to a cardiac etiology. She works as an administrative assistant. (11 points)

1. What investigation would help differentiate between a diagnosis of asthma and COPD? (1 point)

• • Spirometry/Pulmonary Function Testing

2. What are the diagnostic criteria (using spirometry) for asthma in adult patients? (2 points)

• • FEV1/FVC ≤ 0.75 or the lower limit of normal and
  • Post-bronchodilator FEV 1 of more than 12% and of more than 200 mL from baseline

3. What are the diagnostic criteria (using spirometry) for COPD in adult patients? (2 points)

• • FEV1/FVC ≤ 0.70 or the lower limit of normal and
  • No significant post-bronchodilator increase in FEV1

4. What are the characteristics of a COPD exacerbation (HINT: GOLD criteria)? (3 points)

• • Increased sputum
  • Increased purulence
  • Increased dyspnea

5. Apart from asthma, list three other common differential diagnoses for COPD? (3 points)

• • Congestive heart failure
  • ACO (Asthma-COPD overlap)
  • Bronchiectasis
  • Tuberculosis
  • Sarcoidosis
  • Obliterative bronchiolitis
  • Diffuse panbronchiolitis (in patients of Asian descent)
  • Infectious

Helpful CFP Resource:
https://www.cfp.ca/content/67/9/661