105 SAMPs for Success

105 Cases
350+ Questions
A Resident-to-Resident Resource
Cases designed for each of the 105 Priority Topics in Family Medicine

Zia Saleh
Disclaimer: This booklet is meant to be a study guide aimed at assisting you in your preparations for family
medicine certification; however, it is an independently constructed, resident-developed guide, and as such, it is
not a product certified or endorsed by the College of Family Physicians of Canada. The guide is meant to be
used in conjunction with other resources, including those provided by the College. Please notify any
shortcomings or errors to myself (at [email protected]) – I apologize deeply in advance if any are present -
and I will attempt to make the necessary corrections. In some cases, answers you may think of may potentially
be accurate but not noted – I have tried to be exhaustive with possible answers where appropriate. Enjoy, thank
you, and best of luck!

SAMP 1
You are at your clinic seeing Ashley, a 17-year old female who called in for an unscheduled visit due to some
abdominal pain in the lower right side of her abdomen. There is no history of trauma. The pain started shortly
after awakening this morning and is not accompanied by and urinary or bowel changes. Her vitals are normal
and she has no past medical history.
a) Name two surgical emergencies that you would want to rule out.
On further history, Ashley tells you that her last menstrual period was about 6 weeks ago and she has been
having unprotected intercourse with her partner. She also notes she had some vaginal bleeding earlier this
morning. On examination, there are no obvious signs of trauma or lacerations.
b) Name two investigations that would help confirm your suspicion of an ectopic pregnancy.
c) If her blood type was B-, what medication would you need to administer?

SAMP 2
A new patient of yours, Akhil, is a 45-year-old male complaining of dyspepsia over the past few weeks
alongside a sensation of “heartburn” after meals. His past medical history is notable for hypertension and type 2
diabetes as well as an appendectomy in his teenage years. His medications include only ramipril and metformin,
which he has been taking regularly.
a) Name four red flags of dyspepsia you would look for in Akhil’s case.
Akhil has none of the above red flags on history, but when you look up his history on the medical records, you
find he had a recent endoscopy done which showed no ulcers or masses. You decide to diagnose him with
gastroesophageal reflux disease (GERD).
b) Name two classes of medications that can be used to treat Akhil.
c) Name four non-pharmacologic therapies that you can advise to Akhil.

SAMP 3
You are working in the ED on a Saturday night when you hear that EMS is bringing in Larry, an unresponsive
patient in cardiac arrest.
a) Name two signs that help you declare a patient “unresponsive”.
b) List two non-shockable rhythms.
Larry comes in and remains unresponsive as EMS is conducting CPR. No shocks have yet been delivered. His
pattern has been asystole, but you look at the monitor and see the emergence of wide QRS complexes with a
uniform morphology at a rate of 150.
c) What is your next step, as per ACLS guidelines?
You immediately begin CPR once again.
d) List the medication you should administer and the dose as per ACLS guidelines.
On your next check, you feel the return of a pulse in Larry.
e) What are the two important vitals to monitor in ROSC management, as per ACLS guidelines?

SAMP 4
Anafee, a 3-year-old female, comes into your clinic with her mother on an unscheduled visit due to concerns
after Anafee ate some peanut butter today. Within minutes, she erupted in hives and then vomited 2 times
before coming in to see you.
a) While calling EMS, name the medication you would immediately administer in clinic along with the
dose and route.
b) Name two other classes of medications that you expect Anafee will receive once the initial reaction
settles down.
c) List three pieces of critical information you would need to provide Anafee and Pearl prior to discharge.

SAMP 5
Nelisa is a 14-year old female who you are seeing for a routine periodical physical examination. She complains
of fatigue over the past few months, but has had stable weight and has no complaints of pain or shortness of
breath. Her sleep has been normal as has her libido. She has an unremarkable past medical history and is not on
any medications. She is slightly stressed at work, but is managing to cope day by day.
a) Name three initial investigations you would do to work up her fatigue.
You notice she has a microcytic anemia on reviewing your labs.
b) Name four causes of microcytic anemia.

SAMP 6
Tonny is a 75-year old male whom you are seeing who has come into the ED with an acute productive cough
and shortness of breath.
a) List three conditions on your differential diagnosis.
On further history, he has had a mild fever, a previous upper-respiratory tract infection, and has pleuritic chest
pain. On physical exam, you notice crackles in the left lower lobe.
b) Name three investigations that would likely be positive in the context of pneumonia.
c) List two pharmacologic treatment regimens, their route, and their duration for an inpatient with
community-acquired pneumonia.

SAMP 7
Asha is a 31-year old female who presents to your clinic with concerns about intermittent palpitations. She has
no other medical conditions and has previously been healthy. Her pulse is 85, BP 124/80, RR of 14, O2 of 98%,
and T of 36 degrees Celsius.
a) List four items on the differential diagnosis for a young female with palpitations.
On further history, you determine that the palpitations are often associated with moments of anxiety
characterized by panic attacks. In the interim periods, she never has palpitations and feels otherwise well.
b) List four symptoms associated with a panic attack.
These panic attacks have occurred in the context of feeling keyed up, irritable, easily fatigued, and restless
sleep.
c) For how long must a patient have these symptoms to meet the criteria for generalized anxiety
disorder?
d) Name two pharmacologic classes of medications used to treat generalized anxiety disorder and one
non-pharmacologic therapy for anxiety disorder.

SAMP 8
Logan is an 8-year old male who has a known history of asthma. He is presenting for a routine check-up.
a) List four potential triggers for asthma.
b) Name two associated medical conditions, aside from family history, that are often present in
asthmatics.
c) Name four pharmacologic agent classes used to treat an acute exacerbation of asthma.
d) Name three non-pharmacologic interventions that can be employed in asthma diagnoses.

SAMP 9
Sylvia, a 76-year old female, presented to clinic today with a new complaint of “feeling her heartbeat was off”.
She is otherwise feeling well, but does have congestive heart failure (with mitral regurgitation), dyslipidemia,
and hypertension. Her vitals are within normal range aside from a heart rate of 115 beats per minute. When you
feel her pulse, you notice it is irregularly irregular.
a) What single initial investigation would you order to help make a diagnosis?
Based on this investigation, you discover she has atrial fibrillation.
b) Name four potential causes of atrial fibrillation.
c) What time-based criteria would allow you to employ cardioversion without the need for
anticoagulation?
Given her age and her dislike for the idea of cardioversion at this time, you decide to employ a rate control
method.
d) Name two pharmacologic agent classes that you could use for rate control.
You wonder whether you also need to use anticoagulation medications for Sylvia given her CHADS score of
e) What anticoagulant would you use to treat her, given her past medical history?

SAMP 10
Yeleni is a 45-year old female who is a longstanding patient of yours with asthma and pollen allergies, but who
is otherwise well. She has had two sisters who have had breast cancer at the age of 51 and 60, none of whom are
BRCA positive (and neither is Yeleni). However, on your annual mammogram radiology report, there has been
mention of a suspicious breast mass. You decide to call Yeleni in for a chat regarding the next steps.
a) List three potential things you would do to ensure an appropriate setting for the breaking of news to
Yeleni.

SAMP 11
Lorna brings her 10-year old son into clinic noting that he has had difficulty concentrating in class as per his
teachers. He was been disruptive, excessively excited, and has a difficult time paying attention. She noticed this
at home with his homework as well, but did not think too much of it until his teacher sent a letter home recently
about the same. She is wondering about the diagnosis of ADHD.
a) What are five non-pharmacologic treatments for ADHD?
b) Assuming the diagnosis of ADHD is correct, name a medication you could start, the dose, and the
route.
c) List five other elements you would want to understand on history before diagnosing ADHD.

SAMP 12
Pam, a 40-year old female, comes to your clinic crying due to a lump she has noticed in her breast while taking
a shower.
a) List five potential causes of a lump in the breast.
On further history, you uncover that the lump is tender, soft, and has fluctuated in size over the past month
being larger about halfway through the menstrual cycle. She has no family history of breast cancer and has not
had any mammograms. On exam, you notice a tender, soft, mobile lump in a lobule of the left breast.
b) Name the most likely diagnosis.
c) What initial investigation could you undertake to differentiate whether or not this lesion is soft or
solid?
d) What initial investigation should be used to screen Pam for breast cancer when the time comes?

SAMP 13
Shu-yen is a 55-year old female presenting for a periodic health exam after a period of five years. She is
otherwise healthy and has no past medical history aside from hyperthyroidism. Her family history is notable for
early heart disease in her father who had a nonfatal myocardial infarction at the age of 50. She is only taking
Synthroid and a multivitamin daily.
a) List five screening maneuvers that would be indicated for Shu-yen.
Shu-yen’s husband, Wei, comes with her to the appointment. He is 60 years of age, is previously healthy, and
has not seen a physician for 5 years as well.
b) List five screening maneuvers indicated for Wei.
c) Name three pieces of cancer prevention advice would you provide for the both of them?

SAMP 14
Ruiz, a 57-year old male, presents on your rural ED shift complaining of ongoing central chest pain that started
after shoveling his walkway about two hours ago. The pain is worse on movement, radiates to his arm, and is
not relieved by rest. His past medical history includes erectile dysfunction, hypertension, and type 2 diabetes
mellitus. His medication only includes metformin and intermittent sildenafil.
a) List six life-threatening diagnoses you would want to rule out in working up Ruiz.
b) List six risk factors for ischemic heart disease.
c) List three initial investigations you would conduct that would help you diagnose a myocardial
infarction definitively.
You conduct an ECG and see no ST elevations, but new ST-depressions in V5 and V6 in the context of narrow
QRS complexes and sinus rhythm.
d) Name six medication classes you would place Ruiz on.

SAMP 15
A year later, Ruiz comes to the ED again complaining of the same chest pain triggered by vacuuming at home,
but this time he was able to try his nitro spray, which did not resolve his pain as it usually does. Your initial
ECG shows ST-elevation in leads V4- V6. The pain started 1 hour ago. He has not yet taken anything aside
from his nitro spray and his daily medications.
a) What single oral initial treatment will you offer immediately to reduce mortality? Include the dose.
b) Within how long will you need to get him to PCI for him to be eligible?
c) Name five contraindications to TNK-tPA administration.
SAMP 16
Margery is a 89-year old female who is a longstanding patient of yours with type 2 diabetes. She has been
diligent in managing her lifestyle (aside from the odd piece of cake) and has been on metformin 1000mg po bid.
Her HbA1c level is 10.1% today and has been elevated for the last 6 months.
a) What symptoms would you be on the lookout for in Margery’s case?
Margery is asymptomatic at this time.
b) Name one non-pharmacologic and one pharmacologic intervention you could take at this time.

SAMP 17
Michaela is a 60-year old female who is a new patient to you who has COPD. When you open the door to see
her, you immediately she has increased work of breathing and is in the tripoding position. Her oxygen
saturations are 89%. On further history, you sort out that this all happened a day after nearby forest fires began
bringing smoke into the city. She has no chest pain, no hemoptysis, and has had previous similar episodes
before. She is afebrile, her respiratory and heart rate are slightly elevated, and her blood pressure is 130/87.
a) In an acute exacerbation of COPD, list four other diagnoses you would want to rule out.
b) Name two initial therapies could you initiate in the office for this acute exacerbation of COPD.
c) Name two non-invasive investigations that can be used to help diagnose COPD.
Michaela settles down in your clinic with initial medications and her oxygen saturations come up to 92% over
the course of an hour. You notice her pull out a pack of cigarettes on her way out the door and you realize you
need to chat about smoking cessation.
d) Name five methods of delivery of nicotine replacement therapy.

SAMP 18
Lisa is a 16-year old girl who has shyly come into your clinic alone to ask about contraception. She is in a
relationship with a classmate and is wanting to know about contraception options aside from condoms.
a) List six potential contraceptive strategies for Lisa.
b) List five contraindications to combined estrogen-progestin pills.
c) Name three potential side effects of the estrogen-progestin pill.
After hearing about the pill-related options, Lisa also heard from a friend about IUDs and would like to know if
she would be eligible for that.
d) List three contraindications to a progestin-containing IUD.

SAMP 19
Ermin is a 9-month old male who presents on your ED shift for a two-day history of rhinorrhea, a non-barky
cough, and irritability. He has his immunizations up-to-date, has been normal developmentally, and has had no
past medical concerns aside from a small leg laceration from a fall. He was born at term vaginally and went
home the next day with no concerns. He lives with both parents and two older siblings, one of whom had a
“cold” recently.
a) Name four potential causes of these symptoms in Ermin.
On exam, his vitals are normal side from an increased respiratory rate at 40 and one desaturation down to 89%
while he was taking a nap in the emergency department that resolved with low-flow oxygen via nasal prongs.
He appears well and has an unremarkable physical exam aside from rhinorrhea and migratory rales in both
lungs. On further history, he has been eating and drinking about 60% of his usual amount and has had 4-5 wet
diapers daily.
b) Name the most likely diagnosis.
c) List two interventions you would employ in this patient.

SAMP 20
Omar is a 4-year old patient who presents on your ED shift with a non-barky cough that has been lingering for
two days alongside rhinorrhea. He has been wheezing over the past few hours after their visit to an outdoor go-
kart track, and he told his parents that “he feels like he cannot breathe”. His past medical history includes atopic
dermatitis. His family history includes a mother with asthma and a father with diabetes. He has been
developmentally normal, immunized to date, and was born by an unremarkable spontaneous vaginal delivery.
On exam, you notice an elevated respiratory rate at 28, heart rate at 110, and some subcostal indrawing
alongside a wheeze throughout the lungs, but no other abnormalities. He is alert and speaking to you. His
oxygen saturations are 94%.
a) What is the most likely diagnosis in this patient?
b) List four treatments you would administer for this patient with dose, route, and duration.

SAMP 21
A 65-year old female, Bodette, presents to your office for a prescription refill for her hypertension medications.
When you ask her how she is doing, she begins to tear and confesses that she worries she might be depressed.
Her husband passed away a year ago and though she initially felt that all her symptoms were from grief, she
continues to have difficulty sleeping, low energy, little interest in being with friends, poor concentration on her
daily tasks, no appetite, and feels depressed.
a) What two important aspect of depression would you want to inquire about with regard to safety?
b) For how long must a patient have symptoms to declare a major depressive episode (assuming there are
no other reasons to explain the diagnosis)?
c) List three non-pharmacologic therapies that would be useful in treating Bodette’s depression.
SAMP 22
As you are working your night ED shift, from the physician station you hear a seal like, barky cough in the
waiting room. You rush out and see a 3-year old female with increased work-of-breathing and bring her into a
room. Your assessment reveals she has been previously healthy, but at daycare with a lot of sick children and
has had this cough for a day. On exam, her respiratory rate is increased slightly and her oxygen saturations are
94%. She is alert, not cyanotic, and has some substernal indrawing along with normal airway entry bilaterally.
No wheezes or whoops are noted.
a) What five stridor-inducing conditions are on your differential diagnosis?
b) What two therapies would you definitely provide in her mild state of croup?
She returns to the emergency later that evening with the same cough, but now has decreased air entry
bilaterally, worsened stridor, and both substernal and supraclavicular retratctions.
c) What additional therapy would be offered now, and at what dose and route?
d) When can her parents expect her to not have issues with this cough (within how many days)?

SAMP 23
You get a call at 10:00PM from a nurse at a long-term care facility about a patient who has a lower leg that is
swollen, red/purple, and tender to touch. The patient is bed-bound and has a history of dementia, hypertension,
diabetes, and osteoporosis. She has no difficulty breathing and no hemoptysis; she is also afebrile.
a) List three diagnoses on your differential.
When you go to examine her, you feel strong pedal and femoral pulses, a normal temperature over the leg
compared to the other (which is normal in appearance), and note that the tenderness is over the posterior calf.
b) What is the most likely diagnosis?
c) What single definitive investigation would you order to confirm or deny the most likely diagnosis?
d) After talking with the family and obtaining consent from the primary decision-maker given that the
patient no longer makes medical decisions for treatment, name two pharmacologic categories of
treatment.

SAMP 24
You are seeing Ranger, a 2-year old infant that has been vomiting on multiple occasions over the past two days
and who has not been keeping fluids and food down. He has had only 1 wet diaper today and has come to clinic
for a further assessment.
a) Name three physical exam signs that would indicate dehydration.
After your assessment, you decide that this patient requires IV hydration in the emergency department and send
him there. An initial fluid bolus is given.
b) If Ranger weighs 11kg, what would your maintenance fluid rate be per hour?
c) Whilst hydrating, name two objective indicators you could monitor without bloodwork to assess
appropriate response?

SAMP 25
Nasreen, a 70-year old, female comes in with her daughter to clinic at her daughter’s request. Her daughter is
concerned that Nasreen has been quite forgetful over the past few years, with things being worse more recently.
On one occasion, Nasreen was driving and took an hour to get home from the grocery store, which is normally 5
minutes away, noting “I forgot the way” as an excuse. On numerous other occasions, Nasreen forgot how to
make a variety of traditional dishes she was normally an expert at – once, she even left the stove on until the
contents of the pot burnt to a crisp. Nasreen has been otherwise well with surprisingly no notable past medical
history aside from hypertension. She is only on ramipril once nightly. She agrees something is off, but cannot
figure out what exactly.
a) List five neuro-cognitive domains that can be impaired in major cognitive impairment or dementia.
b) Name two potential screening tests that can be used as a measure of impaired cognitive function.
c) List six laboratory investigations used to complement the history of Nasreen.
d) List five basic activities of daily living you would want to ask about.
e) What is the most important and immediate safety concern Nasreen must understand before leaving the
office?

SAMP 26
Rory, a 31-year male, is a fieldworker who comes to see you very rarely for periodic health check-ups. Today,
he opens up to you just as you feel the visit is coming to a close about some issues he has had with substance
use – namely alcohol – that he has battled with. He tells you he is feeling “depressed” and wonders if he might
have depression like his mother and brother.
a) List three potential diagnoses that involve an element of depression.
b) Name five criteria for depression you would look for in your screening.
On further history, you feel that Rory meets the criteria for depression and has no other diagnoses that can
explain his current condition.
c) List two non-pharmacologic therapies you might offer if a diagnosis of depression was uncovered.
d) Name two side effects of tricyclic antidepressants that make them second-line therapies.
e) List five common side effects of SSRI treatments.

SAMP 27
You are seeing a 9-year old female, Debbie, in clinic for concerns about accidents at school where she has wet
her pants on two occasions in the last month. She is otherwise well, has no sleep issues, and has no pain or odd
scents to her urine. She previously had good control of her urine, but is now urinating more frequently and has
had two accidents as a result.
a) List three potential items on your differential diagnosis.
You uncover that Debbie has also felt quite thirsty lately and that her vision has become blurry at times. You
wonder about the diagnosis of diabetes.
b) List three tests you could order to make the diagnosis.
c) In a young child with onset of this condition, what main therapy will you need to initiate?
d) In managing her condition, what four systems would you need to screen at regular intervals to monitor
for complications as she ages?

SAMP 28
You are seeing a 90-year old female, Marie, who has had onset of watery diarrhea three days ago. She notes that
she is stooling three times per day and that she was having regular, once-a-day bowel movements prior to this.
She has a past history of hypothyroidism, hypertension, and osteoporosis and has not started any new regular
medications. She was admitted to hospital six weeks ago for the repair of a Colles fracture from a fall but has
been well since up until this episode; she thinks she may have had an antibiotic prior to the surgery.
Her vitals are: BP 120/80, HR 99, RR 14, O2 94% RA, and Temp of 36.7 degrees Celsius.
a) What is the most important initial intervention you would want to consider?
Given your concern for the potential for C. Difficile, you order a stool sample to check for the toxin’s presence.
b) If found, list two treatment options you could use for the treatment of C. Difficile.
c) How would you monitor for appropriate response to treatment?

SAMP 29
Paola is a 29-year old patient that has come to your practice from a colleague who has had a falling out with
her. As per your colleague, this is how Paola came to her as well – she only stayed a few months before their
therapeutic relationship soured. Paola is healthy overall, but has had troubles with relationships with friends and
family and has attempted suicide on one occasion after breaking up with a boyfriend. She has struggled with a
variety of substance use issues, including with alcohol and cannabis, but has managed to control her intake and
limit them to only a few times per week.
a) Name three characteristics of borderline personality disorder.
b) What particular health risk are those with borderline personality disorder at risk of?
c) What unique therapy would be indicated in treating borderline personality disorder?
During your visit with her, Paola brings up a concern about difficulty breathing when exposed to dogs, in
particular, she wheezes and finds it difficult to get enough air. This issue has persisted since childhood and she
took a “blue puffer” to help with this when needed. Lately, she has had a much worse time because the place
she is living in allows owners to keep dogs.
d) What medication category would you consider starting for Paola (in addition to salbutamol) - name
one example and give the dose.
SAMP 30
Raymond, an elderly 78-year old gentleman, is a new patient to your primary care hospitalist team admitted for
failure to thrive.
a) List three disability risks you would screen for in your care management plan.
b) Name five instrumental activities of daily living you would assess his capability of performing.

SAMP 31
You look at the triage note for Mehdi, a 56-year old male who walked into the ED and who was sawing wood a
few days ago when he felt “dizzy” and suddenly collapsed and woke up with his head next to the motorized
saw. He recalls the moment before blacking out and has a scrape on his head, but feels otherwise normal and
has no memory issues. On further history, this has happened once prior while he was seated and watching
television. His vitals are: BP 145/87, HR 62, RR 12, O2 94%, T 36.3 degrees Celsius. His past medical history
is notable for hypertension, dyslipidemia, and obesity.
a) Name three system-based categorical distinctions you would consider when determining the cause of
“dizziness” in a patient.
b) Given a history of a fall, would you place Mehdi on C-spine precautions?
c) Name five indications for C-spine precautions in trauma.
d) Given a history of a fall, would you conduct a CT head on Mehdi?
e) Name four indications for a CT head in trauma.
Mehdi goes on to tell you he does not experience visual hallucinations of the room spinning around him on
these occasions and that his wife, who came out to see him, did not notice any rigorous jerks or shakes whilst he
was out for a period of about 10 seconds. He returned to normal within minutes and did not experience fatigue
thereafter on both occasions.
f) What key investigations would you want Mehdi to be sent for. List five.
g) Which specialist will Mehdi most likely need referral to?

SAMP 32
Ashley, a patient of yours, calls your office to express concerns about her neighbour Ley who also happens to
be a patient of yours. She tells you that she saw Ley’s husband pushing her around through the window and that
Ley even slapped her. She is concerned about her neighbor, and knowing you’re her doctor, was hoping you
could help.
a) List one criteria for when you would call for immediate intervention.
b) In a situation of confirmed domestic violence, name three key pieces of information you would want to
obtain that would help you in your intervention decision-making.
SAMP 33
Amal is a 24-year old patient who presents to your clinic with painful and frequent urination over the past two
days. She has been otherwise healthy, is on the birth control pill, and has no regular medications.
a) List five components of the differential for Amal.
On further questioning, she has not had any rashes or lesions down below and is not sexually active (she takes
the birth control pill for menorrhagia). She previously urinated normally and has not had any hematuria; she
notes that the skin looks normal down below.
b) List two signs you could measure/elicit which would change your management plan.
c) Assuming there are no red flags, what investigations would you need to conduct to diagnose a UTI, if
any?
d) Name two treatment options for her UTI, including the dose and route.
e) In a patient with asymptomatic bacteriuria, name two instances where you would still treat with
antibiotics?
f) List five risk factors that would make this a complicated UTI, if present.

SAMP 34
You have Jaxon, an 18 month-old male who comes i due to a deviation from his baseline contentment as per his
mother. A fever of 38 degrees Celsius was noted today by mom, for which he had been given Tylenol and had
no further occurrences. He is otherwise well, normal developmentally, and has had his immunizations. A
history of cough and rhinorrhea over the past 2 days was mentioned by his mother along with nasal discharge.
a) List three potential emergency complications of upper respiratory tract infections you would want to
rule out.
On further history, you note that Jaxon is breathing easily and without difficulty and there is no history of
drooling. He has still been playful and looks non-toxic. You hear that he has been tugging at his left ear and has
not been feeding well or drinking well, although is still having multiple wet diapers per day. No diarrhea has
been noticed. You look into the ear and notice a red, bulging, left tympanic membrane. It is not mobile and you
notice fluid behind the right eardrum, but no redness there.
b) Name three risk factors for acute otitis media.
c) List three common bacteria that cause acute otitis media.
d) List three medications you would treat this infant with, including the dose, frequency, and duration.
e) Within what time period should Jaxon clinically improve?
f) Name two risk factors that would trigger an indication for tympanostomy tubes.

SAMP 35
Ozlem is a 15-year old female who comes into clinic for an annual check-up with her mother. When you look at
her growth, you noticed there has been a significant dip over the past year such that her BMI is under the 10th
percentile. She says that she feels otherwise well and explains it by her exercising more and cutting down on her
meal portions. Her mother intervenes and says, “Well, that’s an understatement, you’ve been missing meals
altogether – skipping breakfast, bringing home portions of your lunch, and eating very little at dinner.” She
responds calmly by saying that she felt overweight previously (even though she had a normal BMI) and wants
to be on top of her weight so she can feel good about herself.
a) Name three physical exam signs, other than weight, that would be consistent with anorexia nervosa in
this patient.
As you continue with the visit and ask about pubertal milestones, Ozlem notes she had her first period around
12 years old and had been getting them regularly at around 13, but has not had any over the past 6 months.
b) Name three likely causes of amenorrhea in Ozlem.
c) What is the most critical laboratory investigation you could order in Ozlem?
d) What therapy-centred treatment distinction/difference exists in anorexia vs. in bulimia?

SAMP 36
Ronald is a 78-year old male who has come for his periodic health examination. He has atrial fibrillation,
hypertension, dyslipidemia, hearing impairment, osteoarthritis, and benign prostatic hypertrophy and is on
medications for each of these, which he is seemingly well controlled on. In addition to his new oral
anticoagulant, he is also taking aspirin since he was told to years ago by you. He is here for a general visit and
to “oil the machine” in reference to his overall health.
a) Name three priority areas you could address to maintain Ronald’s health and safety specific to the
elderly.
Ronald goes home with appropriate advice and lives a healthy life for another few years. Over these years, you
have noticed a general decline in his ability to care for himself at home and have noticed that his wife Martha
has been needing to help him to do things he used to before due to his mobility and pain limitations from
osteoarthritis. She also has to constantly intervene to help explain things due to his hearing difficulties (despite
hearing aids). When she comes into the office with him – as she always does – you notice she looks tired and
worn out.
b) List three things you could do to care for Ronald’s caregiver, Martha.

SAMP 37
A 46-year old male comes in on your urgent care shift complaining of a recurrent nosebleed that has been on-
and-off for the past few days. When getting out of bed today, he had another nosebleed after which he felt faint.
He has been otherwise well aside from ongoing problems with easy bruising and notes that when he bleeds from
cuts and scrapes, it takes a while for things to settle down. He is not on any medication.
His vitals are BP 107/87, HR 103, RR 20, O2 97% RA, Temp of 36.7. He is sitting, breathing through his
mouth comfortably, and has pressure on his nares, which appear to have both dried blood and a slight red
trickle. Cardiovascular, pulmonary, and abdominal exam are unremarkable.
a) Name the most important immediate intervention at this moment, given the above information.
b) What type of epistaxis would be most worrisome in this scenario?
c) List five investigations you would order at this point to workup the cause of bleeding in this case.
d) As you conduct your physical exam, if this were a simple and common bleed, where would you expect
the bleeding to arise from?
e) List three potential interventions you could use to treat epistaxis, if active.

SAMP 38
Sam, a 41-year old female, comes to your office with a complaint of feeling tired and fatigued over the past
three months. She has felt like she has much less energy throughout the day and is more sleepy, and as a result,
she has had to take a few days off from work to recuperate sporadically although her work life has been stable.
She has also not had enough energy to maintain her socialization with friends, despite wanting to. Otherwise,
her relationship with her husband is strong and she has a good sex life with no complaints there (aside from
feeling tired once in a while). She is not on any medications and has not had any fever, chills, or night sweats
and is not in any pain nor does she have any difficulty breathing. Her past medical history is remarkable for
only impaired fasting glucose, appendectomy, menorrhagia, and pneumonia.
Her vitals and physical exam are unremarkable. You track her weight and confirm a 1.5kg weight gain over the
past month, which she also mentioned to you.
a) List three red flags for fatigue.
b) List four symptom-driven investigations you would order to work-up Sam’s fatigue.

SAMP 39
Adam, a 4-week old infant, comes in on your urgent care shift with a history of fever over the past two days
measured at 39 degrees Celsius by his mother. He has had a cough and runny nose, and has had two episodes of
post-tussive emesis as well. He has been crying and fussy, declining feeding at the breast on numerous
occasions for this reason. He is only having 6 wet diapers a day compared to his previous nine with three of
them containing stool (his norm).
a) Provide five sinister causes of fever in a 4-week old infant.
b) List five critical investigations you would conduct on Adam.
On assessing Adam, you notice he is slightly tachycardic, but has a normal blood pressure, elevated respiratory
rate, and normal oxygen saturations. His rectal temperature is 39 degrees Celsius. Otherwise, he is alert and
crying with a patent airway and normal skin colour. His capillary refill is 2s.
c) What initial therapeutic interventions would you conduct – name two?
d) What antibiotics would you use to treat Adam, assuming no allergies are present? List two.

SAMP 40
Desiree, a 25-year old female, comes to your clinic due to wrist pain after a fall after some freezing rain.
a) List three physical exam findings that, if found, would require immediate attention.
Your examination of her wrist is unremarkable aside from mild tenderness noted on lateral aspect of the wrist
above the radial styloid. You review an X-ray of the wrist and hand, which appear normal.
b) What injury would you not want to miss, despite a normal X-ray in this case?

SAMP 41
Jamil, a 70-year old male, is a nursing home patient of yours who you are called about regarding some black
tarry stools noted by staff over the past three days. He has not vomited any blood. Jamil has a history of
dementia, hypertension, dyslipidemia, diverticulosis, and hypothyroidism. His medications include telmisartan,
amlodipine, atorvastatin, levothyroxine, and aspirin. He uses both Ibuprofen and Tylenol intermittently for
osteoarthritis, which has been flaring up lately leading to regular use. He has no allergies, does not smoke, and
has never drank alcohol.
His vitals are: BP 120/88, HR 95, RR 14, O2 94% RA, Temp 36.3 degrees Celsius.
a) List the top two immediate interventions you would provide at this point.
b) List three potential non-sinister causes of melena.
c) List the most likely cause of his upper gastrointestinal bleed, given the history above.
d) What since procedure will you conduct to identify/confirm the cause of the bleeding?

SAMP 42
Dwight, a 37-year old male, comes to your clinic complaining of a headache that occurred earlier today whilst
he was trying to relax on the lawn on his farm. He has asthma but has been otherwise well.
a) Provide five “red flags” suggesting a sinister cause of headache.
b) List four causes of headache that require emergent and/or hospital management.
On further history, Dwight tells you this occurs every so often, especially when he is stressed at work as a result
of an annoying co-worker. The headache today is similar in nature to those previously, came on gradually, is on
both sides of his head, and is not associated with any nausea, vomiting, autonomic symptoms, or worrisome
features.
b) Name two oral medications you would suggest.

SAMP 43
Kevin, a 40-year old male, comes in for his first set of annual screening investigations and you notice a single
ALT from his previous healthcare provider of 100.
a) What are six potential causes of a transaminitis?
b) Name two liver enzymes, aside from AST and ALT, that would be elevated in biliary disease.
You look further into Kevin’s past medical history and note it is remarkable for obesity, hypertension, and type
2 diabetes. He is on metformin and ramipril. He tells you he has no pain at all after eating and feels otherwise
well. He is not sexually active and does not recall having contact with blood or bodily fluids of another
individual. He does admit to drinking 10 beers a week. You conduct another test and note his AST is 170. He
was fully vaccinated for Hepatitis A and B prior to a trip to Mexico years ago.
b) What are the two most likely causes of Kevin’s hepatitis?

SAMP 44
Phyllis, a 53-year old female, comes into clinic for an annual periodic health exam. You notice that her LDL is
at 4.9mmol/L and she has a family history of early heart disease. She also has hypothyroidism and category II
obesity.
a) Name three endpoint diagnoses that treating hyperlipidemia is meant to prevent.
b) Would you provide Phyllis with a statin, assuming she can tolerate it?
c) When starting an individual on a statin, list two main adverse effects you would want to monitor for
and two blood markers you would check.

SAMP 45
Stanley, a 53 year-old male, presents to your clinic for follow-up of newly found hypertension. He was started
on ramipril 5mg po nightly and his blood pressure has come down from 150/90 to 145/82, based on average
home pressures.
a) List three potential items that could influence the measurement of a BP in office.
b) List four potential causes of secondary hypertension.
c) Name four lifestyle modifications for the reduction of hypertension.
d) If Stanley were to not have had adequately controlled blood pressure on an increased dose of Ramipril,
give two potential other medication classes that could be used?

SAMP 46
A new family that has arrived from Syria visits you in clinic for a first-time visit. They have all been healthy
their whole life, have no diagnoses, and are on no medications.
a) List one preventive medicine approach you would check on and suggest for this family.
b) Name two potential health risks this family might have given their newly arrived status and country of
origin.
SAMP 47
Nathan, a 4-year old male, comes into your clinic presenting for a check-up following the resolution of a mild
gastroenteritis. He is feeling much better, eating, drinking, and voiding well, but continues to have two semi-
formed stools per day. He is afebrile. It is now flu season. His mother asks about influenza vaccination and
whether it would be possible today.
a) What would you recommend?

SAMP 48
A couple, whom you have known since their teenage years, come to you with concerns about not being able to
get pregnant. They been actively attempting and have no obvious reasons for why they would not be able to
become pregnant.
a) What time frame of active attempts at being sexually active should the above couple be considered
candidates of infertility?
b) List four non-pharmacologic options that may be recommended to increase chances of fertility.
c) On further assessment, you recall that Liam’s wife Jane, is overweight and that she has had irregular
menstrual cycles throughout her life. She also has excess hair growth. What diagnosis would you look for
that could affect her fertility?

SAMP 49
Rehm is a 20-year old male who presents to your office complaining of an inability to sleep well over the past 2
months.
a) What areas of information would you inquire about to find a cause of his insomnia? List five.
b) Provide four pieces of advice for general sleep hygiene that may be of utility to Rehm.

SAMP 50
Gunther, a 62-year old male, is a friend of yours who asks you about whether he should get that “chicken pox
vaccine for adults”.
a) List the two products available in Canada for shingles prevention.
A few days prior to his appointment to get the vaccine, Gunther notes the eruption of vesicles on an
erythematous base on the right side of his upper back. These were preceded by a sharp, tingly sensation the day
prior.
b) What treatment would you provide – give the name and dose?
c) When we he stop being contagious?
SAMP 51
Ajamian, a 56-year old male, comes into your clinic complaining of a week’s worth of intermittent chest pain
that gets worse when he goes up the stairs and does not relieve with rest immediately. It is ongoing currently, is
central, described as “squeezing” and has been going on for 30 minutes. This has been a gradual issue over the
past year, but has been worse lately. Otherwise he has not been ill, has not travelled, and is not coughing. He
has a history of hypertension, dyslipidemia, and he is a smoker with a 25-pack year history. With respect to his
medications, he is currently on ramipril, atorvastatin, and a multivitamin.
a) You look up a exercise stress test that was done six weeks ago, which was unremarkable. Would an
acute coronary syndrome still be the top diagnosis on your differential given this?
b) What would be your immediate plan of action?
c) What medication would you prescribe immediately/en route to his destination with the intent of
reducing mortality?
d) If he is truly having an acute coronary syndrome, name three additional medications you would
prescribe in addition to his ramipril and atorvastatin to reduce his risk of mortality and morbidity.
e) List five risk factors for ischemic heart disease.

SAMP 52
Topp, a 57-year old male, comes into your clinic with concerns about a swollen, painful elbow. He has had no
recent infections, but has noted this to be an issue that has caused him quite severe pain.
a) List five questions to ask that would help rule out serious pathology.
On further questioning, you uncover that Topp has had not just a swollen, painful elbow, but a swollen, painful
left knee and right wrist along with some pain in his knuckles. He has no jaw claudication or scalp tenderness.
He notes these pains had been there since childhood, but he had not mentioned it to anyone since he did not
have a family doctor until now. In the past, he has been diagnosed with asthma, osteoarthritis, and impaired
fasting glucose.
b) Give one question that would help you distinguish between rheumatoid arthritis versus osteoarthritis
in Topp.
c) List two categories of medications used to treat rheumatoid arthritis.
d) You conduct X-rays of his painful joints. What single finding would you expect in rheumatoid
arthritis?

SAMP 53
Angela, a 25-year old female, comes into your office after she sliced a portion of her palm whilst working in a
metal shop a few hours ago. Her vitals are stable and the bleeding from the laceration has stopped.
a) Name three complications of the injury you would want to rule out through physical exam.
Angela tells you she has had three tetanus shots in her life, with the last being when she was a toddler.
b) Would you immunize her?
c) List three signs of infection you would counsel her about returning for after you have sutured up the
wound.

SAMP 54
Mateo is a 5-year old child who is growing up in the foster care system and has come to your clinic for the first
time for a check-up. He appears well, his vitals are stable, and his intake bloodwork, including STI screening, is
normal. His childhood has been marked by domestic violence and a separation from family, but he has been
healthy otherwise. His foster mom tells you he has had some difficulties in kindergarten in maintaining
attention and in completing tasks correctly.
a) What potential diagnosis would you consider in this child given his history?
b) List two potential inputs to learning you would want to check in any child who has an apparent
learning disability.

SAMP 55
Randy is a 35-year old previously healthy male coming into your clinic for a periodic health examination. He is
healthy and well and has no family history of concerning medical diagnoses. He works as an accountant and is
quite happy with his life. His BMI is 23 and his blood pressure is 123/80.
a) List five potential areas of lifestyle you could ask him about on this visit.
You identify that Randy is not exercising well and has been mostly sedentary both at his job, but also at home.
b) List one thing you may want to talk with Randy about prior to providing exercise advice.

SAMP 56
Jon is a 75-year old male who you are seeing in the ED after a fall – he has suffered a traumatic complication
from an episode of syncope. His wife noticed him out on the lawn a few minutes after he had left the house; he
had an unwitnessed fall and appeared to have hit his head on a bicycle that had been laying out on the lawn -
she called EMS to bring him to hospital. On arrival via EMS, he was found to have a depressed level of
consciousness making sounds, withdrawing abnormally to pain, and opening his eyes to pain. He had a large
laceration on his scalp that was actively bleeding.
a) What would you label his Glasgow Coma Scale on arrival at?
b) In your primary survey, list the single most important action you would take in each of i) airway, ii)
breathing, iii) circulation.
c) List the most important laboratory investigation you would order, assuming glucose and a recent
toxicology screen is normal.

SAMP 57
Lonny is a 57-year old female presenting to your clinic with a history of 20 pounds of weight loss over the past
year, which represents 7% of her weight. Her BMI is now 21. She has not had any gastrointestinal symptoms
and has felt otherwise normal aside from some major stressors that have occurred over the past year, including
hospitalization of her husband. She takes no medications and is seen in clinic by you on a yearly basis. Her
vitals are stable and a full physical examination is unremarkable.
a) List three red flags you would want to inquire about.
b) Assuming Lonny’s cancer screening has been up to date as of last year, list five other laboratory
investigations you would order to work up her weight loss.

SAMP 58
Garnet is a 40-year old male who comes into your clinic complaining of sudden-onset back pain earlier today
whilst conducting a move as part of his garbage disposal business. As he was lifting a sofa, he experienced a
sharp pain in his lower back that radiated down to the back of his thigh. Now, the pain is consistent and similar
in character, but worsened by learning forward and when getting up. He has been otherwise healthy up until this
point aside from two previous provoked fractures, none of which required surgical fixation.
a) List seven red flags on your back pain history.
b) Name the most important non-pharmacologic recommendation in patients with acute musculoskeletal
back pain.
c) List the two most important medication categories you would recommend.
d) Within how many weeks would you expect this patient would recover in?

SAMP 59
Daru is a 42-year old male who sparsely attends your clinic due to his inability to maintain a personal residence
and his heavy dependence on alcohol. Aside from mild elevations in his LFTs and various presentations for
cellulitis, he is otherwise well. When he does come to the clinic, he is often intoxicated but is able to converse
and is generally at the same baseline as usual. Today; however, he comes in looking much sicker than usual and
has a temperature of 38 degrees Celsius. He complains of feeling generally unwell over the past two days and
has noted feeling feverish and reports rigors. He also says it hurts when the sun comes out and has been
complaining of some neck stiffness. He does not have any open skin lesions and his bowel and bladder
movements are normal; he has vomited once today.
You immediately send him to the ER for further workup and management.
a) Name the main risk factor for Daru’s suspected bacterial meningitis.
b) In addition to running blood cultures and routine bloodwork, name the two most important
investigations to conduct and in what order you would do them in.
c) In arranging your investigations, you realize both will be significantly delayed by a couple hours due to
personnel and equipment issues. Would you start antibiotics?
d) His lumbar puncture comes back with WBC of 700, a low glucose ratio, and neutrophils. What is the
most likely type of organism causing the meningitis?
e) Name the most important professional group you would inform about this diagnosis.
SAMP 60
Theresa is a 53-year old female who has come in for a periodic health exam. As you are just finishing, you ask
if she has any final concerns, and she says, “It is a tad bit uncomfortable, but I am feeling quite dry down there.”
On further discussion, you recall that Theresa has not had any menstrual periods since before her visit last year.
She goes on to tell you how this has affected her intercourse and how the dryness has been accompanied by
other bothersome menopausal symptoms. She is wanting help with these issues and asks for your advice.
a) List three other menopausal symptoms she likely complained of.
b) Name seven contraindications to long-term hormonal therapy.
c) Assuming she has no absolute contraindications, what would be the general maximum amount of time
you would recommend hormone replacement?
d) List two therapies you could use specifically for vaginal dryness, provide the dose.

SAMP 61
Marge, an 82-year old female, has come to see you today for a complaint of neck pain over the past few months
that is sharp in nature, on the left side of her neck, and radiating down her neck to just above her shoulder. She
has not had any recent falls, has no chest pain or neurologic symptoms, and has not had a fever. Her past
medical history includes hypertension, dyslipidemia, and macular degeneration. When you examine her, you
note she has pain during range of movement to the left but can rotate her neck up to 45 degrees laterally with
pain. The rest of her neck exam is unremarkable.
a) Name the most likely cause of her neck pain.
b) Would Marge meet the criteria for the Canadian C-spine rules?
c) List two non-pharmacologic recommendations you would make.

SAMP 62
Jay is a newborn whom you have just delivered born at 37 weeks who has good tone on assessment but who has
not cried within the 30 seconds following birth. No issues were noted during his prenatal care period and he is
the first baby to his mother. No meconium was noted.
a) Would you leave Jay with routine care or move Jay to a warmer for further assessment?
After clamping and cutting the cord, suctioning, and assessing Jay after initial stimulatory measures, you notice
his heart rate is 84.
b) What immediate first step would you take?
His heart rate normalizes and Jay begins to cry after initial measures.

SAMP 63
Marcus, an 18-year old male, is a new patient of yours who has come in for an initial visit. As you conduct his
biometrics, you see his BMI is 31.2 – on appearance, he is a hefty fellow with visible adiposity collections. On
discussion, you uncover that he has struggled with this throughout his life due to a lack of a desire to exercise
and an inability to control his diet despite various attempts.
a) What type of obesity classification would you place Mark’s BMI in?
b) List three treatable co-morbidities you would assess for in Marcus.

SAMP 64
Shirley, a 52-year old female, presents to clinic for follow-up of a Colles’ fracture she sustained after slipping
on the ice a few weeks ago. You review her X-ray and note appropriate union and healing after her open
reduction, internal fixation surgery.
a) Would Shirley qualify as a candidate for osteoporosis screening?
b) List three activities that can help prevent osteoporosis.
c) Name three pharmacologic treatments for osteoporosis.

SAMP 65
Maxi, a 61-year old male, is a palliative patient of yours suffering from multiple myeloma with cardiac
amyloidosis that has caused congestive heart failure. He has come to your clinic for one of his bi-weekly
appointments. Today, he notes that he has significant pain in his arm – where you know one of his myeloma
lesions is. You decide to discuss opioid progression use. He is currently on 2mg po of morphine q6 hours. His
renal function is currently stable.
a) List two main side effects that he would notice to inform him about if you were to increase his
morphine.
b) If Maxi decides to not progress his opioid dose on a regular basis, what other pharmacologic option
could you offer?

SAMP 66
Haboo is a 57-year old male with Parkinson’s whom you have followed closely since his diagnosis a year ago.
You recall the initial stages of when you diagnosed him with the disease.
a) List three main signs of Parkinsonism.
b) You decide to re-assess Haboo’s tremor. List two characteristics of a classic Parkinsonian tremor.
c) List three common comorbid illnesses in Parkinson’s disease.

SAMP 67
Hunter is a 53-year old male who has been previously healthy. He is attending your clinic for a “general check-
up”. As you run through his chart, you decide today would be a good time to conduct a periodic health
assessment.
a) Hunter asks you about a prostate check. List two limitations of PSA screening.
b) List four causes of an elevated PSA, other than cancer.

SAMP 68
You are seeing a patient that has come to you from a colleague in another province. The patient you are seeing
comes in with a list of diagnoses including hypertension, diabetes, fibromyalgia, and substance abuse. As you
review previous charts, you also note there has been a diagnosis of obsessive-compulsive disorder. On your first
visit, you discuss these with the patient who denies that latter diagnosis and she tells you she has never been
diagnosed with this before.
a) List four traits of obsessive-compulsive personality disorder that you would want to look for/discuss
to re-confirm a diagnosis.

SAMP 69
Shaukat is a 45-year old male who you are seeing on your ED shift. He has come in with a 2-day history of
fever, productive cough worse on breathing, and chest pain. On further history, you uncover that he is a smoker,
but has had no major medical issues until now. Prior to this episode he had a cold, but was otherwise well. On
exam, he is slightly tachycardic, has normal heart sounds, has crackles in the right lower lobe, and has no
visible edema.
a) List three investigations that would be helpful supporting a diagnosis of pneumonia.
b) List three questions you could use to assess for the risk of unusual pathogens.
c) Assuming Shaukat has a community-acquired pneumonia, provide an outpatient treatment regimen
for him including the dose, route, and duration.

SAMP 70
Talia is a 4-year old girl who comes in on your ED shift with her parents who said she had escaped the house
and had been playing in the farm field where pesticide had recently been sprayed. She played in the field for
about 5 minutes before her parents noticed she had slipped through the front door. This occurred 1 hour ago. On
exam, she appeared normal as did her vitals. On presentation she was asymptomatic.
a) List the toxidrome associated with insecticide exposure.
b) List three symptoms associated with this toxidrome.
c) What would be the most important initial intervention after a primary survey?
d) Who would you call to assist you in this scenario?
SAMP 71
Celina, a 21-year old female, comes to your clinic for a visit to discuss her plans for pregnancy. She is sexually
active with protection, but has discussed plans for children with her partner. She has had no complicated
medical history.
a) List three potential high-risk lifestyle factors you would want to assess for.
b) List one pharmacologic recommendation you would make for her in the pre-pregnancy period.
c) If Celina had been sexually active and trying for pregnancy, at what time period would you be
concerned about infertility?

SAMP 72
Johann, a 56-year old male, is a clinic patient of yours who you have been following for five years now. He had
prostate cancer at that time found by an elevated PSA that was further investigated. Having been treated with a
radical prostatectomy with brachytherapy, he is now having his PSA regularly monitored for any increase.
a) List two potential post-surgical complications you would want to check in with Johann about at this
stage.
b) List four symptoms that would cause you worry about potential recurrence.

SAMP 73
Alissa, a 17-year old female, comes through on your ED shift in tears. Her nursing triage note simply says
“assault – will not speak until privately seen by the doc”. When you walk into the room, you find Alissa in tears
– she discloses to you that she was just raped by an unknown man while returning to her university dorm. She
struggled and escaped and came straight to the ER on the advice of her friend.
a) Should you a) take a medical history, b) take an investigative history, or c) do both?
b) List four signs you would assess for on physical exam, specifically in a rape/sexual assault case aside
from vitals.
c) List five laboratory investigations you would order.
d) Assuming Alissa is immunized for Hepatitis B, list two antibiotics you would prescribe for STI
prevention – give the name, dose, route, and duration.

SAMP 74
Kobe, a 32-year old female, is seeing you for a one-day history of a painful left eye that started yesterday
evening. She feels her visual acuity is intact, but has noted no discharge or bleeding, yet she finds her eye to be
quite painful feeling as though “something is stuck on my eye”, especially when closing her eye. She has no
past medical history or allergies and no trauma was noted. She feels otherwise well. When asked about when
this started, she noted no change in her daily routine, but did mention she wears contacts regularly. On exam,
the eye looks normal on initial inspection without a slit lamp and no discharge is seen.
a) List one method you would use to assess visual acuity.
b) List one type of assessment that is most likely to lead to the diagnosis in this case.
c) Would an X-ray or CT be indicated for Kobe?

SAMP 75
Yeemra, a 20-year old female, attends your ED shift with her mother who has concerns about her state of being
lately. She notes that Yeemra has become quite reserved lately and that she is often jerking her head as if she is
looking at or seeing something for seconds at a time. On one occasion after such an episode, she was found to
have suddenly starting cleaning already clean dishes and on another occasion, she began picking up garbage
while on a walk outdoors. Today, Yeemra began yelling for “Pine Sol” and became unsettled when none was to
be found. She began screaming at her mother to obtain some immediately; when her mother told her she did not
have the car, Yeemra took a bucket of water and spilled it all over her room floor. At that point, EMS was
called to bring Yeemra in. Prior to your arrival, she had attempted to strike her bedside nurse whilst agitated.
a) List three symptoms/signs used in the DSM-V diagnostic criteria for schizophrenia.
b) Name a common cause of psychosis that is not schizophrenia, but also present alongside it.
c) List one non-pharmacologic treatment modality in patients with schizophrenia.
d) If you were to start Yeemra on an antipsychotic, list two side effect categories.

SAMP 76
Nir, a 1-year old male, is a patient that has come into the ED having had three seizures in the past 24 hours. His
first seizure ever occurred yesterday, at which point he came to the ER and was discharged home with a
diagnosis of febrile seizure, but overnight he had two subsequent generalized tonic-clonic seizures that lasted 2
minutes in length each. Up until now, he has been healthy; had a normal term birth with immunizations being
up-to date; and has been developmentally normal. When awake, he is eating, drinking, urinating, and playing as
usual although he has become progressively more tired after each seizure.
a) Nir begins to have a seizure in the ED. List three management steps you would take.
b) List three investigations you would order on Nir aside from bloodwork.

SAMP 77
Salim, a 61-year old male, presents to your clinic with complaints about “not being able to get it up as he used
to”. On further discussion, you note that Salim has difficulty obtaining and maintaining an erection for sexual
activity – this has been a gradually progressive problem over the years. He wakes with a half-erect morning
erection and has normal size testes and pubic hair on examination. When discussing about his relationship with
his wife, he has no concerns and no stressors otherwise. Medically, Salim is on telmisartan and amlodipine for
blood pressure and atorvastatin for dyslipidemia. He does not use alcohol or recreational drugs, but is a smoker.
He has had no surgeries and is otherwise well.
a) For how long would Salim have had to have this problem for you to be concerned?
b) What is the most likely medical diagnosis causing of Salim’s erectile dysfunction?
c) List two other contributors to his erectile dysfunction on history.
d) List one pharmacologic medication you could provide for his erectile dysfunction – give the name and
dose.

SAMP 78
Champagne, a 27-year old female, presents to your clinic with a 1-day history of fever and lower abdominal
pain (left worse than right) with an increase in vaginal discharge. Previous to this she had been otherwise
healthy – however, she had had numerous investigations for sexually transmitted infections due to her self-
declared practice of not using protection whilst engaging in sexual activity. Her partners include both men and
women, and she has, on average, approximately 7 per year.
a) List three likely diagnoses you would need to rule out aside from pelvic inflammatory disease.
b) Name one physical exam finding that would increase your suspicion of pelvic inflammatory disease.
c) If found to have pelvic inflammatory disease, what pharmacologic treatments would you administer?
Provide the regimen, dose, and duration.
d) Under what conditions would you need to contact public health about her state?

SAMP 79
Summer, a 30-year old female, brings you a concern of small bumps she noticed on her cheeks and forehead
that are accompanied by redness. She has had this before – this started over the past year – but things have
gotten worse lately. She notes that the lesions are not painful, that the redness often comes and goes, but that her
main concern are the bumps she noticed. She has a history of hypothyroidism and has had an appendectomy,
but no other concerns.
a) List five areas of the body you would inspect in patients complaining of a skin disorder.
b) List the three most likely diagnoses in this case.
c) You make the diagnosis of papulopustular rosacea. List one pharmacologic treatment option.

SAMP 80
Chip, an 80-year old male who is a regular in your practice, comes into your clinic today wanting to finally quit
smoking. He has a history of a STEMI five years ago, hypertension, diabetes (non-insulin dependent), and
chronic obstructive pulmonary disease.
a) List four preparatory tasks you could advise Chip to do in advance of quitting.
b) List three pharmacologic options for Chip to consider.
c) Are concurrent multiple pharmacologic therapies a possibility for smoking cessation?
SAMP 81
Marleau, a 21-year old female, is coming to you for a return visit regarding a pain in her left arm that she has
seen you for previously. She is an avid baseball player (pitching with her right arm) but noticed this pain in her
left arm two weeks after a particularly challenging training camp after which her life became very stressful. The
arm has been X-rayed and assessed by both you and the sports medicine physician, but no specific cause has
been found. The pain has a sharp and intermittent character with no reliable pattern to it; it ranges in severity
from nothing at all to a 7 out of 10 at its worst. Marleau is becoming increasingly distressed by it and is worried
that if it is unsolved, it may affect her ability to become a league pitcher. She has also noted that she feels a
similar pain in her belly and right leg at times; this started shortly after the initial pain arose; however, these
have not had any specific investigation. She comes to your office weekly to chat about the arm. Marleau has no
pertinent medical history.
a) List three potential non-pharmacologic therapies that may be useful for Marleau.
b) Would you conduct any further medical investigations at this point for Marleau?
c) What is the most likely source/main contributing factor to the pain Marleau is experiencing (hint: not
looking for the medical disorder here)?

SAMP 82
Shinjar, a 72-year old male, comes in on your ED shift with a complaint of left arm weakness and left-sided
facial drooping that began 30 minutes ago while he was sitting on the couch. He was immediately brought to
hospital by his wife who noticed his symptoms. He has a past history of hypertension and dyslipidemia, for
which he is on therapies for, but has had no complications of these to date.
a) List four potential diagnoses.
b) What is the most important test to conduct initially?
c) Assuming you are certain that there is no intracranial bleed, what is the general time frame under
which you would want to administer a thrombolytic?
d) List three initial laboratory investigations you would order prior to administering a thrombolytic.

SAMP 83
Emmett is a 31-year old male in your practice who is known to abuse alcohol. At a regular periodic check-up,
you are surprised when he brings up the topic of quitting use. He asks you if there are any tools that can help
him do so. He is still currently drinking heavily and has not yet stopped.
a) List two general co-morbidities you would want to assess for before initiating a therapy plan.
b) Name the one pharmacologic category that would be used to transition him to a treatment plan.
c) List three pharmacologic therapies you could offer after b).
SAMP 84
You are once again seeing a 65-year old female, Bodette for follow-up of depression. She is currently on
sertraline 25mg po daily and has been on this dose for 6 months. You recall that at her initial visit she has
mentioned thoughts of harming herself.
a) List four things you could ask her about suicidality that would help you assess the degree of risk of her
suicidal ideation.
b) List four general risk factors for suicidal tendency.
c) Bodette tells you she still has thoughts but has no plan and no means. What is one thing you could do to
manage her safely?

SAMP 85
Ertiog, a 31-year old female complaining of fatigue, presents to your office with symptoms of weight gain,
feeling cold, and not feeling as energized as usual. She is curious to know whether or not it is her thyroid that is
causing the symptoms. She has generalized anxiety disorder, but has no other medical conditions. She is certain
she is not pregnant and is not currently sexually active.
a) List four other thyroid-related symptoms you would want to ask Ertiog about.
b) List three risk factors for hypothyroidism.
c) You order a TSH and it comes back as 6mIU/L but she has a normal T4 yet is still symptomatic.
Would you treat her for hypothyroidism?

SAMP 86
Levi is an 18-year old male who just graduated high school and who has decided to go on a trip to Mount
Kilimanjaro in Tanzania. He has come to your clinic for travel advice and wonders if it is safe to climb it. He is
a healthy male.
a) List four common pieces of advice you would offer with respect to infectious disease prevention.
b) What is the altitude level at which altitude sickness can occur?
c) On his trip, Levi encounters diarrhea lasting <24 hours that is watery and associated with cramping
and mild pain. List two diarrhea-related circumstances under which he should consider taking
antibiotics.
d) If Levi were to experience mountain sickness, list one pharmacologic and one non-pharmacologic
treatment he could use.
e) If Levi were to experience altitude-related sickness, aside from a neurologic exam, what system would
you want to expect to potentially find abnormaities?
SAMP 87
Meeple, a 3-year old male, comes to your clinic with a sore throat over the past 24 hours. He has not had any
fevers, is eating and drinking slightly less than usual, but is still urinating and stooling well. He has not had a
cough, but has had mild rhinorrhea on and off over the past month. He has had an uncomplicated history,
normal birth, and is immunized up to date. When you look in the back of his throat, you notice white exudate on
the top of his left palatine tonsil. You also notice anterior cervical lymphadenopathy on the same side on
physical exam.
a) What is the most likely diagnosis?
b) Would you prescribe an antibiotic, if so, list the name, dose, and duration?
c) What test would you do prior to initiating any antibiotic therapy?
d) If Meeple had group A streptococcus, within how many days from illness onset would you need to treat
to prevent rheumatic fever?

SAMP 88
Xinsao, a 3-year old female, presents to the ED with fever of 38.3 degrees Celsius over the past day. She has no
respiratory symptoms, has been eating and drinking about 50% of her usual intake, and has been urinating more
frequently. but stooling as per usual. When asked about what is bothering her, she points to her belly, but she
has not vomited or had diarrhea. She has not had any similar episodes before and has had normal development
up until now with a normal birth history and immunizations. On examination, no other finding aside from
discomfort when you touch her lower abdomen. She is conversant during the exam, but resting in her mother’s
lap.
a) What is the most likely diagnosis?
b) What two investigations would be the most helpful in this scenario?
c) If found to have the most likely diagnosis, is any further testing indicated?

SAMP 89
Maurice, a 48-year old man, was diagnosed with the common cold two weeks ago in your clinic. His sore throat
and cough have now settled, but he is continuing to have sinus congestion that is accompanied by purulent
discharge to the amount of a half-cup daily.
a) What other symptoms might suggest an acute bacterial sinusitis – list three?
b) Is it a necessity to treat acute bacterial sinusitis with antibiotics?

SAMP 90
Ngomsi, a 24-year old female, comes to your clinic complaining of vaginal bleeding that started this morning
after waking. The bleeding is painless, now controlled, and associated with the passage of two dime-sized clots.
Ngomsi is feeling worried, but is not nauseated and has not vomited. She feels otherwise well. Her past medical
history includes gestational hypertension and oligomenorrhea. She is not on any medications. She lives with her
husband and 2-year old daughter.
a) Assuming Ngomsi is stable, what is the single most important test to conduct at this time?
b) List four potential causes of her vaginal bleeding.
c) On examination, you notice no diagnostic clues aside from a slightly open cervical os. What is your
diagnosis?

SAMP 91
Eloise, a 19-year old female, presents to your clinic with a complaint of vaginal discharge. She noticed it
approximately two weeks ago and is concerned about its odour. This has happened before to her and she recalls
being given a pill that made it go away. She describes the discharge as clear and runny with a fishy scent and
notes no bleeding. She is not sexually active and never has been. She has no other medical conditions and her
last menstrual period was two weeks ago.
a) What is the most likely diagnosis?
b) You conduct a speculum exam and note the exact same as the patient describes. What investigation
would you require, if any?
c) List one treatment regimen giving the dose and duration.

SAMP 92
Newbie, a 2-week old infant, was born via vaginal delivery (as per your hands) at a weight of 2800g at 37
weeks to a G1P0 mother with no complications. Newbie is in a for a well-baby visit and her parents have no
concerns at this time.
a) What should Newbie’s approximate weight be at this point?
b) You hear that Newbie is exclusively breastfeeding. What additional recommendation would you make
with respect to oral intake for complete nutrients at this stage?
c) Newbie’s mother asks how many diapers she should be having at this stage – what would you say?
d) List three non-pharmacologic safety recommendations you would suggest to Newbie’s mom at this
time.

SAMP 93
Sabina is a 26-year old patient in your practice with Celiac disease. She has come to your clinic to discuss the
new diagnosis (only 1 month ago). She is already on a gluten-free diet, but has questions for you about the
implications of the disease.
a) List three complications of Celiac disease.
b) List three risk factors that you would run through, which you can explain to Sabina.
c) Name the main treatment modality of Celiac disease.
d) In addition to the anti-transglutaminase level, what marker would you look for to help you ensure you
have the correct diagnosis?

SAMP 94
Al, a 34-year old male, is a patient unknown to you who comes in on your ED shift complaining of pain in his
testicles; specifically his right testicle. The pain started yesterday and has been steady; it is an uncomfortable
ache accompanied by a sensation of swelling. A couple hours ago, he began to feel warm but did not measure a
temperature. He is urinating and stooling as per usual with no lower abdominal pain. He is sexually active with
a partner whom he has been with for four years, but he continues to use protection. He has had no medical
history aside from musculoskeletal injuries at work and is fully vaccinated. On examination of the testicle, it
looks slightly swollen and is tender to touch when you palpate the posterior upper left testicle.
a) What three conditions would you want to rule out (not including an STI)?
b) What is the most likely diagnosis?
c) Name the top two laboratory investigations you would conduct.
d) What complication should you warn Al about?

SAMP 95
Henry, a 75-year old male, is in for follow-up regarding his benign prostatic hypertrophy. Since the age of 65,
Henry had gradually progressive frequency and worsening nocturia until he was started on tamsulosin 0.4mg
daily five years ago. Since then, he has had reductions in the number of times he urinates. Today, he wonders if
there is anything he can do to improve his flow. He does not have any pain, fever, or worrisome symptoms. On
a recent visit, you conducted a post-void residual, which was 125cc. His last PSA, 2 years ago, was normal.
a) List two non-pharmacologic recommendations to improve his urinary control.
b) List two pharmacologic recommendations you could suggest.
c) Name two complications of benign prostatic hypertrophy.

SAMP 96
Ernest, a 51-year old male, is in your clinic for a prescription refill. As you chat with him about his gabapentin
for his sciatica, you notice that he has a tremor when he reaches out to you with either hand, especially with
movement of his wrist. The tremor disappears at rest and only occurs with voluntary movement; it does not
appear to be affecting his legs or any other part of his body. His recent bloodwork proved a normal Hb, TSH,
and liver function tests. He does not complain of any specific muscle weakness, gait changes, vision or speech
changes, or vertigo and had not noticed the tremor before.
a) Name the type of tremor he has.
b) If you noticed a convincing abnormality on physical exam, what would be the single most important
investigation to conduct initially?
c) List two possible medications you could consider for Ernest.
SAMP 97
Kamen is a 14-year old male who comes to visit you due to facial acne that had started a few months ago. He
has seen you previously, but at the time did not want to start any medication or topical agents aside from a
benzoyl peroxide wash, which has had minimal effect. Now, he is noticing both facial and upper back acne and
is worried about it affecting his social status at school. On examination, he has ~35 papules and pustules, with
~75 lesions overall. None appear infected. He is otherwise healthy.
a) List three other items on the differential for acne.
b) List two complications of acne.
c) List two potential medication categories you would consider for Kamen.
d) If Kaden was a female, what other treatment option would you consider?

SAMP 98
Roland is a new immigrant to Canada from Cameroon who attends your clinic after initial bloodwork was done
for general health tracking – this is his first set of bloods in Canada. He reports a past history of having had
childhood asthma and appendicitis as a child for which he received an appendectomy. He reports being
otherwise healthy and feels well today. He is a smoker and drinker, especially on weekends. You note a normal
Hb, WBC, creatinine, and electrolytes, but uncover an AST of 97 and an ALT of 69. The rest of his liver
enzymes are normal. On physical exam, his cardiac, pulmonary, and abdominal exam are unremarkable.
a) List three likely causes of this pattern of hepatocellular hepatitis aside from viral hepatitis.
He tells you that he has never had problems in the past and that no one who he traveled with to Canada is ill. He
is loyal to his wife and has only ever had sex with her; on previous STI testing three years ago, they both had a
fully normal screen. You note that his BMI is 24.
b) Based on Roland’s history, what is the most likely cause of his hepatitis?

SAMP 99
Shania, a 29-year old female in your practice, has continued complaints about abdominal cramping and chronic
diarrhea (this is now the third month) accompanied by right lower quadrant pain. She is new to your practice
and has moved from Saskatchewan recently. Her diarrhea appears to be continual with no days of reprieve; her
abdominal pain is crampy, worse in waves, and not relieved by defecation. She is not sure if her diarrhea is
bloody or watery. She is not sexually active and had her last menstrual period one week ago. Otherwise, she is
not on any medications aside from Tylenol and her family history is notable from breast cancer in her
grandmother, diabetes in her father, and depression in her mother. Her vitals are stable.
a) List four potential causes of her chronic diarrhea.
b) Your initial bloodwork demonstrates a mildly low Hb, normal WBC, normal LFTs, and normal
kidney function. An ultrasound of the abdomen proves normal. What would be your next step in
diagnosis?
c) You uncover an inflammatory bowel disease. Name three differences between how Ulcerative Colitis
and Crohn’s affect the body.

SAMP 100
Jonah, a 50-year old male with a history of a myocardial infarction two months ago, presents to your emergency
room with worsening shortness of breath, particularly when lying down. He reports that he wakes up on
occasion at night feeling as though he cannot breathe. He has also been more fatigued lately. He was seen by his
family doctor recently who sent him for a sleep study, which came back negative for obstructive sleep apnea.
He does not have any pain, hemoptysis, gastrointestinal distress, or constitutional symptoms, but has had a
cough recently since his shortness of breath has progressed. He also thinks he has gained about five pounds in
the past month, particularly in his legs.
a) Name the most likely diagnosis.
b) Name the six complaints within the stem that support the diagnosis.
c) List one laboratory investigation that would help confirm your diagnosis if significantly elevated.
d) List two imaging investigations that would help you confirm the diagnosis.
e) You order an echocardiogram for Jonah and uncover that his ejection fraction is 35%. List three
medication classes you would want to make sure are part of his therapy.
f) If Jonah continues to decline with his ejection fraction despite maximal medical therapy, what two
other therapies would you consider?

SAMP 101
Amy, a 27-year old female, presents to your clinic with a complaint of pain that has been occurring in the past
year – the pain is located in multiple regions including her neck, left elbow, lower back, and thighs. She has not
had any fevers, recent illnesses, bowel problems, or weight loss, but has felt quite fatigued. She has a past
history of insomnia and migraines, but has been otherwise healthy. She has no family history of any particular
diseases. She does not use alcohol or drugs and does not smoke. Her physical exam is unremarkable aside from
tenderness in the aforementioned regions.
a) Name the most likely diagnosis.
b) Given that this is the first you have heard of Amy’s symptoms, list five laboratory investigations you
could to do help you rule out more worrisome etiologies.
c) Name one pharmacologic class of medication that could be useful in Amy’s situation.

SAMP 102
Gertrude, a 91-year old female, is on your list as a palliative care patient. Gertrude has multiple myeloma with
various lytic lesions in her bones causing her to have bony pain ranging from 5-10 out of 10 throughout the day.
a) You are thinking about initiating an opioid medication for Gertrude. What physiologic complication of
her disease would you worry about in selecting an opioid dose amount and frequency?
b) You decide to place Gertrude on hydromorphone 2mg IV every 6 hours to start. How much stronger is
hydromorphone than morphine?
c) Gertrude begins to change her behaviour and way of being shortly after being started on the
medication. List four signs of opioid neurotoxicity.
d) List three management steps in dealing with opioid neurotoxicity.

SAMP 103
Kronika, a 62-year old lady comes into your clinic for follow up of her chronic kidney disease. She is about to
go on a vacation to Thailand and wants to do a final check-in before her 2-week trip. Her past history includes
hypertension, type 2 diabetes, depression, and osteoarthritis. Her most recent GFR is 40, unchanged from her
chronic baseline. She currently is on perindopril, atorvastatin, metformin, escitalopram, and acetaminophen.
Recently, due to a knee pain flare up, she has also been taking ibuprofen.
a) Based on this patient’s history, list the two most likely causes of her chronic kidney disease.
b) List the single medication concern you have about this patient’s current medication list.
c) Name two regular medications you might hold if she becomes ill on the trip.
d) Name the single most important piece of non-pharmacologic advice you would give this patient for her
trip.
e) List five complications of kidney disease you would want to watch for in this patient as her kidney
disease progresses.

SAMP 104
Rosenthal, a 60-year old female, presents to your clinic complaining of a sudden rash that erupted on her arm
yesterday during her daytime walk. The rash was red, itchy, and caused raised marks on her skin, but now has
disappeared. She did not have any difficulty breathing, gastrointestinal symptoms, or any sense of feeling faint.
She did mention that this has happened before in her life, but resolved on its own and had not been present for
years until this past month, when it has now occurred twice. There is no obvious trigger that she is aware of.
She is otherwise healthy, but is a smoker.
a) Name the most likely diagnosis.
b) List five pertinent questions you would ask in your diagnostic approach.
c) If this episode were to occur again, name one pharmacologic class of medication that would be useful
for her.

SAMP 105
Carolyn, a 64-year old female, presents to your clinic with a lesion on her left cheek that has been growing over
the past year – it has increased by about 25% in size over that time frame. She has not had any pain, itch,
discharge, or spreading redness of the lesion and has not had any previous similar lesions on her body. Her past
history includes abnormal uterine bleeding that was treated with a hysterectomy as well as a cholecystectomy
for acute cholecystitis, both of which were performed in Arizona where she spends her winters. The lesion is a
well-circumscribed nodule, glossy in appearance, and has a visible vessel within it. It is non-blanchable.
a) What is the most likely diagnosis?
b) What risk factor, on history, predisposes her to these types of lesions?
c) List three possible treatments for this lesion.

Lightning Round Questions

1. Which two rhythms are non-shockable in ACLS?
2. In a patient with a likely allergen exposure, what two signs are needed for anaphylaxis diagnosis?
3. In a patient with longstanding microcytic anemia, what are five potential causes?
4. Which antidepressant class can cause hypertension?
5. What is the most common type of thyroid cancer?
6. What is the first line treatment for syphilis?
7. What are two first line treatments for ADHD patients?
8. What are three topical treatments for rosacea?
9. What is the first line treatment for C. difficile?
10. List three possible medications, as per the Canadian Adult Obesity Guidelines, for obesity treatment?
11. What are two contraindications for buproprion?
12. Which SSRI antidepressant, ideally, should you not use in pregnancy?
13. You have an obese pregnant patient whose BMI is 32 already on prenatals and iron. What medication
should you initiate?
14. What two drugs are approved for alcohol use disorder in Canada?
15. You have a heart failure patient who reports difficulty climbing a single flight of stairs. What NYHA class
is he?
16. When you start an opioid medication, what other medication class should you always initiate in the elderly?
17. When starting a drug, what is the time frame in which SJS and TEN usually occur?
18. Your patient has true vertigo lasting seconds with particular movements of their head. What is the most
likely diagnosis?
19. What test should you order for a patient with unilateral, pulsatile tinnitus?
20. What two medications can you consider for a patient with orthostatic hypotension?
21. List the four most likely sources of a chronic cough with no red flags.
22. Which four medications are used in non-bismuth quadruple therapy for H. Pylori?
23. What five laboratory investigations should you monitor for a patient on isotretinoin?
24. What is the main modality of management for rotator cuff disease?
25. As per the Canadian Diabetic Association guidelines, what is the A1c cut-off for when you would want to
start metformin?
26. What is the general unadjusted MMSE cut-off for normal cognitive function?
27. What is the general unadjusted MOCA cut-off for normal cognitive function?
28. You have a patient newly diagnosed with atrial fibrillation. This patient’s past history includes replacement
of the mitral valve. What anticoagulant would you prescribe?
29. What is the most common bug found in skin abscesses?
30. At what time in pregnancy do you conduct a first trimester screen?
31. List five etiologies of atrial fibrillation.
32. What is the target heart rate in atrial fibrillation patients?
33. List three risk factors for asthma.
34. According to the Canadian pediatric society, list three criteria for diagnosing asthma in a child less than six
years old.
35. What duration of symptoms does a patient have to have in order to be diagnosed with generalized anxiety
disorder?
36. After initiating treatment for a simple pneumonia, after how long should the patients symptoms improve?
37. What are two critically important investigations in any first trimester bleeding cases?
38. List the CENTOR criteria.
39. You have a patient with sinusitis that has lasted ten days, has not improved, and is accompanied by
maxillary tenderness on percussion. Name the treatment, dose, and duration if the patient has no allergies.
40. Patients with this condition should not receive antipsychotic medications.
41. What imaging test would you order in a child with suspected non-accidental injury?
42. What is the transfusion threshold for healthy patients?
43. What organism is worrisome for triggering a rheumatic fever?
44. What is the best imaging test for a renal stone?
45. Name three complications of peptic ulcer disease?
46. What vaginitis cause presents with clue cells on microscopy?
47. According to Choosing Wisely Canada, what imaging test is indicated for individuals with mechanical back
pain?
48. What percentage of patients outgrow a penicillin allergy after 10 years?
49. What sign, in a trauma case, should trigger you to assess the urethra before placing a catheter?
50. What diagnoses are you screening for with a maternal serum screen?
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SAMPS Answers

SAMP 1 Answer Key

a) Ectopic pregnancy, appendicitis, abdominal aortic aneurysm, obstruction, ovarian torsion.
b) Serum beta-hCG, pelvic ultrasound, transvaginal ultrasound.
c) WinRho or Rh immune globulin.

SAMP 2 Answer Key

a) Bleeding, vomiting, dysphagia, weight loss, night sweats, severe fatigue, chest pain, shortness of breath.
b) Proton pump inhibitors, H2-blockers.
c) Weight loss, do not/stop smoking, reduce alcohol, reduce any of spice/coffee/fats/peppermint, do not eat before bed, eat small
volumes, and sit upright after meals.

SAMP 3 Answer Key

a) No breathing, no pulse.
b) Asystole, pulseless electrical activity.
c) Shock the patient (200J biphasic or 360J monophasic).
d) Epinephrine 1mg.
e) Blood pressure and oxygen saturations.

SAMP 4 Answer Key

a) Epinephrine 0.01mg/kg IM.
b) Steroids/glucocorticoids, antihistamines, beta-agonist.
c) EpiPen prescription and locations to place them in, the potential for delayed reaction, advice on how to use the EpiPen, the
diagnosis of anaphylactic allergy.

SAMP 5 Answer Key

a) TSH, Hb, MCV, Na, K, B12, glucose, ferritin, iron, TIBC, iron saturation, ALT.
b) Thalassemia, iron deficiency anemia, anemia of chronic disease, lead poisoning, sideroblastic anemia.
SAMP 6 Answer Key
a) Community-acquired pneumonia, acute heart failure exacerbation, COPD exacerbation, pulmonary embolism, myocardial
infarction, flu, viral URTI/LRTI.
b) Chest X-ray, WBC, CRP.
c) Ceftriaxone 1-2g IV x 5-10 days + azithromycin 500mg po daily x 3 days; levofloxacin 750mg po/IV daily x 5 days; doxycycline
200mg po then 100 mg po bid x 5d (more for outpatients), amoxicillin 1g po tid x 5-7 days (more for out patients). Variations exist.

SAMP 7 Answer Key

a) Panic attack/panic disorder, generalized anxiety disorder, cardiac arrythmias, hyperthyroidism, myocardial infarction, pulmonary
embolus, any valve disorder, pericarditis, congestive heart failure, syncope, hypoglycemia, stimulants.
b) Sweating, trembling, unsteady, depersonalization/derealization, tachycardia, nausea, SOB, fear of death, sensation of
choking/chills/chest pain.
c) 6 months.
d) Selective serotonin reuptake inhibitors, selective serotonin-norepinephrine reuptake inhibitors, norepinephrine-dopamine reuptake
inhibitors, tricyclic antidepressants; and cognitive behavioural therapy.

SAMP 8 Answer Key

a) Dust, mites, cold, pets, exercise, pollution.
b) Allergic rhinitis, atopic dermatitis.
c) Beta-agonists, short-acting anticholinergics, glucocorticoids, inhaled corticosteroids, oxygen, vasodilators/bronchodilators (e.g.
magnesium sulfate).
d) Education, trigger avoidance, regular follow-up, smoke and pollution avoidance, exercise, weight reduction, cleaning.

SAMP 9 Answer Key

a) ECG.
b) Myocardial infarction, congestive heart failure, alcohol (or illicit drug use), hyperthyroidism, pulmonary embolus.
c) First-time onset of atrial fibrillation within 48 hours.
d) Beta-blockers, calcium channel blockers (dihydropyridine and non-dihydropyridine).
e) Warfarin given her valvular heart disease.

SAMP 10 Answer Key

a) Invite her to bring along family, set up an in-person appointment, set up an appropriate length appointment for her, ensure privacy.

SAMP 11 Answer Key

a) Change positioning/allowance of pacing in the classroom, maintaining routine, using reward systems for good behaviour, removing
distractions.
b) Methylphenidate 10mg qam po daily; amphetamine 5mg qam po daily; lisdexamfetamine 20mg po qam daily.
c) Substance use, functional impairment, home environment, medications, past medical history, mood screening, hearing issues, vision
issues.

SAMP 12 Answer Key

a) Fibrocystic change, fibroadenoma, cyst, papilloma, cancer, swollen lymph node, phylloides, abscess.
b) Fibrocystic change.
c) Breast ultrasound.
d) Breast mammography.

SAMP 13 Answer Key

a) Blood pressure, BMI, tobacco use assessment, vaccination assessment, exercise assessment, mammography, Papanicolaou test,
fecal occult immune test (for colon cancer screening), lipid battery (for dyslipidemia screening), Framingham risk score (for
cardiovascular risk), HbA1c (for diabetes screening).
b) Blood pressure, BMI, tobacco use assessment, vaccination assessment, exercise assessment, fecal occult immune test (for colon
cancer screening), lipid battery (for dyslipidemia screening), Framingham risk score (for cardiovascular risk), HbA1c (for diabetes
screening).
c) Smoking and alcohol restraint, up-to-date vaccination, regular exercise, weight control, skin protection with sunblock.

SAMP 14 Answer Key

a) Myocardial infarction, pulmonary embolism, aortic dissection, cardiac tamponade, tension pneumothorax, esophageal rupture.
b) Age, hypertension, diabetes, smoking history, family history of heart disease, dyslipidemia, obesity, sedentary lifestyle.
c) ECG, troponin, CK.
d) Antiplatelet, anticoagulant, ACE inhibitor, beta-blocker, statin, analgesic, vasodilator.

SAMP 15 Answer Key

a) Acetylsalicylic acid 162mg-325mg po x 1.
b) 90 minutes.
c) Current bleeding diathesis, INR >1.3, recent major surgery (<2 months), active PUD, arterial aneurysm, previous hemorrhagic
CVA, CNS damage, prolonged CPR, liver dysfunction.

SAMP 16 Answer Key

a) Polydipsia, polyuria, blurry/altered vision, fatigue, diabetic foot ulcer, peripheral neuropathy, angina.
b) Nonpharmacologic: cut out the carbs/cake; meet with a dietitian, exercise; pharmacologic: start an additional oral hypoglycemia
agent (e.g. SGLT2 inhibitor, GLP1 agonist).

SAMP 17 Answer Key

a) Congestive heart failure, myocardial infarction, pulmonary embolism, malignancy, asthma, systemic infection, anemia.
b) Bronchodilator, anticholinergic, steroids.
c) Pulmonary function test, spirometry, chest X-ray.
d) Patch, gum, inhaler, lozenge, nasal spray.

SAMP 18 Answer Key

a) IUD, withdrawal, abstinence, spermicides, fertility awareness methods, sponge, diaphragm, ring, pill, injectables, implant.
b) Liver disease, active cancer, history of thromboembolism, hypertension, complicated valvular disease, age 35+ smoking 15+
cigarettes daily, multiple cardiovascular risks, migraine with aura – as per UpToDate.
c) Nausea, vomiting, unscheduled spotting, venous thromboembolism, possible increased risk of breast cancer.
d) Active pelvic infection, abnormal uterine anatomy, pregnancy, unexplained vaginal bleeding, active gynecologic malignancy.

SAMP 19 Answer Key

a) Bronchiolitis, asthma, pneumonia, foreign body aspiration, upper respiratory tract infection, influenza.
b) Bronchiolitis.
c) Fluid support, oxygen, bronchodilators.

SAMP 20 Answer Key

a) Asthma exacerbation.
b) Salbutamol 2.5-5mg neb (or 4-8 puffs via MDI) q20 mins x 3; Ipratropium 0.25-0.5mg neb (or 4-8 puffs via MDI) q20 min x 3;
dexamethasone 0.6mg/kg up to 10mg or prednisone 1mg/kg po x 1; oxygen via nasal prongs to keep saturations 92% +.

SAMP 21 Answer Key

a) Suicidality, homicidality.
b) 2 weeks.
c) Counselling/therapy, regular follow-up, exercise, safety plan.

SAMP 22 Answer Key

a) Croup, anaphylaxis, epiglottitis, bacterial tracheitis, retropharyngeal abscess foreign body aspiration.
b) Oxygen, steroids.
c) Racemic epinephrine 0.05mL/kg (max 0.5mL) of 2.25% mixed into a 3mL neb.
d) Within three days.

SAMP 23 Answer Key

a) Deep vein thrombosis, cellulitis, bruise/ecchymosis, varicosities.
b) Deep vein thrombosis.
c) Duplex doppler ultrasound of the leg.
d) New/direct oral anticoagulants or anti Xa inhibitors, vitamin K antagonists (Warfarin), low molecular weight heparins (or
unfractionated heparin).

SAMP 24 Answer Key

a) Dry mouth, dry eyes, dry skin, tachycardia, hypotension, altered level of consciousness.
b) 42mL/hr.
c) Urine output, vital signs (namely, blood pressure and heart rate).

SAMP 25 Answer Key

a) Memory/learning, executive function, language, social/personality, perceptual-motor/visuospatial, complex attention.
b) Montreal cognitive assessment (MOCA), mini-mental status examination (MMSE), verbal fluency test, mini-cog, memory
impairment screen, general practitioner assessment of cognition, short portable mental status questionnaire, free and cued selective
reminding test, 6-item cognitive impairment test.
c) Hemoglobin, WBC, TSH, B12, glucose/HbA1c, creatinine, sodium, potassium, RPR/EIA,c calcium.
d) Dressing, eating, ambulating, toileting, hygiene.
e) She must not continue to drive.

SAMP 26 Answer Key

a) Major depressive disorder, bipolar disorder, dysthymia, schizoaffective disorder, substance-induced depressive disorder, disruptive
mood dysregulation disorder, premenstrual dysphoric disorder, other specified/unspecified depressive disorder.
b) Suicidality, loss of interest, loss of energy, guilt, concentration difficulty, lack of attentiveness, perceptuomotor issues, sleep issues,
sensation of depression.
c) Exercise, therapy, ECT, transcranial magnetic stimulation.
d) Anticholinergic side effects (any), cardiac toxicity.
e) Nausea, weight gain, sexual side effects, drowsiness, fatigue, tremor. Suicide does not count.

SAMP 27 Answer Key:

a) Diabetes, urinary tract infection, constipation, psychologic stress, overactive bladder.
b) Hemoglobin A1c, random glucose, fasting glucose, oral glucose tolerance test.
c) Insulin.
d) Eyes (retinopathy), kidneys (nephropathy), nervous system/MSK (neuropathy), cardiovascular.

SAMP 28 Answer Key

a) Hydration/treat dehydration.
b) Vancomycin, metronidazole.
c) Clinical resolution. Do not accept repeat stool testing.

SAMP 29 Answer Key

a) Instability of interpersonal relationships, insecurity, impulsivity, unstable emotions, identity disturbance, abandonment avoidance.
b) Suicide.
c) Dialectical behaviour therapy.
d) Inhaled corticosteroids (any of beclomethasone up to 480ug daily, budesonide up to 1200ug daily, fluticasone up to 500ug daily,
ciclesonide up to 320ug daily, mometasone up to 440mcg daily).

SAMP 30 Answer Key

a) Falls/mobility, vision, hearing, cognitive impairment.
b) Shopping, housework, accounting, finances management, telephone usage, medication management, meal preparation.

SAMP 31 Answer Key

a) Cardiovascular, neurologic, metabolic, psychogenic.
b) No.
c) Dangerous mechanism, paresthesias, age 65+, cannot do any of ambulation/ROM/sitting/show no C-spine tenderness midline/show
delayed onset of neck pain, any of paralysis/non-trauma case, GCS <15, age <16, previous C-spine surg, pregnancy, known vertebral
disease – as per Canadian C-spine Rules.
d) No.
e) GCS <15 at 2 hours after injury, signs of/suspected basal skull fracture, vomiting 2+ times, age 65+, amnesia before impact 30+
minutes, dangerous mechanism – as per Canadian CT Head Rules.
f) Hb, Na, K, glucose, ECG, Chest X-ray, Holter Monitor.
g) Cardiology.

SAMP 32 Answer Key

a) Imminent risk of serious bodily harm.
b) Nature of violence, weaponry access, child presence/safety, trend of violence.

SAMP 33 Answer Key

a) Cystitis, urethritis, pyelonephritis, renal colic, vaginitis, cervicitis, foreign body, sexually transmitted infection, skin
irritation/cellulitis, trauma, bladder pain syndrome/interstitial cystitis.
b) Flank pain, fever, nausea/vomiting.
c) None.
d) Nitrofurantoin 50mg po qid x 5d; Macrobid 100mg po bid x 5d; Cefixime 400mg po daily for 5d; TMP SMX 1DS tab po bid x 3d;
Ciprofloxacin 250mg po bid x 3d.
e) Pregnancy, prior to any instrumentation.
f) Abnormal urinary tract pathology, pregnancy, renal failure, recent instrumentation, neoplasm, catheter present, immune
compromisation, recurrent UTIs.

SAMP 34 Answer Key

a) Epiglottitis, bacterial tracheitis, retropharyngeal abscess, respiratory distress, mastoiditis, periorbital cellulitis, meningitis,
labyrinthitis, lateral sinus thrombosis.
b) Smoking exposure, bottle feeding, sick contacts, First Nations.
c) Streptococcus pneumonia, Haemophilus Influenzae, Moraxella Catarrhalis, Staphylococcus aureus.
d) Ibuprofen 10mg/kg po q6hours (max 40mg/kd/d); acetaminophen 15mg/kg po q4hours (max 75mg/kg/d); amoxicillin 90mg/kg po
div bid x 5d or 45mg/kg/d div tid. Could consider amox-clav as well if treatment fails.
e) 24-72 hours.
f) Recurrent otitis media (>3 in 6 months, >4 in 1 year), facial abnormalities, hearing loss, anatomic issues.

SAMP 35 Answer Key

a) Hypotension, lanugo hair, dental erosions, knuckle scars.
b) Exercise, stress, anorexia, pregnancy.
c) Potassium level.
d) Family therapy in anorexia vs. CBT in bulimia (in children).

SAMP 36 Answer Key

a) Medication review (including aspirin), screening for modifiable risk factors (e.g. hearing, vision), assessing activities of daily living
and supports he has/may need.
b) Ask about the issues/talk with her, provide community resource support, schedule follow-up visits, organize/encourage respite care
if available, discuss potential placement options.

SAMP 37 Answer Key

a) IV access/IV fluids (circulation).
b) Posterior epistaxis.
c) Platelet count, prothrombin time, partial thromboplastin time, bleeding time, VWF antigen, VWF activity.
d) Anterior inferior nasal septum, Kiesselbach’s plexus, Little’s area.
e) Pressure, cautery, packing, hemostatic balloon, vasoconstrictor.

SAMP 38 Answer Key

a) Fever/chills, night sweats, weight loss, severe depression, suicidality, syncope, shortness of breath, chest pain,
melena/hematochezia, urinary symptoms.
b) Polysomnography/sleep study, depression screen (e.g. PHQ-9), TSH, iron/ferritin/TIBC/saturation index, Hb, MCV, HbA1c (any
glucose testing).

SAMP 39 Answer Key

a) Meningitis, pneumonia, pyelonephritis, sepsis/bacteremia, endocarditis, tuberculosis, measles. Many other causes.
b) Hb, WBC with differential, urine C&S, urinalysis, blood cultures, lumbar puncture, chest X-ray, glucose, CRP.
c) Fluids, antibiotics.
d) Ampicillin, ceftazidime/cefepime/cefotaxime, gentamicin, vancomycin. As per UpToDate and BugsandDrugs.

SAMP 40 Answer Key

a) Open fracture/wound, neural compromise, vascular compromise, infected wound.
b) Scaphoid fracture.

SAMP 41 Answer Key

a) IV access and fluids, proton pump inhibitor use.
b) Certain foods (e.g black licorice), iron intake, bismuth.
c) NSAID/Advil/Ibuprofen.
d) Gastroscopy.

SAMP 42 Answer Key

a) Sudden onset, worst headache experienced, accompanying neurologic symptoms, fever, neck pain, papilledema, worse in the
morning and when getting up, onset after 50, pulsatile tinnitus, precipitated by exercise, jaw claudication, vision changes, scalp
tenderness, trauma.
b) Subarachnoid hemorrhage, meningitis, traumatic head injury, temporal arteritis, intracranial tumour or mass.
c) Ibuprofen, Tylenol, Naproxen.

SAMP 43 Answer Key

a) Cirrhosis, non-alcoholic fatty liver disease, non-alcoholic steatohepatitis (NASH), hepatitis A/B/C/D/E, Budd-Chiari, biliary colic,
cholelithiasis, choledocholithiasis, abscess, tumour/cancer…
b) ALP, GGT.
c) NASH, alcoholic liver disease.
SAMP 44 Answer Key
a) Heart attack, stroke, death.
b) Yes.
c) Transaminitis, myositis, rhabdomyolysis, kidney injury (from rhabdomyolysis); CK, ALT, AST, creatinine.

SAMP 45 Answer Key

a) Caffeine, alcohol, exercise, movement, crossed legs, not having back/legs supported, poorly sized cuff, poorly placed cuff, clothing,
white coat hypertension/anxiety.
b) Coarctation of the aorta, Cushing’s syndrome/disorder, hyper/hypothyroidism, hyperaldosteronism, pheochromocytoma,
obstructive sleep apnea, renal artery stenosis, stimulants, medications.
c) Exercise, weight loss, alcohol reduction, smoking reduction, stress reduction, dietary changes.
d) Calcium channel blockers, diuretics, B-blocker.

SAMP 46 Answer Key

a) Vaccinations.
b) Infectious disease risks, nutritional deficiencies, mental health disorders, poverty.

SAMP 47 Answer Key

a) Vaccinate today, even if slightly unwell.

SAMP 48 Answer Key

a) 1 year/12 months.
b) Regular coitus (q2-3 daily, but not necessarily daily), reduce caffeine/stress/excess exercise, keep testicles cool/do not cycle, weight
optimization.
c) Polycystic ovarian syndrome (PCOS).

SAMP 49 Answer Key

a) Stress, illness, sleep habits, breathing difficulties, snoring, sleep talking or sleepwalking, limb movements, sudden episodes of
falling asleep, medications, substance use, overall mood and well-being.
b) Keep the bed for sex and sleep, no electronic devices before bed, regular routine, limit caffeine, no vigorous exercise an hour before
bedtime.

SAMP 50 Answer Key

a) Zostavax, Shingrix.
b) Valcyclovir 1000mg po tid x 7 days.
c) Once the lesions have crusted over and no new/fresh lesions exist.

SAMP 51 Answer Key

a) Yes.
b) Send him to the ER via EMS.
c) Aspirin.
d) Antiplatelet, B-blocker, and anticoagulant.
e) Age, dyslipidiemia, obesity, hypertension, family history, lifestyle, diabetes

SAMP 52 Answer Key:

a) Fever, night sweats, trauma, jaw pain/vision loss/scalp tenderness, unprotected sex.
b) Is the pain worse in the morning or evening?
c) Anti-inflammatories, disease modifying anti-rheumatic drugs, analgesics.
d) Erosions.

SAMP 53 Answer Key

a) Neurologic compromise, vascular compromise, flexor tendon injury, fracture, foreign bodies.
b) Yes.
c) Pus, redness, swelling, pain.

SAMP 54 Answer Key

a) Attention deficit hyperactivity disorder.
b) Hearing, vision.

SAMP 55 Answer Key

a) Diet, exercise, alcohol intake, tobacco intake, recreational drug usage, sleep, safe sex, injury prevention.
b) Motivational change/his motivations for doing so, what he might think is realistic for him, why he is not exercising, his financial
state.

SAMP 56 Answer Key

a) 8.
b) i) Any suggestion providing oxygenation/assessing airway patency; ii) ventilation (e.g. intubation), iii) stop laceration
bleeding/pressure.
c) Hemoglobin.

SAMP 57 Answer Key

a) Fever, chills, night sweats, severe depression, suicidality, syncope, shortness of breath, chest pain, melena/hematochezia, urinary
symptoms.
b) Hb, WBC, any lytes, TSH, Cr, BUN, any glucose measurement, TSH, any of the LFTs, HIV serology, CRP.

SAMP 58 Answer Key

a) Saddle anesthesia, fecal incontinence, urinary retention, neurologic symptoms (e.g. paresthesias, muscle weakness), trauma, cancer
history, IVDU, chronic disease, constitutional symptoms (fever, weight loss, night sweats).
b) Continue being active.
c) Analgesics, muscle relaxants.
d) 6 weeks.

SAMP 59 Answer Key

a) Alcoholism.
b) CT then LP (if CT normal).
c) Yes.
d) Bacteria.
e) Public health.

SAMP 60 Answer Key

a) Hot flashes/flushing, sleep issues, skin changes, mood changes, urinary incontinence, sexual dysfunction, cognitive issues,
palpitations, headache.
b) Pregnancy, liver disease, previous thromboembolism, cancer, cardiovascular disease, dyslipidemia, migraine with aura, unexplained
vaginal bleeding.
c) 5 years.
d) Replens as needed, Premarin 0.625mg cream nightly for 2 weeks then 1-2x/week, vagifem 1 tab (10 or 25mcg) pv nightly for 2
weeks then 1-2x/week; estradiol cream 100mcg/g daily x 2 weeks, then 1-2x/week; estradiol ring (estring) 1 ring q3mo. Doses vary
slightly.

SAMP 61 Answer Key

a) Osteoarthritis/musculoskeletal pain.
b) No.
c) Physiotherapy, massage, continued activity.

SAMP 62 Answer Key

a) Move Jay to the warmer for resuscitation.
b) Initiative positive pressure ventilation.

SAMP 63 Answer Key

a) Class I Obesity.
b) Hypertension, diabetes, dyslipidemia, sleep apnea, hypothyroidism, osteoporosis (although a bit young).

SAMP 64 Answer Key

a) Yes.
b) Exercise/physical activity, reduce smoking, reduce alcohol, proper diet, Calcium and vitamin D intake.
c) Calcium, vitamin D, bisphosphonates.

SAMP 65 Answer Key

a) Constipation/GI symptoms, sedation.
b) Opioid conversion, breakthrough dose.

SAMP 66 Answer Key

a) Bradykinesia/akinesia/hypokinesia, tremor, rigidity, postural instability, orthostatic hypotension, drooling/salivation.
b) Pill-rolling, resting, 4-6Hz, stopped with movement.
c) Depression, urinary incontinence, dementia, sleep issues, drooling/salivation, constipation, orthostatic hypotension, erectile
dysfunction.

SAMP 67 Answer Key

a) False positives, inability to determine nature of detected possible cancers, inability to know exact range of “normal”.
b) Finger stimulation, prostatitis, ejaculation, urinary tract infection, age.

SAMP 68 Answer Key

a) Pervasive pattern of perfectionism; mental and impersonal control at the expense of flexibility; preoccupation with detail/lists/order;
excessive devotion to work; over conscientious – all of which impair function.

SAMP 69
a) Chest X-ray, CRP, WBC, sputum cultures.
b) Travel, exposure to TB, history of HIV, exposure to birds, aspiration, ill contacts.
c) Levofloxacin 750mg po/IV daily x 5 days; doxycycline 200mg po then 100 mg po bid x 5d (more for outpatients), amoxicillin 1g
po tid x 5-7 days (more for out patients). Variations exist.

SAMP 70 Answer Key

a) Cholinergic.
b) Defecation, urination, sweating, coughing, vomiting, salivation, muscle weakness.
c) Decontamination.
d) Poison control.

SAMP 71 Answer Key

a) IV drug use, domestic violence, smoking, inactivity/being sedentary, alcohol consumption, poverty.
b) Folic acid intake/prenatal vitamins.
c) 12 months.

SAMP 72 Answer Key

a) Erectile dysfunction, urination issues (e.g. incontinence), psychological impact, pain.
b) Fever, night sweats, weight loss, abdominal pain, difficulty breathing, bowel routine, urinary symptoms (frequency, urgency,
dysuria, nocturia, hematuria), lumps/masses, bony pain.

SAMP 73 Answer Key

a) Take a medical history.
b) Lacerations, bruises, bleeding, signs of bodily fluid remnants, abrasions.
c) Seru, beta-hCG, urine for gonorrhea, urine NAAT/culture for chlamydia, urine NAAT/culture for gonorrhea, hepatitis B antibody,
hepatitis B surface antigen, hepatitis B core antigen, HIV serology, hepatitis C antibody, Hb, any of the liver function tests (if starting
HIV prophylaxis), syphilis VDRL/EIA, trichomonas vaginal swab for culture.
d) Cefixime 800mg po x 1 for gonorrhea + azithromycin 1g po x 1 for chlamydia. Other options exist. Metronidazole only if confirmed
trichmonas swab.

SAMP 74 Answer Key

a) Snellen chart.
b) Slit lamp exam with fluorescein looking for corneal ulcer.
c) No.

SAMP 75 Answer Key

a) Hallucinations, delusions, negative symptoms (alogia, anhedonia), disorganized speech/thinking.
b) Substance use and abuse.
c) Family intervention, life skills, cognitive behavioural therapy.
d) Extrapyramidal symptoms, metabolic symptoms, GI symptoms.

SAMP 76 Answer Key

a) Ensure secure airway, provide oxygen, place in left lateral decubitus position, remove hazardous items, provide benzodiazepines.
b) EEG, ECG, MRI.

SAMP 77 Answer Key

a) 3 months.
b) Vascular disease.
c) Anti-hypertensives, smoking.
d) Sildenafil 25-100mg po 30-60 minutes before sex; tadalafil 2.5-10mg po 1-2 hours before sex, vardenafil 5-20mg po 30-60 minutes
before sex.

SAMP 78 Answer Key

a) Appendicitis, ectopic pregnancy, pregnancy.
b) Adnexal/cervical motion tenderness, increased discharge/cervicitis.
c) Cefixime 800mg po x 1 + doxycycline 100mg po bid x 14d + metronidazole 500mg po bid x 14d.; ceftriaxone 250-500mg IM x 1 +
doxycycline 100mg po bid x 14d + metronidazole 500mg po bid x 14d.
d) Confirmation of chlamydia or gonorrhea.

SAMP 79 Answer Key

a) Hands, feet, oral cavity, perineum, scalp, nails, trunk, arms.
b) Acne, rosacea, drug/allergic reaction, folliculitis.
c) Metronidazole, ivermectin, azelaic acid.

SAMP 80 Answer Key

a) Set a quit date, tell friends/family, anticipate challenges, remove tobacco products from home, come up with a cessation plan,
research and select a treatment option.
b) Nicotine replacement therapy, bupropion, varenicline, clonidine.
c) Yes.

SAMP 81 Answer Key

a) Regular visits, psychotherapy, acupuncture, biofeedback.
b) Yes – you would want to investigate the other pains in order to rule out serious medical causes first before proceeding with a
diagnosis of somatic symptom disorder.
c) Stress.

SAMP 82 Answer Key

a) Stroke, transient ischemic attack, subarachnoid hemorrhage, brain tumour, hypoglycemia, subdural hematoma, migraine.
b) CT head.
c) 4.5 hours.
d) INR, glucose, platelet count.

SAMP 83 Answer Key

a) Substance use (other), mental health disorders, lifestyle factors (e.g. poverty, violence, stability).
b) Benzodiazepines.
c) Naltrexone, acamprosate, topiramate, ondansetron, gabapentin, disulfiram.

SAMP 84 Answer Key

a) Thoughts, means, plan, intent, any of b).
b) Single, feeling depressed, previous attempts, substance use, rational thinking loss, social supports lacking, sickness.
c) Any of suicide prevention planning; admit and observe.

SAMP 85 Answer Key

a) Cold intolerance, weakness, cognitive issues, sleep difficulty, irregular menstruation, reduced exercise capacity, constipation, facial
swelling, loss of outer third of eyebrows, dry/brittle hair and nails.
b) Age >45, family history, prior neck radiation, autoimmune disease, pregnancy.
c) No.

SAMP 86 Answer Key

a) Drink bottled water, ensure you are vaccinated, only eat food washed in tap water, wear shoes/sandals when possible, avoid quickly
ascending high altitudes, take along an antibiotic in case you need it, malaria prophyplaxis. Many others.
b) 2500m. `
c) Lasting >24-48 hours, severe symptoms, bloody diarrhea.
d) Go back down, acetazolamide, dexamethasone, nifedipine, sildenafil.
e) Pulmonary.

SAMP 87 Answer Key

a) Strep throat.
b) Yes – penicillin VK 40mg/kg/d po div bid x 10 days; could also use cephalexin, clindamycin, azithromycin, or clarithromycin.
c) Throat swab and culture.
d) 9 days.
SAMP 88 Answer Key
a) Febrile urinary tract infection.
b) Urinalysis, urine culture.
c) No, she is three years old with a first febrile UTI episode.

SAMP 89 Answer Key

a) Facial pain, sinus tenderness, loss of olfaction, fever.
b) No.

SAMP 90 Answer Key

a) Serum b-hCG.
b) Trauma, cervicitis, pregnancy, vaginitis, rectal bleeding, hematuria.
c) Incomplete abortion.

SAMP 91 Answer Key

a) Bacterial vaginosis.
b) None required.
c) Metronidazole 500mg po bid x 7 days or 2g po x 1. Clindamycin is also an option.

SAMP 92 Answer Key

a) 2800g.
b) Vitamin D 400 IU po daily.
c) 6-8.
d) Back-facing car seat (middle); safe sleeping recommendations (e.g. no blanket, sleeping on own in crib, certified crib or bassinet);
no shaking; temperature control and sun shading; adequate supervision; no honey/unpasteurized products; no smoking.

SAMP 93 Answer Key

a) Nutritional deficiency (e.g. anemia), osteoporosis, autoimmune disorders, growth failure, skin lesions, neurologic symptoms,
hepatitis, arthritis, infertility, early menopause.
b) Family history, autoimmune disorders, IgA deficiency, Down’s or Turner’s syndrome.
c) Lifelong gluten-free diet.
d) IgA level.

SAMP 94 Answer Key

a) Testicular torsion, testicular cancer, pyelonephritis.
b) Epididymitis.
c) Urinalysis, urine culture.
d) Potential infertility (or testicular atrophy).

SAMP 95 Answer Key

a) Fluid restriction, avoid irritating foods, timed voiding, Kegel’s, prevent constipation.
b) Increase tamsulosin, start 5-alpha reductase blocker, combine both tamsulosin and 5-alpha reductase blocker. Other options exist:
antimuscarinics, long-acting PDE5 inhibitors.
c) Hydronephrosis, kidney damage, urinary tract infection, bladder stones.

SAMP 96 Answer Key

a) Postural/essential.
b) CT head.
c) Primidone, beta-blocker.

SAMP 97 Answer Key

a) Rosacea, dermatitis, folliculitis, drug reaction.
b) Scarring, social issues.
c) Retinoids, antibiotics.
d) Oral contraceptive pill.

SAMP 98 Answer Key

a) Non-alcoholic fatty liver disease, non-alcoholic steatohepatitis, alcoholic liver disease, drug-related.
b) Alcoholic liver disease.

SAMP 99 Answer Key

a) Celiac disease, ulcerative colitis,. Crohn’s disease, lactose-deficiency, irritable bowel syndrome, cancer.
b) Colonoscopy.
c) Ulcerative colitis affects the rectum only, does not have skip lesions, does not often involve fistulas and strictures, and is limited to
mucosa whereas Crohn’s disease is the opposite.

SAMP 100 Answer Key

a) Congestive heart failure (+/- exacerbation of).
b) Shortness of breath, fatigue, paroxysmal nocturnal dyspnea, orthopnea, weight gain, cough.
c) B-type natriuretic peptide.
d) Chest X-ray, echocardiogram.
e) Diuretics (loop diuretic acutely, potassium-sparing chronically), ACE-inhibitor (or ARB), B-blocker. Accept angiotensin receptor-
neprilysin inhibitor, hyperpolarization-activated cyclic nucleotide-gated channel blockers (Ivabradine).
f) Intra-cardiac defibrillator, cardiac resynchronization therapy.

SAMP 101 Answer Key

a) Fibromyalgia.
b) Any five of hemoglobin, white blood cell count, C-reactive protein, erythrocyte sedimentation rate, creatine kinase, rheumatoid
factor, ferritin/iron, thyroid stimulating hormone, calcium. Alternatives may be acceptable.
c) Any of selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, anti-epileptic
agents, analgesics (any).

SAMP 102 Answer Key

a) Renal disease.
b) Five times as strong.
c) Any four of: vivid dreams, myoclonus, hallucinations, hyperalgesia, confusion, agitation, sedation.
d) Stop the medication, switch classes (and reduce dose), and provide fluid hydration.

SAMP 103 Answer Key

a) Diabetes, hypertension.
b) Ibuprofen.
c) Perindopril, metformin.
d) Hydrate.
e) Acidosis, anemia, electrolyte disturbances (specifically high potassium, low calcium, and high phosphate), intoxication issues from
medications, volume overload, uremia, immune compromisation, secondary hyperparathyroidism.

SAMP 104 Answer Key

a) Urticaria.
b) New irritants/foods/allergens? Insect exposure? Any medications? Photosensitivity? Family history? Treatments used thus far?
Constitutional symptoms?
c) Anti-histamines.

SAMP 105 Answer Key

a) Basal cell carcinoma.
b) Sun exposure/Arizona.
c) Any of: excision, cryotherapy, imiquimod, 5-fluorouracil, radiation, phototherapy.

Lightning Round Answers

1. PEA, asystole.
2. 2+ of skin/mucosal tissue involvement, respiratory compromise, reduced blood pressure, gastrointestinal symptoms.
3. Thalassemia, iron deficiency, anemia of chronic disease, lead poisoning, sideroblastic anemia.
4. Serotonin-norepinephrine reuptake inhibitors.
5. Papillary.
6. Penicillin G.
7. Behavioural management, stimulants.
8. Metronidazole gel, ivermectin, azelaic acid.
9. Vancomycin.
10. Liraglutide, naltrexone-bupropion, orlistat.
11. Seizure/CNS abnormalities, eating disorders, abrupt alcohol/benzo/barbiturate discontinuation.
12. Paroxetine.
13. ASA.
14. Naltrexone and acamprosate.
15. NYHA 3.
16. Laxative.
17. 4-24 days after the drug.
18. Benign paroxysmal positional vertigo.
19. MRI angiogram + venogram.
20. Fludrocortisone, midodrine.
21. Gastroesophageal reflux disease, asthma, post-nasal drip, upper airway cough syndrome.
22. Proton pump inhibitor, metronidazole, clarithromycin, amoxicillin.
23. Hemoglobin, ALT, creatinine, b-HCG, LDL/HDL/triglycerides.
24. Physiotherapy.
25. A1c 1.5% above target.
26. 24.
27. 26.
28. Warfarin.
29. Staphylococcus aureus.
30. 11 week -13 weeks + 6d.
31. Thyroid disorder, hypertension, embolism, alcohol/age, trauma, recent surgery, lone/age, fever, ischemia, valvular disease,
substances, heart pathology, trauma.
32. 80-110.
33. Atopy, family history, smoking.
34. Observed wheeze, observed response to bronchodilator, and ruled out other causes x 2 episodes.
35. Six months.
36. 48-72 hours.
37. B-HCG amd ultrasound.
38. No cough, tonsillar exudate, anterior cervical lymphadenopathy, fever, age <15.
39. Amoxicillin 40-90mg/kg/day po div BID/TID x 10d. Adults 500-1000mg po tid x 5-10d.
40. Lewy body dementia or Parkinson’s disease.
41. Skeletal survey.
42. 70g/L.
43. Group A Streptococcus.
44. Non-contrast CT.
45. Bleeding, perforation, obstruction, MALT lymphoma.
46. Bacterial vaginosis.
47. None.
48. 80%.
49. Blood at the urethral meatus.
50. Trisomy 18, 21, spina bifida, abdominal wall defects.

Reference List

Alberta Health Services. 2020. Bugs and Drugs. Available from: http://www.dobugsneeddrugs.org/about/

Dillon, P. and Moore, S. National Practice SAMP Exam. 2018. The Review Course.

O’Toole, D. (2020). Family Medicine Notes 2020. Edition 8.

The College of Family Physicians of Canada.(n.d.). Examination of Special Competence in Emergency Medicine Short Answer Management Problems (SAMPs).
Available from: https://www.cfpc.ca/uploadedFiles/Education/EM%20Sample%20Samps%20English.pdf

The College of Family Physicians of Canada. (n.d.) Sample Short Answer Management Problems. Available from:
https://www.cfpc.ca/uploadedFiles/Education/Sample-SAMPs.pdf

The College of Family Physicians of Canada. (n.d.) Certification in Family Medicine. Available from: http://cfpc.mcc.ca/StartPage.aspx?t=1

UpToDate. Available from: https://www.uptodate.com/contents/search.

Inspiration for some cases provided by the University of Alberta Faculty of Medicine and Dentistry teaching content for residents.