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

Just a reminder… pay attention to the questions. Here are our general tips one more time:

1. Pay attention to the questions. Look carefully at how many items you are being asked to list. If the question asks for five items, you will not get more marks if you list eight items; the examiner will look at the first five and allocate marks only for the first five answers so be careful. On a SAMP, if it is not clearly stated how many items you should list, look at the amount of points/marks being allocated for the question to get an idea of how many answers the examiner may be anticipating you write down.

2. Do not write lengthy answers. Most questions can be answered in 10 words or less!

3. Be specific when writing down investigations (hemoglobin instead of CBC; CT abdomen instead of CT).

4. Remember that trade names and generic names are both acceptable when writing down medications.

5. For more helpful tips, you can refer to CCFP’s SAMP instructions by clicking here.

SAMP

Sarah, a 29-year-old woman, presents with irregular menstrual cycles over the past six months and a recent onset of milky breast discharge, despite not being pregnant or breastfeeding. She also notes a mild decrease in libido but denies any headaches or visual disturbances. On physical examination, she appears well, with no visual field deficits, though bilateral galactorrhea is observed. Initial blood tests reveal a negative β-hCG, normal thyroid function, and an elevated serum prolactin level of 78 μg/L. This presentation raises suspicion for hyperprolactinemia, prompting consideration of potential causes such as medication effects, macroprolactinemia, or pituitary pathology. Further evaluation is needed to determine the underlying cause and guide appropriate management. (5 points)

1. When is measurement of serum prolactin clinically indicated? (1 point)

• 1. During routine health checks for all adults
  2. In patients with erectile dysfunction, amenorrhea, or galactorrhea outside of pregnancy
  3. Only during pregnancy
  4. When prolactinomas are suspected in asymptomatic individuals
• Answer: B

2. What is considered a normal serum prolactin level in females? (1 point)

• 1. Less than 15 μg/L
  2. Less than 20 μg/L
  3. Less than 25 μg/L
  4. Less than 30 μg/L
     
• Answer: C

3. What is the recommended next step for asymptomatic mild hyperprolactinemia (20-200 μg/L)? (1 point)

• 1. Immediate neuroimaging
  2. Referral to neurosurgery
  3. Repeat testing in 2–4 weeks and evaluation for macroprolactin and pregnancy
  4. Initiation of dopamine agonist therapy
     
• Answer: C

4. Which antipsychotic medications are most likely to cause marked hyperprolactinemia (>100 μg/L)? (1 point)

• 1. Aripiprazole and clozapine
  2. Risperidone, paliperidone, and amisulpride
  3. Quetiapine and olanzapine
  4. Lurasidone and ziprasidone
• Answer: B

5. What finding requires urgent neuroimaging in the context of hyperprolactinemia? (1 point)

• 1. Fatigue and weight gain
  2. Decreased libido alone
  3. Galactorrhea during nursing
  4. Visual dysfunction, such as a field deficit or decreased acuity
     
• Answer: D