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

Lena, a 45-year-old woman, comes to your clinic concerned about her irregular menstrual cycles and frequent hot flashes. She notes that her periods, once regular, now vary by more than 7 days in length. She also reports mood swings, night sweats, and occasional sleep disturbances. She is not using contraception and is unsure if she can still become pregnant. She has no history of chronic illness but is mildly overweight. There is no family history of gynecological cancers. On physical exam, there are no concerning findings. She asks whether she needs hormone testing or imaging to understand what’s going on. (5 points)

1. Based on Lena’s history, what is the most likely diagnosis? (1 point)

• 1. Menopause
  2. Perimenopause
  3. Polycystic ovary syndrome
  4. Premature ovarian insufficiency
     
• Answer: B

2. Which of the following best describes the hormonal evaluation needed in a woman over 40 with signs of perimenopause? (1 point)

• 1. Follicle-stimulating hormone (FSH) and estrogen levels are required
  2. Anti-Müllerian hormone (AMH) levels should be measured
  3. No laboratory tests are required to diagnose perimenopause
  4. Luteinizing hormone (LH) levels are essential
     
• Answer: C

3. Which symptom is not commonly associated with hypoestrogenism during perimenopause? (1 point)

• 1. Hot flashes
  2. Heavy menstrual bleeding
  3. Memory changes
  4. Hirsutism
     
• Answer: D

4. What is the appropriate management for a 45-year-old with new-onset heavy or frequent vaginal bleeding and no obvious cause? (1 point)

• 1. Reassurance and observation
  2. Prescribe oral contraceptives without further evaluation
  3. Transvaginal ultrasound with possible endometrial sampling
  4. Start menopausal hormone therapy immediately
     
• Answer: C

5. Which statement about perimenopause and metabolic health is true? (1 point)

• 1. Metabolic decline begins only after menopause
  2. Perimenopause is associated with slower changes in metabolic markers
  3. Cardiovascular screening should be deferred until postmenopause
  4. Metabolic parameters worsen faster during perimenopause than after menopause
• Answer: D