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

Sara M., a 29-year-old G2P1 at 28 weeks’ gestation, presents for routine prenatal care. She reports persistent fatigue, occasional dizziness, and shortness of breath over the past month. She had similar symptoms during her previous pregnancy but was told they were “just part of being pregnant.”

Vitals & Labs:

• BP: 108/66 mmHg
• Pulse: 92 bpm
• Hb: 98 g/L
• Ferritin: 18 µg/L
• MCV: 75 fL

You suspect iron deficiency anemia. (7 points)

1. Which of the following is a known consequence of untreated prenatal iron deficiency? (1 point)

• 1. Increased birth weight
  2. Shortened gestational age
  3. Reduced postpartum hemorrhage risk
  4. Improved neonatal neurodevelopment
     
• Answer: B – Iron deficiency is associated with adverse outcomes like low birth weight and shortened gestation

2. What is the minimum elemental iron dose per day recommended for oral iron therapy in pregnancy? (1 point)

• 1. 10-20 mg
  2. 30-40 mg
  3. 40-100 mg
  4. 100-150 mg
• Answer: C – 40-100 mg elemental iron daily is the therapeutic range to replenish iron stores

3. Which factor most significantly interferes with oral iron absorption? (1 point)

• 1. Taking with water
  2. Taking with vitamin C
  3. Taking 2 hours after calcium
  4. Taking with milk or eggs
     
• Answer: D – Calcium and phosphates in milk and eggs impair iron absorption

4. True or false: Ferritin levels <30 µg/L are diagnostic for iron deficiency even in the presence of inflammation. (1 point)

• Answer: False – Inflammation may raise ferritin; low ferritin is reliable, but normal/high levels may be misleading in inflammatory states

5. True or false: Ferric derisomaltose (Monoferric) can be safely administered as a single high-dose infusion. (1 point)

• Answer: True – It can be given in doses up to 1500 mg over 30-60 minutes

6. Parenteral iron therapy is indicated in all the following cases except: (1 point)

• 1. Intolerance to oral iron
  2. Hb <80 g/L in the second trimester
  3. Hemoglobinopathy in the first trimester
  4. Inadequate response after 4 weeks of oral iron
     
• Answer: C – Parenteral iron is generally avoided in the first trimester and in patients with hemoglobinopathies unless absolutely necessary

7. True or false: Iron supplementation should continue for at least 3 months after hemoglobin normalization and 6 weeks postpartum. (1 point)

• Answer: True – Continuing treatment helps replete iron stores and prevent relapse postpartum