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

A 68-year-old postmenopausal woman presents with urinary frequency and mild dysuria but no fever, urgency, or suprapubic pain. Her urine culture is negative. She has had two similar episodes over the past year. You are considering diagnosis and management options. (5 points)

1. Which of the following best explains the increased risk of UTIs in postmenopausal women? (1 point)

• 1. Increased renal excretion of glucose
  2. Decline in estrogen levels affecting urogenital mucosal immunity
  3. Decreased fluid intake due to aging
  4. Reduced mobility and hygiene practices
• Answer: B

2. Which of the following most likely explains her current symptoms with a negative urine culture? (1 point)

• 1. Asymptomatic bacteriuria
  2. Overactive bladder
  3. Genitourinary syndrome of menopause
  4. Acute interstitial nephritis
• Answer: C

3. Which of the following would be an appropriate first-line treatment for an uncomplicated UTI in a postmenopausal woman? (1 point)

• 1. Ciprofloxacin for 10 days
  2. Nitrofurantoin 100 mg twice daily for 5 days
  3. Amoxicillin-clavulanate for 7 days
  4. Azithromycin single dose
• Answer: B

4. Which of the following is true regarding asymptomatic bacteriuria in postmenopausal women? (1 point)

• 1. It requires immediate antibiotic treatment
  2. It indicates chronic kidney disease
  3. It is common and does not require treatment
  4. It always precedes symptomatic UTI
• Answer: C

5. Which preventive strategy is supported by evidence for recurrent UTIs in postmenopausal women? (1 point)

• 1. Routine test-of-cure urine cultures
  2. Long-term high-dose antibiotics
  3. Vaginal estrogen therapy
  4. Daily cranberry extract supplementation
• Answer: C

Reference:

CMAJ 2025 February 3;197:E96. doi: 10.1503/cmaj.241258. https://www.cmaj.ca/content/cmaj/197/4/E96.full.pdf