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

Mr. John Smith, a 52-year-old man, visits your clinic for his routine annual physical. He has no specific complaints, but his metabolic profile raises concern. He has a BMI of 29 kg/m² and a waist circumference of 102 cm. His fasting blood glucose is 5.8 mmol/L, and HbA1c is 5.9%, indicating prediabetes. His triglycerides are 2.1 mmol/L, and HDL-C is 1.0 mmol/L, with blood pressure at 135/85 mm Hg.

He reports minimal alcohol intake and no history of viral hepatitis or liver disease. An abdominal ultrasound performed as part of an executive health screen reveals moderate hepatic steatosis. His liver enzymes (ALT, AST) are mildly elevated, and platelets are within normal limits. A FIB-4 score of 1.2 is calculated.

You suspect metabolic dysfunction–associated steatotic liver disease (MASLD). (5 points)

1. Which of the following criteria is essential for the diagnosis of MASLD? (1 point)

• 1. Presence of hepatic steatosis with significant alcohol intake
  2. Hepatic steatosis with at least one cardiometabolic risk factor
  3. Elevated liver enzymes without imaging evidence of steatosis
  4. Hepatic steatosis with viral hepatitis infection
  5. Hepatic steatosis in the absence of any metabolic risk factors
     
• Answer: B

2. What is the most practical non-invasive tool for assessing liver fibrosis in primary care? (1 point)

• 1. Liver biopsy
  2. Magnetic resonance elastography
  3. Fibrosis-4 (FIB-4) score
     
  4. Controlled attenuation parameter (CAP)
     
  5. Ultrasound-dependent fatty liver index
     
• Answer: C

3. In the context of MASLD, what does a FIB-4 score of less than 1.3 indicate? (1 point)

• 1. High risk of advanced fibrosis
     
  2. Indeterminate risk; further testing needed
     
  3. Low risk of advanced fibrosis
     
  4. Presence of cirrhosis
     
  5. Need for immediate liver biopsy
     
• Answer: C

4. Which of the following is a commonly accepted cardiometabolic risk factor contributing to MASLD? (1 point)

• 1. Elevated LDL-C only
     
  2. Underweight BMI
     
  3. Increased waist circumference
     
  4. Normal fasting glucose
     
  5. Daily intake of multivitamins
     
• Answer: C

5. What is the primary management strategy for a patient diagnosed with MASLD? (1 point)

• 1. Initiation of antiviral therapy
     
  2. Lifestyle modification focusing on weight loss and exercise
     
  3. Immediate liver transplantation
     
  4. Long-term corticosteroid therapy
     
  5. No intervention is necessary
• Answer: B