SMLE Saudi Medical Exam: Free Mock Test with Answers
SMLE Saudi Medical Exam: Free Mock Test with Answers (2025)
The Saudi Medical Licensing Exam (SMLE), administered by the Saudi Commission for Health Specialties (SCFHS), is the definitive gateway for medical doctors seeking to practice in the Kingdom of Saudi Arabia. It is a comprehensive, high-stakes examination designed to ensure that every physician meets the rigorous standards of clinical competency and patient safety required by one of the region’s most advanced healthcare systems. Passing the SMLE is not merely an academic achievement; it is a validation of your ability to apply medical knowledge in the complex, real-world scenarios of clinical practice.
While textbooks and review materials are essential for building foundational knowledge, the true key to SMLE success lies in active preparation. The exam is composed entirely of case-based Multiple-Choice Questions (MCQs) that test your clinical reasoning, diagnostic skills, and decision-making abilities. The single most effective way to master this format is to engage with high-quality, realistic mock tests. A mock test does more than just gauge your knowledge; it helps you understand the exam’s pattern, perfect your time management, and build the mental stamina needed for the marathon exam session.
This ultimate 2025 guide has been designed to be your premier resource for SMLE preparation, featuring a comprehensive free mock test with detailed answers and rationales. We will provide a collection of high-yield questions spanning the core disciplines of the SMLE syllabus. This is complemented by a strategic breakdown of the exam and a robust 10-point FAQ section to address all your critical questions. This is your first step towards transforming your preparation into a confident, successful performance.
Key Takeaways for the SMLE
- It’s a Clinical Reasoning Test: The SMLE evaluates your ability to think like a physician—formulating differential diagnoses and management plans.
- Internal Medicine is Paramount: A significant majority of the exam questions are derived from Internal Medicine and its subspecialties.
- Practice with Mock Tests is Crucial: Simulating the exam with high-quality mock tests is the best way to prepare for the format, timing, and pressure of the real thing.
- Analyze Every Rationale: The most profound learning comes from understanding why the correct answer is right and, just as importantly, why the other options are wrong.
- Know International Guidelines: The SMLE is based on the latest, globally accepted, evidence-based clinical guidelines.
Understanding the SMLE Pattern and Syllabus
Before diving into the mock test, it’s essential to understand the structure of the exam you’re preparing for. A clear grasp of the pattern is a core component of effective Saudi Prometric exam preparation.
Core Exam Framework
- Administrator: Prometric, on behalf of the SCFHS.
- Format: Computer-Based Test (CBT) with 100% MCQs.
- Structure: 300 MCQs, divided into two sections of 150 questions each.
- Duration: A total of 6 hours of testing time (3 hours per section), with an optional scheduled break in between.
- Scoring: The SMLE is now scored on a scale out of 800, with a passing score of 500. There is no negative marking.
High-Yield SMLE Syllabus Breakdown
The SMLE is a comprehensive exam, but a strategic approach focuses on the most heavily tested areas.
| Medical Domain | Approximate Weighting & High-Yield Topics |
|---|---|
| Internal Medicine | ~40-50%: This is the largest and most critical section. Focus on Cardiology (ACS, HTN, HF), Endocrinology (Diabetes, DKA, Thyroid), Pulmonology (Asthma, COPD, PE), Gastroenterology (PUD, IBD, Hepatitis), and Infectious Diseases. |
| Pediatrics | ~15-20%: Common infectious diseases, vaccination schedules, developmental milestones, and pediatric emergencies like dehydration and febrile seizures. |
| Obstetrics & Gynecology | ~15-20%: Antenatal care, common complications of pregnancy (pre-eclampsia, gestational diabetes), abnormal uterine bleeding, and common gynecological infections. |
| Surgery | ~10-15%: Recognition and initial management of the acute abdomen (appendicitis, cholecystitis), principles of pre- and post-operative care, and basics of trauma (ATLS). |
| Psychiatry & Ethics | ~5-10%: Diagnosis of major depressive disorder, anxiety disorders, and schizophrenia. Principles of medical ethics and professionalism are also tested. |
Free SMLE Mock Test: Questions, Answers & In-Depth Rationales
This mock test is designed to simulate the style and difficulty of the real SMLE. Take your time with each question, formulate your answer, and then carefully read the rationale to understand the underlying clinical principle. For more extensive practice, a full-fledged Prometric SMLE question bank is highly recommended.
Question 1: Internal Medicine (Cardiology)
A 65-year-old man with a history of hypertension and type 2 diabetes presents to the emergency department with a 2-hour history of crushing substernal chest pain radiating to his left arm. An ECG shows ST-segment elevation in leads II, III, and aVF. Which of the following coronary arteries is most likely occluded?
- Left Anterior Descending (LAD) artery
- Left Circumflex (LCx) artery
- Right Coronary Artery (RCA)
- Left Main Coronary Artery
Correct Answer: C (Right Coronary Artery (RCA))
Rationale: This is a classic presentation of an acute inferior wall myocardial infarction (MI). The ECG findings of ST-segment elevation in leads II, III, and aVF are the hallmark of an inferior MI. The inferior wall of the left ventricle is primarily supplied by the Right Coronary Artery (RCA) in about 85% of the population (right-dominant circulation). Therefore, an occlusion of the RCA is the most common cause of an inferior STEMI.
Why other options are incorrect:
A: An LAD occlusion would cause an anterior wall MI, with ST elevation in leads V1-V4.
B: An LCx occlusion would typically cause a lateral wall MI, with ST elevation in leads I, aVL, V5, and V6.
D: A Left Main occlusion is a catastrophic event that would likely cause widespread ST elevation across the anterior and lateral leads and profound hemodynamic instability.
Question 2: Pediatrics
A 2-year-old boy presents with a 3-day history of a harsh, “barking” cough, low-grade fever, and inspiratory stridor that is worse at night. On examination, he is in mild respiratory distress but is not cyanotic and has good air entry bilaterally. What is the most appropriate first-line treatment for this child?
- Inhaled albuterol
- Oral amoxicillin
- A single dose of oral dexamethasone
- Intravenous ceftriaxone
Correct Answer: C (A single dose of oral dexamethasone)
Rationale: The clinical presentation of a barking cough and inspiratory stridor is classic for laryngotracheobronchitis, commonly known as croup. Croup is a viral infection (most often Parainfluenza virus) that causes inflammation in the subglottic airway. The cornerstone of management for all forms of croup (mild, moderate, or severe) is a single dose of a corticosteroid, such as oral dexamethasone. Steroids reduce airway inflammation and edema, alleviating the symptoms. For moderate to severe cases, nebulized epinephrine may also be used.
Why other options are incorrect:
A: Albuterol is a bronchodilator used for lower airway diseases like asthma or bronchiolitis; it has no effect on the subglottic inflammation of croup.
B & D: Croup is overwhelmingly viral in etiology, so antibiotics are not indicated unless a bacterial superinfection is suspected, which is rare.
Question 3: Obstetrics & Gynecology
A 32-year-old woman at 34 weeks gestation presents for a routine check-up. Her blood pressure is 150/100 mmHg. A urine dipstick shows 2+ proteinuria. She denies headaches or visual disturbances. What is the most likely diagnosis?
- Gestational hypertension
- Chronic hypertension
- Pre-eclampsia
- Eclampsia
Correct Answer: C (Pre-eclampsia)
Rationale: The diagnosis of pre-eclampsia is made based on new-onset hypertension (systolic BP ≥140 or diastolic BP ≥90 mmHg) after 20 weeks of gestation, accompanied by proteinuria (≥1+ on dipstick or ≥300 mg/24h) or signs of end-organ dysfunction. This patient meets the criteria perfectly: she is at 34 weeks, has new-onset hypertension, and has significant proteinuria. The absence of severe features (like headaches or visual changes) categorizes this as pre-eclampsia without severe features.
Why other options are incorrect:
A: Gestational hypertension is new-onset hypertension after 20 weeks *without* proteinuria or signs of end-organ damage.
B: Chronic hypertension is hypertension that is present before pregnancy or diagnosed before 20 weeks of gestation.
D: Eclampsia is the development of new-onset grand mal seizures in a woman with pre-eclampsia.
Frequently Asked Questions (FAQs) for the SMLE
The SCFHS has implemented a scaled scoring system. The exam is scored on a scale from 200 to 800, and the official passing score is 500. This is a standardized score, not a percentage.
Candidates are typically allowed a total of four attempts to pass the SMLE. There are specific rules regarding the time between attempts, which should be verified on the official SCFHS website.
While all three are comprehensive medical licensing exams, the SMLE is specifically tailored to assess competency for practicing as a generalist physician in Saudi Arabia. It has a heavy focus on the most common clinical presentations in primary care and emergency settings. It is similar in style to the USMLE Step 2 CK but may have a different distribution of topics. For official information on similar international exams, you can refer to bodies like the ECFMG for the USMLE.
No, the SMLE is based on international, evidence-based medical guidelines (e.g., from North American or European societies). You should focus on globally recognized best practices for diagnosis and management.
No, the SMLE is the unified licensing examination for all medical graduates, both from within and outside Saudi Arabia, who wish to be licensed as General Physicians.
Primary Source Verification (PSV) by DataFlow is a mandatory step in the SCFHS licensing process. It is a thorough background check where your medical degree, internship, and experience certificates are verified directly from the source institutions. A positive DataFlow report is required to obtain your final Saudi SCFHS license.
The consensus among high-scoring candidates is that the most effective strategy is intensive practice with a high-quality question bank that mimics the SMLE’s format and content. Solving thousands of MCQs and studying their rationales is the key to mastering clinical reasoning.
A dedicated study period of 4 to 6 months is generally recommended for most candidates to comprehensively cover the vast syllabus and complete a large question bank.
No, the exam uses only generic (international non-proprietary) names for all medications. You must be proficient with generic drug names.
The only way to prepare for the mental and physical demands of a 6-hour exam is to take full-length, 300-question mock exams under strict timed conditions. This builds stamina, refines your pacing strategy, and reduces test-day anxiety.
Conclusion: Your Path to a Medical Career in Saudi Arabia
The Saudi Medical Licensing Exam is a rigorous and comprehensive assessment designed to uphold the highest standards of medical practice in the Kingdom. It is a challenging journey, but with a strategic approach centered on active learning, high-yield topics, and realistic exam simulation through mock tests, success is well within your reach. Use this guide and mock test as a starting point to diagnose your strengths and weaknesses, and build a study plan that will carry you confidently to a passing score and the start of a rewarding medical career in Saudi Arabia.
Ready to Move Beyond the Mock Test and Master the SMLE?
Our premier SMLE question bank contains thousands of high-yield clinical vignettes, detailed, evidence-based rationales, and full-length simulated exams designed to cover the entire SCFHS syllabus and guarantee your success.
