Latest SMLE Exam Questions for Internal Medicine 2025
Latest SMLE Exam Questions for Internal Medicine 2025
For any physician aspiring to practice in the Kingdom of Saudi Arabia, the Saudi Medical Licensing Exam (SMLE) represents a formidable challenge and a critical career milestone. While the exam is comprehensive, one domain stands above all others in its scope and importance: Internal Medicine. Constituting the largest portion of the SMLE, this section is the ultimate test of a physician’s ability to diagnose, manage, and apply evidence-based principles to a vast array of adult medical conditions. A strong performance in Internal Medicine is not just beneficial; it is essential for passing the exam.
The SMLE’s Internal Medicine questions are not designed to test simple recall. They are sophisticated, case-based Multiple-Choice Questions (MCQs) that require you to function as a competent internist. You will be presented with complex patient vignettes and challenged to formulate differential diagnoses, interpret subtle lab and imaging findings, and select the single best management step according to the latest international guidelines. Success hinges on your ability to master this clinical reasoning process through rigorous, targeted practice with high-quality, up-to-date questions.
This ultimate 2025 guide is your premier resource for conquering the Internal Medicine section of the SMLE. We will provide a strategic breakdown of the high-yield topics within each subspecialty, followed by a collection of the latest, most relevant sample questions with detailed, guideline-based answers and rationales. This is complemented by a comprehensive 10-point FAQ section to demystify the preparation process. Our goal is to provide you with the tools and insights needed to master the most important part of the SMLE.
Key Takeaways for the SMLE Internal Medicine Section
- It’s a Guideline-Driven Exam: Your answers must be based on the latest international evidence-based guidelines (e.g., ACC/AHA for cardiology, ADA for diabetes).
- Master the “Next Best Step”: The most common question format asks for the most appropriate next step in management, not just the final diagnosis.
- Cardiology & Endocrinology are Kings: These two subspecialties are the most heavily represented and must be a primary focus of your study.
- Differential Diagnosis is a Core Skill: For every case, you must be able to generate a list of plausible diagnoses and know the key features that differentiate them.
- Specialized MCQs are a Must: A generic medical QBank is not enough. You need a resource with a deep bank of complex, case-based Internal Medicine questions.
Deconstructing the SMLE Internal Medicine Syllabus
While Internal Medicine constitutes up to 50% of the entire Saudi Medical Licensure Examination (SMLE), this vast domain is further broken down into several key subspecialties. A strategic study plan allocates time based on the weight of each area.
| Internal Medicine Subspecialty | High-Yield Topics and Key Concepts for 2025 |
|---|---|
| Cardiology | Management of Acute Coronary Syndrome (STEMI/NSTEMI), guideline-directed medical therapy for Heart Failure (HFrEF/HFpEF), management of Hypertension (JNC 8 / ACC/AHA guidelines), Atrial Fibrillation (rate/rhythm control, anticoagulation with CHA₂DS₂-VASc), and Dyslipidemia. |
| Endocrinology | Comprehensive management of Type 2 Diabetes (lifestyle, oral agents, insulin), diagnosis and management of DKA and HHS, diagnosis and management of thyroid disorders (hypo/hyperthyroidism, thyroid storm), Cushing’s syndrome, and adrenal insufficiency. |
| Pulmonology | Stepwise management of Asthma (GINA guidelines), management of COPD exacerbations, diagnosis and management of Pulmonary Embolism, Community-Acquired Pneumonia (CURB-65 score), and interpretation of ABGs and PFTs. |
| Gastroenterology & Hepatology | Management of PUD and H. pylori, GERD, diagnosis and management of IBD (Crohn’s vs. UC), viral hepatitis serology, management of liver cirrhosis and its complications (ascites, SBP, hepatic encephalopathy). |
| Nephrology | Diagnosis and management of Acute Kidney Injury (pre-renal, intrinsic, post-renal), basics of Chronic Kidney Disease management, and interpretation of common electrolyte abnormalities (hyper/hyponatremia, hyper/hypokalemia) and acid-base disorders. |
| Infectious Diseases | Management of sepsis and septic shock, choosing appropriate empiric antibiotics for common infections (pneumonia, UTI, cellulitis), HIV/AIDS (indications for ART, opportunistic infections), and infective endocarditis (Duke criteria). |
| Rheumatology & Hematology | Diagnosis and management of Rheumatoid Arthritis and SLE. Diagnosis and management of gout. Approach to different types of anemia (microcytic, normocytic, macrocytic). Basics of anticoagulation. |
Latest 2025 SMLE Internal Medicine Questions & Answers
This collection of MCQs is designed to reflect the complexity and clinical focus of the SMLE’s Internal Medicine section. For a truly comprehensive preparation, practicing with a full bank of Internal Medicine MCQs is the most effective approach.
Question 1: Cardiology
A 68-year-old woman with a history of hypertension presents with increasing shortness of breath and lower extremity edema over the past month. An echocardiogram confirms a diagnosis of Heart Failure with a reduced Ejection Fraction (HFrEF) of 30%. Her current medications are lisinopril and furosemide. According to the latest guidelines, which of the following medication classes should be added next to provide the greatest mortality benefit?
- Amlodipine
- A beta-blocker such as carvedilol
- Digoxin
- Spironolactone
Correct Answer: B (A beta-blocker such as carvedilol)
Rationale: This question tests your knowledge of the four pillars of guideline-directed medical therapy (GDMT) for HFrEF, which have all been proven to reduce mortality. The four pillars are: 1) an ACE inhibitor/ARB/ARNI, 2) an evidence-based beta-blocker, 3) a mineralocorticoid receptor antagonist (MRA), and 4) an SGLT-2 inhibitor. The patient is already on an ACE inhibitor (lisinopril). The next step with the most significant mortality benefit is the addition of one of the three evidence-based beta-blockers for HFrEF: carvedilol, metoprolol succinate, or bisoprolol. These agents block the detrimental effects of sympathetic nervous system over-activation on the heart.
Why other options are incorrect:
A: Amlodipine (a calcium channel blocker) can be used for hypertension but has no mortality benefit in HFrEF and can sometimes worsen edema.
C: Digoxin is used for symptom control in HFrEF but has not been shown to improve mortality.
D: Spironolactone (an MRA) is one of the four pillars and provides mortality benefit, but guidelines generally recommend initiating a beta-blocker before or concurrently with an MRA after the patient is stable on an ACE inhibitor.
Question 2: Endocrinology
A 25-year-old woman presents to the emergency department with confusion, abdominal pain, and rapid, deep breathing. Her blood glucose is 450 mg/dL, serum bicarbonate is 10 mEq/L, anion gap is 22, and urine ketones are strongly positive. After starting an intravenous infusion of 0.9% normal saline, what is the most critical next step in management?
- Administer a subcutaneous dose of long-acting insulin.
- Administer an intravenous sodium bicarbonate infusion.
- Initiate a continuous intravenous infusion of regular insulin.
- Check a serum potassium level before starting insulin.
Correct Answer: D (Check a serum potassium level before starting insulin.)
Rationale: This is a critical safety step in the management of Diabetic Ketoacidosis (DKA). The patient’s presentation is classic for DKA. Insulin therapy is essential to stop ketogenesis and correct hyperglycemia. However, insulin drives potassium from the extracellular to the intracellular space, which can cause a rapid and dangerous drop in serum potassium levels. Patients with DKA are often total-body potassium depleted even if their initial serum level is normal or high. Starting an insulin infusion in a patient who is already hypokalemic (<3.3 mEq/L) can precipitate life-threatening cardiac arrhythmias. Therefore, it is mandatory to know the potassium level *before* starting insulin. If it is low, potassium must be repleted first.
Why other options are incorrect:
A: DKA requires a continuous IV infusion of regular insulin for precise titration, not subcutaneous long-acting insulin.
B: Sodium bicarbonate is rarely indicated in DKA unless the pH is extremely low (e.g., <6.9), as correcting the underlying ketoacidosis with insulin and fluids will resolve the acidosis.
C: While an IV insulin infusion is the correct treatment, it is not the *next* step. The potassium level must be checked first.
Frequently Asked Questions (FAQs) for the SMLE Internal Medicine Section
The SCFHS uses a scaled scoring system where the exam is scored out of 800. The official passing score is 500. As Internal Medicine is the largest component, a strong performance in this section is statistically crucial for achieving this score.
Internal Medicine and its subspecialties typically constitute the largest portion of the exam, estimated to be between 40% and 50% of the total 300 questions. It is the single most important domain to master.
The gold standard for preparation involves a combination of a comprehensive board review textbook (e.g., *Harrison’s Principles of Internal Medicine* for reference, and review books like *Step-Up to Medicine*) and, most importantly, a high-quality, case-based question bank specifically designed for board-level Internal Medicine, such as the SCFHS Internal Medicine Exam MCQs.
The SMLE is based on international, evidence-based standards of care. You should focus your study on the most current guidelines from major North American and European societies (e.g., ACC/AHA, ADA, GOLD, GINA). Authoritative sources like the New England Journal of Medicine’s Clinical Practice section are excellent for staying up-to-date.
You need the knowledge of a competent general internist, not a subspecialist. For example, you should know the first and second-line treatments for hypertension, but you don’t need to know the intricate details of managing rare genetic channelopathies. The focus is on common diseases and their evidence-based management.
The SCFHS requires you to have an eligibility number to book the exam, and the DataFlow process is a key part of obtaining that eligibility. Primary Source Verification (PSV) of your medical degree and other credentials is a mandatory step before your final Saudi SCFHS license can be granted.
The key is consistent practice under timed conditions. When working through your QBank, do blocks of questions in timed mode to simulate the pace of one question every 1.2 minutes. This builds speed and accuracy and makes the real exam feel familiar.
No, the exam uses only generic (international non-proprietary) names for all medications. You must be proficient with generic names.
The most common mistake is not reading the question carefully and choosing a textbook answer that doesn’t fit the specific nuances of the clinical vignette. Another major error is choosing the “correct diagnosis” when the question asks for the “next best step.”
The final month should be dedicated to intensive MCQ practice and review. Focus on mixed blocks of questions to simulate the random nature of the exam. Use your QBank’s performance analytics to identify your weakest subspecialties and dedicate extra time to reviewing those specific topics.
Conclusion: Your Path to Mastering the Core of the SMLE
The Internal Medicine section of the Saudi Medical Licensing Exam is a rigorous and comprehensive test of your clinical abilities. It is the heart of the SMLE, and your success on the exam as a whole depends on your mastery of this domain. By adopting a strategic, guideline-based study plan and dedicating yourself to intensive practice with high-quality, case-based MCQs, you can build the deep clinical reasoning skills needed to excel. Passing this section is the definitive step toward a successful medical career in the Kingdom of Saudi Arabia.
Ready to Master Internal Medicine and Ace Your SMLE?
Our comprehensive Internal Medicine MCQ package is filled with high-yield clinical cases, guideline-based rationales, and simulated exams designed to cover the entire SCFHS syllabus and ensure you achieve a high score.
