SMLE GP Exam: Sample Multiple-Choice Questions
Looking for real SMLE GP exam sample multiple-choice questions? Here's the real exam format from the official SCFHS Applicant Guide, plus four full-length practice questions in that exact style — with the correct answer and a full explanation for each.
The SMLE (Saudi Medical Licensing Exam) is a computer-based exam of 200 multiple-choice questions, up to 20 of which are unscored pilot items you can't identify while testing. It's split into two 120-minute sections with a 30-minute break between them, and every question is a four-option single-best-answer format — no penalty structure beyond simply not getting credit for a wrong answer. The exam covers the breadth of general practice: internal medicine, surgery, obstetrics and gynaecology, paediatrics, and psychiatry, among other core clinical areas.
Below are four practice questions in that same format and difficulty range — TopQbank's own original items, not real retired SMLE questions (SCFHS doesn't publish those), but built to the same real specification above.
Question 1
A 52-year-old man with type 2 diabetes mellitus has an HbA1c of 8.2% despite lifestyle modification alone for the past 6 months. His eGFR is 78 mL/min/1.73m². Which of the following is the most appropriate initial pharmacologic therapy?
A) Insulin glargine
B) Metformin
C) Glyburide
D) Pioglitazone
Correct answer: B) Metformin. Metformin is the recommended first-line pharmacologic agent for type 2 diabetes in patients with adequate renal function (eGFR > 30 mL/min/1.73m² for continued use, with dose reduction below 45), given its efficacy, low hypoglycemia risk, and cardiovascular safety profile. Insulin and sulfonylureas carry higher hypoglycemia risk as first-line agents, and pioglitazone is not preferred first-line due to weight gain and fluid retention.
Question 2
A 4-year-old boy is brought in with a 2-day history of fever, irritability, and a non-blanching purpuric rash on his legs and trunk. He is lethargic and his neck is stiff on examination. What is the most appropriate immediate next step?
A) Outpatient antipyretics and follow-up in 24 hours
B) Oral amoxicillin and reassessment in 48 hours
C) Immediate parenteral antibiotics and urgent hospital transfer
D) Skin biopsy of the rash
Correct answer: C) Immediate parenteral antibiotics and urgent hospital transfer. A non-blanching purpuric rash with fever, lethargy, and neck stiffness in a child is a classic presentation of meningococcal disease until proven otherwise. This is a medical emergency — empiric parenteral antibiotics (e.g., ceftriaxone) should be given immediately, without waiting for confirmatory testing, followed by urgent transfer for inpatient management.
Question 3
A 58-year-old woman is found to have a blood pressure of 152/94 mmHg on three separate clinic visits over 6 weeks. She has no other medical history and her 10-year cardiovascular risk is low. Which of the following is the most appropriate first-line pharmacologic agent?
A) Beta-blocker
B) ACE inhibitor or calcium channel blocker
C) Loop diuretic
D) Alpha-blocker
Correct answer: B) ACE inhibitor or calcium channel blocker. Current hypertension guidelines recommend an ACE inhibitor (or ARB), calcium channel blocker, or thiazide-type diuretic as first-line options for most patients with uncomplicated primary hypertension. Beta-blockers are no longer considered first-line in the absence of a compelling indication (e.g., ischemic heart disease, heart failure), and loop diuretics and alpha-blockers are not first-line choices for uncomplicated essential hypertension.
Question 4
A 29-year-old woman at 32 weeks gestation presents with a blood pressure of 158/102 mmHg, new-onset proteinuria, and a severe frontal headache. What is the most appropriate immediate management priority?
A) Reassurance and outpatient blood pressure monitoring
B) Admission for blood pressure control and magnesium sulfate for seizure prophylaxis
C) Oral labetalol and discharge home with a follow-up in one week
D) Immediate induction of labour without further assessment
Correct answer: B) Admission for blood pressure control and magnesium sulfate for seizure prophylaxis. New-onset hypertension with proteinuria and a severe headache at 32 weeks is consistent with severe preeclampsia. This requires inpatient management: antihypertensive therapy to control blood pressure and magnesium sulfate to prevent eclamptic seizures, with further assessment (fetal monitoring, bloodwork) determining whether delivery is indicated — not an automatic immediate induction without assessment, and not safe for outpatient management.
Study takeaway: since the SMLE tests the breadth of general practice rather than depth in any one specialty, prioritize broad topic coverage across internal medicine, surgery, OB/GYN, paediatrics, and psychiatry over narrow deep-dives — and because there are up to 20 unscored pilot items mixed in with no way to identify them, answer every question as if it counts, since you genuinely cannot tell which ones do.