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Saudi Board Part One Examination – Internal Medicine: free practice test

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Practice test questions with answers and explanations

Try the questions in the test above first, then open each one here to see the correct answer and why every other option is wrong.

01A 68-year-old man with hypertension smoked half a pack of cigarettes daily for 20 years and quit 12 years ago. He has no abdominal symptoms and has never had abdominal imaging. Which screening test is recommended for him?

Practice question Unit: Ambulatory Care

  1. ALow-dose chest CT every year for lung cancer

    His exposure is 10 pack-years, below the 20 pack-year threshold for lung cancer screening.

  2. BCarotid duplex ultrasonography for silent stenosis

    Screening asymptomatic adults for carotid stenosis is recommended against because harms outweigh benefits.

  3. COne-time abdominal ultrasonography for the aorta ✓ Correct answer

    Men aged 65–75 years who have ever smoked should have a single ultrasound screen for abdominal aortic aneurysm (AAA).

  4. DAnkle–brachial index for peripheral artery disease

    Evidence is insufficient to support routine ankle–brachial index screening in asymptomatic adults.

Reference: SCFHS Saudi Board Part One Blueprint – Internal Medicine (v2) (2024–27), section: Ambulatory Care; USPSTF Recommendation Statement: Screening for Abdominal Aortic Aneurysm (2019), men aged 65–75 years who have ever smoked (grade B)

02A 72-year-old man with an acute inferior STEMI is fully alert and oriented. After the cardiologist explains the benefits and risks of primary PCI, he declines the procedure, stating that he understands he may die without it. What is the most appropriate action?

Practice question Unit: Cardiology

  1. ARespect his decision, offer alternatives and document ✓ Correct answer

    A capable patient may refuse treatment; the physician confirms understanding, offers alternatives such as medical therapy, and documents the discussion.

  2. BGive thrombolysis instead, without a new consent talk

    Thrombolysis is a possible alternative, but it carries its own bleeding risk and also needs his informed consent.

  3. CRespect his refusal and discharge him against advice

    Respecting a refusal does not mean discharge; declining PCI still leaves medical therapy and monitoring to offer in hospital.

  4. DRequest a psychiatric capacity review before deciding

    Refusal alone does not imply incapacity; he is alert, oriented and shows understanding.

Reference: SCFHS Saudi Board Part One Blueprint – Internal Medicine (v2) (2024–27), section: Cardiology; SCFHS Professionalism and Ethics Handbook for Residents, chapter: Informed consent and refusal of treatment

03A 78-year-old man with type 2 diabetes has taken metformin 1 g twice daily for years. His eGFR has declined steadily and is now 25 mL/min/1.73 m². What is the most appropriate change?

Practice question Unit: Endocrinology

  1. AExtended-release metformin

    The formulation does not change renal clearance or the contraindication.

  2. BContinue the current dose with yearly checks

    Continuing full-dose metformin at this eGFR increases the risk of lactic acidosis.

  3. CHalve the metformin dose

    Dose reduction is advised at eGFR 30–45; below 30 metformin is contraindicated.

  4. DStop metformin at this eGFR ✓ Correct answer

    Metformin is contraindicated when eGFR is below 30 mL/min/1.73 m².

Reference: SCFHS Saudi Board Part One Blueprint – Internal Medicine (v2) (2024–27), section: Endocrinology; ADA Standards of Care in Diabetes 2026, section: Pharmacologic Approaches to Glycemic Treatment, metformin and kidney function

04A 62-year-old man with suspected peptic ulcer bleeding is resuscitated and is now haemodynamically stable. Intravenous proton pump inhibitor has been started. When should upper endoscopy be performed?

Practice question Unit: Gastroenterology

  1. AIf bleeding recurs

    Endoscopy is indicated for all admitted patients, not just those who rebleed.

  2. BImmediately, within 2 hours

    Very early endoscopy (within 6 hours) did not improve outcomes over endoscopy within 24 hours.

  3. CAfter 72 hours of PPI therapy

    Delaying endoscopy loses the chance for diagnosis and haemostatic therapy.

  4. DWithin 24 hours of presentation ✓ Correct answer

    Endoscopy within 24 hours after resuscitation is recommended for patients admitted with upper GI bleeding.

Reference: SCFHS Saudi Board Part One Blueprint – Internal Medicine (v2) (2024–27), section: Gastroenterology; ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding (Am J Gastroenterol 2021), timing of endoscopy

05A 62-year-old man has fatigue. Haemoglobin is 98 g/L, MCV 72 fL and ferritin 8 µg/L. He has no gastrointestinal symptoms and takes no NSAIDs. Coeliac serology is negative. What is the most appropriate next step?

Practice question Unit: Hematology

  1. AOral iron trial for 3 months

    Response to iron does not exclude an underlying cancer, so investigation should not wait.

  2. BGastroscopy and colonoscopy ✓ Correct answer

    Iron deficiency anaemia in a man needs bidirectional endoscopy to exclude gastrointestinal cancer.

  3. CFaecal occult blood testing

    A negative occult blood test does not exclude a lesion in iron deficiency.

  4. DBone marrow aspiration

    A ferritin of 8 µg/L already confirms iron deficiency.

Reference: SCFHS Saudi Board Part One Blueprint – Internal Medicine (v2) (2024–27), section: Hematology; British Society of Gastroenterology Guidelines for the Management of Iron Deficiency Anaemia in Adults (2021)

06A 35-year-old Saudi engineer returned 10 days ago from a 3-week work trip to Nigeria. He did not take malaria prophylaxis. He now has fever 39 °C, headache and myalgia. He is alert and haemodynamically stable. Which investigation is most important first?

Practice question Unit: Infectious Diseases

  1. ABrucella serology with a standard agglutination test

    Brucellosis is not the priority after travel to West Africa with acute fever.

  2. BThick and thin blood films for malaria ✓ Correct answer

    Fever after travel to sub-Saharan Africa is malaria until proven otherwise; films (with rapid antigen test) are needed urgently.

  3. CStool culture for Salmonella

    Typhoid is possible, but malaria must be excluded first because it can be rapidly fatal.

  4. DChest radiograph and urinalysis

    He has no respiratory symptoms, and imaging would not exclude malaria.

Reference: SCFHS Saudi Board Part One Blueprint – Internal Medicine (v2) (2024–27), section: Infectious Diseases; Harrison's Principles of Internal Medicine, 21st ed., chapter: Malaria (diagnosis)

07A 79-year-old man has 2 days of lower abdominal discomfort and dribbling of urine. Creatinine has risen from 100 to 380 µmol/L. A tender, dullness-to-percussion suprapubic mass is present. He takes an anticholinergic for overactive bladder. What is the most appropriate immediate step?

Practice question Unit: Nephrology

  1. AInsert a urinary catheter ✓ Correct answer

    Urinary retention with post-renal AKI is relieved immediately by bladder catheterisation.

  2. BStart intravenous saline at 200 mL/hour

    Fluids do not relieve the obstruction and may cause overload.

  3. CUrgent haemodialysis

    Relieving the obstruction usually restores function without dialysis.

  4. DArrange CT urography with contrast

    Contrast imaging delays treatment and adds nephrotoxic risk.

Reference: SCFHS Saudi Board Part One Blueprint – Internal Medicine (v2) (2024–27), section: Nephrology; Harrison's Principles of Internal Medicine, 21st ed., chapter: Urinary Tract Obstruction

08A 72-year-old man with long-standing hypertension has sudden weakness of the left face, arm and leg equally, with no sensory loss, visual field defect, aphasia or neglect. Where is the lesion most likely located?

Practice question Unit: Neurology

  1. ARight parietal cortex in the MCA territory

    A parietal lesion would cause sensory loss or neglect.

  2. BLeft cerebellar hemisphere and vermis

    Cerebellar lesions cause ataxia, not hemiparesis.

  3. CRight occipital lobe (posterior cerebral artery)

    An occipital lesion causes a visual field defect.

  4. DPosterior limb of the right internal capsule ✓ Correct answer

    Pure motor hemiparesis without cortical signs is a lacunar syndrome, typically of the internal capsule.

Reference: SCFHS Saudi Board Part One Blueprint – Internal Medicine (v2) (2024–27), section: Neurology; Harrison's Principles of Internal Medicine, 21st ed., chapter: Ischemic Stroke (lacunar syndromes)

09A 30-year-old woman with acute asthma is too breathless to finish sentences. PEF is 30% of her best and SpO₂ is 91% on air. Arterial PaCO₂ is 5.6 kPa (42 mm Hg) (reference 4.7–6.0 kPa). What is the best interpretation of her PaCO₂?

Practice question Unit: Pulmonary Diseases

  1. AReassuring at this level

    A normal PaCO₂ is not reassuring in a severe attack; it signals fatigue before rising PaCO₂.

  2. BA life-threatening sign of tiring ✓ Correct answer

    In acute asthma PaCO₂ should be low from hyperventilation; a normal value with PEF below 33% and SpO₂ below 92% marks a life-threatening attack.

  3. CCompensation for metabolic alkalosis

    There is no metabolic alkalosis in this picture; the value reflects ventilatory failure.

  4. DExpected in moderate asthma

    A moderate attack has PEF above 50% and a low PaCO₂.

Reference: SCFHS Saudi Board Part One Blueprint – Internal Medicine (v2) (2024–27), section: Pulmonary Diseases; GINA 2025 Global Strategy for Asthma Management and Prevention, management of exacerbations

10A 50-year-old man with newly diagnosed rheumatoid arthritis is to start methotrexate. Blood count, liver tests and creatinine are normal. Which additional test should be done before starting?

Practice question Unit: Rheumatology

  1. AHLA-B*58:01 genotyping

    This allele predicts severe reactions to allopurinol.

  2. BTPMT enzyme activity level

    TPMT is checked before azathioprine, not methotrexate.

  3. CHepatitis B and C serology ✓ Correct answer

    Viral hepatitis raises the risk of methotrexate liver toxicity and HBV reactivation, so screening is advised before starting.

  4. DG6PD enzyme level

    G6PD is checked before dapsone or primaquine.

Reference: SCFHS Saudi Board Part One Blueprint – Internal Medicine (v2) (2024–27), section: Rheumatology; ACR 2021 Guideline for the Treatment of Rheumatoid Arthritis, pre-treatment screening

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