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Saudi Medical Licensure Examination (SMLE): free practice test

Start with 10 free questions to see what needs more practice. Finish to see your score, weakest units and every option explained.

Passing score: 560 on the 200–800 reporting scale. An equivalent raw correct-answer percentage is not published. This is your practice accuracy. It cannot be converted to the exam’s scaled score or used to determine whether you pass.

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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.

01An alert adult with diabetes can swallow safely and has glucose 62 mg/dL. What initial self-treatment follows the CDC 15-15 approach?

Practice question Unit: Medicine

  1. A15 g fast carbohydrate, then recheck in 15 minutes ✓ Correct answer

    This corrects the low and provides a prompt reassessment.

  2. BAn additional rapid-insulin correction dose

    Additional insulin can worsen hypoglycemia.

  3. C15 g carbohydrate, then wait two hours to recheck

    Delayed reassessment can leave persistent hypoglycemia untreated.

  4. DA high-fat snack followed by a delayed glucose check

    Fat slows rapid sugar absorption.

Reference: CDC, Treatment of Low Blood Sugar, The 15-15 rule and Treating severely low blood sugar (May 2024). https://www.cdc.gov/diabetes/treatment/treatment-low-blood-sugar-hypoglycemia.html

02A witness saw a previously normal person suddenly develop stroke symptoms and calls emergency services. Which timing information is particularly useful for treatment decisions?

Practice question Unit: Medicine

  1. AOnly the ambulance call time

    Calling may occur after onset.

  2. BOnly the time the patient arrived in hospital

    Arrival time does not establish symptom duration.

  3. CThe witnessed exact time symptoms began ✓ Correct answer

    In this witnessed event, record onset; also document when last known normal.

  4. DOnly when weakness became most severe

    Peak severity may occur after the first deficit.

Reference: Joint Commission, Stroke Symptoms—Activation of Stroke Response: onset or last known well. https://www.jointcommission.org/en-us/knowledge-library/support-center/standards-interpretation/standards-faqs/000001407

03A 46-year-old asymptomatic man has elevated blood pressure at two clinic visits. There is no evidence of an acute hypertensive emergency. Under the USPSTF screening approach, what should precede long-term treatment?

Practice question Unit: Medicine

  1. AStart lifelong therapy from clinic readings alone

    The USPSTF recommends confirmation before treatment in this nonemergency setting.

  2. BUse a normal ECG to exclude hypertension

    A normal ECG does not rule out hypertension.

  3. CRepeat only after new symptoms appear

    Sustained hypertension may remain asymptomatic.

  4. DConfirm with ABPM or validated HBPM ✓ Correct answer

    Out-of-office confirmation reduces white-coat misclassification.

Reference: USPSTF, Hypertension in Adults: Screening (2021), Clinician Summary. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/hypertension-in-adults-screening

04A stable woman has a positive pregnancy test, but ultrasound identifies neither an intrauterine nor extrauterine pregnancy. What is the appropriate descriptive diagnosis?

Practice question Unit: Obstetrics and gynecology

  1. AConfirmed tubal rupture

    No evidence of rupture is provided.

  2. BPregnancy of unknown location ✓ Correct answer

    The pregnancy location remains unconfirmed.

  3. CConfirmed complete miscarriage

    Not established by these findings alone.

  4. DConfirmed normal intrauterine pregnancy

    No intrauterine pregnancy has been identified.

Reference: RCOG, Ectopic pregnancy: What is pregnancy of unknown location?. https://www.rcog.org.uk/for-the-public/browse-our-patient-information/ectopic-pregnancy/

05After vaginal birth, measured blood loss reaches 350 mL and the woman develops tachycardia and hypotension. Under WHO’s 2025 early-response approach, what is appropriate?

Practice question Unit: Obstetrics and gynecology

  1. AWait until loss exceeds 1000 mL

    Delays care in an unstable patient.

  2. BDisregard vital signs below 500 mL

    Abnormal vital signs alter the response threshold.

  3. CInitiate prompt assessment and PPH response ✓ Correct answer

    Earlier action is advised with ≥300 mL plus abnormal vitals.

  4. DReassure because blood loss is below 500 mL

    Ignores the warning signs.

Reference: WHO/FIGO/ICM joint release 5 October 2025, New diagnostic criteria for rapid action. https://www.who.int/news/item/05-10-2025-global-health-agencies-issue-new-recommendations-to-help-end-deaths-from-postpartum-haemorrhage

06A CTG has a stable baseline of145bpm and variability of10bpm, but recurrent late decelerations are present. What is the overall NICE NG229 classification?

Practice question Unit: Obstetrics and gynecology

  1. ANormal

    Normal requires all four features to be white; late decelerations are red.

  2. BPathological ✓ Correct answer

    NG2291.4.24 amended2025 classifies late decelerations as red; one red feature makes the overall trace pathological under1.4.32.

  3. CSuspicious

    Suspicious describes one amber feature; the late-deceleration feature is red.

  4. DUnclassifiable

    The supplied readable baseline, variability and late-deceleration pattern permit classification.

Reference: NICE NG229 1.4.24 (amended 2025), 1.4.31–32. https://www.nice.org.uk/guidance/ng229/chapter/Recommendations

07Ultrasound confirms ileocolic intussusception in an infant who now has generalized peritonitis and free intraperitoneal air. Which planned intervention is contraindicated?

Practice question Unit: Pediatrics

  1. AUrgent surgical assessment

    Perforated intussusception needs surgical management.

  2. BIntravenous access and resuscitation

    Resuscitation is necessary in this emergency.

  3. CPneumatic enema reduction ✓ Correct answer

    Perforation and peritonitis contraindicate enema reduction.

  4. DAppropriate analgesia

    Pain should still be treated.

Reference: RCH Intussusception, Contrast/gas enema: contraindicated with peritonitis, shock or perforation. https://www.rch.org.au/clinicalguide/guideline_index/Intussusception/

08A child is stridor-free at rest 40 minutes after nebulised adrenaline for croup. The family requests discharge now. What minimum observation period does RCH generally recommend after the dose?

Practice question Unit: Pediatrics

  1. AForty minutes

    Early improvement does not complete the observation interval.

  2. BNo observation if stridor improves

    Treatment response does not eliminate recurrence risk.

  3. CThree hours ✓ Correct answer

    Observe at least three hours for recurrence; selected risks warrant longer.

  4. DOne week in every case

    A fixed week is not routine for a recovering child.

Reference: RCH Croup, Disposition and discharge: minimum 3 hours after nebulised adrenaline (September 2024). https://www.rch.org.au/clinicalguide/guideline_index/Croup_Laryngotracheobronchitis/

09After major trauma, a patient cannot protect his airway or ventilate adequately. An experienced airway team is present. What is the definitive airway approach?

Practice question Unit: Surgery

  1. ABag-mask ventilation as the definitive ongoing airway strategy

    Bag-mask ventilation can be a bridge but is not the definitive airway recommended when protection and ventilation are inadequate.

  2. BA supraglottic airway as the preferred definitive intervention when RSI is feasible

    A supraglottic airway is useful for rescue or bridging; NG39 recommends RSI and tracheal intubation as definitive care here.

  3. CRapid sequence induction and tracheal intubation ✓ Correct answer

    This provides a secured airway when airway protection or ventilation fails.

  4. DNon-invasive ventilation despite inability to protect the airway

    Failure of airway protection requires a definitive protected airway rather than relying on non-invasive support.

Reference: NICE NG39, recommendation 1.2.1; https://www.nice.org.uk/guidance/ng39/chapter/Recommendations

10CT confirms adhesive small-bowel obstruction without peritonitis, ischemia or strangulation. Which initial approach is usually appropriate?

Practice question Unit: Surgery

  1. AImmediate surgery solely to prevent every recurrence

    Recurrence risk alone does not mandate initial surgery.

  2. BOutpatient treatment despite continuing high nasogastric losses

    Ongoing losses require inpatient support and monitoring during the trial.

  3. CContinue normal oral feeding to stimulate transit

    Bowel rest and decompression are part of nonoperative obstruction treatment.

  4. DMonitored nonoperative trial ✓ Correct answer

    Many uncomplicated adhesive obstructions resolve without surgery.

Reference: WSES Bologna ASBO guideline 2017 update, Initial decision making; Non-operative management. https://link.springer.com/article/10.1186/s13017-018-0185-2

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