SMLE Internal Medicine MCQs: Practice Questions With Explanations
Sample SMLE MCQs from Internal Medicine — roughly 30% of the exam by SCFHS's own blueprint — covering cardiology, renal, endocrine and GI, each with the correct answer explained.
Internal Medicine makes up roughly 30% of the SMLE by the Saudi Commission for Health Specialties' own exam blueprint — the single largest of the four core clinical domains. Below is a sample set of Internal Medicine MCQs in clinical-vignette style, grouped by theme.
Cardiology
1. ST-segment elevation in leads II, III and aVF on ECG is most indicative of infarction in which territory?
- A) Anterior wall
- B) Lateral wall
- C) Inferior wall ✅
- D) Posterior wall
2. Which of the following is classically part of Virchow's triad for venous thromboembolism, alongside stasis and endothelial injury?
- A) Hypocoagulability
- B) Hypercoagulability ✅
- C) Vasodilation
- D) Hypervolemia
Renal & Electrolytes
3. Peaked T waves on ECG are classically associated with which electrolyte abnormality?
- A) Hypokalemia
- B) Hyperkalemia ✅
- C) Hypercalcemia
- D) Hyponatremia
4. The most common cause of chronic kidney disease worldwide is:
- A) Glomerulonephritis
- B) Polycystic kidney disease
- C) Diabetes mellitus ✅
- D) Analgesic nephropathy
Endocrinology & Gastroenterology
5. A patient with hypothyroidism is expected to show which thyroid function test pattern?
- A) Low TSH, high free T4
- B) High TSH, low free T4 ✅
- C) Low TSH, low free T4
- D) High TSH, high free T4
6. When endoscopy is performed for suspected H. pylori-associated peptic ulcer disease, the biopsy-based confirmatory test is:
- A) Serum antibody test
- B) Stool antigen test
- C) Urease (CLO) test ✅
- D) Urea breath test
Building Your SMLE Study Plan Around the Blueprint
Since Internal Medicine, Ob/Gyn and Paediatrics together account for roughly 80% of the SMLE, weighting your practice time to match — rather than spreading evenly across every subject — is the single highest-leverage decision you'll make in your prep. Internal Medicine alone deserves close to a third of your total question volume.
HighYield's SMLE question bank is organized to mirror this exact blueprint, with vignette-style questions across all four core domains, every question explained. For the full breakdown of eligibility, syllabus weighting and scoring, see our SMLE Exam Full Guide. Your first 20 questions are free.