SMLE Medicine MCQs: Practice Questions With Explanations

Sample SMLE MCQs from Medicine — at 733 questions the single largest subject in HighYield's SMLE bank without a dedicated practice post yet — covering endocrine emergencies, cardiorespiratory presentations and core internal medicine.

Medicine is the single largest subject in HighYield's SMLE (Saudi Medical Licensing Exam) question bank — bigger even than Pediatrics — and it doesn't yet have a dedicated practice post. It's tested separately from the bank's Internal Medicine subject and leans toward core general-medicine presentations. Below is a sample set of Medicine MCQs.

Endocrine Emergencies

1. A 45-year-old with type 1 diabetes presents with polyuria, abdominal pain, Kussmaul breathing and a fruity breath odor. Blood glucose is 420 mg/dL. What is the most likely diagnosis?

A) Hyperosmolar hyperglycemic state
B) Diabetic ketoacidosis ✅
C) Hypoglycemia
D) Lactic acidosis

2. A patient on long-term corticosteroids abruptly stops them and presents with hypotension, weakness and hyponatremia. What is the likely diagnosis?

A) Addisonian crisis ✅
B) Cushing syndrome
C) SIADH
D) Pheochromocytoma

3. A patient with untreated hypothyroidism presents with bradycardia, hypothermia and confusion. What is the likely diagnosis?

A) Myxedema coma ✅
B) Thyroid storm
C) Hashimoto's encephalopathy
D) Sick euthyroid syndrome

Cardiovascular & Respiratory

4. A patient with atrial fibrillation has a CHA2DS2-VASc score of 3. What is the most appropriate next step for stroke prevention?

A) Aspirin alone
B) Oral anticoagulation ✅
C) No treatment needed
D) Beta-blocker alone

5. A patient with an acute COPD exacerbation is started on short-acting bronchodilators. What should be added next?

A) Long-term oxygen only
B) Systemic corticosteroids ✅
C) Antivirals
D) Diuretics

6. What is the most common causative organism of community-acquired pneumonia in an otherwise healthy adult?

A) Streptococcus pneumoniae ✅
B) Mycoplasma pneumoniae
C) Klebsiella pneumoniae
D) Pseudomonas aeruginosa

Renal & Rheumatology

7. A patient with chronic kidney disease develops fatigue, pallor and a low reticulocyte count. What is the most likely cause?

A) Iron deficiency
B) Erythropoietin deficiency ✅
C) Vitamin B12 deficiency
D) Hemolysis

8. A young woman presents with a malar rash, joint pains and proteinuria, with positive ANA and anti-dsDNA. What is the diagnosis?

A) Rheumatoid arthritis
B) Systemic lupus erythematosus ✅
C) Sjögren syndrome
D) Systemic sclerosis

Prepare with HighYield

HighYield's SMLE question bank covers Medicine alongside Pediatrics, Internal Medicine, General Surgery and every other subject tested on the Saudi Medical Licensing Exam, with every question explained. New to the exam? Start with our SMLE complete guide.