SMLE: Saudi Medical Licensure Examination

Facts last verified 5 October 2026.

Half the SMLE covers women’s and children’s health. Study these topics as well as adult medicine.

Is this the right paper for you?

The SMLE is the medical licensing paper. SCFHS criteria give a medical bachelor’s degree the general physician title. Higher awards lead to other ranks.

  • A pass in the same SCFHS specialty within 5 years can exempt you from a new assessment. High-risk specialties are excluded. Check the licence steps.

Scaled score

Format at a glance

200 questions. Time: Two 100-question sections of 120 minutes with a 30-minute break. Pass mark: 560 on a 200–800 scale.

Delivered by Prometric.

What the paper covers

ProMCQ sets these topic targets for its mock papers, using the published SCFHS blueprint as a guide. They can differ from the official weights, so check the blueprint for those. Each mock includes national-topic content, so its final question shares can differ slightly from these targets.

  • Medicine (30%): Adult medicine is 30%. Read the case findings and choose the next step.
  • Obstetrics & Gynaecology (25%): Obstetrics and gynaecology is 25%. Revise labour decisions and women’s health.
  • Paediatrics (25%): Paediatrics is 25%. Include care of the newborn, growth, vaccines and the sick child.
  • Surgery (20%): Surgery is 20%. Revise acute cases, care before and after surgery, and when to operate.

Sample questions

Eight original practice questions from the SCFHS / SMLE doctors bank. They are written to the paper's style, not taken from the live exam. Pick an answer to see the key and explanation.

  1. A 4-day-old exclusively breastfed term boy is jaundiced. He feeds poorly, has lost more weight than expected, has few wet nappies and has passed little stool. His total serum bilirubin is below the phototherapy threshold for his age in hours. How should this infant's jaundice be managed?

    1. Stop breastfeeding and give formula
    2. Start intensive phototherapy
    3. Reassure and review at 2 weeks
    4. Improve feeding with lactation support
    Answer

    D. First-week jaundice with poor feeding, excess weight loss and low urine and stool output is suboptimal-intake jaundice. Inadequate milk transfer causes dehydration, delayed stooling and increased enterohepatic reabsorption of bilirubin. Management is to improve feeding, not to stop breastfeeding: observe the latch and milk transfer, feed frequently and give lactation support. Expressed milk and judicious donor milk or formula supplementation are added only if clinically required.

  2. A 36-year-old woman with renal impairment has vulvovaginal candidiasis. She is not pregnant. A single oral fluconazole dose of 150 mg is planned, and the prescription is reviewed because fluconazole is cleared renally. How should this prescription be adjusted?

    1. Reduce the single dose
    2. Give repeated reduced doses
    3. Retain the single dose
    4. Change to intravenous fluconazole
    Answer

    C. Fluconazole is cleared renally, so repeated dosing requires adjustment in renal impairment. The single 150 mg dose used for vaginal candidiasis does not require adjustment.

  3. On postoperative day 2 after major surgery, a patient has peripheral oedema and a positive total-body fluid balance but remains relatively intravascularly depleted. Which explanation best accounts for these apparently conflicting findings?

    1. Iatrogenic fluid overload has expanded the interstitium without any capillary leak
    2. Capillary integrity has recovered and auto-diuresis is already at its expected peak
    3. Non-osmotic ADH release alone has shifted fluid into the interstitium
    4. Capillary leak has shifted fluid from the intravascular compartment into the interstitium
    Answer

    D. Major surgery can cause capillary leak, moving fluid from the intravascular space into the interstitium. This produces oedema and positive total-body balance while effective intravascular volume remains depleted.

  4. A 62-year-old man is tested with a new marker that has a sensitivity of 98% and a specificity of 80%. His result is negative. What effect does this negative result have on his probability of disease?

    1. Small decrease
    2. Large increase
    3. Large decrease
    4. No change
    Answer

    C. LR− = (1 − sensitivity) ÷ specificity = 0.02 ÷ 0.80 = 0.025. An LR− below 0.1 gives a large, often conclusive fall in probability of disease.

  5. Which blood value best reflects current marrow red-cell output?

    1. The mean corpuscular volume, which classifies anaemia by cell size
    2. The reticulocyte count, which rises when the marrow is responding
    3. The erythrocyte lifespan, which averages about 120 days
    4. The serum ferritin, which reflects the size of iron stores
    Answer

    B. Reticulocytes are the marrow's receipt: a high count means the marrow is responding. Normal adult reticulocytes are approximately 0.5%–2.5%, and a value above 2.5% suggests increased marrow output such as haemolysis or bleeding.

  6. A young adult is diagnosed with paragonimiasis, the lung-fluke disease caused by Paragonimus westermani. Which food exposure is responsible for this infection?

    1. Eating raw aquatic vegetation such as watercress
    2. Eating undercooked pork or wild game
    3. Eating raw or undercooked crab or crayfish
    4. Ingesting soil contaminated by dog faeces
    Answer

    C. Paragonimiasis is the lung-fluke disease acquired by eating raw or undercooked crab or crayfish, after which the flukes reach the lung and cause chronic cough and haemoptysis.

  7. A patient with ulcerative colitis reports six bloody stools per day and has a pulse of 94/min. Which classification and immediate management best fit this presentation?

    1. Mild-moderate outpatient flare; oral and/or rectal mesalazine
    2. Acute severe ulcerative colitis; admit for intravenous corticosteroids
    3. Acute severe ulcerative colitis; admit for oral corticosteroids and rectal mesalazine
    4. Day-3 steroid failure; start infliximab or ciclosporin rescue
    Answer

    B. Truelove-Witts severe ulcerative colitis requires at least six bloody stools per day plus at least one systemic feature. A pulse above 90/min qualifies, so the patient should be admitted for intravenous corticosteroids and close medical-surgical monitoring.

  8. An immunocompromised patient at risk of tuberculosis has chest imaging showing diffuse bilateral 1–3 mm millet-seed nodules. Which form of tuberculosis is most strongly indicated by this imaging pattern?

    1. Upper-lobe cavitating reactivation tuberculosis
    2. Miliary tuberculosis
    3. Pott disease
    4. Scrofula
    Answer

    B. The diffuse bilateral 1–3 mm millet-seed nodules represent miliary tuberculosis caused by haematogenous dissemination. Immunocompromise further supports this recognition.

Full papers in the real format

10 timed mock papers of 200 questions each, built to the weights above. No question repeats across papers.

How to prepare

  • Use the reading list as a study aid. It includes Toronto Notes, Davidson, Harrison, Nelson, surgery and patient-safety texts.
  • Practise knowledge questions and short clinical cases. Both appear in the applicant guide.
  • The blueprint names disease-frequency and excess-risk calculations. Study how to work these out in the preventive-medicine section.
  • In a short case, read the findings before you choose an answer. Our suggested practice includes cases where you decide the next step.
  • Train for each 120-minute part. Unscheduled breaks do not stop the clock.
  • The SMLE guide gives no way to turn mock marks into scaled scores. Use mocks to find weak topics.

Licensing steps

  1. Check your title and documents: Check which title fits you. Finish DataFlow, then send your file through Mumaris Plus. Read the guide
  2. Check fees and book: Book the paper on your permit. Choose a date within the period printed on it. Read the guide
  3. Check results and register: Find your score and next step. Check your attempts before you book again. Read the guide

Frequently asked questions

What is the SMLE passing score?

560 on a 200 to 800 scale. (SMLE guide).

How many questions are in the SMLE?

200, split into 2 parts of 100. Each part lasts 120 minutes, with a 30-minute break. (SMLE guide).

Can you take the SMLE outside Saudi Arabia?

Yes, at an SCFHS-approved Prometric centre. Choose from the locations offered when you book.

How long is an SMLE result valid for residency?

For Saudi Board applications in 2026, results can be up to 5 years old during the application period. See pass validity by purpose.

Sources

Facts last verified 2026-10-05.

  1. Membership Regulations Criteria (Arabic), Saudi Commission for Health Specialties
  2. SMLE Blueprint and Examination Content Guideline, 2026, Saudi Commission for Health Specialties
  3. SMLE Applicant Guide, Saudi Commission for Health Specialties