SMLE Practice Test

SMLE Exam at a Glance

What changed for SMLE in 2026

• Oct 27, 2026: Delivery changed to Computer-based testing at SCFHS-approved Prometric test centers (Saudi Arabia and abroad) (previously Computer-based at SCFHS-approved Prometric centers (Saudi Arabia and abroad)).^[1]
• Oct 27, 2026: Eligibility changed to Recognized primary degree (MBBS or equivalent), internship trainee, or student one year away from graduation (previously MBBS or equivalent, internship trainee, or final-year student).^[1]
• Oct 27, 2026: Exam fee changed to SAR 120 service fee (previously SAR 120 eligibility service fee).^[2]
• Oct 27, 2026: Passing score changed to 560 on a 200–800 reporting scale (previously 560 on a 200–800 scale).^[1]
• Oct 27, 2026: Score release changed to Within 2–6 weeks of the end of a testing window (previously 2–6 weeks after the window closes).^[1]
• Oct 27, 2026: Retake policy changed to Up to 4 attempts per year; max 1 attempt per window; 2 improvement attempts after passing (previously Up to 4 attempts a year; one sitting per window; 2 improvement attempts after a pass).^[1]
• Oct 27, 2026: Testing window changed to November 1–24, 2026 (previously Nov 1–24, 2026 (next window; then Dec 1–24, 2026)).^[3]

What the SMLE is and how it works

According to Saudi Commission for Health Specialties, “Following the standard-setting exercise, the passing score was determined as 560 on the reporting scale of 200-800. This passing score was reviewed and approved by the Central Assessment Committee (CAC).”^[1]

The SMLE is the licensing exam for medical graduates and trainees who want to practise in Saudi Arabia. The Saudi Commission for Health Specialties (SCFHS) sets and runs it, and its published blueprint is the authority on content and rules.

The exam is computer-based and taken at SCFHS-approved Prometric test centers, in Saudi Arabia and abroad. It is divided into two parts of 100 questions each, with 120 minutes allowed for each part.

Results are reported on a 200 to 800 scale. The passing score is 560, set through a standard-setting exercise and approved by the Central Assessment Committee. Scores are announced within 2 to 6 weeks of the end of a testing window, so expect to wait after you sit the exam.

To apply, you need a recognized primary degree (MBBS or equivalent), or you must be an internship trainee, or a student one year away from graduation. The service fee is SAR 120.

Retakes are limited. You can take the exam up to 4 times a year, with a maximum of 1 attempt per window. After you pass, you are eligible for 2 improvement attempts. The current window listed on the official dates page runs from November 1 to 24, 2026. Fees, dates and rules can change, so check the SCFHS website before you book.

Worked examples: how to reason through SMLE questions

These are practice questions written for this site, not questions from the real exam. Each explanation shows why the right answer is right and why the others are wrong.

Example 1

Question: A 42-year-old woman with a BMI of 38 presents with right upper quadrant pain after a fatty meal, fever, and a positive Murphy sign. What is the most appropriate initial imaging?

1. CT abdomen with contrast
2. Abdominal X-ray
3. Abdominal ultrasound
4. MRCP

Answer: C. Abdominal ultrasound

Explanation:

Right upper quadrant pain after a fatty meal, fever and a positive Murphy sign point to acute cholecystitis, and abdominal ultrasound is the right first test. It is quick, avoids radiation, and shows gallstones, a thickened gallbladder wall and fluid around the gallbladder. CT with contrast is slower, adds radiation and is less sensitive for gallstones, so it is kept for unclear or complicated cases. A plain abdominal X-ray misses most gallstones because they are often not radio-opaque. MRCP is useful when a bile duct stone is suspected, but it is not the starting test. Rule to remember: for suspected biliary disease, start with ultrasound.

Example 2

Question: A 60-year-old male presents with a pulsatile, expansile abdominal mass. CT angiography shows an infrarenal abdominal aortic aneurysm measuring 6.5 cm. What is the recommended management?

1. Annual surveillance with ultrasound
2. Blood pressure control and observation
3. Elective surgical repair (open or EVAR)
4. Emergency surgery only if symptomatic

Answer: C. Elective surgical repair (open or EVAR)

Explanation:

An infrarenal aneurysm of 6.5 cm is large enough that the risk of rupture outweighs the risk of an operation in a fit patient, so elective repair, open or EVAR, is the answer. Annual ultrasound surveillance suits small aneurysms, not this size. Blood pressure control and observation is part of care for every patient, but it is not treatment for an aneurysm that has already reached the repair threshold. Waiting for symptoms is wrong because rupture can be the first event and carries a high mortality. Rule to remember: an aneurysm above the repair threshold means planned repair, and symptoms make it urgent rather than optional.

Example 3

Question: A newborn presents with bilious vomiting within the first 24 hours of life. An upper GI series shows a 'corkscrew' pattern. What is the most likely diagnosis?

1. Pyloric stenosis
2. Midgut volvulus
3. Duodenal atresia
4. Hirschsprung disease

Answer: B. Midgut volvulus

Explanation:

Bilious vomiting in a newborn means obstruction until proven otherwise, and a corkscrew pattern on upper GI series is the classic sign of midgut volvulus from malrotation. Pyloric stenosis causes non-bilious projectile vomiting and appears later, not in the first 24 hours. Duodenal atresia can cause bilious vomiting, but the image would show a double bubble, not a corkscrew. Hirschsprung disease presents with delayed passage of meconium and abdominal distension, and an upper GI series is not its diagnostic test. Rule to remember: bilious vomiting in a neonate needs urgent imaging, and volvulus needs urgent surgery.

How to use these practice tests

Start with the official SCFHS blueprint and read it fully, so you know what the exam covers and how it is scored. Then use these practice sets to find your weak areas rather than to chase a score.

1. Baseline. Do one set from each specialty: Internal Medicine, Surgery, Paediatrics, Obstetrics and Gynaecology, Psychiatry, Pharmacology and Community Medicine and Preventive Health. Note which ones feel slow or uncertain.
2. Targeted work. Spend most of your time on your weakest areas. For every miss, write the rule you got wrong in a line or two, and review those notes regularly.
3. Read the explanations. Check why the wrong options are wrong, since the exam often tests the difference between close answers.
4. Mixed practice. Move to the larger sets, such as the free SMLE practice test and the SMLE exam questions set. Practise in blocks that match the exam format: two parts, each timed separately.
5. Final days. Review your notes, confirm your booking and test center details on the SCFHS site, and rest.

Our questions are written by us and are not real exam questions, so treat them as practice, not a prediction.

Sources & last verified

1. Saudi Commission for Health Specialties — passing score, retake policy, delivery, eligibility (official source). “Following the standard-setting exercise, the passing score was determined as 560 on the reporting scale of 200-800. This passing score was reviewed and approved by…” Verified Oct 27, 2026.
2. Saudi Commission for Health Specialties — exam fee (official source). “Service cost SAR120” Verified Oct 27, 2026 · source checked Oct 17, 2026.
3. Saudi Commission for Health Specialties — testing window (official source). “Tenth | 1 Nov - 24 NOV 2026 | ? Open” Verified Oct 27, 2026 · source checked Oct 17, 2026.

How we verify: editorial & fact-checking policy. Report an error: contact us.