SMLE Cheat Sheet 2026

The 30 highest-yield SMLE facts, distilled from real exam questions. Print it, save it as a PDF, or study it here — free, no sign-up.

1. Which antibiotic class is associated with tendon rupture, particularly the Achilles tendon, especially in elderly patients? → Fluoroquinolones
2. Which drug is the first-line treatment for status epilepticus? → Diazepam or lorazepam IV
3. A patient develops high-output small bowel fistula postoperatively. What electrolyte abnormality is most likely? → Metabolic acidosis with dehydration
4. A patient with depression is started on venlafaxine. At low doses it acts primarily on serotonin reuptake. What additional effect does it have at higher doses? → Noradrenaline reuptake inhibition
5. Which of the following features distinguishes delirium from dementia? → Fluctuating consciousness with acute onset
6. Which of the following is the most common cause of community-acquired pneumonia in Saudi Arabia? → Streptococcus pneumoniae
7. A patient on an SSRI starts taking tramadol and develops agitation, myoclonus, hyperreflexia, diaphoresis, and diarrhoea. What is the most likely diagnosis? → Serotonin syndrome
8. A patient with rheumatoid arthritis on methotrexate develops pancytopenia. What supplement should have been co-prescribed to prevent this complication? → Folic acid
9. A 20-year-old male sustains a fracture of the shaft of the humerus. On examination, there is wrist drop. Which nerve is most likely injured? → Radial nerve
10. A patient develops methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia. What is the drug of choice? → Vancomycin
11. What is the most common cause of iron deficiency anaemia in a premenopausal woman? → Menorrhagia
12. According to the Saudi National Immunization Program, which two vaccines are administered at birth? → BCG and Hepatitis B
13. A patient with heart failure is prescribed digoxin. Which electrolyte abnormality increases the risk of digoxin toxicity? → Hypokalaemia
14. A patient with gout is prescribed allopurinol. What is its mechanism of action? → Inhibits xanthine oxidase
15. A 4-month-old infant is found to have developmental hip dysplasia on screening. What is the most appropriate initial treatment? → Pavlik harness
16. Which of the following is the most common site for ectopic pregnancy? → Ampulla of the fallopian tube
17. A 65-year-old patient with Parkinson disease develops visual hallucinations. Which antipsychotic is safest to use? → Quetiapine or pimavanserin
18. What is the recommended screening test for gestational diabetes mellitus (GDM) according to SCFHS and Saudi guidelines? → 75g OGTT at 24-28 weeks gestation
19. A Rh-negative mother delivers a Rh-positive baby. When should anti-D immunoglobulin be administered? → Within 72 hours of delivery
20. What is the target HbA1c recommended by Saudi Diabetes Clinical Practice Guidelines for most adult patients with type 2 diabetes? → Less than 7%
21. A 3-year-old child presents with barking cough, inspiratory stridor, and a 'steeple sign' on anteroposterior neck X-ray. What is the most likely diagnosis? → Croup (laryngotracheobronchitis)
22. Which drug is the antidote for opioid overdose? → Naloxone
23. A 65-year-old male presents with an irreducible, tender inguinal swelling with vomiting and abdominal distension. What is the diagnosis? → Strangulated inguinal hernia
24. Which class of antihypertensive drugs is teratogenic and absolutely contraindicated in pregnancy? → ACE inhibitors and ARBs
25. A child with a febrile seizure is brought to the emergency department. Which of the following features would classify it as a complex febrile seizure? → Duration of 20 minutes, focal onset
26. Which of the following statistics is the BEST indicator of the overall quality of healthcare in a country? → Infant mortality rate
27. In Saudi Arabia, according to the Mental Health Act and SCFHS guidelines, involuntary psychiatric admission is permitted under which condition? → When there is imminent danger to self or others due to mental illness
28. A patient on lithium presents with tremor, polyuria, and a serum lithium level of 2.5 mEq/L. What is the immediate management? → Stop lithium, IV fluids, and monitor renal function
29. Which drug is used as a first-line disease-modifying antirheumatic drug (DMARD) for rheumatoid arthritis? → Methotrexate
30. A 70-year-old male with COPD presents with acute dyspnoea, right-sided pleuritic chest pain, and tachycardia. D-dimer is elevated. What is the next step? → CT pulmonary angiography