SMLE GP exam sample questions are only useful when they match the exam you will actually sit. Plenty of practice sets online still copy an older format, and candidates who train on them walk into the real test with the wrong pace and the wrong expectations.
The 20 questions below follow the current SCFHS structure: four options, one best answer, scenario-based stems, and a subject split that mirrors the official blueprint. Each one comes with the correct answer and a short explanation, so you learn why an option is right and why the others are not.
These are original practice questions written for revision. They are not copied from SCFHS or Prometric.
Table of Contents
The SMLE GP Exam Format in 2026
Before you start practicing, check that you are preparing for the right version of the exam. According to the current SCFHS blueprint, the SMLE contains 200 multiple-choice questions split into two parts of 100 questions. Each part lasts 120 minutes, with a scheduled 30-minute break in between.
Every question has four options and one best answer. Up to 10% of the questions may be pilot items that do not count toward your score, and you cannot tell which ones they are. The exam is delivered on computer at Prometric test centers.
Some older pages still describe 300 questions over six hours, or a pass mark of 500. That information is outdated. The official passing score is 560 on the SCFHS reporting scale of 200 to 800, and it is a scaled score, not a simple 70% of questions answered correctly. Always confirm your exam details inside your Mumaris Plus account on the SCFHS website before you pay for a booking.
| Detail | Current SMLE format |
|---|---|
| Total questions | 200 MCQs |
| Structure | 2 parts of 100 questions |
| Time | 120 minutes per part, plus a 30-minute break |
| Options per question | 4, single best answer |
| Pilot questions | Up to 10% |
| Passing score | 560 on a 200 to 800 scale |
How the Questions Are Weighted
The SMLE blueprint gives each subject a fixed share of the exam. Medicine carries 30%, Obstetrics and Gynecology 25%, Pediatrics 25%, and Surgery 20%.
The 20 sample questions in this article follow the same proportions: 6 Medicine, 5 OBGYN, 5 Pediatrics, and 4 Surgery. That way your score on this set gives you a rough picture of where you stand across the real exam, not just in your favorite subject.
How to Use These SMLE GP Exam Sample Questions
Do not read the answers first. Set a timer for 24 minutes, which matches the real exam pace of roughly 72 seconds per question, and answer all 20 in one sitting.
Then mark your result by subject. A weak score in one area tells you more than a total score does. If you miss two or more questions in a subject, that subject deserves your next study block.
Most importantly, read every explanation, including for questions you got right. The SMLE tests clinical reasoning, and the explanations show the reasoning the exam expects.
20 SMLE GP Exam Sample Questions With Answers
Medicine (Questions 1 to 6)
Question 1. A 58-year-old man presents with crushing central chest pain for 40 minutes. His ECG shows ST elevation in leads II, III, and aVF. Which artery is most likely occluded?
- A. Left anterior descending artery
- B. Left circumflex artery
- C. Right coronary artery
- D. Left main coronary artery
Answer: C. ST elevation in the inferior leads usually points to the right coronary artery. Because the right ventricle may also be involved, it is sensible to obtain right-sided leads and to be careful with nitrates and fluids.
Question 2. A 45-year-old woman with a BMI of 33 has fasting plasma glucose of 9.2 mmol/L on two separate occasions. She has no contraindications to any medication. What is the most appropriate first-line drug?
- A. Glibenclamide
- B. Metformin
- C. Pioglitazone
- D. Insulin glargine
Answer: B. Metformin is the usual first-line agent for type 2 diabetes, especially in overweight patients, because it lowers glucose without causing weight gain or significant hypoglycemia.
Question 3. A 30-year-old woman reports fatigue, weight gain, and cold intolerance. Her TSH is raised and her free T4 is low. What is the most common cause of this picture in iodine-sufficient areas?
- A. Graves disease
- B. Subacute thyroiditis
- C. Hashimoto thyroiditis
- D. Thyroid carcinoma
Answer: C. Hashimoto thyroiditis is an autoimmune condition and the leading cause of primary hypothyroidism where iodine intake is adequate. Anti-TPO antibodies are typically positive.
Question 4. A 65-year-old man with known COPD presents with worsening breathlessness and increased purulent sputum. Which is the most appropriate initial management?
- A. High-flow 100% oxygen only
- B. Intravenous aminophylline as first line
- C. Short-acting bronchodilators, oral corticosteroids, and controlled oxygen
- D. Immediate endotracheal intubation
Answer: C. An acute COPD exacerbation is treated with bronchodilators, a short course of systemic steroids, and antibiotics when sputum is purulent. Oxygen should be controlled, targeting a saturation of 88 to 92%, because high-flow oxygen can worsen CO2 retention.
Question 5. A 22-year-old woman has sudden palpitations. Her heart rate is 190 beats per minute, the rhythm is regular with narrow QRS complexes, and her blood pressure is stable. What is the best first step?
- A. Synchronized cardioversion
- B. Intravenous amiodarone
- C. Vagal maneuvers
- D. Intravenous digoxin
Answer: C. A stable patient with regular narrow-complex supraventricular tachycardia should try vagal maneuvers first. If they fail, IV adenosine is the next step. Cardioversion is reserved for unstable patients.
Question 6. A 62-year-old man with chronic kidney disease has a potassium of 7.0 mmol/L, and his ECG shows peaked T waves. Which treatment should be given first?
- A. Oral calcium resonium
- B. Intravenous calcium gluconate
- C. Nebulized salbutamol
- D. Intravenous insulin with dextrose
Answer: B. When hyperkalemia causes ECG changes, calcium gluconate comes first because it stabilizes the cardiac membrane within minutes. Insulin with dextrose and salbutamol then shift potassium into cells, and resins or dialysis remove it from the body.
Obstetrics and Gynecology (Questions 7 to 11)
Question 7. A 27-year-old woman at 7 weeks of amenorrhea has severe lower abdominal pain, blood pressure of 80/50 mmHg, and a heart rate of 125. Her pregnancy test is positive and ultrasound shows free fluid in Morison’s pouch. What is the most appropriate management?
- A. Methotrexate
- B. Repeat beta-hCG in 48 hours
- C. Expectant management
- D. Immediate surgical intervention with resuscitation
Answer: D. This is a ruptured ectopic pregnancy with hemodynamic instability. Resuscitation and emergency surgery cannot wait. Methotrexate and expectant management are only for stable, carefully selected patients.
Question 8. A 32-year-old woman at 34 weeks of gestation has a blood pressure of 165/110 mmHg, a severe headache, visual disturbance, and proteinuria. Which drug is used to prevent seizures?
- A. Diazepam
- B. Phenytoin
- C. Magnesium sulfate
- D. Labetalol
Answer: C. Magnesium sulfate is the drug of choice for seizure prophylaxis in severe preeclampsia and for treating eclampsia. Labetalol controls blood pressure but does not prevent seizures.
Question 9. At what gestational age is routine screening for gestational diabetes with an oral glucose tolerance test usually performed in average-risk women?
- A. 8 to 10 weeks
- B. 12 to 16 weeks
- C. 24 to 28 weeks
- D. 36 to 38 weeks
Answer: C. Screening is generally done between 24 and 28 weeks, when insulin resistance from placental hormones begins to unmask glucose intolerance. High-risk women may be screened earlier.
Question 10. What is the most common cause of primary postpartum hemorrhage?
- A. Retained placental tissue
- B. Genital tract laceration
- C. Uterine atony
- D. Coagulopathy
Answer: C. Uterine atony accounts for the majority of primary postpartum hemorrhage. First-line management is uterine massage together with oxytocin.
Question 11. A 52-year-old woman has been postmenopausal for three years and now reports vaginal bleeding. What is the most appropriate initial investigation?
- A. Pap smear
- B. Serum CA-125
- C. Transvaginal ultrasound to measure endometrial thickness
- D. Hormone profile
Answer: C. Postmenopausal bleeding must be assumed to be endometrial cancer until proven otherwise. Transvaginal ultrasound is the usual first step, and a thickened endometrium leads to endometrial sampling.
Pediatrics (Questions 12 to 16)
Question 12. An 8-month-old infant has a barking cough, inspiratory stridor at rest, and a low-grade fever. A neck X-ray shows a steeple sign. What is the most appropriate treatment?
- A. Oral amoxicillin
- B. Nebulized salbutamol
- C. Single dose of dexamethasone
- D. Immediate intubation
Answer: C. This is croup, which is viral. A single dose of corticosteroid reduces airway swelling and is the mainstay of treatment, with nebulized adrenaline added for severe cases.
Question 13. A 2-year-old child has had watery diarrhea for two days. He is mildly dehydrated, alert, and drinking eagerly. What is the best management?
- A. Intravenous fluid bolus
- B. Oral rehydration solution
- C. Oral antibiotics
- D. Loperamide
Answer: B. Mild to moderate dehydration is managed with oral rehydration solution. Antibiotics are not routinely needed, and loperamide should be avoided in young children.
Question 14. A 4-year-old boy develops periorbital swelling and tea-colored urine two weeks after a sore throat. Which laboratory finding is expected?
- A. Low serum C3
- B. Elevated serum C3
- C. Low anti-streptolysin O titer
- D. Normal complement with heavy proteinuria
Answer: A. This is post-streptococcal glomerulonephritis. Serum C3 is typically low and returns to normal within about six to eight weeks, which helps separate it from other glomerular diseases.
Question 15. A full-term newborn looks jaundiced at 18 hours of age. What is the most likely cause?
- A. Physiological jaundice
- B. Breast milk jaundice
- C. Biliary atresia
- D. Hemolytic disease of the newborn
Answer: D. Jaundice in the first 24 hours is never physiological. ABO or Rh incompatibility is a leading cause and needs prompt investigation and treatment.
Question 16. A child sits without support, crawls, uses a pincer grasp, and says “mama” without meaning. What is the most likely age?
- A. 4 months
- B. 6 months
- C. 9 months
- D. 15 months
Answer: C. Crawling and a developing pincer grasp fit about 9 months. Sitting alone is closer to 6 months, and walking comes later, around 12 to 15 months.
Surgery (Questions 17 to 20)
Question 17. A 22-year-old man has periumbilical pain that has moved to the right lower quadrant, with anorexia, fever, and a raised white cell count. What is the most appropriate management?
- A. Observation for 48 hours
- B. Barium enema
- C. Colonoscopy
- D. Appendectomy
Answer: D. The classic history and examination point to acute appendicitis, and surgery is the treatment of choice. Imaging is reserved for unclear presentations.
Question 18. A 40-year-old woman has right upper quadrant pain after fatty meals, fever, and a positive Murphy sign. Which is the best initial imaging study?
- A. Abdominal ultrasound
- B. CT scan of the abdomen
- C. HIDA scan
- D. MRCP
Answer: A. Ultrasound is the first-line investigation for suspected gallstone disease and cholecystitis. It is quick, safe, and shows stones, wall thickening, and pericholecystic fluid.
Question 19. A man with a penetrating chest injury has low blood pressure, distended neck veins, absent breath sounds on the right, and tracheal deviation to the left. What is the next best step?
- A. Chest X-ray
- B. Needle decompression
- C. Pericardiocentesis
- D. Endotracheal intubation
Answer: B. This is a tension pneumothorax, which is a clinical diagnosis. Immediate needle decompression saves lives, and waiting for an X-ray can be fatal.
Question 20. A 60-year-old man has painless jaundice, weight loss, and a palpable, non-tender gallbladder. What is the most likely diagnosis?
- A. Choledocholithiasis
- B. Acute cholecystitis
- C. Hepatitis A
- D. Carcinoma of the head of the pancreas
Answer: D. A painless, enlarged gallbladder with jaundice follows Courvoisier’s sign, which suggests malignant obstruction of the common bile duct, most often from pancreatic head cancer.
What Your Score Tells You
If you answered 16 or more correctly, you are in a strong position, but keep practicing with full 100-question blocks to build stamina. A score between 11 and 15 means your core knowledge is there and your gaps are probably in specific topics, so focus your revision by subject.
Below 11 does not mean you will fail. It means you should build a structured plan before booking. Start with high-yield topics in Medicine and OBGYN, since together they carry 55% of the exam.
Exam Day Strategy for the SMLE
You have about 72 seconds per question, so avoid spending three minutes on a single stem. Answer what you can, flag what you cannot, and come back.
Read the last line of the question first. It tells you whether the exam wants a diagnosis, a next step, or a most likely cause, and that changes how you read the scenario.
There is no negative marking, so never leave a question blank. Treat every item as scored, because you cannot tell which ones are pilot questions.
From Practice to Registration
Practice questions are only one part of the journey. Before you can sit the SMLE, your credentials must pass Primary Source Verification through DataFlow, and you need an active Mumaris Plus profile. You can read how that works in our SCFHS DataFlow guide and our general DataFlow process guide, or see the DataFlow Group directly for current case procedures.
If you are also considering other Gulf exams, our DHA exam guide and MOH exam guide explain how those systems differ. For hands-on help with registration, crash courses, and mock tests, see our services page.
Frequently Asked Questions
How many questions are in the SMLE exam?
The current SCFHS blueprint describes 200 multiple-choice questions in two parts of 100, with 120 minutes per part and a 30-minute break. Up to 10% may be pilot questions.
What is the SMLE passing score?
The official passing score is 560 on a reporting scale of 200 to 800. It is a scaled score, so it does not equal a fixed percentage of correct answers.
How is the SMLE divided by subject?
Medicine accounts for 30%, Obstetrics and Gynecology 25%, Pediatrics 25%, and Surgery 20%.
Are these SMLE sample questions from the real exam?
No. They are original practice questions written to match the format and subject weighting of the SMLE, not actual SCFHS questions.
Is there negative marking in the SMLE?
No. They are original practice questions written to match the format and subject weighting of the SMLE, not actual SCFHS questions.
Is there negative marking in the SMLE? No. You should answer every question, even when you are unsure.
Get Started
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