SPLE exam: free questions, blueprint and pass score

Results: A scaled score on a 200-800 reporting scale, with a statement of results and a feedback report comparing you with other test takers - announced 2-6 weeks after the test window closes.

Attempts: You may sit each licensure exam up to four times a year, counted from your first attempt, until you pass. You cannot sit twice in the same testing window - the second sitting counts as an attempt and its result is void. Arriving more than 30 minutes late also counts as an attempt unless SCFHS accepts a documented reason. After passing, you get two further attempts to improve your score, for residency selection.

1. Question 1Basic Biomedical Sciencesmedium

   A patient with macrocytic anaemia has raised serum methylmalonic acid and raised homocysteine. Which deficiency best explains both results?

   1. AFolate
   2. BVitamin B12 (cobalamin)
   3. CIron
   4. DVitamin B6 (pyridoxine)
   Show answer and explanation▾

   Answer: B. Vitamin B12 (cobalamin)

   Vitamin B12 is the cofactor for methylmalonyl-CoA mutase and methionine synthase, so deficiency raises both methylmalonic acid and homocysteine. Folate deficiency raises homocysteine only, which is how the two are told apart. Iron deficiency causes a microcytic anaemia.

   Reference: Lippincott Illustrated Reviews: Biochemistry, 8th ed. (2021)

2. Question 2Basic Biomedical Scienceseasy

   A tuberculin skin test shows induration that peaks 48-72 hours after injection. Which type of hypersensitivity reaction is this?

   1. AType I (IgE-mediated)
   2. BType II (antibody-mediated cytotoxic)
   3. CType III (immune complex)
   4. DType IV (T cell-mediated, delayed)
   Show answer and explanation▾

   Answer: D. Type IV (T cell-mediated, delayed)

   The tuberculin reaction is the classic type IV, delayed-type hypersensitivity, mediated by sensitised T cells and peaking at 48-72 hours. Type I reactions such as anaphylaxis occur within minutes, and types II and III are antibody-mediated.

   Reference: Paul, Fundamental Immunology, 7th ed. (2012)

3. Question 3Pharmaceutical Scienceseasy

   A drug with first-order elimination and a half-life of 6 hours is started as a regular maintenance dose with no loading dose. About how long will it take to reach steady state?

   1. A6 hours
   2. B12 hours
   3. C24-30 hours
   4. D72 hours
   Show answer and explanation▾

   Answer: C. 24-30 hours

   Steady state is reached after about 4-5 half-lives, whatever the dose: 4 to 5 × 6 hours = 24-30 hours. After one half-life a drug is only at 50% of its steady-state level.

   Reference: Shargel, Applied Biopharmaceutics & Pharmacokinetics, 7th ed. (2016)

4. Question 4Pharmaceutical Sciencesmedium

   A 70 kg patient needs a loading dose of a drug to reach a plasma concentration of 10 mg/L. The volume of distribution is 0.5 L/kg and bioavailability is 100%. What loading dose is needed?

   1. A35 mg
   2. B350 mg
   3. C700 mg
   4. D3,500 mg
   Show answer and explanation▾

   Answer: B. 350 mg

   Loading dose = Vd × target concentration. Vd = 0.5 L/kg × 70 kg = 35 L, and 35 L × 10 mg/L = 350 mg. The other answers come from misplacing a decimal or leaving out the body weight.

   Reference: Ansel's Pharmaceutical Calculations, 15th ed. (2017)

5. Question 5Pharmaceutical Sciencesmedium

   A patient taking simvastatin 40 mg daily is prescribed clarithromycin for pneumonia. What is the main risk of this combination?

   1. AReduced statin effect through enzyme induction
   2. BMyopathy and rhabdomyolysis from raised simvastatin levels
   3. CHypoglycaemia
   4. DQT shortening
   Show answer and explanation▾

   Answer: B. Myopathy and rhabdomyolysis from raised simvastatin levels

   Clarithromycin strongly inhibits CYP3A4, the main route of simvastatin metabolism, so statin levels rise sharply and myopathy or rhabdomyolysis can follow. The statin is usually withheld during the course, or azithromycin is chosen instead. Clarithromycin prolongs the QT interval rather than shortening it.

   Reference: Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed. (2023)

6. Question 6Pharmaceutical Scienceseasy

   A patient arrives with visual blurring and a severe metabolic acidosis with a high anion gap after drinking a methanol-containing liquid. Which antidote blocks the formation of its toxic metabolite?

   1. AFomepizole
   2. BNaloxone
   3. CFlumazenil
   4. DAtropine
   Show answer and explanation▾

   Answer: A. Fomepizole

   Fomepizole inhibits alcohol dehydrogenase, which stops methanol being converted to formic acid, the cause of acidosis and optic nerve damage. Ethanol is an alternative and haemodialysis may be needed. Naloxone reverses opioids, flumazenil reverses benzodiazepines and atropine treats organophosphate poisoning.

   Reference: Goldfrank's Toxicologic Emergencies, 11th ed. (2019)

7. Question 7Pharmaceutical Scienceseasy

   A carer asks whether enteric-coated tablets can be crushed so a patient can swallow them more easily. Why should they not be crushed?

   1. ACrushing makes the drug more potent
   2. BThe coating protects the drug from stomach acid, or the stomach from the drug, until it reaches the intestine
   3. CThe coating is what contains the active drug
   4. DCrushed tablets cannot be absorbed at all
   Show answer and explanation▾

   Answer: B. The coating protects the drug from stomach acid, or the stomach from the drug, until it reaches the intestine

   An enteric coating resists gastric acid and dissolves at the higher pH of the small intestine. Crushing it can destroy acid-labile drugs, such as some proton pump inhibitors, or expose the stomach to irritant drugs. Ask for a suitable liquid or dispersible form instead.

   Reference: Aulton's Pharmaceutics: The Design and Manufacture of Medicines, 5th ed. (2017)

8. Question 8Social, Behavioural and Administrative Sciencesmedium

   In a trial, 10% of patients on placebo and 6% on a new drug had a stroke over 5 years. What is the number needed to treat to prevent one stroke over 5 years?

   1. A4
   2. B10
   3. C17
   4. D25
   Show answer and explanation▾

   Answer: D. 25

   Absolute risk reduction = 10% - 6% = 4% (0.04), and NNT = 1 / ARR = 1 / 0.04 = 25. The relative risk reduction is 40%, which sounds larger but does not give the NNT.

   Reference: De Muth, Basic Statistics and Pharmaceutical Statistical Applications, 3rd ed. (2014)

9. Question 9Social, Behavioural and Administrative Scienceseasy

   A study compares two treatments by their cost per quality-adjusted life year (QALY) gained. What type of economic evaluation is this?

   1. ACost-minimisation analysis
   2. BCost-benefit analysis
   3. CCost-utility analysis
   4. DCost-of-illness analysis
   Show answer and explanation▾

   Answer: C. Cost-utility analysis

   Cost-utility analysis measures outcomes in QALYs, combining length and quality of life. Cost-benefit analysis puts outcomes in money, cost-minimisation assumes equal outcomes, and cost-of-illness studies describe the burden of a disease.

   Reference: Rascati, Essentials of Pharmacoeconomics, 3rd ed. (2020)

10. Question 10Social, Behavioural and Administrative Sciencesmedium

    A hospital pharmacist in Riyadh suspects that a newly marketed drug caused a serious skin reaction in a patient. Where should the suspected adverse drug reaction be reported?

    1. ATo the Saudi Food and Drug Authority (SFDA) pharmacovigilance system
    2. BOnly to the patient's insurer
    3. CTo the Saudi Commission for Health Specialties
    4. DThere is no need to report a suspected reaction until causality is proven
    Show answer and explanation▾

    Answer: A. To the Saudi Food and Drug Authority (SFDA) pharmacovigilance system

    In Saudi Arabia, suspected adverse drug reactions are reported to the SFDA's national pharmacovigilance system. Reporting does not require proof of causality: suspicion is enough, and serious reactions to new drugs are a priority. SCFHS licenses practitioners but does not run drug safety reporting.

    Reference: SFDA Guideline on Good Pharmacovigilance Practices (GVP)

11. Question 11Clinical Sciencesmedium

    A patient stable on warfarin with an INR of 2.5 needs an antibiotic for a urinary tract infection. Which antibiotic is most likely to raise the INR significantly?

    1. ANitrofurantoin
    2. BTrimethoprim-sulfamethoxazole
    3. CFosfomycin
    4. DAmoxicillin
    Show answer and explanation▾

    Answer: B. Trimethoprim-sulfamethoxazole

    Sulfamethoxazole inhibits CYP2C9, which metabolises the more potent S-enantiomer of warfarin, and it displaces warfarin from protein binding, so the INR can rise sharply. Choose an alternative where possible, or check the INR within a few days. The others have smaller or less predictable effects.

    Reference: Lexicomp Drug Interactions (Wolters Kluwer)

12. Question 12Clinical Sciencesmedium

    For a patient with serious MRSA infection, which approach to vancomycin monitoring do current consensus guidelines recommend?

    1. APeak levels above 40 mg/L
    2. BAUC-guided dosing, targeting an AUC of 400-600 mg·h/L
    3. CNo monitoring, because toxicity is rare
    4. DTroughs of 15-20 mg/L for every patient
    Show answer and explanation▾

    Answer: B. AUC-guided dosing, targeting an AUC of 400-600 mg·h/L

    The 2020 ASHP/IDSA/PIDS/SIDP consensus recommends AUC-guided dosing with a target AUC of 400-600 mg·h/L, which gives efficacy with less kidney injury than aiming for troughs of 15-20 mg/L. Peak levels are not used for vancomycin.

    Reference: ASHP/IDSA/PIDS/SIDP Consensus Guideline: Therapeutic Monitoring of Vancomycin for Serious MRSA Infections (2020)

13. Question 13Clinical Scienceseasy

    A woman with chronic hypertension, controlled on lisinopril, finds she is 7 weeks pregnant. Which change is recommended?

    1. AContinue lisinopril throughout pregnancy
    2. BSwitch to labetalol or nifedipine
    3. CAdd an angiotensin receptor blocker
    4. DStop all antihypertensives without monitoring
    Show answer and explanation▾

    Answer: B. Switch to labetalol or nifedipine

    ACE inhibitors and ARBs are fetotoxic, causing renal damage and oligohydramnios, especially later in pregnancy, and should be stopped. Labetalol, nifedipine and methyldopa are the preferred options in pregnancy, and blood pressure should continue to be monitored.

    Reference: ACOG Practice Bulletin No. 203: Chronic Hypertension in Pregnancy (2019)

14. Question 14Clinical Scienceseasy

    A patient starting levothyroxine also takes a calcium carbonate supplement every morning. What is the best counselling advice?

    1. ATake both together with breakfast
    2. BTake levothyroxine on an empty stomach and separate it from calcium by at least 4 hours
    3. CTake levothyroxine only on alternate days
    4. DStop the calcium permanently
    Show answer and explanation▾

    Answer: B. Take levothyroxine on an empty stomach and separate it from calcium by at least 4 hours

    Calcium, iron and antacids bind levothyroxine in the gut and reduce its absorption. It should be taken on an empty stomach, 30-60 minutes before breakfast or at bedtime, with calcium taken at least 4 hours apart.

    Reference: American Thyroid Association Guidelines for the Treatment of Hypothyroidism (2014)

15. Question 15Clinical Scienceseasy

    A parent asks a community pharmacist for something to bring down the fever of their 9-year-old child, who has influenza. Which medicine should the pharmacist advise against?

    1. AParacetamol
    2. BIbuprofen
    3. CAspirin
    4. DOral rehydration fluids
    Show answer and explanation▾

    Answer: C. Aspirin

    Aspirin given to children and teenagers during viral illnesses, especially influenza and chickenpox, is linked to Reye's syndrome, which can be fatal. Paracetamol or ibuprofen at weight-based doses, with fluids, are appropriate.

    Reference: Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care, 20th ed. (2021)

1. 1

   Apply through SCFHS's e-application

   SCFHS processes your application and issues a scheduling permit with your eligibility period, emailed to you. Check the eligibility criteria for pharmacists on the SCFHS website before applying.

2. 2

   Book with Prometric

   Use the permit to schedule a date at an SCFHS-approved Prometric centre, in Saudi Arabia or abroad, within your eligibility period and SCFHS's testing windows.

3. 3

   Bring your permit and ID

   Bring the scheduling permit and a passport (or a national or residence ID in Saudi Arabia), with your name exactly as it appears on the permit.

4. 4

   Wait for your results

   SCFHS's guides for its licensure exams release results 2-6 weeks after the testing window closes, with a statement of results and a feedback report.