Skip to content
PassCurve

Free practice questions

Free KMLE practice questions

These ten questions are pulled straight from the PassCurve KMLE bank and shown exactly as a candidate meets them in a real revision session, nothing held back and nothing simplified for the page. Answer one, then open the reveal underneath to see the correct option, why every option is right or wrong, and the specific guideline the answer rests on.

The Kuwait Medical Licensing Examination is sat in English, so every question here is written in English too, the language you will actually read on exam day. Ten questions from one sitting will not replace a full revision plan, but they are a fast, honest way to see where your knowledge already holds and where it still has gaps. Read the KMLE exam guide for the exam's format, eligibility and scoring, or start a free session in the app now to keep going past these ten.

Every explanation below is evidence based: each one names the specific guideline it rests on and the date that source was last read, so you can check it yourself rather than take our word for it. These questions are written and fact-checked with AI assistance; not individually signed off by a physician.

Internal Medicine

Question 1 of 10 Nephrology

A 38-year-old Bangladeshi construction worker is brought to the emergency department in Kuwait during July after experiencing a generalized tonic-clonic seizure at his worksite. His colleagues report that he had been working outdoors in 48°C (118.4°F) heat and had consumed several liters of plain water throughout his shift to stay hydrated. Prior to the seizure, he complained of a severe headache and nausea. On examination, he is postictal and confused. His temperature is 37.8°C (100.0°F), blood pressure is 105/65 mmHg, and heart rate is 118/min. Laboratory studies reveal a serum sodium of 112 mEq/L and a serum osmolality of 235 mOsm/kg H2O. What is the most appropriate next step in management?

  • Administer intravenous 3% sodium chloride
  • Administer oral tolvaptan therapy
  • Administer intravenous 0.9% sodium chloride
  • Initiate strict oral fluid restriction
Show the answer and explanation

Correct answer: A

  • A. Administer intravenous 3% sodium chloride

    Severe symptomatic hyponatremia (e.g., presenting with seizures or coma) is a medical emergency caused by cerebral edema. The standard of care is an immediate intravenous bolus of hypertonic (3%) saline to rapidly increase serum sodium and reduce intracranial pressure, regardless of the patient's underlying volume status.

  • B. Administer oral tolvaptan therapy

    Tolvaptan is a vasopressin V2-receptor antagonist used for euvolemic and hypervolemic hyponatremia (e.g., heart failure, SIADH). It is contraindicated in hypovolemic patients and is not indicated for the acute management of life-threatening hyponatremic seizures.

  • C. Administer intravenous 0.9% sodium chloride

    Isotonic (0.9%) saline is the treatment of choice for asymptomatic or mildly symptomatic hypovolemic hyponatremia. However, it will not raise the serum sodium rapidly enough to treat acute hyponatremic seizures and reverse cerebral edema.

  • D. Initiate strict oral fluid restriction

    Fluid restriction is the first-line therapy for asymptomatic or mildly symptomatic euvolemic hyponatremia (e.g., SIADH). It acts too slowly to be of use in acute severe symptomatic hyponatremia, where immediate reversal of cerebral edema is required.

TAKEAWAY

Severe symptomatic hyponatremia presenting with seizures or coma requires immediate treatment with intravenous hypertonic (3%) saline to rapidly reverse life-threatening cerebral edema.

Harrison's Principles of Internal Medicine, 21st Edition · Chapter 63: Fluid and Electrolyte Disturbances - Hyponatremia (checked 16 August 2026)

Question 5 of 10 Nephrology

A 48-year-old Egyptian male expatriate presents to a hospital in Kuwait with a 2-week history of fatigue, joint pains, and a new rash on his legs. He works as a site supervisor in the petrochemical industry. His medical history is notable for untreated hepatitis C virus (HCV) infection, which was incidentally diagnosed during pre-employment visa screening five years ago. His blood pressure is 155/95 mmHg. Physical examination reveals palpable purpura over both lower extremities and mild pedal edema. Laboratory investigations show: Serum creatinine: 185 µmol/L (2.1 mg/dL) Complement C3: 0.85 g/L (Normal: 0.75-1.65 g/L) Complement C4: 0.04 g/L (Normal: 0.14-0.54 g/L) Rheumatoid factor: Positive Urinalysis: 3+ protein, 25-30 red blood cells per high-power field, and occasional red blood cell casts. Which of the following is the most likely finding on renal biopsy?

  • Membranoproliferative glomerulonephritis
  • Membranous nephropathy
  • Focal segmental glomerulosclerosis
  • Pauci-immune crescentic glomerulonephritis
Show the answer and explanation

Correct answer: A

  • A. Membranoproliferative glomerulonephritis

    This patient's presentation of palpable purpura, arthralgias, renal failure with an active urine sediment, isolated low C4, and positive rheumatoid factor in the context of chronic HCV infection is classic for mixed cryoglobulinemic vasculitis. The most common renal manifestation of HCV-associated cryoglobulinemia is type 1 membranoproliferative glomerulonephritis (MPGN).

  • B. Membranous nephropathy

    Membranous nephropathy typically presents with nephrotic-range proteinuria without significant hematuria or red blood cell casts. While it can be secondary to infections, it is much more strongly associated with hepatitis B rather than hepatitis C, and it does not typically consume complement C4 or cause palpable purpura.

  • C. Focal segmental glomerulosclerosis

    Focal segmental glomerulosclerosis (FSGS) presents with nephrotic syndrome and is associated with viral infections like HIV, but not typically HCV. It features normal complement levels and lacks the systemic vasculitic signs seen in this patient.

  • D. Pauci-immune crescentic glomerulonephritis

    Pauci-immune crescentic glomerulonephritis (seen in ANCA-associated vasculitis) can present with rapidly progressive renal failure and active urine sediment, but complement levels are typically normal. It is not classically driven by HCV or associated with a positive rheumatoid factor and isolated severe C4 depression.

TAKEAWAY

Hepatitis C virus infection is strongly associated with mixed cryoglobulinemia, which typically presents with palpable purpura, arthralgias, low C4, positive rheumatoid factor, and membranoproliferative glomerulonephritis (MPGN) on renal biopsy.

KDIGO 2024 Clinical Practice Guideline for the Management of Antineutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitis and Other Glomerular Diseases (including HCV-associated glomerular diseases) · Management of HCV-Associated Glomerular Diseases (checked 16 August 2026)

Question 9 of 10 Respiratory

A 28-year-old male expatriate from Bangladesh presents to a pre-employment medical fitness clinic in Kuwait. He is completely asymptomatic and denies any cough, fever, night sweats, or weight loss. His vital signs are normal. As part of the mandatory visa screening protocol, a chest radiograph is performed, which reveals a 2-cm cavitary lesion in the apical segment of the right upper lobe. What is the most appropriate next step in management?

  • Sputum nucleic acid amplification testing
  • Computed tomography scan of the chest
  • Empiric initiation of antitubercular therapy
  • Serum interferon-gamma release assay
Show the answer and explanation

Correct answer: A

  • A. Sputum nucleic acid amplification testing

    Correct. The World Health Organization (WHO) strongly recommends rapid molecular tests (e.g., Xpert MTB/RIF) as the initial diagnostic test for all individuals with suspected pulmonary tuberculosis based on clinical or radiological findings, allowing for rapid detection of Mycobacterium tuberculosis and rifampicin resistance.

  • B. Computed tomography scan of the chest

    Incorrect. While a CT scan can characterize the lesion further, it will not provide the necessary microbiological confirmation of active tuberculosis. Sputum testing is the immediate priority.

  • C. Empiric initiation of antitubercular therapy

    Incorrect. Empiric treatment should not be initiated in an asymptomatic patient solely based on radiographic findings; microbiological confirmation is required first to avoid unnecessary toxicity and to check for drug resistance.

  • D. Serum interferon-gamma release assay

    Incorrect. An interferon-gamma release assay (IGRA) only indicates immune reactivity to Mycobacterium tuberculosis (typically latent infection) and cannot differentiate between active disease and latent infection.

TAKEAWAY

In patients with radiographic findings suspicious for active pulmonary tuberculosis (e.g., apical cavitation), the most appropriate initial diagnostic step is microbiological confirmation using sputum nucleic acid amplification testing (NAAT).

WHO consolidated guidelines on tuberculosis. Module 3: Diagnosis - rapid diagnostics for tuberculosis detection · Section 2.1: Initial diagnostic tests for diagnosis of TB with drug-susceptibility testing (checked 16 August 2026)

Obstetrics and Gynaecology

Question 2 of 10 Obstetrics

A 32-year-old Egyptian expatriate, gravida 3, para 2, presents to a maternity hospital in Kuwait at 35 weeks and 4 days of gestation complaining of intense, generalized pruritus that is worse at night. The itching is particularly severe on her palms and soles. She has no visible rash. Her pregnancy has been otherwise uncomplicated. Cardiotocography shows a reactive fetal heart rate pattern. Laboratory investigations reveal: Alanine aminotransferase (ALT): 110 U/L Aspartate aminotransferase (AST): 95 U/L Total serum bile acids: 112 micromol/L What is the most appropriate next step in the management of this patient?

  • Schedule induction of labor at 36 0/7 weeks of gestation
  • Proceed with immediate cesarean delivery
  • Schedule induction of labor at 37 0/7 weeks of gestation
  • Initiate ursodeoxycholic acid and schedule induction at 39 0/7 weeks of gestation
Show the answer and explanation

Correct answer: A

  • A. Schedule induction of labor at 36 0/7 weeks of gestation

    For patients with intrahepatic cholestasis of pregnancy (ICP) and total bile acid levels of 100 micromol/L or more, the risk of fetal demise is significantly elevated. Guidelines recommend delivery at 36 0/7 weeks of gestation to mitigate the risk of stillbirth.

  • B. Proceed with immediate cesarean delivery

    Immediate delivery is not indicated as fetal status is reassuring (reactive CTG). The patient can safely wait the remaining three days until 36 0/7 weeks, and vaginal delivery via induction is generally preferred over cesarean unless there are standard obstetric indications.

  • C. Schedule induction of labor at 37 0/7 weeks of gestation

    Delivery at 36 0/7 to 39 0/7 weeks (typically 37-38 weeks) is recommended for uncomplicated ICP with bile acid levels less than 100 micromol/L. This patient's level is 112 micromol/L, mandating earlier delivery.

  • D. Initiate ursodeoxycholic acid and schedule induction at 39 0/7 weeks of gestation

    Delaying delivery to 39 weeks is contraindicated in ICP due to the unpredictable risk of late third-trimester stillbirth. While ursodeoxycholic acid can be used for maternal symptom relief, it does not reliably prevent fetal death and should not delay indicated early delivery.

TAKEAWAY

In intrahepatic cholestasis of pregnancy, severe disease defined by total bile acids ≥ 100 micromol/L carries a high risk of stillbirth, and delivery is recommended at 36 0/7 weeks of gestation.

Society for Maternal-Fetal Medicine (SMFM) Consult Series #53: Intrahepatic cholestasis of pregnancy · Timing of Delivery (checked 16 August 2026)

Question 6 of 10 Obstetrics

A 30-year-old Indian expatriate in Kuwait, who is in her first pregnancy (gravida 1, para 0), presents to a primary care polyclinic at 12 weeks of gestation for a routine antenatal visit. She has a pre-existing history of type 2 diabetes mellitus and chronic hypertension. Her current medications include methyldopa and insulin. Today, her blood pressure is 138/88 mmHg, and her body mass index is 34 kg/m². Urinalysis is negative for protein. Which of the following medications is most appropriate to initiate at this time to reduce her risk of developing pre-eclampsia?

  • Enoxaparin sodium
  • Nifedipine
  • Low-dose aspirin
  • Magnesium sulfate
Show the answer and explanation

Correct answer: C

  • A. Enoxaparin sodium

    Enoxaparin is a low-molecular-weight heparin used for thromboprophylaxis (e.g., in antiphospholipid syndrome or prior venous thromboembolism). It is not indicated for the primary prevention of pre-eclampsia in patients whose only risks are diabetes and chronic hypertension.

  • B. Nifedipine

    While nifedipine is a safe antihypertensive used in pregnancy, this patient's blood pressure is adequately controlled on methyldopa. Adding nifedipine does not prevent the underlying pathophysiology of pre-eclampsia.

  • C. Low-dose aspirin

    Low-dose aspirin is recommended starting at 12 to 28 weeks of gestation (optimally before 16 weeks) for women with one or more high-risk factors for pre-eclampsia, which include chronic hypertension, pre-existing diabetes mellitus, nulliparity, and obesity.

  • D. Magnesium sulfate

    Magnesium sulfate is used for seizure prophylaxis in cases of severe pre-eclampsia or eclampsia, and for fetal neuroprotection during preterm labor. It has no role in the primary prevention of pre-eclampsia during the first trimester.

TAKEAWAY

Low-dose aspirin should be initiated between 12 and 28 weeks of gestation (optimally before 16 weeks) to prevent pre-eclampsia in women with high-risk factors such as pre-existing diabetes, chronic hypertension, and obesity.

ACOG Practice Bulletin No. 202: Gestational Hypertension and Preeclampsia · Clinical Considerations and Recommendations: Prevention (checked 16 August 2026)

Question 10 of 10 Obstetrics

A 31-year-old Indian expatriate, G2P1, presents to a primary care polyclinic in Kuwait for her first antenatal visit at 8 weeks of gestation. Her body mass index is 36 kg/m². Her mother has type 2 diabetes mellitus. Her blood pressure is 120/78 mmHg. Physical examination reveals acanthosis nigricans on her posterior neck. Which of the following is the most appropriate next step regarding her glycemic assessment?

  • Perform a 50-g glucose challenge test at 16 weeks
  • Measure fasting plasma glucose level at 20 weeks
  • Order a 75-g oral glucose tolerance test at 24 weeks
  • Assess hemoglobin A1c level at the current visit
Show the answer and explanation

Correct answer: D

  • A. Perform a 50-g glucose challenge test at 16 weeks

    Performing a screening test at 16 weeks delays the diagnosis of overt pregestational diabetes. Early screening should occur immediately at the initiation of prenatal care for high-risk patients.

  • B. Measure fasting plasma glucose level at 20 weeks

    Waiting until 20 weeks to evaluate glycemic status misses the critical window for early first-trimester glycemic control, which is essential to reduce the risk of congenital anomalies associated with undiagnosed pregestational diabetes.

  • C. Order a 75-g oral glucose tolerance test at 24 weeks

    Routine screening at 24-28 weeks of gestation is the standard of care for women with average risk. This patient has multiple strong risk factors necessitating early testing at the first visit, rather than waiting for the routine late second-trimester window.

  • D. Assess hemoglobin A1c level at the current visit

    Patients with risk factors for type 2 diabetes (BMI ≥ 25 kg/m² plus additional risk factors such as high-risk ethnicity, family history of diabetes, or signs of insulin resistance like acanthosis nigricans) should undergo early screening for pregestational diabetes at their first prenatal visit. Hemoglobin A1c, fasting plasma glucose, or a 75-g oral glucose tolerance test are acceptable modalities for this early screening.

TAKEAWAY

Pregnant women with multiple risk factors for type 2 diabetes mellitus (such as obesity, high-risk ethnicity, and acanthosis nigricans) should be screened for overt pregestational diabetes at their first antenatal visit using standard diagnostic criteria.

ACOG Practice Bulletin No. 226: Screening for Gestational Diabetes Mellitus · Early Screening for Overt Diabetes (checked 16 August 2026)

Pediatrics

Question 3 of 10 Growth and Development

A 14-year-old boy of Egyptian descent is brought to a pediatric clinic in Kuwait by his parents due to concerns about his height. He is the shortest boy in his class. He has no history of chronic illness and takes no medications. His father is 175 cm (5 ft 9 in) tall and mentions that he also experienced a late "growth spurt" at age 16. The boy's current height is below the 3rd percentile for his age, and his weight is at the 10th percentile. His growth velocity over the past year has been 5 cm/year. Physical examination reveals a normal thyroid gland, Tanner stage 1 pubic hair, and a testicular volume of 3 mL bilaterally. A radiograph of the left hand and wrist reveals a bone age of 11.5 years. Which of the following is the most likely diagnosis?

  • Familial short stature
  • Constitutional delay of growth and puberty
  • Klinefelter syndrome
  • Growth hormone deficiency
Show the answer and explanation

Correct answer: B

  • A. Familial short stature

    Familial short stature typically presents with a bone age that matches the chronological age, and the parents are usually short. This patient has a delayed bone age and an average-height father.

  • B. Constitutional delay of growth and puberty

    Constitutional delay of growth and puberty (CDGP) is characterized by short stature, delayed bone age, normal growth velocity for the bone age (typically 5 cm/year before puberty), and often a family history of delayed puberty. This patient perfectly fits this profile.

  • C. Klinefelter syndrome

    Klinefelter syndrome (47,XXY) typically presents with tall stature (due to delayed epiphyseal closure and disproportionately long legs) and small, firm testes, not short stature.

  • D. Growth hormone deficiency

    Growth hormone deficiency presents with a significantly decreased growth velocity (typically <4 cm/year in older children) and dropping across height percentiles. This boy has a normal prepubertal growth velocity of 5 cm/year.

TAKEAWAY

Constitutional delay of growth and puberty presents with short stature, normal prepubertal growth velocity, delayed bone age, and a family history of 'late bloomers'.

Nelson Textbook of Pediatrics, 21st Edition · Section 27: Endocrinology, Chapter: Short Stature (checked 16 August 2026)

Question 7 of 10 Growth and Development

A 14-year-old Egyptian boy residing in Kuwait is brought to a primary care polyclinic for evaluation of short stature. His parents are concerned because he is the shortest boy in his class. His father mentions that he himself was a "late bloomer" who continued growing well into high school. On examination, the boy's height is 142 cm (below the 3rd percentile) and his weight is 38 kg (5th percentile). He is at Tanner stage 1 for pubic hair and genital development. His growth chart shows that he has been growing at a steady rate of 5 cm/year, tracking parallel to, but below, the 3rd percentile curve since he was 3 years old. A radiograph of the left hand and wrist reveals a bone age of 11 years. His calculated mid-parental target height is 176 cm (50th percentile). Which of the following is the most likely diagnosis?

  • Constitutional delay of growth and puberty
  • Primary hypothyroidism
  • Familial short stature
  • Growth hormone deficiency
Show the answer and explanation

Correct answer: A

  • A. Constitutional delay of growth and puberty

    Constitutional delay of growth and puberty (CDGP) is characterized by short stature, a normal growth velocity that tracks parallel to the growth curve, delayed bone age, and a normal mid-parental target height. A family history of delayed puberty is classic.

  • B. Primary hypothyroidism

    Primary hypothyroidism can cause delayed bone age and short stature; however, it is associated with a markedly reduced growth velocity and typically presents with weight gain or an elevated body mass index, unlike this patient's proportional weight.

  • C. Familial short stature

    Familial short stature presents with a normal growth velocity tracking parallel to the curve, but the bone age matches the chronological age, and the mid-parental target height is typically low.

  • D. Growth hormone deficiency

    Growth hormone deficiency causes delayed bone age and short stature, but it is characterized by an abnormally low growth velocity (typically <4 cm/year in older children), causing the growth curve to cross percentiles downward.

TAKEAWAY

Differentiating constitutional delay of growth and puberty (CDGP) from other causes of short stature relies on three main factors: delayed bone age, normal growth velocity, and a normal mid-parental target height.

Nelson Textbook of Pediatrics, 21st Edition · Chapter 581: Short Stature (checked 16 August 2026)

Surgery

Question 4 of 10 General Surgery

A 42-year-old Egyptian expatriate woman presents to the emergency department in Kuwait with a 12-hour history of severe right upper quadrant abdominal pain radiating to her right shoulder. The pain started after eating a large, fatty meal. She reports nausea and two episodes of vomiting. Her body mass index is 34 kg/m². Vital signs show a temperature of 38.2°C, heart rate of 98/min, and blood pressure of 130/85 mmHg. Abdominal examination reveals focal tenderness and inspiratory arrest upon deep palpation of the right upper quadrant. Laboratory investigations show a leukocyte count of 14,500/mm³ and normal liver function tests. A transabdominal ultrasound demonstrates gallstones, a gallbladder wall thickness of 5 mm, pericholecystic fluid, and a common bile duct diameter of 4 mm. Which of the following is the most appropriate next step in management?

  • Discharge with oral antibiotics and elective surgery in 6 weeks
  • Laparoscopic cholecystectomy
  • Percutaneous cholecystostomy
  • Endoscopic retrograde cholangiopancreatography (ERCP)
Show the answer and explanation

Correct answer: B

  • A. Discharge with oral antibiotics and elective surgery in 6 weeks

    Delayed elective cholecystectomy is no longer the preferred initial approach due to higher rates of readmission for recurrent biliary events (e.g., biliary colic, pancreatitis) and longer total hospital stays compared to early surgery.

  • B. Laparoscopic cholecystectomy

    This patient has acute calculous cholecystitis. Early laparoscopic cholecystectomy (preferably within 72 hours of symptom onset) during the same hospital admission is the gold standard of treatment for stable patients.

  • C. Percutaneous cholecystostomy

    Percutaneous cholecystostomy is a drainage procedure reserved for critically ill patients with acute cholecystitis who are unfit for general anesthesia and surgery (e.g., severe sepsis or multiorgan failure). This patient is hemodynamically stable and fit for surgery.

  • D. Endoscopic retrograde cholangiopancreatography (ERCP)

    ERCP is indicated for choledocholithiasis (common bile duct stones) or acute cholangitis. This patient has normal liver function tests and a normal common bile duct diameter (4 mm), making ERCP unnecessary.

TAKEAWAY

Early laparoscopic cholecystectomy (within 72 hours) is the standard of care for patients presenting with acute calculous cholecystitis who are fit for surgery.

Tokyo Guidelines 2018 (TG18): Management strategies for acute cholecystitis · Surgical management of acute cholecystitis (checked 16 August 2026)

Question 8 of 10 Urology

A 42-year-old Egyptian construction worker presents to the emergency department in Kuwait during July with sudden-onset, severe right flank pain that radiates to his right groin. He reports nausea and one episode of vomiting. He has no significant past medical history. His temperature is 37.1°C (98.8°F), blood pressure is 145/92 mmHg, and heart rate is 105/min. Physical examination reveals right costovertebral angle tenderness. Urinalysis shows 15-20 red blood cells per high-power field and no leukocyte esterase or nitrites. Which of the following is the most appropriate initial imaging investigation?

  • Renal and bladder ultrasonography
  • Non-contrast computed tomography
  • Plain abdominal radiography
  • Intravenous pyelography
Show the answer and explanation

Correct answer: B

  • A. Renal and bladder ultrasonography

    While ultrasonography is safe and avoids radiation, its sensitivity for detecting ureteral stones (especially in the mid-ureter) is significantly lower than NCCT. It is the preferred initial modality in pregnant women and children, but not in adult males.

  • B. Non-contrast computed tomography

    Non-contrast computed tomography (NCCT) is the gold standard and preferred initial imaging modality for suspected acute renal colic in non-pregnant adults. It has the highest sensitivity and specificity for identifying stones, their size, and location.

  • C. Plain abdominal radiography

    Plain abdominal radiography (KUB) has low sensitivity and specificity. It misses radiolucent stones (e.g., uric acid) and small stones, and can be obscured by bowel gas. It is not the preferred initial diagnostic test.

  • D. Intravenous pyelography

    Intravenous pyelography is an outdated modality for acute stone diagnosis. It has been largely replaced by NCCT due to its lower sensitivity, longer examination time, and risks associated with intravenous contrast.

TAKEAWAY

Non-contrast computed tomography (NCCT) is the gold standard and most appropriate initial imaging modality for suspected urolithiasis in non-pregnant adults.

EAU Guidelines on Urolithiasis · Chapter 3: Diagnostic Evaluation (checked 16 August 2026)

Ready for more than ten

These ten are a sample of a full KMLE revision session: five new questions a day free, weighted to the exam and tilted toward whatever subject is currently costing you marks, with everything you miss scheduled to come back before you forget it. The review deck is free forever.

Start free Read the KMLE exam guide

More free practice questions

PassCurve covers eight MENA licensing exams. Practise a different one:

PassCurve is an independent revision tool. It is not affiliated with, endorsed by, or accredited by the Saudi Commission for Health Specialties (SCFHS), the Dubai Health Authority (DHA), the Department of Health Abu Dhabi (DOH), Qatar's Department of Healthcare Professions (DHP/QCHP), the Ministry of Health and Prevention (MOHAP), Bahrain's National Health Regulatory Authority (NHRA), the Kuwait Ministry of Health, Prometric, or Pearson VUE. Always confirm current exam rules with the relevant authority before you rely on anything here.