The One Page Guide To Multiple Choice Questions (MCQs)

Anatomy of an MCQ An MCQ is comprised of a stem, followed by a series of options, including a correct answer and some distractors. Ideally, each question should have 5 options, but 4 options is acceptable. The stem provides the questions subject and may include a patient vignette. Stems typically conclude with a direct question, such as, Which of the following options Top 10 Rules for Writing MCQs 10. Make sure the question can be answered without looking at the options. There should be a single correct answer. 9. 8. 7. 6. Include as much of the question as possible in the stem. The stem should be long and the options short. Avoid superfluous information or red herrings. Make sure that the correct answer and the distractors are similar (i.e. all percentages, gene names, hormones, cardiac medications, etc.). Write options that are grammatically consistent and logically compatible with the stem. List options in logical, numerical or alphabetical order Distractors should be realistic and the same relative length as the correct option. Avoid absolute terms, e.g. always, never and all in the options Also avoid vague terms, such as usually or frequently Avoid negatively phrased items, such as those with except or not in the stem. Do not hinge the correct response of an item to the answer of a related item. Questions should be independent from one another. Avoid None of the above and All of the above. Focus on important concepts. Make certain questions address specified learning objectives. Dont waste time testing trivial facts. Examples of Well Written MCQs
A 30-year-old man has loss of pain and temperature sensation from the neck down on the right side of the body and on the left side of the face; partial paralysis of the soft palate, larynx, and pharynx on the left; and ataxia on the left. This syndrome is most likely to result from thrombosis of which of the following arteries? A. B. C. D. E. Basilar Right posterior inferior cerebellar Left posterior inferior cerebellar* Right superior cerebellar Left superior cerebellar Several contiguous cells are labeled with a fluorescent dye that cannot cross cell membranes. One cell is experimentally bleached with light that destroys the dye, but soon recovers dye fluorescence. This recovery is best explained by the presence of which of the following structures between the bleached cell and its fluorescent neighbors? A. B. C. D. E. A basal lamina Desmosomes Gap junctions* Glycosaminoglycans Tight junctions

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Adapted from Constructing Written Test Questions for the Basic and Clinical Sciences 3rd edition (revised), 2002. Susan Case & David Swanson, authors. Published by the National Board of Medical Examiners, Philadelphia.