How To

Answer

MCQs
2007

Why do we
have this

Importance of MCQ
- Many exams in medical collage
are MCQ style
- A lot of other exam like
- Saudi Counsel Exam
- USMLE ( step 1 , step 2)
- MCCEE

WHAT
DO YOU
EXPECT FROM

Objectives
- How to prepare yourself for
MCQs exam?
- Common MCQs types.
- Common mistakes in MCQs
- Strategies for answering MCQs.
- How to make educated guess?

Knowledge
- there is no substitute for the
knowledge.
-TO
Main
goal
is
SHOW THE RIGHT WAY

IN ANSWERING MCQs FOR

THOSE WHO HAVE THE
KNOWLEDGE

How to Prepare for MCQ Exam

What is more important

for you ?
m
e
h
T
f
o
1- Knowledge.
h
t
o
B
2- Pass the exam.

How to Prepare for MCQs Exam

Decide what your goal is.
Plane how you will reach your goal
Choose what to study & what to ignore
Using
The course out line
Given lecture
Provided resource e.g. textbook ,web site..
Talk to students who took the exam

How to Prepare for MCQs Exam

How to study
3 stage
You must learn basic term & definition
You must learn central concept
You must be able to apply these concept

Organize study schedule

Not to spend too much time on one area &
ignore others.

Decide your weak area

Highly Effective Studying Methods

1.
2.
3.
4.
5.

Ask yourself questions

Use graphs and charts
Paraphrase
Summary note
Make use of past examination
papers
6. Link up with a friend

1) Ask Yourself Questions

Advantages:
Framing the material
To focus on the key areas.
Preparing for questions you may see
on the examination
Get into the mind of the questions
writer

2) Use Graphs and Charts

To enhance your
comprehension of the
material
Drawing a graph from
memory will give you the
confidence that you have
truly mastered the material

3) Paraphrase
Summarize the key
content in your own word.

4) Summary Note
If you can summaries the
topic that means you are
ready !!!

5) Make Use of Past Examination Papers

If possible, get hold of some

past papers and work through
them to get an idea of the
kinds of questions asked and
what is expected from you.

6) Link Up With a Friend

Studying in a group
and discussing key
concepts and ideas
with a friend may be
helpful.
It can also help you to
stay motivated and to
keep you on track.

7) Practice MCQ
Advantages:
to learn how to deal with MCQ exam better
(how to read it , how to avoid the misleading
answer ,time management).
to acquired new knowledge . As you
answering MCQs, examine whether you got
them right and look at why you got the
question right or wrong.
To evaluate your knowledge. and give you
clues about what to study more.
To learn from your mistake e.g. if you misread
the question then ask your self why I have
misread it & how to avoid that in the future .

How to Prepare?
Be careful .Many students
study what they know best and
give less time to subjects that
make them uncomfortable

Resources
Choose ONE main book as
primary study book and the
other as back-up to clarify
points as needed.

Anatomy of MCQ
STEM
question or incomplete statement

OPTIONS
suggested answers or completions

DISTRACTERS
incorrect responses

KEY
correct response

MCQ Question Subtypes

1. Positively worded questions ("most likely")

2. Negatively worded questions ("least likely")
3. Clinical case questions (long clinical cases)
4. "Two-Step" (double-jump) questions
5. "Bait and Switch" questions
6. Conjunction questions
7. "True/False" (fast-recall) questions
8. Visual questions

Positively Worded Questions

Positively worded
questions ask you to
select the answer that is
("most likely") to be true

Positively Worded Questions

An 85-year-old man has had urinary
frequency, difficulty initiating stream, and
dysuria for the last two months. A rectal
exam reveals an enlarged prostate.
Prostate-specific antigen (PSA) is not
elevated. Which part of the prostate is
most likely affected in this patients
condition?

Positively Worded Questions

A. Peripheral zone
B. Prostatic capsule
C. Prostatic urethra
D. Posterior lobe of the prostate
E. Transitional/central zone
Correct answer
(e)

Clinical Case Questions

Clinical case questions are distinguished
by a fairly lengthy presentation of a
patients history, physical exam findings,
and maybe even lab results. Your task is
to read through this detailed information
and arrive at the best answer to the
question being asked.
The most important part of the clinical
case question is the last sentence

Clinical Case Questions

A 24-year-old woman presents with a fever and myalgias.
She experienced brief, self-limited diarrhea 24 hours
after attending a barbecue two weeks earlier. She
remained asymptomatic until the day prior to
presentation when she developed a fever of 39.4 C (105
F), conjunctivitis, and severe muscle pain. On physical
examination, she appears acutely ill and has a fever of
39.4 C . There is a diffuse maculopapular rash and
generalized muscular tenderness. Several hemorrhages
are noted beneath the fingernails. Admission hemogram
reveals a white blood cell count of 15,000/mm3 with 25%
eosinophils. What is the infectious form of the most likely
causative agent?

Clinical Case Questions

A. Cyst
B. Cysticerci
C. Encysted larvae
D. Ovum
E. Rhabditiform larvae
Correct answer
(c)

"Two-Step" Questions
Two-step (also called double-jump)
questions require several cognitive
steps to arrive at a correct answer.
Given x ----- 1----- 2 ----- d
stem
Answer

"Two-Step" Questions
A 46-year-old, bright, energetic, overweight man
loves to talk and give his opinion on the world
around him. He is always quick with a joke and
seems to love a good laugh. Yet, whenever he
has to talk in front of more than three or four
people, he reports sweating, heart palpitations,
and trembling hands. "My mind just goes blank,"
he says, "and I feel that I'm going to say
something so stupid that I would rather die"
What would be the most appropriate treatment
for this man?

"Two-Step" Questions
A.
B.
C.
D.
E.

Alprazolam
Atenolol
Clonidine
Diazepam
Phenelzine
Correct answer
(b)

Conjunction Questions
In the same manner as two-step
questions, conjunction questions require
two correct choices to arrive at the best
answer.
Options are presented as sets of terms or
facts linked by a conjunction (usually the
word "and"). The best answer is the one in
which both parts of the option are correct

Conjunction Questions
A 66-year-old man has been brought to his physician's
office by his wife who expresses concern that
"something is just not right." During neurological
examination, both recent and long-term memory appear
unimpaired. However, the patient seems to have
difficulty concentrating. He asks repeatedly where he is
am what he is doing there. He has difficulty with simple
arithmetic and writing simple sentences. He has no
difficulty outlining or reproducing presented figures, but
on discrimination task, he confuses his right and left
hands. This patient is most like suffering from lesions
affecting which lobes?

Conjunction Questions
A. Dominant parietal and frontal
B. Dominant parietal and dominant
temporal
C. Dominant temporal and frontal
D. Nondominant parietal and dominant
temporal
E. Nondominant parietal and nondominant
temporal

Correct answer
(a)

"Bait and Switch" Questions

Bait and switch questions begin by
presenting material that may lead you to
think about content in one direction, but they
then shift you to another line of thought at
the end;
The key question is always given in the last
line of the question stem.

"Bait and Switch" Questions

A 59-year-old man with a history of hypertension
and cigarette smoking survived myocardial
infarction two years ago. He has been reluctant to
follow the die prescribed by his physician, but as
part of his recovery program. Following an early
morning run, he consumes a breakfast consisting
of cereal, eggs, sausage, pancakes with maple
syrup, and coffee with cream and sugar. Which of
the following proteins will most likely be activate in
the liver of the patient ?

"Bait and Switch" Questions

A. Glycogen phosphorylase
B. PEP carboxykinase
C. HydroxymethyIglutaryl-CoA
reductase
D. Glycogen synthase
E. Carnitine acyltransferase
Correct answer
(e)

Recall Questions
- Stimulus Response Questions

Given x ----------------- d
stem
Answer
These are easy questions and
they depend on facts which you
should know (knowledge)

Recall Questions
The most important stimulus for
respiratory centers in the brain is ?
A- Oxygen
B- Carbon dioxide
C- Carbon monoxide
D- pH
E- Nitrogen
Correct answer
(b)

Visual Questions
These questions including
pictures, histology slides,
and MRI and CT scan
results, as a part of
questions.

Common Problems on MCQs exams

Problem Type

Source of Errors

Format problems

Particular question subtypes

Anxiety problems

Questions containing numbers,

or done early in the review
session

Fatigue problems

Questions done late in review

session

Reading errors

More common in long questions

Directionality errors

Questions that ask prediction

consequences

Steps For Solving MCQs

1 Step
st

Steps For Solving MCQs

Steps For Solving MCQs

Steps For Solving MCQs

Steps For Solving MCQs

2 Step
nd

Steps For Solving MCQs

Reading The
Questions

Steps For Solving MCQs

- Read instructions and questions
most carefully.
- Ask yourself, is the question
asking for
- The only correct answer ?
- The best answer ?
- The incorrect answer (except) ?

- Convert any double negatives to

positives.

Important MCQs term

Golden Role In Reading The Questions

Be Smart
BUT dont to be too smart
Remember that the exam contains
different levels of questions including
easy & very easy questions

Clinical Case
A 19 year-old patient presents in the emergency department
Complaining of abdominal pain in right iliac fossa of 3 hours duration
associated with nausea, vomiting, and loss of appetite. On examination
he shows tenderness on the right iliac fossa, and low grade fever. Lab
test shows normal red blood cell count with elevation of leucocytes
count. Nothing appear clearly in AXR or US. What is most likely the
diagnosis?

a) Cholecystitis
b) Pancreaitis
c) Intestinal obstruction
d) Appendicitis

Read the Question

- Time spent reading question is well
spent
- Studies have shown most students
look at the answers first. ????!!!
- Pick out key words (high light them)
- Paraphrase the question

Clinical Case
A 19 year-old patient presents in the emergency department
Complaining of abdominal pain in right iliac fossa of 3 hours duration
associated with nausea, vomiting, and loss of appetite. On examination
he shows tenderness on the right iliac fossa, and low grade fever. Lab
test shows normal red blood cell count with elevation of leucocytes
count. Nothing appear clearly in AXR or US. What is most likely the
diagnosis?

a) Cholecystitis
b) Pancreaitis
c) Intestinal obstruction
d) Appendicitis

Clinical Case
A 19 year-old patient presents in the emergency department
Complaining of abdominal pain in right iliac fossa of 3 hours duration
associated with nausea, vomiting, and loss of appetite. On examination
he shows tenderness on the right iliac fossa, and low grade fever. Lab
test shows normal red blood cell count with elevation of leucocytes
count. Nothing appear clearly in AXR or US. What is most likely the
diagnosis?

a) Cholecystitis
b) Pancreaitis
c) Intestinal obstruction
d) Appendicitis

Cholecytitis: Abdominal pain & tenderness in

the right upper quadrant fever & +ve Murphys
sign.
Pancreatitis: Epigastric pain & tendrenss
radiate to the back with High amylase level
Intestinal obstruction : abdominal pain,
vomiting, constipation and distention
Appendcitis: Abdominal pain in the right iliac
fossa associated with nausea, vomiting and
loss of appetite.

Clinical Case
A 19 year-old patient presents in the emergency department
Complaining of abdominal pain in right iliac fossa of 3 hours duration
associated with nausea, vomiting, and loss of appetite. On examination
he shows tenderness on the right iliac fossa, and low grade fever. Lab
test shows normal red blood cell count with elevation of leucocytes
count. Nothing appear clearly in AXR or US. What is most likely the
diagnosis?

a) Cholecystitis
b) Pancreaitis
c) Intestinal obstruction
d) Appendicitis

Steps For Solving MCQs

3 Step
rd

Steps For Solving MCQs

Answering
The Question

Steps For Solving MCQs

1 Step
st

Try to answer the question

without looking at the choices

??!!Why
Its the best way to avoid distracters

Steps For Solving MCQs

If You Couldnt Answer

Next Step

Steps For Solving MCQs

2 Step
nd

Look at the choices &

Try to pick the right
answer

Steps For Solving MCQs

If You Couldn't Answer

Next Step

Steps For Solving MCQs

3 Step
rd

Answering by exclusion
Consider each choice as a
True/False question

Steps For Solving MCQs

If you can conclude that
all choices are wrong
except one that means
you have reached the
right answer

Steps For Solving MCQs

Till this step, you have
answered the question
with your pure knowledge
& you dont need to revise
it at the end of the time

Steps For Solving MCQs

If You Couldn't Answer

Next Step

Steps For Solving MCQs

If after exclusion you have:
2 choices = 50 % to be the right answer
3 choices = 33% to be the right answer
4 choices = 25 % to be the right answer

Steps For Solving MCQs

4 Step
th

Educated Guess
The main goal is to maximize
the chance of getting the right
answer & minimize the chance
of getting the wrong answer

Steps For Solving MCQs

Consider Guessing Only
If There is

NO Negative Marking

Educated
Guess

1) Length of the Question

If an option is much
longer or much
shorter its more likely
to be correct

1) Length of the Question

Example :
Progressive weakness, first of the lower
extremities then of the upper extremities
is most likely to occur in patients with:
A. Tularemia
B. Crohn's disease
C. Goodpasture's syndrome
D. Guillain-Barre syndrome (acute idiopathic
polyneuritis)

2) Grammatical Consistency
Options that are not
grammatically aligned with
the stem are probably false
There is grammatical
alignment between the stem
and the correct answer

2) Grammatical Consistency
Grammatical mistakesif the
last word of the lead line of
the question is an, you
would infer the first letter of
the correct choice would be
an vowel )a, e, i, o, u( .

2) Grammatical Consistency
Example :
What are the complications
of hypertension ?
A.
B.
C.
D.

Intestinal obstruction
Bronchial asthma
Ischemic heart diseases
Pneumonia

3) Opposites
- Two choices say the opposite
thing: Then one of them may be the
correct answer
- If you think two answer are so close
that you cannot reasonably choose
between them, then the odds are
that neither one is correct; you
need to look carefully at a different
option

3) Opposites
Example :
Carpal spasm following inflation of blood
pressure cuff for 2 minutes above the
systolic blood pressure (positive
Trousseau sign) occurs in:
A.
B.
C.
D.

Hypocalcemia
Hypercalcemia
Hypoglycemia
Hypokalemia

4) Specific Determiners
False Response

All
Always
Never
Only

True Responses
May be
Can be
Is possible
Can appear

4) Specific Determiners
- All the above (>1)
- Non of the above
- A and B

4) Specific Determiners
Example :
The following statements regarding epistaxis
are false EXCEPT:
A. Epistaxis never occurs in children
B. It results from rupture of posterior nasal
vessels only
C. It always treated by ligation of the ipsilateral
internal carotid artery
D. Epistaxis may be treated by cautery of Little's
area

5) Overuse of the Same Word or Expression

- Some test makers have tendency

to repeat word or phrases in the
options
- If you are unsure of an answer
select from options with the
repeated words or phrases
- Select an option in which a key
word from the stem is repeated

5) Overuse of the Same Word or Expression

Example
What is the complication of
premature rupture of
membrane ?
A. Premature labor
B. Post partum hemorrhage
C. Anemia
D. Hypertension

6) Numeric mid-range
When all option can listed in
numeric order (e.g percentages )
the correct choice will most
often be one of the two middle
values.

6) Numeric mid-range
Example
What percentage of patients with acute
myocardial infarction die before reaching
a hospital?
A. 1%
B. 20%
C. 50 %

7) Think Backwards
- Try

to think why he put that

question in the exam
- LECTURES
- HIS WAY
- IMPROTANT POINTS
- REPEATED QUESTION

Steps For Solving MCQs

If You Couldn't Answer

Next Step

Steps For Solving MCQs

5 Step
th

Pick Any Choice

That means 25% you may get the
right answer if you have 4 choices
Dont waste your time trying to answer
difficult question because the easy & difficult
question has the same mark

Golden Role In Answering MCQs

Try To Be Relaxed
Remember that unconscious
mind doesnt work under stress

Changing Answers
In general your odds of
changing a correct answer
to a wrong is much higher
than the reverse that is
simply not worth the risk
-9 9 , 9 9 9 9 9 9 9 9 9

Time Management
Check time /10 questions
If I finished earlier what I
have to do?!!
- Make sure you have answered all
questions
- Review what you have marked already

REFERENCES
BOOKS
KAPLAN MEDICAL
NMS REVIEW FOR USMLE

WEB SITES

www.residencyandfellowship.com
www.studentbmj.com
www.bmjlearning.com
www.mededuc.com

THANK YOU
Amer Khojah
Seraj Makkawi