Tips for Constructing Multiple Choice Questions (MCQs)

  1. MCQs should consist of a brief stem (clinical scenario) followed by a lead-in question and four response options.
  2. Choices for the MCQ should consist of one best answer and three distractors.
  3. Avoid the following for your MCQ choices and design:
    • MCQ choices that include “none of the aboce” or “all of the above”.
    • Combination of choices for answers (e.g., “a and c”).
    • Questions worded “all of the following are true except …” or “which of the following is NOT correct”.
    • Any question that uses the word “always” or “never”.
    • Use of abbreviations.
    • Use of trade names for medications (e.g., refer to “paroxetine,” not “Paxil”).
  4. Avoid single fact recall questions (e.g., “Which antidepressant has the longest half-life?”)
  5. Make distractor choices for the MCQ plausible and similar in appearance and length to the answer.
Example of a Good MCQ:

A 46-year-old female treated with escitalopram 20 mg daily for major depression presents with confusion, tachycardia, nausea, diaphoresis, diarrhea and clonus. She had recently started a new medication.

Which new medication is most likely the cause of her current symptoms?

  • a) Methylphenidate
  • b) Lithium
  • c) Bupropion
  • d) Lorazepam