How to succeed at MCQs

What is an MCQ exam?












Perhaps it's best to leave those 30 troublesome questions? But what if luck is on your side...


Do you see how negative marking can complicate things?


MCQs: the basics


Ventricular fibrillation is a recognized hazard in

A. ventricular ectopics occurring on the peak of the R wave.
B. digitalis toxicity
C. overdrive pacing.
D. prolonged QT interval.
E. third degree (complete) heart block.

(correct answers: BDE)

The typical MCQ is made up of a 'stem' or statement followed by several (often five) related completion items or options. The statements following the stem can be all true, all false, or a combination of true and false (sadly, unlike the example above, the answer is never handily provided in brackets after the question). The incorrect answers are called 'distractors' - they are meant to distract you from the correct answers, and for this reason, the distractors will be close enough to the correct answers to be plausible.

The stem should be read in turn with each of the completion statements. Each statement is independent, and there will be no fixed pattern to the number of true or false answers.

You may also be given the option of answering true or false for each statement, and there may even be a don't know (DK) option. There's an example below:

The following are risk factors for breast cancer:

High alcohol intake T F DK
Nullparity T F DK
Late menopause T F DK
Early pregnancy T F DK
Late pregnancy >30yrs T F DK

The most common format currently used for MCQ exams is the extended matching item (EMI), or extended matching question (EMQ). An EMI question is similar to an MCQ in that you still have a stem and a range of options to choose from; however, EMI questions are thought to be a better tool for getting students to apply knowledge, as although more than one of the options might be correct, it's the best answer that's required. The question takes the form of a short case study that may include details such as test results, signs or symptoms. Students are then asked to make a diagnosis. Take a look at the example below, which is taken from Susan M. Case and David B. Swanson's Constructing Written Test Questions for the Basic and Clinical Sciences (Third edition, 2002).

An EMI question:

A. Acute leukaemia H. Hereditary spherocytosis
B. Anaemia of chronic disease I. Iron deficiency
C. Congestive heart failure J. Hyperthyroidism
D. Depression K. Lyme disease
E. Epstein-Barr virus infection L. Folate deficiency
F. Microangiopathic haemolytic anaemia M. Miliary tuberculosis
G. Glucose 6-phosphate dehydrogenase deficiency N. Vitamin B12 deficiency

For each patient with fatigue, select the most likely diagnosis

1. A 19 year old woman has had fatigue, fever, and sore throat for the past week. She has a temperature of 38.3C (110F), cervical lymphadenopathy, and splenomegaly. Initial laboratory studies show a leukocyte count of 5000/mm3 (80% lymphocytes, with many lymphocytes exhibiting atypical features). Serum aspartate aminotransferase (AST, GOT) activity is 200U/L. Serum bilirubin concentration and serum phosphatase activity are within normal limits.

(answer: E)

2. A 15 year old girl has a two-week history of fatigue and back pain. She has widespread bruising, pallor and tenderness over the vertebrae and both femurs. Complete blood count shows haemoglobin concentration of 7.0 g/dL, leukocyte count of 2000/mm3, and platelet count of 15,000/mm3.

(answer: A)

For the example above, you would need to choose the correct answer for each question from the list of options.

Activity: What will your MCQs or EMIs look like? - 10 minutes

It's important to know what kind of questions you'll get - and whether you'll be negatively marked, so you know what to practice, and what's the best question answering technique for you to adopt.

1. If you don't already know, find out what format your MCQ exams will take. Your study guide or course handbook is a good place to look, or, you could ask a friendly lecturer. Students in the years above you may also offer you some good advice.

Recommended Further Reading

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