Multiple choice questions

Generally, an MCQ consists of a problem, known as a stem, which is then followed by a series of alternative answers. Students generally choose one of these answers in relation to the problem or question posed.

Advantages and limitations

  • Highly objective and reliable for testing large cohorts.
  • Can assess student learning across a wide range of discipline knowledge.
  • Reduces marking time.
  • Easy to implement as online test.
  • A bank of MCQs can be used in numerous ways.
  • Questions frequently only test lower order thinking skills; good design is needed.
  • Feedback to students is not common on these assessments.
  • Students may acquire false knowledge through lures in the distractors.
  • Writing good questions (and answers) is difficult and takes time.

Guidelines for constructing multiple choice questions

Anatomy of MCQ

Multiple choice question items consist of a stem and alternatives.

The stem comprises of the problem while the list of options with one correct or most appropriate (answer) + the incorrect answer (distractor) are called the alternatives (Steven et al., 1991).

Anatomy of MCQ - a stem leading to a problem/context and alternatives leading to an answer or distractors

General rules for the...

  • The stem is a complete statement and can be answered without looking at the options.
  • Include in the stem any words that might otherwise be repeated in each alternative.
  • Avoid negatives, or use them sparingly, in the stem. In general the stem should be stated in a positive form.
  • Stem should be clear and specific with clear and consistent layout.
  • In testing for definitions, use the term in the stem rather than as an option.
  • Alternative options are mutually exclusive.
  • The length of the alternative options are about equal (preferably short).
  • Avoid using absolutes such as always, never, and all.
  • Avoid vague, frequency terms such as rarely, and usually.
  • Avoid the use of 'All of the above', 'Both a. and d. above,' and 'None of the above’.
  • Present alternatives in a logical order (chronological, numerical, etc.) but ensure the correct answer is not always a middle value.
  • Grammar should be consistent in the stem and alternatives.
  • Only one correct answer is included.
  • The position of the correct answer varies.
  • Avoid convergence problems where the correct answer includes the most elements in common with the other options.
  • All distractors are plausible.
  • Common student misunderstandings have been incorporated in the distractors.

Examples of multiple choice questions

Your questions can access a range of cognitive skills/action verbs.

Skill 1


If the learning outcome is requiring to access a lower order thinking skill such as remembering; then constructing a direct question could be a possible way forward.

For example: What is the average effective radiation dose from chest CT?

  1. 1 mSv
  2. 8 mSv*
  3. 16 mSv
  4. 24 mSv
Skill 2


If the module/subject learning outcome is requiring to access the ability of the student to demonstrate their understanding then following example could be an option.

For example: What is phase 3 called?

Example of a graph used in question

  1. Decline
  2. Introduction
  3. Growth.
  4. Maturity*.
Skill 3


If the learning outcome is requiring the student to apply their knowledge, then a question should potentially require student to undertake some calculation.

For example:

In 2011 budget airline, EasyJet announced it was ordering 15 new aircraft. The new planes were faster and improved the company’s productivity. EasyJet hoped to make a profit of $2 million per year from each of the new planes it had ordered. Which of the following is most likely to increase EasyJet's profit?

EasyJet should increase:

  1. Revenue by more than cost
  2. Fixed costs
  3. Variable costs by more than fixed costs*
  4. Ticket prices
Skill 4


If the learning outcome is requiring to the student analyse, then a question should provide students with a platform to be demonstrate their ability to analyse.

For example:

Which of the following actions would decrease the radiation dose from chest CT the least?

  1. Decreasing mA from 250 to 125
  2. Decreasing kVp from 140 to 120
  3. Decreasing the pitch from 2 to 1*
  4. Decreasing scan time from 1 to 0.5
Skill 5


If the learning outcome is requiring the student evaluate; then a question should provide students with a platform to be demonstrate their ability to evaluate the scenario.

For example:

A 15-year-old boy has had two episodes of severe anaphylactic shock following bee stings. Which of the following is the most appropriate intervention?

Administration of corticosteroids during the summer

  1. Long-term prophylactic antihistamine therapy
  2. Protective clothing
  3. Desensitization with bee venom extract*
  4. Restrict him to the house during the summer months

Additional resources