Creating Multiple Choice Questions

Test questions should address concepts communicated in the activity’s learning objectives. While it is appropriate for some questions to assess knowledge gained from participating in the activity, questions should go beyond knowledge to assess whether participants can apply the information in clinical practice. Such questions have the advantage of providing participants with reinforcing feedback in specific, practical applications. They also allow the Society to determine whether learning objectives were achieved and may indicate the potential for change in clinical practice as a result of the educational intervention.

Suggestions for creating multiple choice questions:

  • Use a question format.Do not use incomplete or fill-in-the-blank sentences.
  • All questions should be multiple choice with a single best answer-no true/false or matching.
  • Avoid negative question constructions such as “What is the least likely diagnosis?” or “which of the following is FALSE?” Answering such questions requires that participants use “backward logic” that may increase confusion and imprecision rather than reinforcing educational messages.
  • Avoid trick questions.
  • Pose one clear concept or task in each question, as shown by examples below.

Clinical features Which of the following symptoms is characteristic of the patient's adrenal insufficiency? Which set of symptoms is suggestive of Grave's disease?
Disease mechanisms
How can you best explain this patient's refractory heart failure? Which one of the following cytokines increases risk of tissue damage?

Which of the following factors best explains the reversal of T2DM after bariatric surgery?
Diagnosis Which of the following is the most likely diagnosis for this patient? Which of the following strategies represents the best approach to diagnosis of Cushing's syndrome?
Diagnostic testing Which one of the following laboratory studies would you order next to distinguish primary from secondary adrenal insufficiency? Which of the following tests would be most useful in diagnosing hyponatremia?
Which one of the following treatments would you recommend to further lower low density lipoprotein levels? According to NCEP-ATP III guidelines, which treatment combination is recommended for high-risk patients with high triglycerides or low HDL-cholesterol?
Epidemiology This patient is at increased risk for which of the following? What is the incidence of acromegaly in the United States?

Writing Answer Choices:

  • Provide 5 answer options: 1 correct answer and 4 distracters (incorrect choices).
  • Make sure there is only one right answer.
  • Use realistic, plausible distracters. Avoid answers that are trivial, implausible, or obvious.Good distracters include common misconceptions, outdated beliefs or treatment recommendations, and frequently confused ideas.
  • Make the options similar in terms of grammar, length, and complexity.
  • Do not use “all of the above” or similar answer combinations or “none of the above” either as a distracter or as a correct answer.