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MCQ - Multiple Choice Questions

MCQs versus Short Essay Questions

Revising for a MCQ test requires a special approach of prep work clearly compared to an essay test. MCQ tests ask trainees to recognise a correct response from a set of alternatives that include 3 or 4 incorrect solutions (called distracters), rather than asking the trainee to create a right solution entirely from his/her very own mind.

Compared to essay questions, trainees think..

  • The correct answer is amongst the feasible responses. Therefore, a trainee can score points with a lucky guess (and they’re right).
  • Many MCQ tests often tend to stress fundamental interpretations or straightforward comparisons, rather than asking trainees to evaluate brand-new info or apply theories to new circumstances.   However, the newer MCQs do tend to test application to different contexts.
  • In an essay question, all the marks lie in the response to that essay.    In an MCQ, each question has a lower point value than in an essay question.    If you get one wrong, you can make up for it with the numerous other MCQs. 
  • Despite these elements, however, MCQ exams can really be extremely difficult.

Why are MCQs so difficult?

To answer an MCQ test requires trainees to be acquainted with a much more comprehensive range of knowledge than essay tests do since MCQ tests consist of several inquiries.   And it’s not just low order thinking like the recall of facts, diagnoses, features and characteristics.   They can test high order thinking skills like the application of a certain concept in different conditions.   Trainees can not easily “bluff” on a MCQ exam liken they sometimes can do with essay questions.  And finally, because it is a lot more tough for a teacher to write excellent MCQs than to develop essay questions, trainees frequently face a higher risk of unintended ambiguity with the questions..

Types of MCQ

SINGLE BEST ANSWER

A palpable left parasternal impulse suggests which abnormality?

a) Right ventricular hypertrophy
b) Aortic stenosis
c) Aortic regurgitation
d) Left ventricular hypertrophy

Which of the following is true of a lower motor neurone lesion in the arm?

a) It leads to increased tone in the arm (hypertonia)
b) Fasciculations are never seen
c) The reflexes are brisk
d) An ulna nerve palsy is an example of a lower motor neurone lesion

A 29 year old woman comes to see you as her GP complaining of tremors and palpitations.  She says she has also lost weight, though without dieting.  On examination, her pulse rate is approximately 100/min and regular.   Her BP is 142/89 mmHg and her BMI is 19.  There are no added cardiac sounds.  The ECG confirms the diagnosis of a sinus tachycardia.  What would you suggest as the most useful next thing

a) admit her
b) repeat ECG in a 2-3 days times
c) CXR
d) TFTs
e) FBC (= FBP)
f) Fasting glucose

Comments: Many educationalist believe that simple MCQs do not really test knowledge at a functional working level.   Instead, it’s more of a memory game where it purely tests lower order thinking skills of simply recalling a fact.  This is why more and more medical examinations opt for contextual more complex single best answer MCQs – because the scenario makes you THINK and makes you make a DECISION about option is best rather than recalling a single fact.  These more complex contextual MCQs test higher order thinking skills that are useful at the ground floor level at your work place.

EXTENDED MATCHING QUESTION

Options:

  1. Radiofemoral delay
  2. Pan-systolic murmur
  3. Systolic blood pressure of 220 mmHg
  4. Tapping apex beat
  5. Chest pain eased by glyceryl trinitrate in 5 minutes
  6. Third heart sound
  7. Splinter haemorrhages
  8. Breathlessness eased by lying flat
  9. Slow-rising carotid pulse
  10. Bradycardia with pulse rate 20 per minute
  11. Chest pain eased by glyceryl trinitrate after an hour

The patients described below have come to see you. Which of these clinical features are they most likely to demonstrate?

a) A 65 year old man is admitted after a collapse when running for the bus. On examination, he has a sustained heaving apex beat that is slightly displaced and an ejection systolic murmur.

b) An 80 year old woman is admitted with an excruciating pain between the shoulder-blades. You can palpate the right radial pulse but not the left.

c) A 70 year old man had a myocardial infarction two years ago. He is now admitted with gradually increasing breathlessness worse on lying flat with crepitations in the lung bases.

d) A 65 year old woman has been increasingly breathless over the last few years. On auscultation, she has a loud first heart sound and a mid-diastolic murmur.

e) The patient is a 60 year old man who smokes 20 per day. He comes to clinic complaining of a tight pain in the centre of his chest which comes on when he walks uphill.

Some preparation tips for MCQ exams

  • Start revising early.
  • Look at your exam syllabus and try to cover everything that is on it.
  • MCQ examinations tend to concentrate on details.  However, you can’t retain lots of details successfully in your temporary memory. But… if you learn a little each day as well as allow plenty of time for repeat reading and testing yourself, you will certainly build a lot more reputable long-lasting memory.
  • Make sure you read actively rather than passively.   For example, as you examine your course notes as well as your assigned readings, make lists, tables, flowcharts and so on.
  • Pay particular attention to basic terms as well as ideas and exactly how to apply them in the real world (e.g. in patients with the very same problem but different contexts). These sorts of questions are the type that typically appear on medical MCQ exams.
  • Break down complicated concepts and pathways into small multi-step procedures.   And understand the logic behind them.  Compare pathways and flowcharts for applying the same thing in different contexts.   For example, how does the management of UTI differ in girls and boys?   Seek resemblances and distinctions that may be used to distinguish right choices from distracters in an MCQ exam.
  • If your textbook highlights new vocabulary or key definitions, be sure that you understand them.   There are many terms that will be new for you in the field of Medical Statistics, for example.  I
  • Do not merely memorise meanings. Understand their real meaning.  Be able to describe them in your own words because many MCQs may reword them.
  • Brainstorm possible questions with several other trainees on your training scheme.
  • Practice on example questions, if you have accessibility to a study guide or old tests.

Strategies for maximising your MCQ success in the actual exam

The very best way to boost your chances, obviously, is to study meticulously prior to the examination. There is no good alternative to knowing the right solution. All those trainees who have passed the MCQ and said they didn’t study hard are not telling you the entire truth – they did!   They just want to look better than they are.    Those who say the MCQ test was easy and have passed – the test was easy because they studied hard.   No one likes saying how hard they studied.   Yes, there are MORE effective and LESS time consuming methods of studying (see BVTS pages on “How we Learn, How to Study”) – nevertheless, they still studied hard.  Here are some strategies for helping you answer the individual multiple-choice questions.  Please remember, none of these are fool-proof. 

  • Slow down and read the stem question and responses carefully (and perhaps underline important words).  Even a well-prepared trainee can make foolish errors on an MCQ test – for example, selecting a distracter that looks very similar to the appropriate answer. 
  • To improve your focus further and reduce the chances of misreading: use a piece of paper (or your hand) to cover up the answers and start by reading the stem question.  Then release each response one by one to help you focus on each option one by one. 
  • Try to anticipate the right reaction before you are distracted by seeing the alternatives. Then, reveal the responses.   If you see the reaction that you expected, circle it and then check to be sure that none of the other responses is better.
  • If you do not see an action that you expected, then consider some of the adhering to strategies to eliminate options that are most likely wrong.  Here are some further tips on this.
      1. Cross of responses that you are fairly sure are NOT right.   Then make a logical guess from the options that remain.
      2. Responses that make use of definitive words like “always” or “never” are usually incorrect.   However, good examiners have cottoned onto this and will usually develop questions which make use of conditional words like “normally” or “probably”.  
      3. “Funny” or “odd” responses are normally incorrect.
      4. “All of the above” can often be the correct answer. If you think each response is probably right, pick “all of the above.”.
      5. “None of the above” is usually an inaccurate answer.  However, this is less reliable than the “all of the above” rule. Be really cautious not to be caught by dual negatives.   However, dual negatives is a marker that an MCQ is poorly written.
      6. A lengthy response option is often the right one (due to the fact that examiners have a tendency to pack the right answer with extra detail).
      7. An option that duplicates keywords n the stem is likely to be right.   Likewise, if there are three very similar responses out of five, one of the three is likely to be right.
      8. When examiners are devising questions, they naturally try to “hide” the correct answer.   So, they try and conceal it by distractions.    So, if you have no idea which is the correct answer, choose (b) or (c) rather than (a).    Response (a) is normally least likely to be the right one.
      9. If you can’t address a question within a minute or less, mark or circle it so you know to come back to it later.  Then move onto the next question and swiftly answer all the ones that you can.  Then come back to the ones you have marked for review.  

Please leave a comment if you have a tip, spot an error, spot something missing or have a suggestion for a web resource.
And of course, if you have developed a resource of your own, please email it to me to share with others.

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