What is a Multiple Choice Question?

A MCQ consists of a problem and a list of alternative solutions. The problem may be stated in the form of a direct question or incomplete statement called the Stem of the question. The student is requested to read the stem and alternative solutions and choose the one that is correct or best. This alternative is called the Answer. Depending on the format of the MCQ, there may be more than one answer. The other (incorrect) alternatives are called Distracters.


All of the following are involved in the synthesis of epinephrine EXCEPT

(A) Tyrosine hydroxylase
(B) Monoamine oxidase
(D) Norepinephrine
(E) Dopamine

The Answer is (B), while (A), (C), (D) and (E) are the Distracters.

The Stem

Characteristics of good stems include:

  1. The best stems state the problem clearly and completely using a direct question in the positive form.
  2. The stem should include as much of the item as possible (i.e., words repeated in each of the alternatives are better included in the stem).
  3. Stems should not include irrelevant material. When test­ing higher-order learning, however, it may be relevant to include information which is usually available, although not re­quired to solve the problem. This allows you to test whether the student knows which information is rele­vant to the problem.
  4. Some problems, particularly those which test higher-order learning, are not amenable to direct questions and incomplete statements may be better in these cases. The stem should still direct the student to the problem being tested.
  5. Whenever questions or incomplete statements must be made in the negative form it is crucial to emphasize this by using bold, italics, or CAPITALS, or better yet a COMBINATION of these, to alert the student.

Exercise #1

Which of the following are good MCQ stems? How might the others be improved?

  1. Normally, in the body, excitation of motoneurons in the spinal cord follows which of the following principles?
  2. Which of the following is not involved in the synthesis of epinephrine?
  3. Which of the following states is not located north of the Mason-Dixon line?
  4. Acetylcholine
  5. The amount of acetylcholine released at the neuromuscular junction by a single nerve action potential
  6. Which one of the following is the best source of heat for home use?
  7. Many people predict that there will be an extreme inflationary period following removal of government wage/price controls. If you were a financial advisor to the gov­ernment, which of the following measures would you advocate, if you wished to retard the inflationary trend?

 Some Possible Suggestions - Exercise #1

  1. This stem is satisfactory provided that the qualifiers normally and in the body are necessary. Normally eliminates pathological situations from the question and in the body re­stricts the question from including electrical excita­tion. Most stems can, however, be improved. Colleagues and graduate students are often helpful with this task.
  2. Although it is a good idea to use a direct question, putting an EXCEPT at the end of the stem makes the questions clearer as the student reads the alternatives. If you use the negative put it in bold capitals.
    • All of the fol­lowing are involved in the synthesis of epinephrine EXCEPT
  3. This stem could be stated in the positive form:
    • Which one of the following states is located south of the Mason-Dixon line?
  4. This is a common form of incomplete statement but it fails to focus the student on the point of the problem. The stem used in #5 is much better and still doesn't limit the scope of the question too much.
  5. Probably good as is.
  6. The main problem with this stem is the use of the word best since this is too vague a term. A better stem would be:
    • In western Canada, which one of the following is the most economical source of heat for home use?
  7. This stem seems wordy but it sets up an interpretive exercise and clarifies the situation under which the student is expected to judge the alternative solutions. Nevertheless, an expert might suggest a better stem.

 The Answer and Distracters

Some recommendations for answers and distracters:

  1. The answer(s) should be correct; not just within the con­text of the course material, but generally.
  2. The distracters should be plausible. They are intended to distract students with insufficient understanding from the correct answer. They should represent common concep­tual errors. If the question has numerical answers, cal­culate what the answers would be when students make spec­ific errors and include these values as distracters. If a distracter is not selected by any student, it makes no contribution to the function of the item and it should be revised.
  3. All of the alternatives should be grammatically consis­tent with the stem. If the format allows for more than one correct answer then be sure to use is/are etc. in the stem.
  4. Avoid the use of always or never in distracters. Since few phenomenon or situations occur always or never, this qualifier is a cue that the distracter is incorrect.
  5. Make the answer and distracters equally long and quali­fied. In a effort to satisfy the generally correct cri­terion of a good answer, instructors often make the an­swer longer and more carefully qualified than the dis­tracters. It is also best to use similar phrases and/or sentence structures for all of the alternatives.
  6. Beware of distracters none of the above or all of the above (usually used out of desperation in trying to find a fourth or fifth distracter). When the distracter is all of the above it is better to use a different format of MCQ which allows for this possibility automatically. If you use none of the above, then be sure that for some questions, none of the above, is the correct response.