Types of Multiple Choice Questions

The MCQ format allows for the efficient assessment of a wide range of content for large numbers of examinees.  MCQs can vary considerably in structure.

Common MCQs and examples

Conventional multiple choice

Which one of the following cranial nerves is responsible for all movements of facial expression?

    1. Trigeminal nerve (CN V)
    2. Facial nerve (CN VII)
    3. Vagus nerve (CN X)
    4. Hypoglossal nerve (CN XII)

Scenario-based multiple choice with vignette used as the stem

(May have more than one MCQ based on the vignette)

Questions 1-3 relate to the following clinical vignette:

Mary is a 10-year-old female who was diagnosed with diabetes mellitus two years ago and is subsequently taking insulin.  Over the past 48 hours, Mary has complained of generalised fatigue, fever, thirst, loss of appetite, nausea, vomiting and frequent urination.  Due to not eating, her mother has given Mary half of her usual insulin dose.  Mary presented to the emergency department of the local hospital where she appeared pale, dehydrated and was hyperventilating. Examination of her cardiovascular and respiratory systems were within normal limits.

  1. Which one of the following is the likely primary cause of the changes in her blood pH?

    1. Ketoacidosis
    2. Dehydration
    3. Hyperventilation
    4. Renal impairment
  2. On presentation to the emergency department, which one of the following biochemical processes is predominant in Mary’s liver?

    1. Lipolysis
    2. Glycolysis
    3. Gluconegenesis
    4. Fatty acid synthesis
  3. Which one of the following changes is most likely to have an important role in the pathogenesis of her diabetes?

    1. Impaired glucose uptake in skeletal muscles
    2. Destruction of the alpha cells of the islet of Langerhans
    3. Infiltration of the islets of Langerhans with mononuclear cells
    4. Enhanced hepatic glucose output

Adapted from Azer (2003).

Alternate choice

Which one of the following would most effectively slow down the process of photosynthesis in plants?

    1. Cold weather
    2. Stormy weather


Match the common name to the phylum of the following animals:

  1. Cicada A. Mollusca
  2. Dog B. Annelid
  3. Snail C. Arthropoda
  4. Earthworm D. Chordata


The number of minutes in 2.3 hours is 138 minutes.

    1. True
    2. False

Complex multiple choice (not recommended)

Which of the following are examples of theories of child development?

    1. Piaget’s cognitive development theory
    2. Liebig’s theory of the minimum
    3. Skinner’s operant conditioning theory
    4. Bandura’s social learning theory
    5. A and B
    6. A, C and D
    7. B, C and D


Azer, S. (2003). Assessment in a problem-based learning course. Biochemistry and Molecular Biology Education, 31(6), 428-434.

Haladyna, T., Downing, S., & Rodriguez, M. (2002). A review of multiple-choice item-writing guidelines for classroom assessment. Applied Measurement in Education, 15(3), 309-333. Doi: 10.1207/S15324818AME1503_5

Palmer, E., & Devitt, P. (2007). Assessment of higher order cognitive skills in undergraduate education: modified essay or multiple choice questions? BMC Medical Education, 7(49), 1-7. Doi: 10.1186/1472_6920_7_49

Note: MCQ stems may also include a scenario, vignette, diagrams (e.g. tables, charts, graphs, equations), reading passage or other visual or digital (if using online assessment) materials.

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