We have compiled a list of useful tips for writing multiple-choice questions and also what should be avoided.

Rule 1 Incorrect answers should appear to be just as plausible as correct ones:

Bad example: Acetylsalicylic acid can produce the following side effects:

• GI bleeding
• reduced aggregation of thrombocytes
• respiratory insufficiency
• severe genetical changes

In this example, it is possible to conclude that a drug, which produces respiratory insufficiency or severe genetical changes cannot be permitted on the market without a prescription. The correct answers can be determined by process of elimination.

Rule 2 The answers should clearly be identifiable as either correct or incorrect. Avoid combining two lines of thought in one observation.

Bad example: Acetylsalicylic acid can produce the following undesired side effects:

• GI bleeding
• reduced aggregation of thrombocytes
• increased risk of fractures from epileptic seizures

In this case, the student is misled by the formulation “undesired side effects”, as he or she knows that the reduction of blood clotting can also have a desired therapeutical effect.

Rule 3 The question should include all necessary, but no irrelevant information. Avoid long, overly informative sentences. Also avoid negative formulations and double negatives.

Bad example: It is not possible, as many studies have shown, to rule out the following side effects for the widespread drug Aspirin® (Agent: Acetylsalicylic acid), which is also produced cheaply by many pharmaceutical companies under another name, due to the fact that the exclusive license of the patentee has expired:

Rule 4 When writing the answers be careful not to include undesired clues to the correct answers. Additions like “usually, generally, often, sometimes” are seen as clues to the correct answers; additions like “always, never, every, none, only” tend to point towards the wrong answer.

Bad example: Acetylsalicylic acid can produce the following side effects if taken continually over a long period of time:

• GI bleedings often occur
• usually the aggregation of thrombocytes is reduced
• the tendency for fractures is always increased
• every patient suffers from at least one epileptic seizure

Rule 5 All given answers should correspond grammatically to the question, so as to avoid that grammatical inconsistencies give clues to the correct answers.

Bad example: After taking Acetylsalicylic acid:

• GI bleeding can occur
• blood clotting reduces
• tendency for fractures is increased
• epileptic seizures can occur

The first and the last answer do not correspond grammatically to the question. Students can guess the correct answer based on the grammatical structure.

Rule 6 The correct answers should not be recognizable through the external picture.

Bad example: Acetylsalicylic acid changes the bleeding time to:

• less than 1 min
• 1 min
• more than 5 min with 500 mg Aspirin per day