Manual for ESTRO Teachers

UNION EUROPÉENNE DES MÉDEC INS SPÉC IAL I STES EUROPEAN UNION OF MEDI CAL SPEC IAL I STS Association internationale sans but lucratif – International non-profit organisation

Example MCQ’s:

As a simple exercise, examine the examples below and think about the tips you have reviewed in the preceding text. As you look at each of the 5 questions, think about whether or not the item was written correctly, whether it needs improvement and if so what improvements would you make.

1) A 32 year old woman presents to the emergency department with a 3 day history of cough and increasing shortness of breath. On examination she has a respiratory rate of 30 breaths per minute and there is an audible expiratory wheeze.

Which of the following is the most likely diagnosis?

A)

Acute exacerbation of asthma

B)

Diabetic ketoacidosis

C)

Hypothyroidism

D)

Myocardial infarction

E)

Uncontrolled hypertension

The correct answer is “A”.

This would appear to be a good question because it fulfils many of the criteria that have been reviewed in the text, such as: a) there is a clear, concise history followed by salient examination findings, b) there is a positively worded question and c) there are 5 distinct answers, listed in alphabetical order and all of similar length. The question is of course extremely easy with the stem including only information related to the respiratory system. Therefore based on guessing the most likely diagnosis is A as this is the response that most closely relates to the respiratory system. This means the Angoff score is likely to be very high (greater than +0.95) so the question will not adequately discriminate. The Angoff score will be improved with the use of more difficult distractors such as other respiratory diagnoses.

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