Ian Bickle gives some tips

Multiple choice questions (MCQs) are an effective method of knowledge assessment widely used in medical education. This type of question features frequently throughout undergraduate and postgraduate assessment.

Approaching MCQs can be harder than it seems with potential pitfalls for the unwary and bonus marks for those with a sound understanding of what to watch out for.

Point 1: Beware of the specific wording of question stems, especially the words commonly, typically, and rarely. A statement may be correct in essence but not when these words are taken into account.

In the above example (D) demonstrates this point well. Amylase can be raised in obstructive jaundice; however, it is not a typical feature--typical meaning that you expect it to be present.

Point 2: Watch out for questions in which the statement includes two pieces of information. Often one piece (the initial part) is correct, but the part that follows is incorrect. Those who read the first part and pay little attention to the remainder of the question will be caught out.

In the box above (E) is a prime example. The start of the sentence is true--Crohn's is a transmural disease. However this is not confined to the small bowel. It can occur throughout the gastrointestinal tract.

Point 3: Attention should be paid to any questions that feature numbers. These can easily be adulterated and trick you.

Approaching this question you may vaguely remember something about the number two. Therefore you may be quite pleased to see 20% as it seems to fit in with what you remember. The answer is in fact 2%; a zero has been added for those lacking in specific knowledge.

Point 4: "Absolute statements" are something else to be on the look out for. The statement made can be very plausible and a reasonable option, but it is not absolutely true.

Surgery to the affected arteries in intermittent claudication is one treatment option--often the only definitive treatment. However, the word "requires" in this stem implies all intermittent claudication sufferers require surgery. This is not the case.

Point 5: A little knowledge is a dangerous thing. Do not try to read into a question too much--it can often end up going dreadfully wrong.

Those with outstanding drug knowledge will appreciate that goserelin, a treatment often used in prostate carcinoma, can cause gynaecomastia as a side effect. Therefore you may assume that (A) is correct.

Point 6: Generally speaking if you have no idea about the topic of the stem using first principles to deduce an answer is beneficial. But life is not that simple and sometimes first principles just do not run true.

You might know all about the pathology of inflammatory bowel disease and take the following line of thought. Crohn's disease is transmural, it has the potential to go through the bowel wall and so establish fistulas. In contrast you appreciate that ulcerative colitis is confined to the mucosa and submucosa so that there is no way that fistulas could form. Rectal fistulas can in fact occur in both diseases.

Point 7: You cannot have enough medical vocabulary--it really helps.

You might know of the two breast diseases fibroadenosis and fibroadenoma, but cannot remember the distinguishing factors. If you appreciate that fibroadenosis is also called fibrocystic disease and that fibroadenoma is often referred to as a "breast mouse" (therefore mobile like a mouse) you have worked out the correct answer.

After reading the above you might feel like digging a big hole to jump into--so let us finish with something to show the value of thinking about your MCQ technique.

Let us assume that you approach this question knowing nothing about cholangitis, except Charcot's triad (fever, pain, and jaundice). (A) can be ruled out as false. (C) can be answered correctly from basic knowledge of Charcot's triad. This leaves one with gallstones, stricture of the common bile duct, and cholangiocarcinoma. The word cholangitis infers inflammation of the bile duct(s), possibly from infection. Ascending indicates its coming from below, upwards. All these remaining three could cause blockage, this can lead to stasis, stasis encourages infection, it can then ascend. You have full marks!

Prepared in collaboration with PasTest Ltd. MCQs supplied by PasTest Ltd from 150 essential MCQs for surgical finals, Delilah Singh and Rema Hassanally