1. Test Item Writing Exercises: MCQ Higher Order Thinking

2. Multiple Choice Question (MCQ) Examples Sample item What is problematic about this item? How does it need to be revised?

3. Question 1 Following a second episode of infection, what is the likelihood that a woman is infertile? a)Less than 20% b)20 to 30% c)Greater than 50% d)90% What is problematic about this item? How does it need to be revised?

4. Question 1 Following a second episode of infection, what is the likelihood that a woman is infertile? a)Less than 20% b)20 to 30% c)Greater than 50% d)90% Problematic area Distractors

5. Question 1 Following a second episode of infection, what is the likelihood that a woman is infertile? a)Less than 20% b)20 to 30% c)Greater than 50% d)90% Problematic area Distractors Suggested revision Arrange all options as either ranges or percentages, not both

6. Question 1 Following a second episode of infection, what is the likelihood that a woman is infertile? a)Less than 20% b)20 to 30% c)Greater than 50% d)90% Following a second episode of infection, what is the likelihood that a woman is infertile? a)20% b)30% c)50% d)90% Incorrect Suggested

7. Question 2 A 30-yr old man presented with a 4-month history of dyspnea, low-grade fever, cough, and fatigue. Given the following chest radiograph, what is the most likely diagnosis? a)pulmonary edema b)streptococcal pneumonia c)adult respiratory distress syndrome d)pulmonary alveolar proteinosis e)B and C only f)None of the above What is problematic about this item? How does it need to be revised?

8. Question 2 A 30-yr old man presented with a 4- month history of dyspnea, low-grade fever, cough, and fatigue. Given the following chest radiograph, what is the most likely diagnosis? a)pulmonary edema b)streptococcal pneumonia c)adult respiratory distress syndrome d)pulmonary alveolar proteinosis e)B and C only f)None of the above Problematic area Distractors

9. Question 2 A 30-yr old man presented with a 4- month history of dyspnea, low-grade fever, cough, and fatigue. Given the following chest radiograph, what is the most likely diagnosis? a)pulmonary edema b)streptococcal pneumonia c)adult respiratory distress syndrome d)pulmonary alveolar proteinosis e)B and C only f)None of the above Problematic area Distractors Suggested revision Omit options ‘e’ & ‘f’ and arrange in abc order

10. Question 2 A 30-yr old man presented with a 4- month history of dyspnea, low-grade fever, cough, and fatigue. Given the following chest radiograph, what is the most likely diagnosis? a)pulmonary edema b)streptococcal pneumonia c)adult respiratory distress syndrome d)pulmonary alveolar proteinosis e)B and C only f)None of the above A 30-yr old man presented with a 4- month history of dyspnea, low-grade fever, cough, and fatigue. Given the following chest radiograph, what is the most likely diagnosis? a)adult respiratory distress syndrome b)pulmonary alveolar proteinosis c)pulmonary edema d)streptococcal pneumonia Incorrect Suggested

11. Question 3 What is the term used to describe the process of helping a new employee to settle quickly into their job so they become efficient and productive workers? a)action learning b)discovery learning c)observation d)induction What is problematic about this item? How does it need to be revised?

12. Question 3 What is the term used to describe the process of helping a new employee to settle quickly into their job so they become efficient and productive workers? a)action learning b)discovery learning c)observation d)induction Problematic area Distractors

13. Question 3 What is the term used to describe the process of helping a new employee to settle quickly into their job so they become efficient and productive workers? a)action learning b)discovery learning c)observation d)induction Problematic area Distractors Suggested revision Arrange in abc order and describe in a similar manner

14. Question 3 What is the term used to describe the process of helping a new employee to settle quickly into their job so they become efficient and productive workers? a)action learning b)discovery learning c)observation d)induction What is the term used to describe the process of helping a new employee to settle quickly into their job so they become efficient and productive workers? a)action learning b)discovery learning c)inductive learning d)observational learning Incorrect Suggested

15. Question 4 An 8-year-old boy with acute lymphoblastic leukemia has experienced three relapses in the past 2 years. He was seen by 3 different physicians as the family has moved 3 times in the past year. The only available treatment is experimental chemotherapy. Without treatment, the child is unlikely to survive for more than 6 weeks; with treatment, his prognosis is unknown. The parents do not want further treatment for their son and wish to take him home; the child also says he wants to go home. Which of the following is the most appropriate course of action? a)Report the parents to social services for medical neglect b)Discharge the child against medical advice c)Discharge the child routinely d)Petition the court for an order for treatment What is problematic about this item? How does it need to be revised?

16. Question 4 An 8-year-old boy with acute lymphoblastic leukemia has experienced three relapses in the past 2 years. He was seen by 3 different physicians as the family has moved 3 times in the past year. The only available treatment is experimental chemotherapy. Without treatment, the child is unlikely to survive for more than 6 weeks; with treatment, his prognosis is unknown. The parents do not want further treatment for their son and wish to take him home; the child also says he wants to go home. Which of the following is the most appropriate course of action? a)Report the parents to social services for medical neglect b)Discharge the child against medical advice c)Discharge the child routinely d)Petition the court for an order for treatment Problematic areas: Stem and distractors

17. Question 4 An 8-year-old boy with acute lymphoblastic leukemia has experienced three relapses in the past 2 years. He was seen by 3 different physicians as the family has moved 3 times in the past year. The only available treatment is experimental chemotherapy. Without treatment, the child is unlikely to survive for more than 6 weeks; with treatment, his prognosis is unknown. The parents do not want further treatment for their son and wish to take him home; the child also says he wants to go home. Which of the following is the most appropriate course of action? a)Report the parents to social services for medical neglect b)Discharge the child against medical advice c)Discharge the child routinely d)Petition the court for an order for treatment Problematic areas: Stem and distractors Suggested revision: Eliminate extraneous or irrelevant information and arrange distractors in abc order

18. Question 4 An 8-year-old boy with acute lymphoblastic leukemia has experienced three relapses in the past 2 years. He was seen by 3 different physicians as the family has moved 3 times in the past year. The only available treatment is experimental chemotherapy. Without treatment, the child is unlikely to survive for more than 6 weeks; with treatment, his prognosis is unknown. The parents do not want further treatment for their son and wish to take him home; the child also says he wants to go home. Which of the following is the most appropriate course of action? a)Report the parents to social services for medical neglect b)Discharge the child against medical advice c)Discharge the child routinely d)Petition the court for an order for treatment An 8-year-old boy with acute lymphoblastic leukemia has experienced three relapses in the past 2 years. He was seen by 3 different physicians as the family has moved 3 times in the past year (eliminate). The only available treatment is experimental chemotherapy. Without treatment, the child is unlikely to survive for more than 6 weeks; with treatment, his prognosis is unknown. The parents do not want further treatment for their son and wish to take him home; the child also says he wants to go home. Which of the following is the most appropriate course of action? a)Discharge the child against medical advice b)Discharge the child routinely c)Petition the court for an order for treatment d)Report the parents to social services for medical neglect (rearrange) Incorrect Suggested

19. More Information… Test Item Writing Exercises http://digitalcommons.hsc.unt.edu/test_items/ Sample Items and Patterning http://www.nbme.org/PDF/ItemWriting_2003/2003IWGwh ole.pdf Christine Savi, PhD CLD & QEP: Assessment 817.735.2942