Introduction
The test wise student takes advantage of cues that the instructor inadvertently puts in when he/she writes the test. If you search for and make use of these cues when you are in doubt about a test answer, you will get a higher score.
Presented are some useful tips for the Testwise or rather Non-Testwise students.
The following is a list of cues for picking the correct Options on objective tests when you are not completely sure of your answer.

A. Cues In The Items
The first main type of cue concerns the list of Options in a multiple-choice item. Four factors are frequently associated with the correct Option:

1. Length
The correct Option is often the longest. Most tests are somewhat consistent about the length of correct answers. If you notice that most of the correct answers have been the shortest, then when you are not sure, pick the shortest. If on the other hand, most of the correct answers have been the longest, pick the particular trend for either the longest or the shortest, try the longest. For example:
Secondary gain is:
a. Synonymous with malingering
b. A frequent problem in obsessive-compulsive disorder
c. A complication of a variety of illnesses and tends to prolong many of them
d. Never seen in organic brain damage
The length of option c gives a hint that it may be the answer.

2. Two Options Mean the Same
The correct Option is probably not one of a pair of similar statements. If two Options mean the same thing and there is only one correct answer, you can eliminate both of them. Neither will be correct, and then make your choice from the remaining Options. Example:
Which one of the following group of drugs is preferred in a hypertensive patient with Diabetes Mellitus?
a. ACE Inhibitors
b. Beta Blockers
c. Antagonist at Beta receptors
d. Calcium Channel Blockers
Since Options B and C have similar meanings, choose your one answer from Options A or D

3. Logical Cues
Epinephrine causes which one of the following effects on systolic blood pressure?
a. Decrease
b. Increase
c. Remains the same
d. Epinephrine is no longer used
e. Epinephrine may be given orally

In this item, Options A, B, and C include all possibilities. The test wise student knows that A, B, or C must be correct, whereas the non-test wise student spends time considering D and E. Often D and E are only there because 4, 5 options are needed and the item writer may not have paid much attention/time to the merits of option D and E. Sometimes they are partially correct and confusing because they cannot be rank-ordered on the same dimension as options A, B and C. This flaw is commonly seen when the options are “increases”, “decreases” and/or “remains the same” or similar type of logical cues like:
A patient of BPH may be treated with
a. Alpha Blocker
b. Surgery
c. Depends on Patient whether he wants Medicine or Surgery

4. Two Options are Opposite
The correct Option is probably one of a pair of direct opposites. If you notice that two Options have opposite meanings, one of them is probably correct. Here is an example:
1. The planarian has:
a. An anterior brain.
b. Three legs.
c. Red eyes.
d. A posterior brain.
Notice that Options A and D are opposite. Therefore, you would eliminate the other two Options because it’s rather likely that if two opposite Options are given, one of them is correct. In this item, A is the correct response.
If there are two answers which express opposites, pick one or the other and ignore other Options

5. Convergence/Overlapping of Words
Test wise students know that if answer options include two, three or more things, and some of the options have the same things in them, than the overlap is because something is correct within the overlap. So choose that item that has the most common overlapping words.
Convergence: correct answer has the most in common with other choices
Local anesthetics are most effective in the
A. Anionic form, acting from inside the nerve membrane
B. Cationic form, acting from inside the nerve membrane
C. Cationic form, acting from outside the nerve membrane
D. Uncharged form, acting from inside the nerve membrane
E. Uncharged form, acting from outside the nerve membrane

In this example, the test wise student would eliminate “anionic form” as unlikely because “anionic form” appears only once; that student would also exclude “outside the nerve membrane” because “outside” appears less frequently than “inside”. The student would then have to decide between Options B and D. Since three of the five options involve a charge; the test wise student would then pick Option B.

6. Most General Option
The correct Option is often the most general, since the most general includes the most information. You will often find a list of items that have some very technical and specific Options and one Option that is more general. Chances are the most general Option is the correct one. For example:
1. The lungs
a. Are solid and immobile, located within the chest.
b. Are the only organs that secrete insulin.
c. Function primarily in respiration.
d. Possess the sphincter of Oddi.
Even if you aren’t sure of the correct answer, you can see that Option A, B, and D all deal with specific facts and details about the lungs. C deals with a main feature of the lungs, respiration. Since C is the more general answer and allows for more variability, it is the correct answer.

7. Non-homogenous Items
The options are not homogenous. There is nothing or little common among them, thus making the answer easy. For example:
Which one of the following is a proton pump inhibitor used in treatment of Peptic ulcer?
a. Captopril
b. Diazepam
c. Omeprazole
d. Propranolol
e. Tubocurarine

This may be a question from GIT module but there is only one drug from GIT section and all options are non-homogenous making it easy for the test-wise student.

8. Impossible/Implausible Distracters
Some options are implausible or impossible and thus can be eliminated. For example:
Which of the following has helped most to increase the length of human life?
a. Fast driving
b. Avoidance of overeating
c. Wider use of vitamins
d. Wider use of inoculation
Flaw: highly implausible distracter. Choice “A” is unreasonable, reducing the item to a three-choice item.

9. Mathematical Question-Middle Value
The correct answer is usually of middle value. If the options are given in order-big to small or small to big, and you are not sure of the answer, eliminate the extremes and choose one of the middle answers. For example:
The mature human has how many teeth?
a. 7
b. 15
c. 32
d. 54
Eliminate the extremes 7 and 54, you are left with 15 and 32 which is the answer!

B. Cues in The Relation Between Stems and Options

The next group of cues are found in both the stem and the Options. In this group are factors within the stem of the item which will help you to choose the correct Option. We will call this group relationship cues, since the relationship between the stem and Options is the main feature.

1. Grammatical Cues
a. Agreement of A and An
In a test item, the correct Option should agree grammatically with the stem. For example, a stem ending with the word “an” calls for a response beginning with the letters a, e, i, o, or u. A stem ending with the word “a” calls for an Option beginning with any other letter. This example illustrates this rule of grammatical agreement:

1. A biologist who specializes in the study of the relationships of an organism to its environment is known as an:
a. Ecologist
b. Structuralist
c. Taxonomist
d. Naturalist
Since the stem ends with the word an, the correct Option must begin with a vowel. The only one that fills this requirement is ecologist. A is the correct answer

b. Singular and Plurals
If the stem uses the word ‘IS’, then the correct Option will be a singular word. If the stem has the word ‘ARE’, find an Option with a plural, or a word which means more than one object. For example:
1. Important in feeling pain are:
a. Bone
b. Ear
c. Muscle
d. Nerves
Since the stem calls for a plural answer (notice the words are in the stem) the correct Option must be plural. The only possibility is nerves. Even if you weren’t sure of the answer, you could choose D, the only plural, and you would be correct.

c. Other Grammatical Cues

A 60-year-old man is brought to the emergency department by the police, who found him lying unconscious on the sidewalk. After ascertaining that the
airway is open, the first step in management should be intravenous administration of
A. Examination of cerebrospinal fluid
B. X-rays
C. CT scan of the head
D. Phenytoin
E. Diazepam
In this example, test wise students would eliminate A, B and C as options because they do not follow grammatically or logically from the stem. Test wise students then have to choose only between D, and E.

2. Word Association/Word Repeats
The third category of relational cues utilizes word associations, synonyms, similar meanings or word repeats. In items giving these cues there will be a word in the stem which has a direct relationship with a word in one of the Options.
Look at this example:
1. The Strong-Campbell Vocational Interest Blank is used to measure
a. Aptitudes
b. Interests
c. Achievement
d. Adjustment
The word interests in the stem matches Option B. This is a very direct clues as to which Option B is correct. This is almost a give-away item. Of course, this cue will not be 100% effective, and there will be times when a direct association is not correct. In general, however, the cue is a good one.

One more example:
A 58-year-old man with a history of heavy alcohol use and previous psychiatric hospitalization is confused and agitated. He speaks of experiencing the world as unreal. This symptom is called
a. Depersonalization
b. Derailment
c. Derealization
d. Focal memory deficit
e. Signal Anxiety
The item uses the word ‘unreal’ in the question and ‘derealization’ in the options which is an obvious clue (synonyms)

C. Specific Determiners

1. Specific Words Making a Statement False (Absolute Terms)
There are specific determiners for False. Absolute words, like always, generally indicate that the statement is false. This is because there are very few absolutes, and it takes only one exception to make the statement false. The following is a list of specific determiners which are associated with incorrect statements:
a. Always
b. Never
c. Only
d. Necessarily
e. Must
f. All
g. None
h. Impossible
These words in a statement suggest that the statement holds all of the time with no exceptions. Since there are exceptions to most statements, statements using these words are usually false.

2. Specific Words Making a Statement True
There are specific determiners for True. These words are associated with correctness. Such words are less absolute and allow for exceptions and variability. When you see one of these words in a statement, you can predict that the statement will be true. The list of specific determiners that indicates correct statements is
a. Often
b. Perhaps
c. May
d. Seldom
e. Generally
f. Rarely
g. Usually

Now look at this example:
1. It is generally sunny during the summer.
What is the specific determiner in the statement? The word generally. This word is not absolute; therefore, the statement is probably true.
If the item had read:
1. It is always sunny during the summer.
You could guess that the statement is false. This statement means that there are never any days without sun during the summer. This is obviously not true. The word generally in the first example allows for some exceptions and would, therefore, be true. Watch for these specific determiners.
Absolute words in either a True-False item or in multiple-choice Options probably indicate a false statement. Less absolute words that are associated with correct items probably indicate true statements.

D. Inter-Item Cues

There may be clues in one MCQ that tell you about another. They are called
inter-item cues. When you have a question or a doubt about the correct answer for a MCQ, keep your question in mind as you do other items.

You will find that there may be information given in the stem of another item that will help you answer the one that gave you problems. The information given in the items may also help you reconsider an answer you had already made. You may find information that will cause you to change a previous answer. This cue is very important because necessary information may be given to you right on the test.

For a better score, it is important to utilize these informational cues as well as the probability cues that we have been discussing. This fact is very important in the Integrated Modular Teaching System. For example the answer of a question asked in Pharmacology may be helped by the stem of a question asked in Medicine.
And remember, it is a good idea to change answers. You’ll gain more than you’ll lose.

E. Miscellaneous Tips
If despite all the above tips, you are still ABSOLUTELY unsure of the answer then try the following:
1. Go through past papers of the college, institution/examining body. You will be surprised to see how many questions are repeated in examinations. They maybe exactly repeated word to word or carry same idea or theme with similar or same options. Also ask your seniors if they remember any questions and note them down
2. Don’t pick an answer that is too simple or obvious
3. When in doubt pick ‘b, c’ middle answers as statistically these have seen to be ‘more correct’. Some teachers now alternate answers
4. Or for every unsure answer tick one specific answer either a, b c or d. In this way you will get ¼ right at least. This can be improved if one partially knows the answer

All of these tips need lots & lots of practice and SHOULD ONLY BE ATTEMPTED LIKE THIS IF ONE HAS ABSOLUTELY NO CLUE to the answer or ONLY PARTIALLY knows the answer.

F. Other flaws made in MCQS include:

1. Cover the options Rule
Students should be able to or partially able to give correct answer even after covering all the answers. Unable to do so means MCQ is flawed

2. Two or more answers are correct:
Example: Numeric Data is not consistent:
Following a second episode of infection, what is the likelihood that a woman is infertile?
a. Less than 20%
b. 20-30%
c. Greater than 50%
d. 75%
e. 90%
Two answers expressed in ranges. Greater than 50% also includes answers d and e. Such a question should be CANCELLED.

3. Options are long and complicated.
Ideally stem (question) is longer than the options. If stem is short and answers are long, item is FLAWED

4. Language in the options is not parallel
Slavery was first started
a. At Jamestown settlement.
b. At Plymouth settlement.
c. At a settlement in Massachusetts.
d. A decade before the Civil War.
Flaw: Non-parallel distracters. Choices “A” and “B” give specific places, “C” designates a more general area, “D” specifies a time. This ambiguity makes more than one choice correct.

5. Window Dressing:
Unnecessarily lengthening the stem of the question. For example:
A 35 years old patient Muhammad Nawaz was admitted in emergency at GTTH at 11 am. He is having breathlessness. A Junior doctor was on duty, who nebulized him with SALBUTAMOL. This drug:
a) Is selective beta1 agonist
b) Has its actions competitively antagonised by chlorpheneramine
c) Produces constriction of blood vessels in skeletol muscles
d) Is used in asthma
e) Produces accommodation for near vision
There is no relation between the LEAD question (last sentence of the question) and the remaining part of the question. One can simply ask about Salbutamol ! This FLAW is very common among teachers trying to make a scenario!!

Summary

1. Use the item types that provide the most direct measures of student performance specified by the learning outcome.
2. Avoid verbal associations that give away the answer.
3. Avoid grammatical inconsistencies that eliminate wrong answers.
4. Avoid specific determiners that make certain answers probable (e.g. sometimes) and others impossible (e.g. always).
5. Avoid stereotyped or textbook phrasing of correct answers.
6. Avoid material in an item that aids in answering another item.
7. Avoid trick questions that might cause a knowledgeable student to focus on the wrong aspect of the task.
8. Ensure that the difficulty level matches the intent of the learning outcome and the age group to be tested.
9. Ensure that there is no disagreement concerning the answer. Typically the answer should be one that experts would agree on the correct or best answer.
10. Write the test items far enough in advance that they can be later reviewed and modified as needed.
11. Write more test items than called for by the test plan. This will enable you to discard weak or inappropriate items during the item review and make it easier to match the final set of items to the test specifications.
12. The number of test items depends on the age of the students tested, the time available for testing, type of test items used and on the type of interpretation to be made.
Experience in testing is frequently the only dependable guide for determining proper test length.
13. Give due consideration to the best arrangement of the test items. Where possible, all items of the same type should be grouped together. The items should be arranged in terms of increasing difficulty

For MCQs, SEQs, Quizzes, Tips, Mneumonics in #Pharmacology please visit daily http://www.facebook.com/pharma4all for MBBS, BDS, FCPS, USMLE, PLAB etc students with detailed answers/explanations

For MCQs in Pharmacology (4500 MCQs) divided into units, chapters, and topics read:

‘Learning Pharmacology from Nauman’s MCQS’

Learning Pharmacology from Nauman’s MCQs