I've had a few student questions this week about exam technique so wanted to share my thoughts with all of you on how to best approach multiple choice / extended matching questions. Let me know what you think? 🤔🧠
MCQs in med school aren’t just about choosing the right answer — they’re about how you think. Whether you’re deep in basic sciences or navigating clinical vignettes, the same core strategies apply. Here’s how to level up your approach 👇
🔍 1. Read the question carefully — what is it really asking?
Don’t just skim. Slow down. Look for age, key symptoms, timing, and red flags.
Is it asking for a diagnosis? A next step in management? The most appropriate investigation? Are they testing your understanding of a physiological mechanism? A drug’s action?
👉 Key words like “most likely”, “initial”, “best”, “except”, or “mechanism” can completely change the question's focus.
Not every detail in the stem helps you — some are distractions to test your focus.
🧠 2. Pause and think before you peek at the options.
Get into the habit of working through the question before you look at the choices.
Ask yourself:
– What system or concept is being tested?
– Can I predict what the answer should be?
– What’s the most likely diagnosis?
– What would I do for this patient in real life?
Doing this strengthens both diagnostic and scientific reasoning — and helps you avoid being swayed by wrong-but-plausible sounding answers (aka distractors).
⚠️ What are distractors?
Distractors are incorrect answers that sound reasonable — but aren’t right. They’re not random — they’re plausible answers designed to distract you, to test common misconceptions, incomplete thinking, or poor prioritisation.
🔹 Clinical examples: outdated treatments, common misdiagnoses
🔹 Science examples: mechanisms that are true — but for the wrong drug or condition
👉 The best distractors are technically correct statements — just not the right answer for that question.
⚗️ Here’s an example of a scientific-style MCQ:
A 68-year-old man is prescribed warfarin for atrial fibrillation. He is advised to have regular INR monitoring.
❓ What is the mechanism of action of warfarin?
✋ COVER THE ANSWERS. THINK. WHAT DO YOU EXPECT TO SEE?
👇 Now check the options:
A. Inhibition of factor Xa
B. Activation of antithrombin III
C. Vitamin K antagonist
D. Inhibition of platelet aggregation
E. Direct thrombin inhibition
✅ Correct answer: C
🧠 Why? Warfarin inhibits vitamin K epoxide reductase, which is necessary for the activation of clotting factors II, VII, IX, and X. It’s a vitamin K antagonist.
🔎 Distractor breakdown:
The other options describe mechanisms of different anticoagulants:
- A. Inhibition of factor Xa → Mechanism of rivaroxaban, apixaban, and edoxaban.
- B. Activation of antithrombin III → Mechanism of heparin.
- D. Inhibition of platelet aggregation → Mechanism of aspirin and clopidogrel.
- E. Direct thrombin inhibition → Mechanism of dabigatran.
🤔 Can’t see your answer?
Go back. Reread the stem. Try to generate a new option.
Still stuck? Start eliminating.
🎯 Even an educated guess from 2 or 3 options is better than a blind one from 5!
✅ 3. Eliminate with intent.
Don’t just guess — be deliberate:
– Does this option fit all the facts in the question?
– Is it first-line or guideline-recommended?
– Is this mechanism/pathway relevant here?
Even if you’re unsure, eliminating the obvious wrong ones sharpens your odds — and your thinking.
🧪 4. Think across disciplines. Be safe. Be evidence-based.
If you’re stuck on a clinical question, choose the option that:
✔️ Promotes patient safety
✔️ Uses resources wisely
✔️ Reflects Australian clinical guidelines
And for basic science — connect the dots. Know how renal physiology influences blood pressure. How pharmacokinetics changes with age or liver disease. Medicine isn’t studied in silos — and MCQs reflect that.
💬 Let’s break down another quick example:
A 72-year-old woman presents with sudden dyspnoea and pleuritic chest pain. She had a total hip replacement last week. HR 110, RR 24, SpO₂ 91% on room air.
❓ What’s the most appropriate next step in management?
✋ COVER THE ANSWERS. THINK. WHAT DO YOU EXPECT TO SEE?
👇 Now check the options:
A. Start IV antibiotics
B. Order a D-dimer
C. Arrange CT pulmonary angiogram
D. Give salbutamol
E. Perform bedside echocardiogram
✅ Correct answer: C
🧠 Why? This is a high-probability pulmonary embolism (immobility, post-op, sudden dyspnoea). A D-dimer is not useful when clinical suspicion is high — it’s used to rule out PE in low-risk cases. CT pulmonary angiogram is first-line for diagnosis in this context.
🔎 Distractor breakdown:
– A sounds urgent but doesn’t fit the story (no fever or signs of infection)
– B is tempting if you forget how pre-test probability affects test choice
– D might seem helpful for breathlessness, but misses the diagnosis
– E is plausible but not definitive and not first-line
⏱️ Bonus tip: Don’t get stuck — manage your time!
Some questions will challenge you more than others — that’s normal. If a question is taking too long, mark it, move on, and come back later.
Spending too much time on one tricky question can cost you easier marks elsewhere. Trust your prep, stay calm, and keep moving. Often, coming back with a fresher head (and after answering related questions) will help the answer click.
📚 Final tip: Actively review your incorrect answers.
Ask yourself:
– Why did I get this wrong?
– What tripped me up — was it a concept or a distractor?
– How would I explain this to someone else?
That’s how knowledge sticks — and clinical reasoning gets sharper.
💬 Got an MCQ you’re stuck on?
Whether it’s potassium channels or pericarditis, drop it in the comments and we’ll figure it out together 👇
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