 Multiple choice questions MCQs are widely used in medical education as they provide a quick and easy way to assist student understanding of course material. However, creating high quality MCQs requires careful planning and design as poorly constructed items can lead to unreliable results. This paper outlines some basic guidelines for constructing effective MCQs including ensuring that each item tests only one concept structuring items so that they contain no extraneous information and providing distractors that are relevant to the question being asked. Additionally, higher order MCQs should be designed to assist students ability to analyze synthesize and evaluate concepts. Finally, medical educators must be skilled in test item writing in order to create effective MCQs that accurately measure student performance.