Among the wide variety of written methods of assessment, multiple choice questions (MCQs), especially the single best option variety, remain the staple of examinations administered to medical students.

MCQs are used extensively by medical schools and also in the initial steps of examinations by licensing bodies.Their logistical advantage of allowing testing of large number of students and broad sampling of topics in a relatively short time remains unchallenged by any other formats of written examinations.

The format and wording of the stem of a MCQ, play an essential role in determining what is being assessed. In its simplest form a MCQ can ask about an isolated fact. Such a ‘context-free’ MCQ tests rote knowledge only.

Higher order skills, such as interpretation and problem solving are best tested using a ‘context-rich’ stem, in which the question is embedded in a meaningful context.

In medical subjects, context enrichment most often takes the form of a clinical vignette. The advantages of enriching the stem with a clinical vignette are two-fold. First, it allows for the assessment of higher order cognitive skills. Second, information is thought to be better recalled when the learning context is similar to retrieval context.

In this book, MCQs are based on clinical vignettes. The clinical context will increase commitment of the student to acquire and retain basic knowledge of medical biochemistry.

Dr. Ranjit Patil.

Dr. Kavindra Borgaonkar.