This document provides guidance on constructing effective multiple choice test items. It discusses best practices such as using practical stems, 3-5 plausible answer options, avoiding negative wording or grammatical clues in the correct answer, and ensuring distractors are chosen by some test takers. Multiple choice tests can reliably measure learning from knowledge to evaluation, but require time to develop high-quality items and may not assess all skills. Scores depend partly on reading ability and sometimes more than one answer is justifiable.