Stem and lead-in (multiple choice questions)

Last revised by Amanda Er ◉ on 14 Jul 2022

Citation, DOI, disclosures and article data

Citation:

Gaillard F, Er A, Sharma R, et al. Stem and lead-in (multiple choice questions). Reference article, Radiopaedia.org (Accessed on 24 Sep 2023) https://doi.org/10.53347/rID-50229

DOI:

https://doi.org/10.53347/rID-50229

Permalink:

https://radiopaedia.org/articles/50229

rID:

50229

Article created:

25 Dec 2016, Frank Gaillard ◉ ◈

Disclosures:

At the time the article was created Frank Gaillard had no recorded disclosures.

View Frank Gaillard's current disclosures

Last revised:

14 Jul 2022, Amanda Er ◉

Disclosures:

At the time the article was last revised Amanda Er had no financial relationships to ineligible companies to disclose.

View Amanda Er's current disclosures

Revisions:

15 times, by 5 contributors - see full revision history and disclosures

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help

The stem and lead-in are the first parts of multiple choice questions and are sometimes rolled into one short sentence or phrase.

These have dual purposes:

provide context for the question and provide any relevant information
instruct the examinee exactly what needs to be done to answer the question correctly

clear: the stem should be clearly written, and unambiguous; do not try and trick the examinee
short: try and keep the stem as short as possible without, however, diminishing comprehension (e.g. avoid acronyms)
avoid negatives
- in most instances, stems should be worded to achieve a positive/true answer, as this reinforces knowledge.
  - positive: "In what demographic is MS most common?"
  - negative: "In what demographic is MS least common?"
- sometimes the learning goal is a negative answer and if this is the case the negative term should be in ALL CAPS and emboldened (e.g. "Which of the following is FALSE?") to avoid misreading
- read more about negative questions
avoid double negatives: double negatives are never needed and should be avoided
use the present tense
- generally, the stem should be in the present tense (e.g. "A 50-year-old male presents with abdominal pain and a CT scan is performed")
avoid teaching: questions are questions, not didactic teaching. Therefore avoid including non-question specific facts within stems.

Content order

When writing the stem, try to stick to a natural order that places content in an order that has maximal readability and limits confusion:

age/sex
relevant history
presenting signs and symptoms
what was done
lead in question

Lead-in

The lead-in follows the stem and is used to instruct the examinee as to exactly what is required to answer the question correctly. It can either be in the form of a question or a phrase needing completion.

question-type lead-in
- "What is the most likely diagnosis?"
- "Which of the following is FALSE?"
completion-type lead in
- "The third branch from the arch of the aorta is..."
- "All of the following are reasonable diagnoses EXCEPT..."

It is essential that for the completion type lead-in, that the alternatives (see below) are phrased in such a way that they grammatically finish the lead-in appropriately – in other words, you should be able to read the lead-in followed by each alternative, and it should make sense.

Style

Both the stem and lead-in should have normal sentence capitalization and punctuation. There are a few special notes specific to multiple choice questions:

question-type lead-ins should finish with a question mark ( ? )
- e.g. "What is the most likely diagnosis?"
completion-type lead-ins should finish with an ellipsis ( ... )
- e.g. "The most common cause of a headache is... "
if the lead-in is asking to pick the single wrong answer (negative question) the negative word should be in ALL CAPS and emboldened, to make it harder to misread
- e.g. "Which of the following is FALSE?"