Despite the variety of assessment tools available, multiple choice questions (MCQs) still play an integral part in examinations at both a national and speciality board level. MCQs have a number of methodological advantages yet their strength is related to the quality of the question posed. Specifically, there has been a move towards the MCQ testing a taxonomically higher order concept of integration-interpretation and problem solving. This paper focuses on question development and the potential pitfalls to avoid.