Background: Multiple-choice questions (MCQs) are the most widely used format for assessing theoretical knowledge among undergraduate medical students. High-quality MCQs are essential for ensuring reliable and valid assessment. This study aimed to evaluate the quality of MCQs used in pharmacology examinations through item analysis and to identify robust items for inclusion in a departmental question bank.

Materials and Methods: A retrospective analysis was conducted on 36 single-best-response MCQs administered to MBBS students in pharmacology during the academic year 2024–25. Each MCQ consisted of a stem, one correct key, and three distractors. Student responses from four examination papers were compiled. After preparing a merit list, the top and bottom thirds of students were identified. Item analysis was performed using Microsoft Excel to calculate the Difficulty Index (DIF-I), Discrimination Index (DI), and Distractor Efficiency (DE).

Results: The mean DIF-I was 55.42% (±14.99), mean DI was 0.49 (±0.14), and mean DE was 90.72% (±17.14). According to DIF-I, 28 items were acceptable, 10 ideal, 6 very easy, and 2 very difficult. Based on DI, 29 items showed excellent discrimination, and 7 were good. Twenty-seven items had zero non-functional distractors (NFDs), 8 had one NFD, and 1 had two NFDs. The correlation between DIF-I and DI was negative but non-significant (r = −0.1274, p = 0.459).

Conclusion: Item analysis proved to be a valuable tool for assessing MCQ quality. Most items (77.78%) demonstrated acceptable difficulty and excellent discrimination (80.56%). Following analysis, five items were recommended for removal, four for distractor modification, and two very easy items for revision. The remaining items were deemed suitable for the departmental question bank.

KEYWORDS: Multiple-choice Questions, Item Analysis, Difficulty Index, Discrimination Index, Distractor Efficiency, Pharmacology, Medical Education, Question Bank.