Medical, dental and master's students in biomedical sciences frequently take standardized, multiple-choice question tests to assess their foundational knowledge. Reasons for its widespread use include reliability, efficiency, low cost and when the questions are well-constructed, high accuracy. However, multiple choice questions may present challenges for test-takers when they contain item writing flaws (flawed, ambiguous, or poorly constructed test questions) that can potentially compromise the fairness and validity of the assessment.