Background: MCQs have been implemented by several medical institutes during the last few years. Maintaining thehigh quality of these MCQs is crucial. This study aims to assess the MCQ quality by identifying errors in the itemwriting of Bacha Khan Medical College’s pharmacy examinations.Study design: A cross-sectional descriptive StudyDuration and place of study: department of Pharmacology at Bacha Khan Medical College from Jan 2005to July 2005Methods: This analytical research assessed the item writing flaws (IWF) of multiple-choice questions (MCQs) interms of (a) issues about irrelevant difficulty and (b) issues about test wisdom, which were used in the Bacha KhanMedical College’s final pharmacology examinations. Every multiple-choice question was given a unique rating basedon its irrelevant difficulty and test knowledge. Grade 1 was assigned for no IWF, Grade 2 for one IWF, and Grade3 for several.Results: One hundred MCQs in all were examined. Most of the things were found to be correct in item writing.Of the MCQs of irrelevant difficulty, 75% had no IWF—ninety percent of the multiple-choice questions needed tohave test-wise problems.Conclusion: Even though the majority of the multiple-choice questions (MCQs) were free of IWF, a significant portionhad errors. It is advised that each topic has a systematic faculty development process to raise the quality of MCQs.Key Words: Item Writing Flaws, MCQs Quality, Evaluation.