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compare standalone multiple choice questions mcqs integrated clinicalscenario case cluster multiple choice questions csmcqs problembased learning pbl environment retrospective descriptive analysis mcq examinations conducted course integrates subspecialties anatomical pathology chemical pathology hematology immunology microbiology pharmacology mcq items analyzed reliability kuderrichardson20 kr20 level difficulty pi discrimination index di item distractors student performances statistical analysis results extracted integrity online itemanalysis programme results standard standalone cs multiple choice questions compared kr20 csmcqs standalone mcqs consistently high kr20 pi higher csmcqs significant difference csmcqs standalone mcqs pi di range difficulty levels found based blooms taxonomy mean scores class higher csmcq examination compilation csmcq examination challenging csmcqs compare favorably standalone mcqs provide opportunities integration subspecialties assessment keeping pbl assess students cognitive skills reliable practical different levels item difficulty promote multilogical critical thinking students scores higher csmcq examination may suggest better understanding material andor better question clarity scenarios flow logically increasing number scenarios ensures examination course content