To the best of the author's knowledge, this is the first study among post-graduate pediatric students from Saudi Arabia, to present the results of item analysis of an MCQ-based exam. The study highlights the importance of optimizing the quality of MCQs by following established guidelines, to make MCQ-based clinical assessments more effective. It reiterates the importance of a reasonable DFI well aligned with students' knowledge levels, maximum distractor functionality, and an impactful DI, in developing high-quality MCQs.