Multiple-Choice Questions

Inpatient medication recommendation requires clinicians to repeatedly select specific medications, doses, and routes as a patient's condition evolves. Existing benchmarks formulate this task as admission-level prediction over coarse drug codes with multi-hot diagnostic and procedure code inputs, failing to capture the per-timepoint, information-rich nature of real prescribing. We propose RxEval, a prescription-level benchmark that evaluates LLM prescribing capability by multiple-choice questions: each question presents a detailed patient profile and time-ordered clinical trajectory, requiring selection of specific medication-dose-route triples from real prescriptions and patient-specific distractors generated via reasoning-chain perturbation. RxEval comprises 1,547 questions spanning 584 patients, 18 diagnostic categories, and 969 unique medications. Evaluation of 16 LLMs shows that RxEval is both challenging and discriminative: F1 ranges from 45.18 to 77.10 across models, and the best Exact Match is only 46.10%. Error analysis reveals that even frontier models may overlook stated patient information and fail to derive clinical conclusions.

Multiple-choice QA benchmarks usually evaluate small language models (SLMs) as direct answerers, but deployed language-model systems increasingly rely on external scaffolds such as tools, code, and repeated model calls. We introduce Code-Guided Reasoning (CGR), an evaluation protocol and generated-program resource for measuring when executable reasoning scaffolds improve SLM performance on MCQA tasks. CGR standardizes six components: a normalized item interface, a direct solver prompt, a generator prompt, a Python scaffold, solver-call and extraction helpers, and a three-channel result record. On 20,498 retained result rows from a locally prepared MCQA bundle and six metadata-registered solver models, the observed non-zero-baseline partition shows 66.21% macro assisted accuracy versus 38.11% direct accuracy, a +28.10 percentage-point difference with a pair-bootstrap interval of [20.32, 36.43]. Under a stricter Ab > 30% direct-signal gate, the macro difference is +14.11 points. These estimates are descriptive. Assisted inference uses a larger solver-call budget, answer extraction is brittle, Time-MQA contains the observed regressions, and some generated programs violate the no-hard-coding instruction. CGR provides the trace package needed to interpret these results, including direct, assisted, and generator-side answers, partition definitions, generated programs, response metadata, and audits.

Evaluating large language models (LLMs) in the biomedical domain requires benchmarks that can distinguish reasoning from pattern matching and remain discriminative as model capabilities improve. Existing biomedical question answering (QA) benchmarks are limited in this respect. Multiple-choice formats can allow models to succeed through answer elimination rather than inference, while widely circulated exam-style datasets are increasingly vulnerable to performance saturation and training data contamination. Multi-hop reasoning, defined as the ability to integrate information across multiple sources to derive an answer, is central to clinically meaningful tasks such as diagnostic support, literature-based discovery, and hypothesis generation, yet remains underrepresented in current biomedical QA benchmarks. MedHopQA is a disease-centered multi-hop reasoning benchmark consisting of 1,000 expert-curated question-answer pairs introduced as a shared task at BioCreative IX. Each question requires synthesis of information across two distinct Wikipedia articles, and answers are provided in an open-ended free-text format. Gold annotations are augmented with ontology-grounded synonym sets from MONDO, NCBI Gene, and NCBI Taxonomy to support both lexical and concept-level evaluation. MedHopQA was constructed through a structured process combining human annotation, triage, iterative verification, and LLM-as-a-judge validation. To reduce leaderboard gaming and contamination risk, the 1,000 scored questions are embedded within a publicly downloadable set of 10,000 questions, with answers withheld, on a CodaBench leaderboard. MedHopQA provides both a benchmark and a reusable framework for constructing future biomedical QA datasets that prioritize compositional reasoning, saturation resistance, and contamination resistance as core design constraints.

Medical vision--language models (VLMs) are usually evaluated on intact image--question pairs, but trustworthy clinical use requires a stronger property: a model must recognise when the evidential basis for an answer has failed. We study this through silent failures under perturbed evidence, where a vision-required medical question is paired with a false premise, wording perturbation, knowledge-only rewrite, or ROI-corrupted image, yet the model returns a fluent non-refusal answer. We introduce medvigil, a 300-case evaluation suite drawn from four public medical VQA sources, supervised end to end by four board-certified radiologists: every gold answer, refusal option, candidate-answer set, paraphrase, false-premise trap, ROI box, and clinical risk tier is clinician-authored. Two attending radiologists annotate every case in parallel, a senior radiologist consolidates the released manifest, and a separate fourth radiologist independent of construction answers every probe to provide the human reference baseline. The release contains 2556 MCQ probes, 240 counterfactual triplets, physician-adjudicated risk-tier and answerability flags, ROI boxes, and a paired open-ended variant. We report seven correctness-conditioned audit metrics that summarise into the medvigil Composite Score (MCS), and audit 16 vision-capable models plus two text-only baselines. The independent radiologist scores MCS 83.3 at silent-failure rate 5.8%, leaving a 14.1-point composite headroom above the strongest audited model (Claude Opus 4.7 at 69.2). The benchmark and evaluation harness are publicly released.

Background: Existing MRI LLM benchmarks rely mainly on review-book multiple-choice questions, where top proprietary models already score highly, limiting discrimination. No systematic benchmark has evaluated vendor-specific scanner operational knowledge central to research MRI practice. Purpose: We developed MRI-Eval, a tiered benchmark for relative model comparison on MRI physics and GE scanner operations knowledge using primary multiple-choice questions (MCQ), with stem-only and primed diagnostic conditions as complementary analyses. Methods: MRI-Eval includes 1365 scored items across nine categories and three difficulty tiers from textbooks, GE scanner manuals, programming course materials, and expert-generated questions. Five model families were evaluated (GPT-5.4, Claude Opus 4.6, Claude Sonnet 4.6, Gemini 2.5 Pro, Llama 3.3 70B). MCQ was primary; stem-only removed options and used an independent LLM judge; primed stem-only tested responses to incorrect user claims. Results: Overall MCQ accuracy was 93.2% to 97.1%. GE scanner operations was the lowest category for every model (88.2% to 94.6%). In stem-only, frontier-model accuracy fell to 58.4% to 61.1%, and Llama 3.3 70B fell to 37.1%; GE scanner operations stem-only accuracy was 13.8% to 29.8%. Conclusion: High MCQ performance can mask weak free-text recall, especially for vendor-specific operational knowledge. MRI-Eval is most informative as a relative comparison benchmark rather than an absolute competency measure and supports caution in using raw LLM outputs for GE-specific protocol guidance.

We present our shared task on evaluating the adaptability of LLMs and NLP systems across multiple languages and cultures. The task data consist of an extended version of our manually constructed BLEnD benchmark (Myung et al. 2024), covering more than 30 language-culture pairs, predominantly representing low-resource languages spoken across multiple continents. As the task is designed strictly for evaluation, participants were not permitted to use the data for training, fine-tuning, few-shot learning, or any other form of model modification. Our task includes two tracks: (a) Short-Answer Questions (SAQ) and (b) Multiple-Choice Questions (MCQ). Participants were required to predict labels and were allowed to submit any NLP system and adopt diverse modelling strategies, provided that the benchmark was used solely for evaluation. The task attracted more than 140 registered participants, and we received final submissions from 62 teams, along with 19 system description papers. We report the results and present an analysis of the best-performing systems and the most commonly adopted approaches. Furthermore, we discuss shared insights into open questions and challenges related to evaluation, misalignment, and methodological perspectives on model behaviour in low-resource languages and for under-represented cultures.

Large language models (LLMs) are increasingly used to generate multiple-choice questions (MCQs), where correct answers should ideally be uniformly distributed across options. However, we observe that LLMs exhibit systematic position biases during generation. Through extensive experiments with 10 LLMs and 5 vision-language models (VLMs) on three MCQ generation tasks, we show that these biases are structured, with similar patterns emerging within model families. To investigate the underlying mechanisms, we conduct probing experiments and find that hidden representations in the question stem encode predictive signals of the correct answer position, suggesting that answer position may be implicitly planned during generation. Building on this insight, we apply activation steering to manipulate internal representations and influence answer position. Our results show that steering can partially control positional preferences and substantially shift answer position distributions. Our findings provide a practical framework for studying implicit positional planning in LLMs and highlight the importance of controllable generation for reliable MCQ construction and evaluation.

While large language models (LLMs) are increasingly being explored for mental health applications, recent studies reveal that they can exhibit stigma toward individuals with psychological conditions. Existing evaluations of this stigma primarily rely on multiple-choice questions (MCQs), which fail to capture the biases embedded within the models' underlying logic. In this paper, we analyze the intermediate reasoning steps of LLMs to uncover hidden stigmatizing language and the internal rationales driving it. We leverage clinical expertise to categorize common patterns of stigmatizing language directed at individuals with psychological conditions and use this framework to identify and tag problematic statements in LLM reasoning. Furthermore, we rate the severity of these statements, distinguishing between overt prejudice and more subtle, less immediately harmful biases. To broaden the reasoning domain and capture a wider array of patterns, we also extend an existing mental health stigma benchmark by incorporating additional psychological conditions. Our findings demonstrate that evaluating model reasoning not only exposes substantially more stigma than traditional MCQ-based methods but also helps identify the flaws in the LLMs' logic and their understanding of mental health conditions.

Practitioners deploying small open-weight large language models (LLMs) for medical question answering face a recurring design choice: invest in a domain-fine-tuned model, or keep a general-purpose model and inject domain knowledge at inference time via retrieval-augmented generation (RAG). We isolate this trade-off by holding model size, prompt template, decoding temperature, retrieval pipeline, and evaluation protocol fixed, and varying only (i) whether the model has been domain-adapted (Gemma 3 4B vs. MedGemma 4B, both 4-bit quantized and served via Ollama) and (ii) whether retrieved passages from a medical knowledge corpus are inserted into the prompt. We evaluate all four cells of this 2x2 design on the full MedQA-USMLE 4-option test split (1,273 questions) with three repetitions per question (15,276 LLM calls). Domain fine-tuning yields a +6.8 percentage-point gain in majority-vote accuracy over the general 4B baseline (53.3% vs. 46.4%, McNemar p < 10^-4). RAG over MedMCQA explanations does not produce a statistically significant gain in either model, and in the domain-tuned model the point estimate is slightly negative (-1.9 pp, p = 0.16). At this scale and on this benchmark, domain knowledge encoded in weights dominates domain knowledge supplied in context. We release the full experiment code and JSONL traces to support replication.

Large language models (LLMs) have shown strong performance on legal benchmarks, including multiple-choice components of bar exams. However, their capacity for generating open-ended legal reasoning in realistic scenarios remains insufficiently explored. Notably, to our best knowledge, there are no prior studies or datasets addressing this issue in the Japanese context. This study presents the first dataset designed to evaluate the open-ended legal reasoning performance of LLMs within the Japanese jurisdiction. The dataset is based on the writing component of the Japanese bar examination, which requires examinees to identify multiple legal issues from long narratives and to construct structured legal arguments in free text format. Our key contribution is the manual evaluation of LLMs' generated responses by legal experts, which reveals limitations and challenges in legal reasoning. Moreover, we conducted a manual analysis of hallucinations to characterize when and how the models introduce content not supported by precedent or law. Our real exam questions, model-generated responses, and expert evaluations reveal the milestones of current LLMs in the Japanese legal domain. Our dataset and relevant resources will be available online.

Video Large Language Models (Video LLMs) incur high inference latency due to a large number of visual tokens provided to LLMs. To address this, training-free visual token pruning has emerged as a solution to reduce computational costs; however, existing methods are primarily validated on Multiple-Choice Question Answering (MCQA) benchmarks, where coarse-grained cues often suffice. In this work, we reveal that these methods suffer a sharp performance collapse on fine-grained understanding tasks requiring precise visual grounding, such as hallucination evaluation. To explore this gap, we conduct a systematic analysis and identify sink tokens--semantically uninformative tokens that attract excessive attention--as a key obstacle to fine-grained video understanding. When these sink tokens survive pruning, they distort the model's visual evidence and hinder fine-grained understanding. Motivated by these insights, we propose Sink-Token-aware Pruning (SToP), a simple yet effective plug-and-play method that introduces a sink score to quantify each token's tendency to behave as a sink and applies this score to existing spatial and temporal pruning methods to suppress them, thereby enhancing video understanding. To validate the effectiveness of SToP, we apply it to state-of-the-art pruning methods (VisionZip, FastVid, and Holitom) and evaluate it across diverse benchmarks covering hallucination, open-ended generation, compositional reasoning, and MCQA. Our results demonstrate that SToP significantly boosts performance, even when pruning up to 90% of visual tokens.

Distractor generation (DG) remains a labor-intensive task that still significantly depends on domain experts. The task focuses on generating plausible yet incorrect options, known as distractors, for multiple-choice questions. A reliable distractor must be contextually relevant to the question and able to mislead examinees through implicit reasoning when identifying the correct answer. While a recent method integrates fine-tuning pre-trained encoder-decoder models with contrastive learning to generate semantically relevant distractors for a given question-answer, it often fails to capture the underlying reasoning process that experts utilize when selecting distractors in benchmarks. In this paper, we explore large language models (LLMs) reasoning for DG through in-context learning with unsupervised semantic retrieval for selecting few-shot examples. We design a rationale-augmented DG framework that jointly generates distractors and their rationales for a given question-answer. Extensive experiments on six benchmarks, with varying average distractor lengths and domains, demonstrate that prompting LLMs with few-shot examples substantially improves the performance compared to recent DG models. It outperforms recent approaches and achieves state-of-the-art results in generating reasoned distractors that align with human-labeled benchmarks.

Safety alignment in large language models (LLMs) is primarily evaluated under open-ended generation, where models can mitigate risk by refusing to respond. In contrast, many real-world applications place LLMs in structured decision-making tasks, such as multiple-choice questions (MCQs), where abstention is discouraged or unavailable. We identify a systematic failure mode in this setting: reformulating harmful requests as forced-choice MCQs, where all options are unsafe, can systematically bypass refusal behavior, even in models that consistently reject equivalent open-ended prompts. Across 14 proprietary and open-source models, we show that forced-choice constraints sharply increase policy-violating responses. Notably, for human-authored MCQs, violation rates follow an inverted U-shaped trend with respect to structural constraint strength, peaking under intermediate task specifications, whereas MCQs generated by high-capability models yield near-saturation violation rates across constraints and exhibit strong cross-model transferability. Our findings reveal that current safety evaluations substantially underestimate risks in structured task settings and highlight constrained decision-making as a critical and underexplored surface for alignment failures.

Recent deployments of large language models (LLMs) as autonomous trading agents raise questions about whether financial decision-making competence generalizes beyond specific market patterns and how it should be trained and evaluated in noisy markets lacking ground truth. We propose a structured framework for training and evaluating such models. Central to our approach is a curated, multiple-choice question (MCQ) dataset derived from classic textbooks and historical markets, verified by an AI committee, enriched with structured reasoning traces, and augmented to reduce shortcut learning. To evaluate whether performance on isolated MCQs generalizes to real-world trading, we introduce a two-stage protocol combining test-set evaluation with an MCQ-based chronological trading simulation. Extensive evaluations across market regimes provide statistically robust evidence that open models trained with our framework exhibit competitive, risk-aware behavior over time, outperform open-source baselines, and approach frontier-model performance at smaller scale. We release the dataset and evaluation framework to support further research.

In recent years, corpus-driven AI methods, such as Large Language Models (LLMs), have seen widespread use in education. While on the surface their abilities look promising for tasks ranging from generating assessment materials to simulating student performance, we should be aware of the subtle nuances of their frequentist nature that might be affecting their behaviour. In this work, we focus on the aspect of corpus frequency in the context of creating high-quality Multiple Choice Questions (MCQs), specifically asking: What if corpus prevalence were enough to identify the correct answer to an MCQ? We propose a computational method of assessing corpus prevalence of MCQ options in large text corpora leveraging textual embeddings using both expert- and machine-generated MCQ sets. The key finding, across three large question sets, is that correct answers, independently of the question stem, are significantly more available than incorrect options. Specifically, using Wikipedia as the retrieval corpus, we find that always selecting the most prevalent option leads to scores up to 9.0% above the random-guess baseline. We also find that MCQ distractors generated by LLMs often show similar patterns of prevalence compared to expert-created options, despite the LLMs' frequentist nature and their training on large collections of textual data. Moreover, we find that corpus prevalence does not necessarily correlate with how recognisable terms are to humans. This highlights the need to better understand how corpora are used in AI-driven methods for education, whether applied directly or indirectly via LLMs.

Previous works identify sensitivity to option order as a key issue in multiple-choice VQA (MC-VQA) evaluation and propose protocols to mitigate this effect. We show that such mitigation is insufficient to ensure the validity of MC-VQA as a reliable benchmark for Multimodal Large Language Model (MLLMs): performance remains highly sensitive to semantically neutral prompt format choices that are not controlled by current benchmarks. In a large-scale study spanning seven MLLMs and five MC-VQAs datasets, we find frequent rank reversals even under order-invariant evaluation. These reversals arise when we systematically vary option ID sets, delimiters, and separators, yielding 48 semantically equivalent prompt formats. Mechanistic analyses trace this instability to low-level language modeling effects: tokenizer-induced fusion or removal of option ID tokens introduces corrupted option ID tokens into the input sequence, while the choice of option ID sets directly affects the reliability of attention patterns for option selection. Accordingly, MC-VQA rankings correlate weakly with open-ended evaluation, indicating that MC-VQA reflects option-selection dynamics in addition to multimodal reasoning. These findings identify prompt formatting as a major, previously under-controlled confounder in MC-VQA benchmarking and motivate evaluation protocols that explicitly control prompt format sensitivity.

Large language models (LLMs) are now widely deployed in user-facing applications, reaching hundreds of millions of users worldwide. Despite their widespread adoption, growing reliance on their outputs raises significant concerns, particularly as users may be exposed to model-inherent biases that disadvantage or stereotype certain groups. However, existing bias benchmarks commonly rely on simple templated prompts or restrictive multiple-choice questions that fail to capture the complexity of real-world user interactions. In this work, we address this gap by introducing a counterfactual framework that automatically generates realistic, open-ended questions for LLM bias evaluation. Through iterative question mutation, our approach systematically explores areas where models are most likely to exhibit biased behavior. Beyond just detecting harmful biases, we also capture increasingly relevant response dimensions, such as asymmetric refusals and explicit bias acknowledgment. Building on this, we construct CAB, a diverse and human-verified benchmark for realistic and nuanced bias evaluations on current frontier LLMs. Our evaluation using CAB highlights the continued need for fairness research by showing that all examined models exhibit persistent biases across certain scenarios.

Large language models are increasingly deployed for legal question answering, where evaluations typically focus on multiple-choice accuracy. This measure overlooks a common failure: whether the citation source attached to an answer exists and supports the rule the system attributes to it. We present L-MARS, an open multi-agent legal QA system with agentic search and judge-driven evidence checks, and audit it claim by claim against its cited source. Each atomic claim is labelled with a six-class taxonomy and scored with strict-ALCE under cross-provider judging, where the answerer and verifier come from different model families. On a stratified 100-question Bar Exam audit, retrieval barely moves accuracy, yet the multi-turn judge loop lifts strict citation F1 from 0.13 (naive RAG) to 0.25 and cuts the no-citation rate from 34% to 13%. We further introduce Faith-Search, a post-draft step that re-verifies and repairs unreachable citations; it drops the unreachable rate below 1% but does not improve F1 over the multi-turn loop, so we report it as a targeted reachability intervention rather than a faithfulness breakthrough. A 50-question LegalSearchQA case study confirms the picture: retrieve-then-draft pipelines saturate near 0.75 citation F1, while a single-agent web-search baseline collapses to 0.22 under external audit.

We describe our entry to the EgoLongQA track of the Wearable-AI Challenge in ECCV 2026, which placed first in the <=2B parameter division with 0.8279 on the held-out test set. Our system is a single 2B vision-language model that answers multiple-choice questions about ten-minute egocentric videos in one greedy forward pass; It is obtained by distilling the junior perception module of a tool-using agentic pipeline, not the agent itself into a small student, using teacher traces filtered to those that answered correctly. it reaches 89% of the accuracy of the large agentic pipeline using 1.1% of its parameters. This raises a 27.1% base model to 81.4% on our held-out questions. The 2B backbone has 2.2132B parameters and therefore over the divisional limit, to make the entry admissable we prune the multilingual embedding table from 248,320 to 143,469 rows, reaching 1.9985B with provably identical logits on retained rows.