Multiple choice questions [MCQs__ampersandsignrsquo;] form one of the tools for evaluation of medical graduates. The widespread use of MCQs__ampersandsignrsquo; raises the question of their validity and authenticity. The present study was focused on MCQ validation with an attempt to highlight the importance of item analysis and discuss the myths and realities of MCQs__ampersandsign#39;. Aim: The aim was to perform Item analysis while probing into myths and realities of MCQ as an assessment tool for first year medical students. A total of hundred students underwent MCQ test as part of their first periodic assessment. Methodology: A total of hundred students underwent MCQ test as part of their first periodic assessment. A pre-validated MCQ test was given to students and a post-validation was done through item analysis. The indices were calculated using Microsoft excel and various indices compared. Results: Inspite of using a well-designed MCQ test validated by senior faculty and colleagues, after item analysis the difficulty index of 65 % items and discrimination index of 75 % items was in the acceptable range. The distractor efficacy showed that 9 out of 120 distractors needed revision. Conclusions: Item analysis must be routinely implemented to validate MCQs__ampersandsignrsquo;. The myths like shortfalls of MCQ framing, only four options in clinical setting or cueing effect are duly considered and the realities like strict and elaborate protocol for MCQ construction, stimulating critical and lateral thinking of students should be implemented. An integrated approach can help to achieve an ideal assessment tool for the benefit of students.