Foundation of quality examination is based on the key features of validity and reliability of question papers. Question papers of examination boards in Pakistan—usually these features as contents of a question paper—are written by a single paper setter. To address these issues, Federal Board of Intermediate and Secondary Education (FBISE) recruited and trained senior faculty members to write, review, and moderate multiple-choice question (MCQ) items which are the key components of its question papers. Fitness of these items was determined through field testing and analysis using standard measuring indices. Aggregate item survival rate has been 43% despite relaxed limits of difficulty index (DIFI) and discrimination index (DI). However, the questions with extraordinarily low or high DIFI values were found to be associated with other problems as well. Moreover, apart from utility of point biserial (pbs), mutual relationship of distractor efficiency (DE) and DIFI is also discussed. And based on these attributes, these questions were declared fit or unfit for future use or review respectively.