This study investigates how the functionality of distractors in multiple-choice questions (MCQs) affects exam quality in pediatric board examinations. Analyzing 839 MCQs from 2021 to 2024, distractors were classified as functional (selected by at least 5% of examinees) or non-functional (selected by fewer than 5%). The findings reveal that 42% of distractors were non-functional. As the number of non-functional distractors per item increased, the items became easier and exhibited a lower discrimination index, meaning they were less effective at distinguishing between high- and low-performing candidates. The study underscores the need to improve distractor design through targeted item revisions and enhanced item-writing training, ensuring more reliable and valid assessments.