This qualitative study looks at multiple-choice questions (MCQs) in examinations and their effectiveness in testing higher-order cognition. While there are claims that MCQs can do this, we consider many assertions problematic because of the difficulty in interpreting what higher-order cognition consists of and whether or not assessment tasks genuinely lead to specific outcomes. We interviewed university teachers from different disciplines to explore the extent to which MCQs can assess higher-order cognition specified in Bloom's taxonomy. The study showed that study participants believed MCQs can test higher-order cognition but most likely only at levels of 'apply' and 'analyse'. Using MCQs was often driven by the practicality of assessing large classes and by a need for comparing students' performances. MCQs also had a powerful effect on curriculum due to the careful alignment between teaching and assessment, which makes changes to teaching difficult. These findings have implications for both teaching and how higher education is managed.