Here is a model which seems pretty close to my experience of writing multiple choice tests.
Let's view the answer $t$ to each question as a binary string in $S:=\{ 0,1 \}^k$, all equally likely. The scantron sheet offers $a$ answers per question, so the instructor must present the student with an $a$-element set $C$ of choices, one of which must be the true answer $t$. The student tries to solve the problem on his or her own, obtaining a string $s \in S$; each of the bits of $s$ has probability $p>1/2$ of matching the corresponding bit of $t$ and probability $1-p$ of being flipped. The student must then, as a function of $C$ and $s$, choose one of the elements of $C$.
A pure strategy for the instructor is a function from $S$ to $a$-element subsets of $S$, turning the true answer $t$ into the list of choices $C$. A mixed strategy for the instructor is a probability distribution on pure strategies.
The student knows the instructor's mixed strategy (the instructor has written many exams, which are now in the basements of fraternities) and know his probability of error $p$ (the student has taken practice exams). Therefore, upon seeing $C$ and computing $s$, the student performs a quick maximum likelihood analysis and returns the element of $C$ most likely to have lead to the pair $(C,s)$.
The instructor wants to minimize both Type I errors (students who have $s\neq t$ but answer correctly) and Type II errors (students who have $s =t$ but answer incorrectly). For concreteness sake, let's say the instructor wants to minimize the sum of these, although other weightings are certainly reasonable.
How well can the instructor do?