A commonly accepted rule for developing equated examinations using the common-items non-equivalent groups (CINEG) design is that items common to the two examinations being equated should be identical. The CINEG design calls for two groups of examinees to respond to a set of common items that is included in two examinations. In practice, this rule has been extended to include the order in which options appear in the two examinations. The performance of a common set of items in which the order of options for one test form was experimentally manipulated was examined to determine if reordering multiple-choice item options resulted in any significant effect on item difficulty. Data from 759 subjects (graduates of medical specialty residency training programs) were gathered as part of the annual administration of a certification examination in a medical specialty area. Each subject responded to 20 multiple-choice items with a projected visual as the stimulus for each item. Examinees had to select from about 30 choices the option that correctly identified the projected visual. Two response booklet forms, differing only in that the position of the 20 options was scrambled, were used. A total of 380 examinees responded to Booklet A, and 379 examinees responded to Booklet B. One examinee was randomly excluded from the analyses for Booklet A. It was found that reordering items often has significant but unpredictable effects on item performance. A linkage is made to previous research on the "response set" construction, and cautions are suggested regarding the effect of reordering options. (SLD)