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This preliminary study investigates how familiarity with multiple-choice questions (MCQs) influences test-taking strategies, visual attention, and working memory. Using eye-tracking and the Adaptive Composite Complex Span (ACCES) test, we observed 30 participants navigating standardized reading tests in the Nelson-Denny Reading Test (NDRT) and American College Testing (ACT). Results showed that participants reporting greater familiarity with MCQs demonstrated more efficient visual attention patterns, fewer fixations on timers, and shorter test completion times. Conversely, less familiar participants exhibited increased cognitive load. Significant correlations emerged between working memory scores, test performance, and fixation behaviors. Limitations include the small sample size and the reliance on self-reported familiarity. These findings highlight the importance of considering familiarity and cognitive factors in assessment design and instructional practices.