What is being tested and therefore learned?
When only one of the options in a multiple-choice test starts with a capital letter, it is a non-linguistic clue as to which word goes first -- or, when only one word is required, which one is to be selected. This is consequently testing problem-solving ability, not language proficiency.
A similar mistake occurs when the correct answer is a verb, and the given alternatives are one verb and three nouns; or when the test of the understanding of different pronouns, and only one pronoun is included in the response alternatives.
A good multiple-choice test would have all response alternatives in the same format, and of the same type.