As detection and subsequent remediation of misconceptions developed within high-school organic chemistry courses in regard to various classes of organic compounds are a prerequisite for meaningful learning of more advanced organic chemistry content, this study sought to identify high-school students' misconceptions about alcohols and carbonyl compounds by means of a four-tier test. The test items comprise the answer and reason tier in a multiple-choice question format, and the response to each tier is accompanied by a confidence rating provided on a six-point confidence scale. The test was administered to 154 students, and evidence of satisfactory validity and internal consistency of both the cognitive scores and confidence ratings was obtained. Since a correct response to a four-tier item presupposes that both the answer and the reason tier within which all the distracters originate from the previously detected challenges with the above-mentioned content are answered correctly, the mean score on the test was predictably low. At the same time, the confidence ratings associated with the students' incorrect responses enabled a more accurate differentiation between wrong answers caused by the lack of knowledge and the existence of misconceptions, compared to all of the other types of diagnostic tests that were previously implemented for this purpose. The identification of eight misconceptions about alcohols and carbonyl compounds within this study paves the way for the development of remediation approaches that would neutralize the negative impact of these conceptual difficulties on the meaningful learning of all related organic chemistry content.