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NRCME Test Questions | 100% Correct
Answers | Verified | Latest 2024 Version
What minimum PaO2 level is necessary if the driver has an ABG due to a chronic respiratory disorder? a.70mmHg b.55mmHg c.60mmHg d.65mmHg - ✔✔Correct answer is "D". To be qualified, the driver should meet a minimum arterial blood gas (PaO2) greater than 65. A driver first perceives a whispered voice at 5 feet in his right ear and 4 feet in his left ear. All other aspects of his physical examination are unremarkable. The examiner should: a.Permanently disqualify the driver because he "failed" the whispered voice test. b.Certify the driver for 2 years. c.Certify the driver for 1 year. d.Require an audiometric test to determine the extent of hearing loss in his left ear. - ✔✔Correct answer is "B". The driver is qualified to drive without restriction as long as he is able to perceive a whispered voice at 5 feet in 1 ear. A driver reports for an examination 6 weeks after suffering a mild heart attack and presents a note from his cardiologist stating that he is able to return to work immediately without restriction. Included within the note, the cardiologist provides recent testing information showing that the driver had an ETT that showed he was able to reach 12 METS during the test. His echocardiogram showed an ejection fraction of 65%. The examination of the driver is unremarkable. The examiner should: a. Temporarily disqualify the driver. b. Qualify the driver for 1 year. c. Qualify the driver for 2 years. d. Consult with the cardiologist to determine if the driver suffers from angina. - ✔✔Correct answer is "A". The driver has not completed the required 2-monthwaiting period, but all other requirements for medical clearance and required testing have been met. The driver would be certified for 1 year at the completion of the waiting period. The date of the certification would be from the date of the original examination.
A driver provides an audiometric test documenting the following:
- 500 Hz: 2. 1000 HZ: 3. 2000 HZ: 4. 4000 Hz: 35 Right ear; 40 Left ear 40 Right ear; 45 Left ear 40 Right ear; 45 Left ear 50 Right ear; 50 Left ear
The medical examiner should: a. Disqualify the driver because he does not meet minimum hearing requirementsto drive. b. Certify the driver for 2years. c. Certify the driver for 1 year. d. Require the driver to obtain a hearing exemption. - ✔✔Correct answer is "B". The examiner would average the results from 500 Hz, 1000 Hz and 2000 Hz. This average is 38.33 in the Right and 43.33 in the Left ear. A driver must have an average hearing loss of less than or equal to 40 in the better ear. This does not have to be met in both ears. During the examination of a commercial driver, the examiner notices that the driver's peripheral vision is 70 degrees to the left and 80 degrees to the right. The examiner should: a. Qualify the driver for 2 years. b. Require the driver to obtain a vision exemption because of the limitation in the driver's left peripheral field. c. Disqualify the driver. d. Have the driver consult with an Ophthalmologist to determine if the driver's peripheral vision meets minimum standards. - ✔✔Correct answer is "A". A driver must exhibit a minimum peripheral vision of 70 degrees bilaterally. During examination, the medical examiner notices that the driver is distant, lacks eye contact and shows absolutely no emotional response during the exam. The examiner's best response should be: a. Provide the driver with a "CAGE" questionnaire to determine if he suffers from alcoholism. b. c. Certify the driver with a 1-time, 3-month certificate to determine if there is any effect on the driver's ability to drive a CMV.
A driver reports that he had a hunting accident wherein he suffered a left orbital fracture. He presents a note at the time of the examination from an ophthalmologist stating "may drive". His exam is unremarkable except for a limitation in peripheral vision in his left eye, which was inconclusive. His distance vision was 20/20 right and 20/40 left. The medical examiner should? a. Council the driver on the need for a vision exemption. b. Disqualify the driver pending vision exam to determine if it meets peripheral vision requirements. c. Certify the driver for 1 year. d. Certify the driver for 2 years. - ✔✔Correct answer is "B". The driver must have a peripheral vision of 70 degrees bilaterally to certify to drive a CMV. What minimum PaO2 level on an ABG performed for a chronic respiratory disorder is necessary to certify a commercial driver? a. 55 mm Hg. b. 60 mm Hg. c. 65 mm Hg. d. 70 mm Hg. - ✔✔Correct answer is "C". Blood oxygen saturation must be a minimum of 65 mm Hg for the driver to certify. A driver is taking Topamax for the treatment of migraine headaches. He reports good management of his headaches and they never seem to interfere with his driving ability with the medication. The medical examiner should? a. Obtain medical clearance for the condition and the medication. b. Disqualify the driver because he is taking an anti-seizure medication. c. Certify the driver for 1 year. d. Certify the driver for 2 years. - ✔✔Correct answer is "A". Topamax is a medication that is used for seizure control. The examiner should confirm with the prescribing provider that the driver does not take it to control seizures, and he is capable of driving a CMV. A 26 year-old driver presents for a first-time certification. He has a long-standing history of ADHD and is taking methylphenidate. You have verified his diagnosis and obtained clearance from his treating psychiatrist. As the certified examiner, you: a. Should disqualify the driver, explaining that use of such stimulants is cause for disqualification. b. May certify for a maximum of 6 months.
c. May certify for a maximum of 12 months. d. May certify for a maximum of 2 years. - ✔✔c. May certify for a maximum of 12 months. A driver has a blood pressure of 168/112 mm Hg confirmed during the examination. The driver should be: a. Disqualified. b. Certified for 6 months. c. Certified for 1 year. d. Certified for 2 years. - ✔✔Correct answer is "A". This is Stage 3 hypertension. The driver is disqualified until his blood pressure is less than 140/90 mm Hg at which time he will have a maximum certification of 6 months. For how long would a driver be certified if he is taking Micardis HCT for hypertension, and has a confirmed blood pressure of 148/96 mm Hg at the time of the examination? a. 3 months b. 6 months c. 1 year d. 2 years - ✔✔Correct answer is "A". Because the driver has a history of hypertension (he is taking medication), and he had Stage 1 hypertension during his exam, he would be provided a 1- time, 3-month certificate in order to lower his blood pressure to an acceptable level during that time. During the examination, a driver is found to have a positive "Babinski" reflex. The examiner should: a. Certify the driver for 1 year. b. Certify the driver for 2 years. c. Council the driver to obtain an SPE. d. Disqualify the driver until s/he has a neurological consultation. - ✔✔Correct answer is "D". A positive Babinski reflex is indicative of abnormalities in the motor control pathways leading from the cerebral cortex and is widely used as a diagnostic aide in disorders of the central nervous system. The examiner should obtain clearance from a neurologist prior to reconsidering the driver for certification. All of the following are required components of all DOT medical examinations EXCEPT? a. Vision
b. 60. c. 70. d. 80. - ✔✔Correct answer "B". 60-70 Hour Limit: A driver may not drive after 60/70 hours of duty in 7/ consecutive days. Many versions of the NRCME exam will have one question about the 60/70 rule. A blood pressure of 166/92 mm Hg would be? a. Considered normal b. Stage 1 hypertension. c. Stage 2 hypertension. d. Stage 3 hypertension. - ✔✔Correct answer is "C". The driver has Stage 2 hypertension (160 - 179/100 - 109). The driver is taking "Sinemet" for the treatment of Parkinson's disease. The medical examiner should: a. Disqualify the driver. b. Obtain medical clearance from a neurologist. c. Counsel the driver to obtain a neurologist waiver. d. Certify the driver for 1 year. - ✔✔Correct answer is "A". A driver who is diagnosed with Parkinson's is permanently disqualified. The driver uses hearing aids during the whisper test. He is able to hear at 5 feet on the right and 4 feet on the left. a. Send the driver for an audiometric test. b. Disqualify the driver. c. Certify the driver for 1 year. d. Certify the driver for 2 years. - ✔✔Correct answer is "D". The driver is able to use hearing aids during the whisper test (and this should be marked on the form). A driver must only qualify in 1 ear to certify and there is no limitation of certification time. The minimum acceptable spirometry values required to certify a driver are: a. FEV1 70%, FVC 65%, FEV1/FVC ratio 65% b. FEV1 65%, FVC 60%, FEV1/FVC ratio 65%
c. FEV1 65%, FVC 65%, FEV1/FVC ratio 65% d. FEV1 60%, FVC 60%, FEV1/FVC ratio 60% - ✔✔Correct answer is "B". The minimum acceptable values are 65%, 60%, and 65% (FEV1, FVC, FEV1/FVC ratio). A driver presenting to your office marks down that he is taking "nitroglycerin" for angina and he has been doing so for a few years. Upon questioning he indicates that he has needed more nitroglycerin recently because his episodes have become more frequent. Your best course of action is to: a. Council the driver to increase his dose of medication. b. Certify the driver for 1 year. c. Provide a 1-time, 3-month certificate to monitor his condition. d. Disqualify the driver and refer him to his cardiologist for further evaluation. - ✔✔Correct answer is "D". Disqualify the driver because his angina is not stable. The longest the medical examiner would certify a driver with a history of Stage 3 hypertension is: a. 3 months b. 6 months c. 12 months d. 24 months - ✔✔Correct answer is "B". The driver may only be certified for a maximum of 6 months for the rest of his/her driving career. A driver is taking Wellbutrin to help him stop smoking. He has provided a note from his PCP stating that he has no side effects and confirms that he is taking the medication for smoking cessation.The examiner would? a. Certify the driver for 2 years. b. Certify the driver for 1 year. c. Disqualify the driver because the medication is not allowed. d. Council the driver to only take the medication at night. - ✔✔Correct answer is "A". The driver is not being treated for a psychiatric condition such as anxiety or depression, and he has clearance. He would be able to be certified for 2 years. During the history, the driver admits to taking Benadryl for seasonal allergies. The examiner should? a. Counsel the driver to not take the medication for 12 hours prior to driving.
c. Certify the driver for 2 years. d. Counsel the driver that he needs to apply for an endocrine exemption. - ✔✔Correct answer is "C". The driver's hypothyroidism is well managed and he is asymptomatic. The driver may be certified for 2 years. A 48-year-old male driver presents for a certification examination. He reports in his history a back injury that had occurred 4 years earlier. He states that he was out of work following back surgery for over a year, but since has returned to driving and his last certification was good for 2 years. He lists as his only medication Oxycodone, which he takes only as needed. He reports seeing his "pain doctor" every few months for evaluation. He also reports he has had a steroid injection (series of 3) about a year ago, which "helped a lot." The examiner should: a. Request medical clearance. b. Certify the driver for 1 year. c. Certify the driver for 2 years. d. Disqualify the driver. - ✔✔Correct answer is "A". The driver suffers a chronic pain condition which may inhibit his ability to perform all essential functions associated with driving a CMV. He is also taking a narcotic medication. Both of these will need clearance from a treating provider prior to making a decision regarding certification. A driver should not be certified when an ABG reveals a PaO2 of less than 65 at altitudes below: a. 2,000 feet b. 3,000 feet c. 5,000 feet d. 7,000 feet - ✔✔Correct answer "C" The threshold changes to 60 mm Hg at altitudes above 5,000 feet. A driver presents for certification after a myocardial infarction. What is theminimum waiting period status post myocardial infarction? 2 months 6 months 1 year 2 years - ✔✔Correct answer is "A". There is a 2-month waiting period from the date of the MI.
A driver presents for certification 6 weeks after suffering a myocardial infarction. She presents a note from her cardiologist, clearing her to drive a CMV without restrictions. Her post MI echocardiogram shows an EF of 50%. Her EKG shows no ischemia. Her ETT exceeds FMCSA standards. The medical examiner should: Certify the driver for 3 months. Certify the driver for 1 year. Certify the driver for 2 years Disqualify the driver. - ✔✔Correct answer is "D". The driver should be disqualified because she has not met the minimum wait time of 2 months (8 weeks) after suffering a myocardial infarction. The driver can return for certification in two more weeks. A driver presents for certification. He checks "yes" for "Anxiety, depression, nervousness, and other mental health problems" for the Driver Health History portion of the Medical Examiner Report Form. He clarifies he has depression which is controlled with medications and electroconvulsive therapy (ECT). Following ECT, the driver should be symptoms free for how long before being certified? a. 3 months b. 6 months c. 12 months d. 24 months - ✔✔Correct answer is "B". Following ECT, the waiting period is 6 months. Maintenance or ongoing ECT for depression is not certifiable. According to FMCSA regulations, which of the following must the medical examiner evaluate when examining a driver's eyes? a. Pupil reactivity b. Iris symmetry c. Conjunctival injection d. Corneal thickness - ✔✔Correct Answer is "A". Pupil reactivity (the only option that is included on the Medical Exam Report Form for physical examination of the eyes). This is a cranial nerve test. A positive finding indicates a significant neurological problem that must be worked up or have an explanation that clarifies whether or not the driver has a condition that may interfere with the ability to safely operate a CMV. According to FMCSA regulations, medical qualification for two years can be given to a driver who has:
examination. The driver's SpO2 is 90 percent in the medical examiner's office. The rest of the examination is normal. The driver should be: a. Temporarily disqualified pending results of a cardiac workup. b. Qualified since she has no cardiac symptoms. c. Temporarily disqualified until further evaluation. d. Qualified because her O2 saturation exceeds the minimum. - ✔✔Correct Answer "C". This is the correct response because the driver has a non-diagnosed respiratory or thoracic illness that might interfere with the ability to safely operate a CMV. The driver should not be certified until the etiology is confirmed and treatment has been shown to be effective, safe, and stable. Also, according to FMCSA medical guidelines, a SpO2 of less than 92 percent warrants obtaining an arterial blood gas analysis. Which of the following stages of hypertension calls for a medical certificate that expires in one year? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4 - ✔✔Correct Answer "A". Medical certificates for drivers with Stage 1 hypertension expire after a year. Stage 2 hypertension results in a one-time, three-month medical certificate. Stage 3 corresponds to a medical certificate, good for 6 months from date of examination if the reading is less than or equal to 140/90 mm Hg. Lastly, Stage 4 hypertension doesn't exist. Which of the following is true of psychological disorders in drivers? a. Drivers with a mood disorder may, during a manic episode, exhibit grandiosity, impulsiveness, irritability, and aggressiveness b. Drivers with a mood disorder will exhibit quicker reaction times during a depressive episode c. Drivers with an active psychotic disorder will exhibit completely predictable behavior, accompanied with poor judgment d. Drivers with personality disorders may exhibit flexibility and adaptive behaviors with a decreased crash rate - ✔✔Correct Answer "A". Drivers with an active psychotic disorder will exhibit unpredictable behavior, accompanied with poor judgment. Drivers with a mood disorder will exhibit slower reaction times during a depressive episode and grandiosity, impulsiveness, irritability, and aggressiveness during a manic episode. Lastly, drivers with personality disorders may exhibit inflexibility and maladaptive behaviors, along with an increased rash rate.
A medical examiner observes that a driver has a blood pressure of 160/100 mm Hg and the driver had no prior knowledge of high blood pressure. Which of the following is the appropriate subsequent action for the medical examiner? a. Qualify the driver for 1 year. b. Obtain a second blood pressure reading later during the examination c. Qualify the driver for a 1 time 3-month certificate. d. Put the driver in Determination Pending to allow time for a hypertension evaluation by the PCP. - ✔✔Correct Answer "B". If the initial blood pressure reading of a driver is equal to or above 140/90 mm Hg, a second reading should be taken later during the exam. When deciding if a commercial driver should be medically certified, what is the fundamental question a medical examiner should examine regarding cardiovascular health? a. Has the driver ever had a cardiovascular disease? b. Does his or her family have a history of cardiovascular disease? c. Does the driver have a cardiovascular disease that increases the risk of sudden death or incapacitation? d. What is the likelihood that he or she will contract a cardiovascular disease? - ✔✔Correct Answer "C". When looking at the cardiovascular health of a driver, the fundamental question is whether the driver has a cardiovascular disease that increases the risk of sudden death or incapacitation, creating a danger to the safety and health of the driver, as well as the public sharing the road. While history and family history of such diseases are important, they are not the fundamental questions necessary about which to ask. If a medical examiner uses the number 1 during the physical examination, the medical examiner is indicating which of the following parts of the body system? a. Ears b. General Appearance c. Abdomen d. Heart - ✔✔Correct Answer "B". 1 refers to General Appearance, 4 refers to Ears, 6 refers to Heart, and 8 refers to Abdomen When conducting a vision examination, a driver must have at least what distant visual acuity in each eye with or without correction?
d. Disqualify - ✔✔Correct Answer "C". This is a cough suppressant and has sedative effects. Counsel the driver about not consuming the medication within 12 hours of driving. Which of the following is an assessment of L4 nerve root pathology? a. Plantar flexion. b. Patellar reflex. c. Hip Extension. d. Hand in pocket paresthesia. - ✔✔Correct Answer "B". Possible Abdominal Aortic Aneurysm which is a medical emergency. A driver presents for his DOT physical. A lateral pulsation is palpated approximately 2 inches superior of the umbilicus. Auscultation in this area reveals an obvious bruit. What is the most important next step? a. Counsel on the importance of a good diet. b. Refer for diagnostic imaging and probable emergency care. c. Refer to a gastroenterologist. d. Give the driver a 1-year recertification. - ✔✔Correct Answer "B". Possible Abdominal Aortic Aneurysm which is a medical emergency. A driver has a limitation of 35 degrees of cervical rotation to the right and left but can view both side mirrors. What is the next best step?: a. Disqualify the driver. b. Certify the driver for 1 year. c. Certify the driver for 2 years. d. Disqualify the driver pending a functional evaluation. - ✔✔Correct answer "C". The FMCSA has not adopted a standard cervical range of motion guideline for drivers. However, drivers must be able to view both mirrors. If the driver can rotate the spine as needed to see both mirrors s/he can be certified for up to 2 years. A driver presents with a history of an isolated TIA 6 months previously. He presents with a return to work letter from his primary care physician and his neurologist. The driver is taking Hydrochlorothiazide and Simvastatin. All other aspects of the exam and history were normal. What should the examiner do next? a. Certify the driver for 1 year.
b. Temporarily disqualify the driver. c. Certify the driver for 3 months. d. Certify the driver for 2 years. - ✔✔Correct answer "B". There is a waiting period of one year following a TIA. If there is any presence of seizure, the driver must wait 5 years before being certified. Which of the following is a criterion for certification after a myocardial infarction? a. EKG showing no signs of ischemia. b. Echocardiogram showing an EF >= 40%. c. ETT showing 85% of maximum predicted HR. d. All of the above. - ✔✔Correct answer is "D". All the listed choices are criteria for certification post myocardial infarction after meeting the 2-month wait time. Certification is granted for one 1 year. A driver presents for initial certification. His blood pressure is 180/102 mm Treated with amlodipine 5 mg daily. Which of the following best represents the medical examiner's BP staging and certification decision? a. Stage II hypertension b.c. Stage III hypertension d. Stage II hypertension Certify: 3-month card Certify: 6-month card Certify: 1 year - ✔✔Correct answer is "B". 180/102 is consistent with stage III hypertension (SBP of 180 is stage III, and DBP of 102 is stage II; the greater stage is obtained). Stage III hypertension is disqualified, according to FMCSA guidelines. In order to be recertified after disqualification for stage III hypertension, a driver must present evidence of good blood pressure control, i.e. <140/90. If upon returning, the BP is controlled (<140/90), the driver gets a 6- month card. A driver reports that he was hospitalized recently for palpitations. He states he was diagnosed with atrial fibrillation and was put on warfarin therapy. Which of the following is the correct certification criteria for atrial fibrillation? a. Waiting time: 1 month INR monthly Cert: 1yr b. Waiting time: 1 week INR: monthly Cert: 2yrs c. Waiting time: none INR: annually Cert: 6mon d. Waiting time: 1 year INR: weekly Cert:1yr - ✔✔Correct answer is "A". The waiting period for atrial fibrillation is 1 month with at least monthly INR. If stable and tolerating medications without side effects, certification is granted for 1 year
Who can perform the vision portion of the interstate CMV driver physical examination other than the medical examiner? a. Medical assistant. b. Ophthalmologist. c. Optometrist. d. Any of the above. - ✔✔Correct answer "D". A Medical Examiner, Medical assistant, or Ophthalmologist/Optometrist may perform the vision testing. A driver has an abdominal aortic aneurysm. The medical examiner obtains a copy of a recent abdominal sonogram indicating that the aneurysm is 5.3 cm in diameter. According to current recommendations, can the medical examiner certify this driver? a. No. b. Only if there is written clearance by a vascular surgeon. c. Yes, but the patient must undergo serial ultrasounds every 3 months. d. Yes, but the patient must undergo serial ultrasounds every 6 months. - ✔✔Correct answer "A". An aneurysm must be less than 5 cm for certification. According to regulations, which of the following can grant drivers an SPE certificate? a. Medical examiners. b. Orthopedic surgeons. c. Physical Medicine & Rehab physicians. d. The FMCSA. - ✔✔Correct answer "D". Only the FMCSA can grant an SPE certificate at one of the FMCSA centers As a certified medical examiner, for how long must you retain a copy of the Medical Examination Report Form for each driver? a. 1 year. b. 3 years. c. 5 years. d. 10 years. - ✔✔Correct answer "B". You are to retain the driver medical records for a minimum of 3 years.
As a medical examiner, you will need to provide a copy of the Medical Examination Report Form to a driver who is applying for, or renewing, a: a. Skill Performance Evaluation (SPE) certificate. b. Hearing exemption certificate. c. Seizure exemption certificate. d. Any of the above. - ✔✔Correct answer "D". Since the medical examiner does not complete any of the three certificates listed - they are approved by the FMCSA - the driver must have a copy of the Medical Examination Report Form to apply for each exemption certificate. Which of the following is true of the vision requirements for commercial drivers? a. The requirement for central distant visual acuity is at least 20/40 in each eye. b. The requirement for distant binocular visual acuity is at least 20/50. c. Contact lenses may not be worn to meet distant visual acuity requirements. d. The driver must meet either the distant visual acuity requirement for each eye OR the binocular visual acuity requirement. - ✔✔Correct answer "A". The Snellen chart or the Titmus Vision Tester measures static central vision acuity. The requirement for central distant visual acuity is at least 20/40 in each eye and distant binocular visual acuity of at least 20/40. Test results must be recorded in Snellen-comparable values. Eyeglasses or contact lenses may be worn to meet distant visual acuity requirements. When corrective lenses are worn to meet vision qualification requirements, corrective lenses must be worn while driving. Which is accurate regarding the hearing test required of commercial motor vehicle drivers? a. The forced whisper test must be administered first. b. Hearing aids cannot be used to pass the test. c. If the driver perceives a forced whisper in one ear at 6ft, he has met the hearing requirement. d. If the driver attempts to meet the requirement using a hearing aid, only the audiometric test is administered. - ✔✔Correct answer "C". The required tests screen for hearing loss in the range of normal conversational tones. Two tests are used to screen hearing: a forced whisper test AND/OR an audiometric test. Either test may be administered first. Administration of the second test may be omitted when the test results of the initial test meet the hearing requirement for that test. Hearing requirements are (1) First perceive a forced whispered voice, in one ear, at not less than five feet OR (2) Have an average hearing loss, in one ear, less than or equal to 40 decibels (dB).
