Study with the several resources on Docsity
Earn points by helping other students or get them with a premium plan
Prepare for your exams
Study with the several resources on Docsity
Earn points to download
Earn points by helping other students or get them with a premium plan
Community
Ask the community for help and clear up your study doubts
Discover the best universities in your country according to Docsity users
Free resources
Download our free guides on studying techniques, anxiety management strategies, and thesis advice from Docsity tutors
A collection of actual exam questions and answers for the nrcme (national registry of certified medical examiners) exam, which is required for commercial drivers in the united states. The questions cover various medical conditions and their implications for driving safety, including diabetes, hypertension, heart disease, and neurological disorders. Each question includes a detailed answer with rationale, providing insights into the reasoning behind the correct answer. This resource can be valuable for individuals preparing for the nrcme exam, as it offers a realistic representation of the exam content and helps them understand the medical standards for commercial driving.
Typology: Exams
1 / 15
A 22-year-old male contracted meningococcal meningitis from his college roommate, discharged from the hospital 3 months ago. He brings no records with him. He is on no medications, is otherwise healthy, and his physical examination is entirely normal. The correct determination would be: - ANS Obtain hospital records. If there was no seizure activity, he must undergo a one year waiting period before he can be qualified, if there was seizure activity, he must undergo a 5-year waiting period seizure free and off anticonvulsant medication before he can be qualified. A 35-year-old patient presents for initial certification. He has no known medical history. His urinalysis reveals 3+ glycosuria. Which of the following next steps is most reasonable? - ANSAssign him a status of "Determination Pending" until further evaluation by his primary care physician. A 43 year-old generally healthy female bus driver indicates she is allergic to aspirin. Upon further questioning, she relates that she had febrile seizures at age 2, and her mother was told not to give her aspirin afterwards. She never had
recurrence of the seizures nor any other neurological sequelae. Her examination is normal. You determine: - ANSCertify for 2 years. A 43 year-old male driver has an otherwise normal exam except for amputation of the ring and little fingers of the left hand. The driver: - ANSCan be cleared for two years if his grip strength is normal. A 45 year-old man presents for initial certification. He states that at one time he "may" have been diagnosed with diabetes, but is not taking any medication. Which of the following mandatory in this patient to determine certification? - ANSUrine for glucose. A 46-year-old male driver presents for recertification. He has a history of chronic gastro esophageal reflux disease. He takes esomeprazole (Nexium) and over-the- counter cimetidine (Tagamet). He states that he feels fine, but has trouble finding foods that do not trigger his GERD when he is on the road. Which of the following should the medical examiner do first? - ANSCorrelate the GI history findings with the abdominal examination. A 47 year-old driver with a Fixed Deficit of an Extremity should have a physical exam - ANSBiannually or more frequently if indicated.
A 50 year-old male smoker had a percutaneous coronary intervention procedure 2 weeks ago after an abnormal stress test. He is asymptomatic, stage 2 HTN controlled on ramapril and labetolol. What is the certification period? - ANSCertify 6 months. Advise to have ETT before 6 month follow up. If he remains stable with a normal ETT, certify for one year. A 69 year-old male driver had a femoral-popliteal bypass 4 months ago with resolution of chronic leg pain due to claudication. His surgeon clears him for driving. He is on coumadin with INRs consistently in the therapeutic range since discharge. The correct determination is: - ANSMeets standards, qualified for one year. A commercial driver was diagnosed with an acute DVT 3 months ago. He has been on warfarin and his monthly INR has been between 2.0 and 3.0. You should: - ANSAdvise that he should move and stretch his legs regularly while driving. A DOT driver presents for his medical exam. On his history he advised that he regularly takes Dextromethorphan. This should prompt the ME to do the following? - ANSCounsel the driver about not consuming the medication within 12 hours of driving. A driver describes halos around lights at night and occasional mild headaches. This is suggestive of what disease? - ANSglaucoma
A driver has had his second spontaneous pneumothorax on the same side 3 months ago. There has been no surgical intervention. The FVC is 68%. The correct determination in this case is: - ANSDo not certify until the condition has been corrected surgically. A driver is disqualified on 3-11-13 due to benign positional vertigo. She returns on 6-20-13 with a note from her ENT that she has been symptom free since 4-16-13. You would: - ANSerform a recertification exam. If qualified issue a two year certification. A driver is found to have diminished central acuity during Snellen chart acuity testing. This is suggestive of: - ANSmacular degeneration A driver is taking Celexa for the treatment of what he calls a "mild depression". He reports he has not considered or attempted suicide. The examiner should do what? - ANSTemporarily disqualify the driver until he obtains written clearance for the depression and the medication from the treating provider. A driver is unable to pick out the numbers in an Ishihara color blindness test. However, he is able to distinguish red, green, and amber stoplights. Can he be certified? - ANSHe may be fully qualified for 2 years.
A driver presents for clearance to return to driving a CMV six weeks after arthroscopic carpal tunnel repair on his right hand. Can he be recertified if he passes the grip strength test, and, if so, for how long? - ANS2 years A driver presents for her DOT medical exam. During the exam history it is revealed that the driver is taken Lisinopril for hypertension, Simvastatin, and Antabuse. All other aspects of history and exam were normal. What should the examiner do next: - ANSDisqualify the driver. A driver presents for his DOT exam. He had a myocardial infarction 5 week previous to the exam. He presents with a return to work letter from his cardiologist with no restrictions. Testing information included revealed that the driver was able to reach 12 METS and his left ventricular ejection fraction was 65%. Based off of this information what certification decision should be made by the examiner? - ANSTemporarily disqualify the driver because the waiting period is 2 months A driver presents for his DOT exam. On the medical history the driver notes that it has been a month since he has smoked and has been taking Chantix to help him with efforts. Which of the following should the medical examiner do next? - ANSDisqualify the driver until it has been shown that he is no longer taking the medication and no residual side effects are present.
A driver presents post operation of the cervical spine. Which of the following may be a reason for disqualification? - ANSless than 45 degree cervical rotation. A driver presents with a history of an isolated TIA 6 months previous. 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? - ANStemporarily disqualify the driver because the waiting period is 1 year after TIA A driver returns to work after a two week absence due to a respiratory illness. He presents a note from his physician that he was unable to work as a truck driver because of the illness and is now cleared for returning to work. His medical certificate expires in 3 months. The driver: - ANSshould undergo a new examination A driver was discharged from the hospital 10 weeks ago after an MI. He is asymptomatic and has a note from the cardiologist that he had a satisfactory in office ETT the week prior to your examination and that he may drive. His pre- discharge ECHO shows an EF of 45%. His examination is normal. Your determination: - ANScertify for 1 year because waiting period is at least 2 months after MI, no sypmtoms, ETT pass, LVEF greater than 40 and no ECG changes
A driver who presents taking the following medication should normally be disqualified, but may be certified if the prescribing physician notifies the Medical Examiner that the driver is safe to be a CMV driver while he/she is being prescribed this medication: A Methotrexate. B Hydrocodone. C Methadone. D Prozac. - ANShydrocodone A driver with a history of diabetes, who is taking Metformin, provides a note from his primary care provider that lists his A1c level as 10. His exam is essentially normal including laboratory analysis, except he is very overweight. The medical examiner should: - ANS A driver with a history of diabetes, who is taking Metformin, provides a note from his primary care provider that lists his A1c level as 10. His exam is essentially normal including laboratory analysis, except he is very overweight. The medical examiner should: - ANScertify for 1 year A driver with a recent diagnosis of congestive heart failure and known ventricular arrhythmias may be certified for driving if his left ventricular ejection fraction is at least: - ANS50%
A driver with an Abnormal Aortic Aneurysm (AAA) can be certified: - ANSFor 1 year if between 4 and 5 cm, asymptomatic, with a recommendation from a cardiovascular specialist who understands the functions and demands of commercial driving. A driver with Atrial Fibrillation and good rate control: - ANSCan be certified for 1 year after one month waiting period for stable anticoagulation therapy. According to FMCSA regulations, medical qualification for two years can be given to a driver who has: - ANSAn SPE certificate for a left below the knee amputation. After a TIA a driver may not be certified if he/she: - ANSHas not completed a one year waiting period seizure free and off anticoagulants. Allergic Rhinitis involving inflammation of the nasal portion of the upper respiratory tract rarely renders a driver incapable of operating a commercial vehicle. A driver may be certified with allergic rhinitis and on what kinds of meds?
As the medical examiner you notice a patient's urinalysis is positive for 3+ protein. You should: - ANSDetermine if additional evaluation is required and request or recommend primary care provider follow-up. CAn a driver with a hearing aid use it to pass hearing test? - ANSYes he can use hearing aid to undergo the forced whisper test. Also he should carry a spare power source for his hearing aids while driving Can hearing aids be worn during the forced whisper test? - ANSNO Can you provide a copy of the Medical Examination Certificate to the driver and a copy to the employer? - ANSYES Driver certification is determined based on whether or not the driver meets the requirements of the FMCSA physical qualifications standards cited in what CFR? - ANS49 CFR 391. During his visit to the medical examiner, a driver complains of severe pain in his finger for the last two weeks after it was punctured. The examination reveals an infected, swollen finger. After the medical examiner inquires, the driver states that the pain is made worse when he grips the steering wheel. Which of the following should the medical examiner do next? - ANSAssess the driver's grip strength.
During the DOT exam a driver perceives a whispered voice at 5 feet in his left ear and 4 feet in his right ear. This is an otherwise normal/unremarkable exam. All other aspects of his physical examination are unremarkable. As the examiner what would you do next? - ANSCertify the driver for 2 years. Following acute myocardial infarction, the waiting period is a minimum of 2 months before the commercial driver can be considered for certification. The driver must have a post-MI echocardiogram demonstrating an EF of at least: - ANS40% How long is the SPE or skilled Performance evaluation certificate valid for? - ANS years If a driver responds yes to the history section of the exam form, what details must he include? - ANS1. date of onset
Regulation 49CFR391.64 allows driving within an exempt intracity zone, which refers to which type of geographical area: - ANSMinicipality The driver reports a suicide attempt 6 months earlier, following the break-up of his marriage. He noted seeing a psychiatrist and he takes Citalopram daily and he reports he feels fine now and is moving on with his life. He provides a release from his doctor that he may return to work without restrictions. The medical examiner should? - ANSdisqualify the driver The Federal Diabetes Exemption Program guidelines for blood glucose monitoring include using a device that records the results for later review and measuring blood glucose level before driving and: - ANSEvery 2 to 4 hours while driving. The medical examiner should educate the driver to refrain from operating a vehicle for at least how long after taking a medication with sedating side effects? - ANS12 hours the waiting period for certification of a driver is a minimum of one year after which of the following? Select an Answer: A Bacterial meningitis without early seizures.
B Viral encephalitis with early seizures. C Post-surgical removal of a spinal tumor. D Moderate traumatic brain injury. - ANSbacterial meningitis without early seizures. WHY because viral encephalitis with early seizures is 5 years. Post surgical is 3 months. Moderate TBI without early seizures or mild TBI with seizures is 2 years Upon examination of a 46 year-old male smoker, you detect an irregularly irregular heart rhythm. The rate is 140 bpm. This is unknown to the driver and he denies any symptoms of lightheadedness, shortness of breath, dizziness, palpitations, nor any cardiac history. You would: - ANSDisqualify and refer to his PMD or cardiologist for further evaluation. Upon examination of a commercial driver, you note scarring of the tympanic membranes. You should: - ANSdocument the finding What are 2 examples of sleepiness surveys? - ANSEpworth sleepiness scale and Stanford sleepiness scale What are the 3 classes of TBI? - ANS1. Severe, penetrates the Dura, causes loss of consciousness and lasts longer than 24 hours
What is max certification? - ANSCerebellum and brainstem vascular lesions. 1 year waiting period. Max certification 1 year What physical abilities must drivers have? - ANSgrip strength, upper body strength and balance and flexibility When do you issue a 3 month certificate? - ANSIssued for the first time a driver exhibits stage 2 hypertension Which is true of FMCSA Driver Exemption Programs? - ANSAn exemption is valid for 2 years, with an annual medical examination. Which of the following best describes the length of time to certify a driver who has non-insulin diabetes mellitus treated with oral medication and no other medical issues? - ANSWhile such drivers may be certified for 2 years, the FMCSA prefers that such drivers should have annual re-certification examinations. Which regulation describes your duties as a medical examiner? - ANS49 CFR
You certified a driver with history of stage 3 hypertension for 6 months and now he is back for recertification. What do you do? - ANSfill out a new form, check recertification and do a full physical exam You disqualified a driver due to Stage 3 hypertension. He is back today and his BP is less than 140/90. What do you do? - ANSCertify for 6 months only