NRCME TEST QUESTIONS [100% CORRECT ANSWERS VERIFIED AND UPDATED/GUARANTEED 2024-2025, Exams of Nursing

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NRCME TEST QUESTIONS [100% CORRECT ANSWERS

VERIFIED AND UPDATED/GUARANTEED 2024-

1. 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 mini- mum arterial blood gas (PaO2) greater than 65. 2. 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. 3. 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 examina- tion.

4. A driver provides an audiometric test documenting the following: 1. 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 require- mentsto 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. 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. 5. 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. 6. 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. d. Require a skill performance evaluation to ascertain if the driver has any limitations with driving.: Correct answer is "B". The driver exhibits what may be considered a "flat affect" which is seen in schizophrenia and in severe depression. The driver should be evaluated by a mental health expert to make a diagnosis prior to certification. 7. A driver admits to the use of marijuana for the treatment of his glaucoma, which is legal in the State in which he lives. He provides medical documenta- tion for the glaucoma

indicating he is able to drive a truck. He began using the marijuana about three months ago. His current medical card has no limitations listed and is for 2 years. His certification examination is within normal limits. The medical examiner should: a. Disqualify the driver. b. Perform a urine drug collection and provide the release from the testing provider. c. Certify the driver for 1 year. d. Certify the driver for 2 years.: Correct answer is "A". Use of marijuana is prohibited by Federal law while driving a CMV and trumps State law in this matter.

8. A driver has a blood pressure of 136/92 mm Hg. This is: a. Within normal limits and would not affect the driver's certification. b. Stage 1 Hypertension. c. Stage 2 Hypertension. d. Stage 3 Hypertension.: Correct answer is "B". This is Stage 1 Hypertension, which is defined as 140-159/90 - 99. 9. A driver is taking Celexa for the treatment of what he calls a "mild depres- sion." He reports he has not considered or attempted suicide. The examiner should? a.Temporarily disqualify the driver until he obtains written clearance for the depression and the medication from the treating provi b. Certify the driver for a period of 1 year. c. Certify the driver for a period of 2 years. d. Disqualify the driver until he is no longer requiring medication for the treatment of depression.: Correct answer is "A". Medical clearance is required for all mental health disorders. Celexa is an SSRI or 2nd Generation anti-depressant and is acceptable. 10. 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. 11. 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.

12. 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. 13. 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 ver- ified 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. 14. 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. 15. 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.

16. 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 clear- ance from a neurologist prior to reconsidering the driver for certification. 17. All of the following are required components of all DOT medical examina- tions EXCEPT? a. Vision b. Hearing c. Blood Pressure d. Ophthalmoscopic examination: Correct answer is "D". There are four required components of every examination: vision, hearing, blood pressure and urinalysis. Ophthalmoscopic examination is not required but may be done if deemed necessary. 18. A driver reports in his history that he was treated for epilepsy 14 years ago but stopped taking anti-epileptic medication on his own since his move to your area 11 years ago. He has not seen a neurologist nor a health care provider in over 10 years and reports no seizures during this period. The examiner should: a. Request medical clearance, and if obtained the driver may be certified for 1 year. b. Request medical clearance, and if obtained the driver may be certified for 2 years. c. Refer the driver to the epilepsy/seizure exemption program. d. Disqualify the driver.: D. Disqualify Comment: Even though the driver reports exceeding the 10-year waiting period, it was not under medical supervision and the driver discontinued medication use and treatment outside of medical oversight. Since the driver cannot a documented med- ical history this driver does not meet the non- discretionary epilepsy standard until it is established that the driver is 10 years seizure-free while off anti-convulsants. 19. A driver reports for a re-certification examination 8 weeks after having triple coronary artery bypass surgery. He presents a note from his treating provider stating that he is able to return to driving without restriction. Addi- tionally, the note mentions that the driver's results of his ETT were normal,

and his echo showed a left ventricular ejection fraction of 75%. The examiner should? a. Temporarily disqualify the driver until he has completed the required waiting period. b. Permanently disqualify the driver because his ejection fraction is too low. c. Certify the driver for 1 year only. d. Certify the driver for 2 years because he has medical clearance.: Correct answer "A". Following CABG, there is a 3-month waiting period. Since the driver is only at 8 weeks post-op, he would have to wait 4 more weeks until he can certify. Once he completes his waiting period, he would be certified for 1 year from the date of the original examination.

20. What is the maximum number of hours a CMV driver can drive in 7 con- secutive days? a. 50. 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. 21. 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 hyperten- sion (160 - 179/100 - 109). 22. 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. 23. 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.

24. 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). 25. A driver presenting to your office marks down that he is taking "nitroglyc- erin" 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. 26. 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. 27. 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. 28. During the history, the driver admits to taking Benadryl for seasonal aller- gies. The examiner should? a. Counsel the driver to not take the medication for 12 hours prior to driving. b. Obtain medical clearance from the driver's PCP that he/she can drive. c. Disqualify the driver until he/she is no longer taking Benadryl.

d. Provide a 1-time, 3-month certificate to determine the medication's ef- fect on the driver.: Correct answer is "A". Counsel the driver concerning use of over-the-counter anti- histamines, and anti-tussives (both cause drowsiness and should not be taken while driving) and about the 12- hour rule.

29. A driver has a history of a moderate Traumatic Brain Injury that occurred 3 years ago as a result of a car accident. He reports he has fully recovered and provides a note from his neurologist stating that he suffered no seizures and that he is able to return to driving. He does not list any medications in his history. The examiner should: a. Disqualify the driver. b. Require the driver to take a "Folstein's mini mental state exam." c. Certify the driver for one year. d. Certify the driver for two years.: Correct answer is "C". The driver suffered no seizures from the TBI, has completed the required waiting period (2 years), and has medical clearance. If the rest of the examination is unremarkable, the driver could be certified for 1 year. 30. A driver reports a suicide attempt 10 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: a. Disqualify the driver. b. Require a CAGE questionnaire. c. Certify the driver for 1 year. d. Certify the driver for 2 years.: Correct answer is "A". The driver is temporarily disqualified because he has not completed the mandatory waiting period for suicide attempt of 1 year. Once he has completed this, he may be certified for 1 year due to the continued treatment of depression (taking an SSRI). The certification is from the date of the original examination. 31. The driver lists Synthroid for the treatment of hypothyroidism. He has been taking it for about 6 months and feels fine now. His examination is essentially normal. The examiner's best course of action is to? a. Request medical clearance for the medication prior to certification. b. Certify the driver for 1 year. 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. 32. 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.

33. 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, feet. 34. 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. 35. 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.

36. A driver presents for certification. He checks "yes" for "Anxiety, depres- sion, nervousness, and other mental health problems" for the Driver Health History portion of the Medical Examiner Report Form. He clarifies he has de- pression 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. 37. 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. 38. According to FMCSA regulations, medical qualification for two years can be given to a driver who has: a. An SPE certificate for a left below the knee amputation (BKA) b. Hypertension c. A recent diagnosis of Lewy body dementia d. Documented medical marijuana use for pain control: Correct Answer is "A". In order to obtain the SPE certificate, the driver had to demonstrate the ability to perform all tasks for the CMV job description. 39. 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 exam reveals an infected, swollen finger. After the ME inquires, the driver states that the pain is made worse when he grips the steering wheel. Which of the following should the ME do next? a. Obtain a hand X-ray b. Assess capillary refill in the hand c. Obtain a culture and sensitivity d. Assess the driver's grip strength: Correct Answer "D". The condition does not present a safety risk unless it interferes with the ability of the driver to hold and

control the steering wheel. The purpose of this question is to remind you to think like a medical examiner while taking the NRCME exam, not a primary care provider. Your focus is on DOT certification, not treatment of the infected finger. There will be questions like this on the exam.

40. A new driver who had a myocardial infarction six months ago is certified after completing an acceptable exercise tolerance test and is cleared by a cardiologist. According to FMCSA guidelines, which of the following is rec- ommended regarding recertification and exercise tolerance test monitoring- intervals? Receritification/Excercise Tolerance Test a. Every year/ Every year b. Every 2 years/ Every year c. Every year / Every 2 years d. Every 2 years / Every 2 years: Correct Answer "C". According to FMCSA medical guidelines, when an MI is part of the medical history, there is a significant increased risk of another MI to occur within six months to 1 year; therefore, a maximum of one-year certification is the guideline. MI guidelines also recommend exercise tolerance testing at least every two years to demonstrate continued ability to safely operate a CMV 41. A 25-year-old driver denies a history of any medical problems. She is a nonsmoker who exercises regularly without symptoms. The medical examiner auscultates bilateral wheezes during the 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. 42. 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 hyper- tension 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.

43. Which of the following is true of psychological disorders in drivers? a. Drivers with a mood disorder may, during a manic episode, exhibit grandios- ity, 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 be- haviors with a decreased crash rate: Correct Answer "A". Drivers with an active psychotic disorder will exhibit unpredictable behavior, accompanied with poor judg- ment. Drivers with a mood disorder will exhibit slower reaction times during a depres- sive 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. 44. 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/ mm Hg, a second reading should be taken later during the exam. 45. 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 dis- ease?: 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.

46. 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 47. When conducting a vision examination, a driver must have at least what distant visual acuity in each eye with or without correction? a. 20/ b. 20/ c. 20/ d. 20/60: Correct Answer "C". The driver must have at least 20/40 distant visual acuity in each eye with or without correction. 20/20 and 20/10 are higher standards than necessary. 48. Which of the following is NOT true regarding the physical examination? a. The individual parts of the body system are categorized numerically b. For each body system, mark "Yes" on the Report Form if abnormalities are detected, or "No" if the body system is normal c. There is a maximum height requirement d. The medical examiner must document all abnormal findings on the Report Form, even if they are not disqualifying: Correct Answer "C". There is not in fact a maximum (or minimum) height (or weight) requirement for drivers. For each body system, mark "Yes" on the Report Form if abnormalities are detected or "No" if the body system is normal. The medical examiner must document all abnormal findings on the Report Form, even if they are not disqualifying. Lastly, the individual parts of the body system are categorized numerically. 49. Which of the following colors is not necessary to be able to distinguish and recognize in traffic signals and devices? a. Blue b. Green c. Amber d. Red: Correct Answer "A". Due to specifically the colors of a stoplight and most

road signs, it is necessary for a driver to be able to recognize the colors amber, red, and green. Blue is not a necessary color to recognize in traffic signals and devices.

50. A DOT driver presents for his medical exam. On his history, he states that he regularly takes Dextromethorphan. This should prompt the medical examiner to: a. Give a one-year recertification b. Give a 3-month recertification c. Counsel the driver about consuming the medication within 12 hours of driving 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. 51. 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. 52. 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 Abdom- inal Aortic Aneurysm which is a medical emergency. 53. 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. 54. 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.

55. 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 cer- tification post myocardial infarction after meeting the 2-month wait time. Certification is granted for one 1 year. 56. 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. 57. 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 58. A driver presents for certification. She reports that she was hospitalized recently for chest pain. She states she was diagnosed with a myocardial infarc-

tion, and subsequently underwent left coronary artery balloon angioplasty. She was put on Xarelto. Which of the following best represents certification decision for this driver? a. waiting time: 2mon INR:none Cert: 2yr b. waiting time: 1wk INR: none Cert: 1yr c. waiting time: 2mon INR: none Cert: 1yr d: waiting time: 1 yr INR: monthly Cert: 2 yrs: Correct answer is "C". Since the angioplasty was the result of a myocardial infarction, the waiting time is 2 months. Without an MI, the waiting time post angioplasty is 1 week. No INR monitoring is required for the newer anticoagulants (Xarelto, Eliquis, Pradaxa, etc.). A patient on warfarin requires at least monthly INRs. The maximum certification for a myocardial infarction is 1 year.

59. The driver presents for re-certification. He admits a cerebellar stroke 2 years ago that has resolved without any residual deficits. He presents clear- ance from his neurologist, and he is on no anti-seizure or stroke medication. He is otherwise medically fit. What is the certification decision? a. Disqualify, as he has not met the waiting period. b. Certify for 1 year. c. Certify for 2 years. d. Obtain head CT to rule residual deficits.: Correct answer is "B". The waiting period for cerebellar or brain stem strokes is 1 year. The driver has met the waiting period, obtained clearance from his neurologist and is on no medications for stroke. He can be certified for 1 year. 60. A driver presents for examination following a spontaneous pneumotho- rax one month earlier. The records provided by the driver indicate that the pneumothorax reduced the driver's forced vital capacity (FVC) to 58% of the predicted forced vital capacity. As the medical examiner, you should: a. Certify the driver for one year. b. Certify the driver for two years. c. Do not certify the driver. d. Disqualify the driver for 6 months and re-evaluate at 6-month recheck.: Cor- rect answer "C". Do not certify. According to recommendations, this driver should not be certified until the medical examiner has verified that the recovery is complete, with X- rays, and the driver has an adequate FVC. 61. 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.

62. 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.: Cor- rect answer "A". An aneurysm must be less than 5 cm for certification. 63. 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 64. 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. 65. 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. 66. 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 require- ments. When corrective lenses are worn to meet vision qualification requirements, corrective lenses must be worn while driving.

67. 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). 68. When a driver who wears a hearing aid is unable to pass a forced whisper test, referral to which of the following is required? a. An audiologist. b. An otolaryngologist. c. A hearing aid center. d. Any of the above is acceptable.: Correct answer "D". A hearing aid may be used during forced whisper testing. When a driver who wears a hearing aid is unable to pass a forced whisper test, referral to an audiologist, otolaryngologist, or hearing aid center is required. 69. Which of the following frequencies is NOT included as part of the audio- metric hearing test for commercial motor vehicle drivers? a. 500 hertz (Hz). b. 1,000 Hz. c. 2,000 Hz. d. 4,000Hz.: Correct answer "D". The hearing requirement for an audiometric test is

based on hearing loss only at the 500 Hz, 1,000 Hz, and 2,000 Hz frequencies that are typical of normal conversation.

70. A commercial driver is taking Coumadin for a diagnosis of atrial fibrillation. As the medical examiner, you explain to the driver that: a. He cannot be certified to drive. b. He can be certified to drive for 2 years as long as he provides documentation that his INR is therapeutic. c. He must undergo monthly INR monitoring. d. He can be certified to drive only if he switches to a newer anticoagulant that does not require INR monitoring.: Correct answer "C". For a patient taking Coumadin, the maximum certification period is 1 year. Recommend to certify the driver if the driver is stabilized on medication for at least 1 month, provides a copy of the INR results at the examination, and has at least monthly INR monitoring. 71. Which of the following scenarios regarding a driver with a known abdomi- nal aortic aneurysm would warrant disqualification from commercial driving? a. The AAA is 4.5 cm and it is asymptomatic; the driver has not seen a cardiovascular specialist - he is only followed by his PCP. b. The AAA increased from 3.4 cm to 4.0 cm during the last 6-month period. c. The AAA has 5.1 cm in size, and has been stable for over 1 year. d. ALL of the above are disqualifying.: Correct answer "D". Do not certify the driver if the AAA Is greater than 4 cm but less than 5 cm and driver does not have medical clearance for commercial driving from a cardiovascular specialist; Is greater than or equal to 5 cm; has increased more than 0.5 cm during a 6-month period, regardless of size. 72. A driver presents for initial certification to drive 3 months following a myocardial infarction.An in-hospital post-MI echocardiogram showing at least what left ventricular ejection fraction is sufficient for certification to drive? a. 30%. b. 35%. c. 40%. d. 45%.: Correct answer is "C". For an initial certification following an MI, an in-hos- pital post-MI echocardiogram showing an LVEF greater than or equal to 40% is sufficient. 73. What is the minimum waiting period following Coronary Artery Bypass Graftingsurgery? a. One month. b. Two months c. Three months d. Dependent on the type of CABG performed and the number of vessels

involved.: Correct answer "C". A significant risk associated with CABG surgery is the high long- term reocclusion rate of the bypass graft. The Waiting Period is a Minimum of 3 months regardless of type of CABG surgery performed.

74. Following an uncomplicated, elective percutaneous coronary intervention procedure to treat stable angina, the post-procedure waiting period is: a. 1 week. b. 3 weeks. c. 1 month. d. 2 months.: Correct answer "A". Following an uncomplicated, elective percuta- neous coronary intervention procedure to treat stable angina, the post-procedure waiting period is 1 week. The waiting period allows for a small threat caused by acute complications at the vascular access site. Drivers undergoing PCI in the setting of an acute myocardial infarction or unstable angina should be restricted from driving duties for the longer waiting period recommended for these conditions. 75. Which cardiac condition is disqualifying? a. Hypertrophic cardiomyopathy. b. Mitral valve prolapse. c. Ebstein anomaly. d. Aortic valve repair for aortic stenosis 4 months prior to exam.: Correct Answer "A": A driver with a diagnosis of Hypertrophic Cardiomyopathy may not be certified to drive. Similarly, a driver with a diagnosis of Restrictive Cardiomyopathy may not be certified to drive. 76. A driver who exhibits difficulty breathing and has a history of COPD should undergo additional pulmonary testing. A forced expiratory volume in the first second of expiration (FEV1) less than what level of predicted should prompt arterial blood gas measurements? a. 50%. b. 55%. c. 65%. d. 70%.: Correct answer is "C". Obvious difficulty breathing in a resting position is an indicator for additional pulmonary function tests. If the forced expiratory volume in the first second of expiration (FEV1) is less than 65% of that predicted, arterial blood gas measurements should be evaluated. 77. A driver has a fixed deficit that is less than the whole hand. Which of the following is true regarding certification of this driver? a. The driver requires a Skill Performance Evaluation (SPE) certificate. b. As a medical examiner, you determine if the severity of a fixed deficit that is less than the whole hand is medically disqualifying unless the driver has an SPE certificate.

c. The patient requires referral to an orthopedic surgeon who understands the nature of commercial motor vehicle driving. d. NONE of the above are correct.: Correct answer "B". When the loss of (hand, foot, leg, or arm) or a fixed impairment to an extremity may interfere with the ability of the driver to operate a commercial motor vehicle safely, you are responsible for determining if the driver is otherwise medically fit to drive. A driver may be allowed to drive if the qualification requirements for a Skill Performance Evaluation (SPE) certificate under 49 CFR 391.49 are met. As a medical examiner, you determine if the severity of a fixed deficit that is less than the whole hand is medically disqualifying unless the driver has an SPE certificate pursuant to 49 CFR 391.49. The SPE is applicable only for fixed deficits of the extremities.

78. A urinalysis is a required part of the driver evaluations. If the UA indicates glycosuria, the medical examiner: a. Must disqualify the driver. b. Must not certify the driver until a repeat urinalysis in at least one week reveals resolution of glycosuria. c. Must obtain a consultation with an endocrinologist. d. May elect to perform a finger stick to obtain a random blood glucose.- : Correct answer "D". Glycosuria may indicate poor blood glucose control. When urinalysis shows glycosuria, you may elect to perform a finger stick test to obtain a random blood glucose. 79. You are required to perform a urinalysis (dip stick) as a part of every driver certification and recertification medical examination. An abnormal result for which of the following mandates temporarydisqualification? a. Protein. b. Blood. c. Glucose. d. NONE of the above.: Correct answer "D". Proteinuria, hematuria, or glycosuria may be an indication for further testing to rule out any underlying medical problem. You should advise the driver of any abnormal findings and when indicated, encour- age the driver to seek primary care provider evaluation, particularly if an abnormal urinalysis could indicate the presence of a medical condition that if left untreated could result in a serious illness that might affect driving. 80. Each of the following mandates disqualification in a driver with a history of alcoholism EXCEPT: a. He voluntarily attends a 12-step program to maintain his recovery. b. He has not successfully completed counseling and/or treatment. c. He has a current diagnosis of alcoholism.

d. ALL of the above are disqualifying.: Correct answer "A". Ongoing voluntary attendance at self- help groups (e.g., 12-step programs) for maintenance of recovery is not disqualifying.

81. A female driver presents for re-certification who is in her fourth day of menses with heavy bleeding. Her US shows a Specific gravity of 1.020; Protein is +1; Blood is +4; Glucose is negative. All other aspects of her medical examination are within normal. The examiner should: a. Obtain medical clearance prior to certification. b. Disqualify the driver. c. Certify the driver for 1 year. d. Certify the driver for 2 years.: Correct answer "D". The abnormality in the UA is the level of blood in the urine, which is likely a result of the driver's menstrual cycle. Without any other identified abnormality, the driver would be certified for 2 years. 82. At initial certification, a driver is found to have a blood pressure of 165/105 mm Hg. You give him a certification for three months. Upon recheck, his blood pressure is 135/85. As medical examineryou: a. Give him a 6-month certification. b. Give him a one-year certification from date of initial exam. c. Give him a one-year certification from date of recheck. d. Repeat the 3-month certification.: Correct answer is "B". This driver has stage 2 hypertension on initial exam. He qualifies for certification has his blood pressure at recheck is below 140/90. 83. A diagnosis of which of the following mandates disqualification from commercial motor vehicle driving? a. Schizophrenia. b. Hypertrophic cardiomyopathy. c. Parkinson's disease. d. All of the above.: Correct answer "D". Each condition listed entail risks too great for commercial motor vehicle driving. 84. Which of the following accurately describes the FMCSA's requirement regarding grip strength for certifying commercial drivers? a. The FMCSA requires Dynamometer testing to measure grip strength. b. The FMCSA requires Sphygmomanometer used as a screening test for grip by having the applicant repeatedly squeeze the inflated cuff while noting the maximum deflection on the gauge. c. The FMCSA accepts either Dynamometer testing or Sphygmomanometer testingfor

certification. d. The Federal Motor Carrier Safety Administration does not require any spe- cific test for assessing grip power.: Correct answer "D". The Federal Motor Carrier Safety Administration does not require any specific test for assessing grip power. The driver must have sufficient grasp and prehension to control an oversize steering wheel, shift gears using a manual transmission, and maneuver a vehicle in crowded areas.

85. FMCSA guidance recommends drivers NOT be certified with the following conditions EXCEPT: a. Uncontrolled vertigo. b. Meniere's disease. c. Labyrinthine fistula. d. Otitis Media.: Correct answer "D". Otitis media is not disqualifying. 86. A driver with a history of congestive heart failure is asymptomatic at time of presentation for certification. What minimum left ventricular ejection fraction is required for certification? a. 40% b. 45% c. 50% d. 55%: Correct answer "A". The minimum LVEF for certification is 40% in a patient with known Congestive Heart Failure. 87. A driver presents for certification and notes that he is recently had a surgical repair of an aneurysm in his left leg. What is the minimum waiting period following surgical repair of an aneurysm? a. 1 month b. 3 months c. 6 months. d. 1 year.: Correct answer "B". Aneurysms can develop in visceral and peripheral arteries and venous vessels. Rupture of any of these aneurysms can lead to gradual or sudden incapacitation and death. Much of the information on aortic aneurysms is applicable to aneurysms in other arteries. The waiting period is a minimum 3 months post-surgical repair of an aneurysm. 88. Which of the following is true regarding the FMCSA Blood Pressure regu- lations for commercial motor vehicle drivers? a. Only BP readings taken during the driver physical or follow-up examinations may be used for certification decisions.

b. A BP greater than 145/89 mm Hg should be confirmed with a second measurement taken later during the examination. c. Trained assistive personnel may take and record the BP. d. All of the above are correct.: Correct answer "D". Trained assistive personnel may take and record the BP and pulse. When BP, pulse rate, or both are significant factors in your decision not to certify a driver, it is prudent for you to measure the readings yourself. However, the Medical Examiner must sign the Medical Examina- tion Report form. By signing the Medical Examination Report form, you are taking responsibility for and attesting to the validity of all documented test results.

89. As part of the evaluation of a driver presenting for initial certification, as the medical examiner, you must perform testing for: a. Alcohol. b. Marijuana. c. Opiates. d. NONE of the above.: Correct answer "D". Testing for controlled substances is not a part of the physical qualifications for the driver examination process. Testing for controlled substances falls under a different regulation. However, if you suspect a need for drug/alcohol testing, contact the Federal Motor Carrier Safety Adminis- tration, or the motor carrier directly, for information on controlled substances and alcohol testing under Part 382 of the Federal Motor Carrier Safety Regulations. 90. Select the correct statement regarding evaluation and certification of acommercial motor vehicle driver: a. There are no work restrictions permitted. The commercial driver must be able to perform all job-related tasks, including lifting, to be certified. b. The SPE program is intended only for individuals with fixed deficits of the extremities (not for individuals with progressive diseases). c. A driver is certified from the date of examination. If only the disqualifying condition, e.g., blood pressure, is evaluated at the next examination following temporary disqualification,the date of the initial examination is used to cal- culate the certification period. If the examiner performs a complete physical examination, then the certification period is calculated from the date of this examination. d. ALL of the above are correct.: Correct answer "D". Each answer listed is correct. 91. Which of the following is NOT a mission of the FMCSA? a. Develop and enforce data-driven regulations that balance motor carrier (truck and bus companies) safety with industry efficiency. b. Target educational messages to carriers, commercial drivers, and the public.

c. Partner with stakeholders including Federal, State, and local enforcement agencies, the motor carrier industry, safety groups, and organized labor on efforts to reduce bus and truck-related crashes. d. Oversee the prosecution of criminally negligent cases of motor carrier safety breaches.: d. Oversee the prosecution of criminally negligent cases of motor carrier safety breaches.

92. In which of the following cases should you mark an exam as "incomplete examination"? a. When you do not have enough information to make a decision. b. When you have scheduled a follow up appointment for the to return with additional lab tests. c. When one provider begins an exam that will be completed by another provider. d. When the driver leaves before you have completed the exam and made a decision.: d. When the driver leaves before you have completed the exam and made a decision. 93. It is the responsibility of the Motor Carrier to make sure that commercial motor vehicle drivers meet each of the following requirements EXCEPT: a. Be at least 21 years old. b. Speak and read English well enough to understand highway/traffic signals and converse with law enforcement. c. Have a current Medical Examiner's Certificate on file. d. Provide their full Medical Examination Report Form to the motor carrier.: d. Provide their full Medical Examination Report Form to the motor carrier. 94. What HgbA1C level is indicative of a diagnosis of diabetes? a. 4.8% b. 6.5% c. 7.9% d. 10%: b. 6.5% 95. A driver presents for her first DOT medical exam. She is 48 years old and starting truck-driving school as a second career. She has no previous diagnosis of HTN, but her blood pressure today is 176/124 mm Hg. What time period is appropriate for certification? a. 1 year. b. 6 months. c. 1-time certification for 3 months.