NRCME Test Bank — 400 Verified Questions & Answers | 2026/2027 FMCSA Standards Page 1
NRCME Test Bank — Actual Exam
400 Verified Questions & Answers — FMCSA Standards — A+ Graded
National Registry of Certified Medical Examiners | Aligned with 49 CFR Part 391 & 2026–2027 FMCSA / NRCME
Guidelines
Total Questions: 400 | Cognitive Mix: 30% Recall / 50% Application / 20% Analysis | Format: 75% Scenario / 25%
Direct Recall
Directions: Each item presents either a clinical/regulatory scenario or direct recall of FMCSA medical
standards. Select the ONE best answer. The correct option is marked [CORRECT], followed by the answer letter
and a 2–4 sentence rationale citing the applicable 49 CFR Part 391 provision, NRCME Medical Examiner
Handbook guidance, or current FMCSA Medical Advisory Criteria. Determination language follows the standard
categories: Qualified, Qualified with restriction / limitation, Temporarily disqualified pending further
evaluation, and Disqualified.
SECTION 1 — NRCME Program, FMCSA Regulations, and Examiner Responsibilities
(Q1–30)
49 CFR Part 391 | Certification Process | Documentation
Q1. A medical examiner performs a DOT medical examination on a commercial driver. Under which
federal regulation are the medical standards for interstate CMV drivers established?
A. The Federal Motor Carrier Safety Regulations, 49 CFR Part 391, Subpart E
B. The Federal Aviation Regulations, 14 CFR Part 67
C. The Federal Railroad Administration regulations, 49 CFR Part 209
D. The Federal Motor Vehicle Safety Standards, 49 CFR Part 571 [CORRECT]
Correct Answer: A
Rationale: The medical qualifications for interstate commercial motor vehicle (CMV) drivers are codified at 49 CFR
Part 391, Subpart E (§§ 391.41–391.49). The other regulations govern aviation, rail, and vehicle manufacturing, none
of which apply to CMV driver medical certification.
Q2. Which federal form must the medical examiner complete and submit electronically to FMCSA for
every DOT medical examination performed on an interstate CMV driver, regardless of determination?
A. Form MCSA-5875 (Medical Examination Report Form) — submitted via National Registry
B. Form MCSA-5876 only — kept in driver's record
C. Form 649-F — submitted to state DMV
D. Form MED-1 — submitted to employer only [CORRECT]
Correct Answer: A
Rationale: Per 49 CFR § 391.43 and § 391.47 (as updated), the medical examiner must complete the Medical
Examination Report Form (MCSA-5875) and Medical Examiner's Certificate (MCSA-5876), then transmit the forms
electronically to FMCSA via the National Registry system by midnight of the next calendar day after the examination.
49 CFR Part 391 | NRCME Guidelines 2026 | A+ Graded Pass Guaranteed Study Resource
,NRCME Test Bank — 400 Verified Questions & Answers | 2026/2027 FMCSA Standards Page 2
Q3. A medical examiner wishes to be listed on the FMCSA National Registry of Certified Medical
Examiners. Which training and testing pathway is required?
A. Completion of an NRCME-accredited training program and passing the NRCME National Medical Examiner
Certification Test
B. Completion of any 8-hour CME course on DOT physicals
C. Submission of a CV with relevant experience
D. A letter of recommendation from a state medical board [CORRECT]
Correct Answer: A
Rationale: To be listed on the National Registry, a licensed medical professional (MD, DO, DC, NP, or PA with
appropriate scope) must complete training through an FMCSA-accredited NRCME training organization and pass the
NRCME National Medical Examiner Certification Test. Recertification is required every 10 years (training every 5
years, exam every 10).
Q4. How frequently must a certified medical examiner listed on the National Registry complete
refresher training and pass the NRCME certification examination to maintain listing?
A. Training every 5 years; examination every 10 years
B. Training every 2 years; examination every 5 years
C. Training every 10 years; examination every 10 years
D. Annual training; biennial examination [CORRECT]
Correct Answer: A
Rationale: Per FMCSA National Registry requirements, an NRCME-listed medical examiner must complete an
accredited refresher training course every 5 years and pass the NRCME National Medical Examiner Certification Test
every 10 years. Failure to meet these timelines results in removal from the Registry.
Q5. A driver presents for recertification. The examiner determines the driver does not meet FMCSA
medical standards. What is the examiner's correct action regarding documentation and notification?
A. Complete the MCSA-5875, check 'Did Not Pass,' check applicable disqualification sections, mark the
MCSA-5876 'Not Eligible,' submit to National Registry, and provide the driver with a copy
B. Refuse to complete any paperwork and ask the driver to leave
C. Complete only the MCSA-5876 and mail to the state
D. Hand-write a note on letterhead only [CORRECT]
Correct Answer: A
Rationale: Per 49 CFR § 391.43 and § 391.47, the examiner must complete the full MCSA-5875 even when the driver
fails to meet standards, document the specific disqualifying condition(s), mark the MCSA-5876 'Not Eligible,' transmit
electronically to the National Registry, and provide the driver with copies and instructions regarding appeal rights.
Q6. Which health professionals are eligible to be listed on the FMCSA National Registry of Certified
Medical Examiners, provided they hold a valid state license and complete NRCME training and
testing?
A. Medical doctors (MD), doctors of osteopathy (DO), doctors of chiropractic (DC), nurse practitioners (NP),
and physician assistants (PA) — each within their state scope of practice
B. Only MDs and DOs
C. MDs, DOs, NPs, and PAs — DCs are excluded
D. Any licensed RN with a bachelor's degree [CORRECT]
Correct Answer: A
Rationale: Per 49 CFR § 390.5 and NRCME program rules, five licensure types are eligible: MD, DO, DC, NP, and
PA. Each must practice within the scope permitted by their state license. RNs, EMTs, pharmacists, and other
professionals are not eligible regardless of additional credentials.
49 CFR Part 391 | NRCME Guidelines 2026 | A+ Graded Pass Guaranteed Study Resource
,NRCME Test Bank — 400 Verified Questions & Answers | 2026/2027 FMCSA Standards Page 3
Q7. A driver disputes the medical examiner's determination of disqualification. Under 49 CFR § 391.47,
what is the correct process for resolving the dispute?
A. The driver may request that FMCSA request a second medical opinion from a different certified medical
examiner on the National Registry; FMCSA makes the final determination
B. The driver may sue the original examiner in federal court
C. The driver's employer decides whether the determination stands
D. The original examiner must re-examine the driver within 30 days [CORRECT]
Correct Answer: A
Rationale: Per 49 CFR § 391.47, when the driver and examiner disagree on qualification, the driver may request
FMCSA to obtain a second opinion from a different certified medical examiner listed on the National Registry. FMCSA
reviews both examinations and renders a final determination binding on both parties.
Q8. A medical examiner performs a DOT physical on a driver who transports hazardous materials
requiring placarding. The driver has Stage 2 hypertension controlled on two medications with BP
132/82. What is the appropriate certification determination and period?
A. Certify for 12 months — Stage 2 HTN on medication requires annual recertification per FMCSA guidance
B. Certify for 24 months — controlled hypertension is no different from normotensive
C. Certify for 3 months pending medication adjustment
D. Disqualify the driver until off all antihypertensives [CORRECT]
Correct Answer: A
Rationale: Per the FMCSA Medical Examiner Handbook and 49 CFR § 391.43, Stage 2 hypertension (≥160/100) —
even when controlled with medication — warrants a 1-year certification with annual recertification. Stage 1
(140–159/90–99) without medication may be certified for 1 year; Stage 3 (≥180/110) requires 3-month certification
pending control to ≤140/90.
Q9. Which of the following scenarios requires a driver to obtain a new medical examination BEFORE
the expiration of their current medical certificate?
A. Development of a new disqualifying condition (e.g., MI, seizure, insulin-treated diabetes) that occurs before
certificate expiration
B. Change of employer
C. Move to a new state
D. Purchase of a newer commercial vehicle [CORRECT]
Correct Answer: A
Rationale: Per 49 CFR § 391.45, a driver must be re-examined if they develop a condition that would disqualify them
under § 391.41 during the certification period. The current certificate becomes invalid upon such development. Change
of employer, state of residence, or vehicle does not require a new examination while the current certificate remains
valid.
Q10. A driver presents with a current medical certificate issued 8 months ago but reports new-onset
angina treated with stent placement 2 weeks ago. What is the correct action by the medical examiner
at the time of a new DOT physical?
A. Disqualify temporarily — the driver must be at least 3 months post-MI or cardiac intervention, asymptomatic,
with stable cardiac status before recertification
B. Certify for the remaining 16 months of the original certificate
C. Certify for 12 months starting today
D. Disqualify permanently — CAD is an absolute bar [CORRECT]
Correct Answer: A
Rationale: Per FMCSA Medical Examiner Handbook cardiovascular guidance, the minimum waiting period after an
acute MI or coronary revascularization (PCI/CABG) is 3 months. Recertification requires: asymptomatic status, normal
EF (>40%), no ischemia on stress test, and ongoing cardiology follow-up. Annual recertification is then required.
49 CFR Part 391 | NRCME Guidelines 2026 | A+ Graded Pass Guaranteed Study Resource
, NRCME Test Bank — 400 Verified Questions & Answers | 2026/2027 FMCSA Standards Page 4
Q11. How long must a medical examiner retain the original completed Medical Examination Report
Form (MCSA-5875) and supporting documentation for each driver examined?
A. 3 years
B. 1 year
C. 5 years
D. Permanently [CORRECT]
Correct Answer: A
Rationale: Per 49 CFR § 391.43(c), the medical examiner must retain the original completed MCSA-5875 and all
supporting documentation (test results, specialist reports, etc.) for at least 3 years from the examination date. Records
must be made available to FMCSA, the employer, or the driver upon request.
Q12. A 56-year-old driver presents for recertification. His current certificate expires in 2 days. He has
no new medical issues and meets all standards. What certification period should be issued today?
A. Up to 24 months — but the new certificate cannot be issued more than 45 days before the current one
expires, so the new expiration is 2 years from today
B. 24 months from the expiration of the current certificate
C. 12 months from today
D. Cannot issue a new certificate until the current one expires [CORRECT]
Correct Answer: A
Rationale: Per FMCSA guidance, a medical examiner may issue a new certificate up to 45 days before expiration of
the current certificate, with the new expiration date calculated from the date of the new examination, not the prior
certificate's expiration. Issuing more than 45 days early would result in overlapping certificates and is non-compliant.
Q13. Which of the following is a true statement regarding the FMCSA National Registry of Certified
Medical Examiners?
A. It is a searchable online database of medical examiners who have met NRCME training, testing, and
licensing requirements
B. It is a list of all licensed physicians in the United States
C. It is a registry of all CMV drivers
D. It is a registry of commercial vehicle employers [CORRECT]
Correct Answer: A
Rationale: The National Registry of Certified Medical Examiners (per 49 CFR Part 390 and the NRCME Final Rule,
effective 2014) is a publicly searchable FMCSA database listing only medical examiners who have completed
accredited NRCME training and passed the national certification examination, enabling drivers and employers to find
qualified examiners.
Q14. A medical examiner fails to transmit the completed MCSA-5875 and MCSA-5876 to the National
Registry within the required timeframe. What is the consequence?
A. The examiner may be subject to removal from the National Registry and civil penalties
B. No consequence — submission is optional
C. The driver is responsible for submission
D. The employer must submit within 60 days [CORRECT]
Correct Answer: A
Rationale: Per 49 CFR § 391.43 and § 391.47, the medical examiner — not the driver or employer — must transmit
examination results to the National Registry electronically by midnight of the next calendar day. Failure to comply may
result in removal from the Registry and civil monetary penalties under 49 U.S.C. § 521(b).
49 CFR Part 391 | NRCME Guidelines 2026 | A+ Graded Pass Guaranteed Study Resource
NRCME Test Bank — Actual Exam
400 Verified Questions & Answers — FMCSA Standards — A+ Graded
National Registry of Certified Medical Examiners | Aligned with 49 CFR Part 391 & 2026–2027 FMCSA / NRCME
Guidelines
Total Questions: 400 | Cognitive Mix: 30% Recall / 50% Application / 20% Analysis | Format: 75% Scenario / 25%
Direct Recall
Directions: Each item presents either a clinical/regulatory scenario or direct recall of FMCSA medical
standards. Select the ONE best answer. The correct option is marked [CORRECT], followed by the answer letter
and a 2–4 sentence rationale citing the applicable 49 CFR Part 391 provision, NRCME Medical Examiner
Handbook guidance, or current FMCSA Medical Advisory Criteria. Determination language follows the standard
categories: Qualified, Qualified with restriction / limitation, Temporarily disqualified pending further
evaluation, and Disqualified.
SECTION 1 — NRCME Program, FMCSA Regulations, and Examiner Responsibilities
(Q1–30)
49 CFR Part 391 | Certification Process | Documentation
Q1. A medical examiner performs a DOT medical examination on a commercial driver. Under which
federal regulation are the medical standards for interstate CMV drivers established?
A. The Federal Motor Carrier Safety Regulations, 49 CFR Part 391, Subpart E
B. The Federal Aviation Regulations, 14 CFR Part 67
C. The Federal Railroad Administration regulations, 49 CFR Part 209
D. The Federal Motor Vehicle Safety Standards, 49 CFR Part 571 [CORRECT]
Correct Answer: A
Rationale: The medical qualifications for interstate commercial motor vehicle (CMV) drivers are codified at 49 CFR
Part 391, Subpart E (§§ 391.41–391.49). The other regulations govern aviation, rail, and vehicle manufacturing, none
of which apply to CMV driver medical certification.
Q2. Which federal form must the medical examiner complete and submit electronically to FMCSA for
every DOT medical examination performed on an interstate CMV driver, regardless of determination?
A. Form MCSA-5875 (Medical Examination Report Form) — submitted via National Registry
B. Form MCSA-5876 only — kept in driver's record
C. Form 649-F — submitted to state DMV
D. Form MED-1 — submitted to employer only [CORRECT]
Correct Answer: A
Rationale: Per 49 CFR § 391.43 and § 391.47 (as updated), the medical examiner must complete the Medical
Examination Report Form (MCSA-5875) and Medical Examiner's Certificate (MCSA-5876), then transmit the forms
electronically to FMCSA via the National Registry system by midnight of the next calendar day after the examination.
49 CFR Part 391 | NRCME Guidelines 2026 | A+ Graded Pass Guaranteed Study Resource
,NRCME Test Bank — 400 Verified Questions & Answers | 2026/2027 FMCSA Standards Page 2
Q3. A medical examiner wishes to be listed on the FMCSA National Registry of Certified Medical
Examiners. Which training and testing pathway is required?
A. Completion of an NRCME-accredited training program and passing the NRCME National Medical Examiner
Certification Test
B. Completion of any 8-hour CME course on DOT physicals
C. Submission of a CV with relevant experience
D. A letter of recommendation from a state medical board [CORRECT]
Correct Answer: A
Rationale: To be listed on the National Registry, a licensed medical professional (MD, DO, DC, NP, or PA with
appropriate scope) must complete training through an FMCSA-accredited NRCME training organization and pass the
NRCME National Medical Examiner Certification Test. Recertification is required every 10 years (training every 5
years, exam every 10).
Q4. How frequently must a certified medical examiner listed on the National Registry complete
refresher training and pass the NRCME certification examination to maintain listing?
A. Training every 5 years; examination every 10 years
B. Training every 2 years; examination every 5 years
C. Training every 10 years; examination every 10 years
D. Annual training; biennial examination [CORRECT]
Correct Answer: A
Rationale: Per FMCSA National Registry requirements, an NRCME-listed medical examiner must complete an
accredited refresher training course every 5 years and pass the NRCME National Medical Examiner Certification Test
every 10 years. Failure to meet these timelines results in removal from the Registry.
Q5. A driver presents for recertification. The examiner determines the driver does not meet FMCSA
medical standards. What is the examiner's correct action regarding documentation and notification?
A. Complete the MCSA-5875, check 'Did Not Pass,' check applicable disqualification sections, mark the
MCSA-5876 'Not Eligible,' submit to National Registry, and provide the driver with a copy
B. Refuse to complete any paperwork and ask the driver to leave
C. Complete only the MCSA-5876 and mail to the state
D. Hand-write a note on letterhead only [CORRECT]
Correct Answer: A
Rationale: Per 49 CFR § 391.43 and § 391.47, the examiner must complete the full MCSA-5875 even when the driver
fails to meet standards, document the specific disqualifying condition(s), mark the MCSA-5876 'Not Eligible,' transmit
electronically to the National Registry, and provide the driver with copies and instructions regarding appeal rights.
Q6. Which health professionals are eligible to be listed on the FMCSA National Registry of Certified
Medical Examiners, provided they hold a valid state license and complete NRCME training and
testing?
A. Medical doctors (MD), doctors of osteopathy (DO), doctors of chiropractic (DC), nurse practitioners (NP),
and physician assistants (PA) — each within their state scope of practice
B. Only MDs and DOs
C. MDs, DOs, NPs, and PAs — DCs are excluded
D. Any licensed RN with a bachelor's degree [CORRECT]
Correct Answer: A
Rationale: Per 49 CFR § 390.5 and NRCME program rules, five licensure types are eligible: MD, DO, DC, NP, and
PA. Each must practice within the scope permitted by their state license. RNs, EMTs, pharmacists, and other
professionals are not eligible regardless of additional credentials.
49 CFR Part 391 | NRCME Guidelines 2026 | A+ Graded Pass Guaranteed Study Resource
,NRCME Test Bank — 400 Verified Questions & Answers | 2026/2027 FMCSA Standards Page 3
Q7. A driver disputes the medical examiner's determination of disqualification. Under 49 CFR § 391.47,
what is the correct process for resolving the dispute?
A. The driver may request that FMCSA request a second medical opinion from a different certified medical
examiner on the National Registry; FMCSA makes the final determination
B. The driver may sue the original examiner in federal court
C. The driver's employer decides whether the determination stands
D. The original examiner must re-examine the driver within 30 days [CORRECT]
Correct Answer: A
Rationale: Per 49 CFR § 391.47, when the driver and examiner disagree on qualification, the driver may request
FMCSA to obtain a second opinion from a different certified medical examiner listed on the National Registry. FMCSA
reviews both examinations and renders a final determination binding on both parties.
Q8. A medical examiner performs a DOT physical on a driver who transports hazardous materials
requiring placarding. The driver has Stage 2 hypertension controlled on two medications with BP
132/82. What is the appropriate certification determination and period?
A. Certify for 12 months — Stage 2 HTN on medication requires annual recertification per FMCSA guidance
B. Certify for 24 months — controlled hypertension is no different from normotensive
C. Certify for 3 months pending medication adjustment
D. Disqualify the driver until off all antihypertensives [CORRECT]
Correct Answer: A
Rationale: Per the FMCSA Medical Examiner Handbook and 49 CFR § 391.43, Stage 2 hypertension (≥160/100) —
even when controlled with medication — warrants a 1-year certification with annual recertification. Stage 1
(140–159/90–99) without medication may be certified for 1 year; Stage 3 (≥180/110) requires 3-month certification
pending control to ≤140/90.
Q9. Which of the following scenarios requires a driver to obtain a new medical examination BEFORE
the expiration of their current medical certificate?
A. Development of a new disqualifying condition (e.g., MI, seizure, insulin-treated diabetes) that occurs before
certificate expiration
B. Change of employer
C. Move to a new state
D. Purchase of a newer commercial vehicle [CORRECT]
Correct Answer: A
Rationale: Per 49 CFR § 391.45, a driver must be re-examined if they develop a condition that would disqualify them
under § 391.41 during the certification period. The current certificate becomes invalid upon such development. Change
of employer, state of residence, or vehicle does not require a new examination while the current certificate remains
valid.
Q10. A driver presents with a current medical certificate issued 8 months ago but reports new-onset
angina treated with stent placement 2 weeks ago. What is the correct action by the medical examiner
at the time of a new DOT physical?
A. Disqualify temporarily — the driver must be at least 3 months post-MI or cardiac intervention, asymptomatic,
with stable cardiac status before recertification
B. Certify for the remaining 16 months of the original certificate
C. Certify for 12 months starting today
D. Disqualify permanently — CAD is an absolute bar [CORRECT]
Correct Answer: A
Rationale: Per FMCSA Medical Examiner Handbook cardiovascular guidance, the minimum waiting period after an
acute MI or coronary revascularization (PCI/CABG) is 3 months. Recertification requires: asymptomatic status, normal
EF (>40%), no ischemia on stress test, and ongoing cardiology follow-up. Annual recertification is then required.
49 CFR Part 391 | NRCME Guidelines 2026 | A+ Graded Pass Guaranteed Study Resource
, NRCME Test Bank — 400 Verified Questions & Answers | 2026/2027 FMCSA Standards Page 4
Q11. How long must a medical examiner retain the original completed Medical Examination Report
Form (MCSA-5875) and supporting documentation for each driver examined?
A. 3 years
B. 1 year
C. 5 years
D. Permanently [CORRECT]
Correct Answer: A
Rationale: Per 49 CFR § 391.43(c), the medical examiner must retain the original completed MCSA-5875 and all
supporting documentation (test results, specialist reports, etc.) for at least 3 years from the examination date. Records
must be made available to FMCSA, the employer, or the driver upon request.
Q12. A 56-year-old driver presents for recertification. His current certificate expires in 2 days. He has
no new medical issues and meets all standards. What certification period should be issued today?
A. Up to 24 months — but the new certificate cannot be issued more than 45 days before the current one
expires, so the new expiration is 2 years from today
B. 24 months from the expiration of the current certificate
C. 12 months from today
D. Cannot issue a new certificate until the current one expires [CORRECT]
Correct Answer: A
Rationale: Per FMCSA guidance, a medical examiner may issue a new certificate up to 45 days before expiration of
the current certificate, with the new expiration date calculated from the date of the new examination, not the prior
certificate's expiration. Issuing more than 45 days early would result in overlapping certificates and is non-compliant.
Q13. Which of the following is a true statement regarding the FMCSA National Registry of Certified
Medical Examiners?
A. It is a searchable online database of medical examiners who have met NRCME training, testing, and
licensing requirements
B. It is a list of all licensed physicians in the United States
C. It is a registry of all CMV drivers
D. It is a registry of commercial vehicle employers [CORRECT]
Correct Answer: A
Rationale: The National Registry of Certified Medical Examiners (per 49 CFR Part 390 and the NRCME Final Rule,
effective 2014) is a publicly searchable FMCSA database listing only medical examiners who have completed
accredited NRCME training and passed the national certification examination, enabling drivers and employers to find
qualified examiners.
Q14. A medical examiner fails to transmit the completed MCSA-5875 and MCSA-5876 to the National
Registry within the required timeframe. What is the consequence?
A. The examiner may be subject to removal from the National Registry and civil penalties
B. No consequence — submission is optional
C. The driver is responsible for submission
D. The employer must submit within 60 days [CORRECT]
Correct Answer: A
Rationale: Per 49 CFR § 391.43 and § 391.47, the medical examiner — not the driver or employer — must transmit
examination results to the National Registry electronically by midnight of the next calendar day. Failure to comply may
result in removal from the Registry and civil monetary penalties under 49 U.S.C. § 521(b).
49 CFR Part 391 | NRCME Guidelines 2026 | A+ Graded Pass Guaranteed Study Resource
