NRCME Study Exam 2023 Answered 100% Correct

vision requirements - ANSWER-Distant vision 20/40 each eye and 20/40 both eyes, Peripheral vision at least 70 degrees, Ability to recognize and distinguish betwen the colors of traffic signals and devices. If the driver presents a valid vision exemption, how long can he be certified? - ANSWER-1 year The driver with a vision exemption must present what 2 things before receiving the medical examiner's certificate. - ANSWER-Valid vision exemption and copy of the specialist eye examination report. When applying for a vision exemption, the driver should include a copy of the Medical Examination Report form and the medical examiner's certification with what marked? - ANSWER-The "accompanied by" exemption checkbox and write "vision" to identify the type of exemption. If the driver is qualified by operation of 49 CFR 391.64 due to participation in the vision study program, what must the driver present to qualify for certification? - ANSWER-Letter identifying the driver as a participant and copy of the specialist eye examination. How long can a driver who is qualified by operation of 49 CFR 391.64 be certified. - ANSWER-1 year hearing requirements - ANSWER-Whisper at not less than 5 feet in 1 ear, or average hearing loss no greater than 40 dB at 500Hz, 1000Hz, 2000 Hz in 1 ear. What is the waiting period for vertigo caused by benign positional vertigo or acute/chronic peripheral vestibulopathy? - ANSWER-3 months Name 4 otic conditions that are automatic disqualification - ANSWER-Meniere's, uncontrolled vertigo, labyrinthine fistula, nonfunctioning labyrinth Apnea-hypopnea index of [blank] or more episodes per hour is diagnostic of OSA - ANSWER-30 3 requirements for a passing ETT - ANSWER-1. increased SBP of at least 20 without angina 2. workload capacity >6 METs 3. no significant ST depression Examiners must retain records for how many years? - ANSWER-3 Regulation that describes the physical qualifications of drivers. - ANSWER-49 CFR 391.41 Regulation that describes the responsibilities of the medical examiner. - ANSWER-49 CFR 391.43 Regulation that describes the process for conflict resolution when there is a disagreement between the primary care provider for the driver and the medical examiner for the motor carrier concerning driving qualifications. - ANSWER-49 CFR 391.47 Regulation that describes the Skill Performance Evaluation (SPE) Certification Program. - ANSWER-49 CFR 391.49 Regulation that describes limited exemptions for intra-city zone drivers. - ANSWER-49 CFR 391.62 Regulation that describes grandfathering for certain drivers who participated in vision and diabetes waiver study programs. - ANSWER-49 CFR 391.64 Regulation that includes regulations for medical review officers and substance abuse professionals, including drug and alcohol testing procedures. - ANSWER-49 CFR 40 Define Stage I Hypertension - ANSWER-BP greater than or equal to 140/90 What is the maximum certification period for stage I hypertension if this is the 1st examination at which the driver has BP equivalent to stage I hypertension and has no history of hypertension? - ANSWER-1 year What is the maximum certification period for untreated known or inadequately controlled stage I hypertension? - ANSWER-3 months What is the maximum certification period for blood pressure >140/90 and the following: follow-up 3 months certificate or history of stage III hypertension - ANSWER-None, driver is disqualified Define Stage II hypertension. - ANSWER-BP is ≥ 160 to <180 SYSTOLIC, and is ≥100 to < 110 Diastolic What is the maximum certification period for Stage II hypertension with blood pressure >140/90? - ANSWER-3 months What is the maximum certification period for Stage II hypertension with blood pressure </140/90? - ANSWER-1 year Define Stage III hypertension. - ANSWER-BP >180 Systolic and > 110 Diastolic What is the maximum certification period for Stage III hypertension with blood pressure >140/90? - ANSWER-1 time certificate for 3 months in accordance with stage 1 or 2 HTN guidelines, as determined by a case by case basis. What is the maximum certification period for a driver with a history of Stage III hypertension but t exam his BP is at or less 140/90 and treatment is well tolerated? - ANSWER-6 months What is the maximum certification period for Stage III hypertension with blood pressure >180/110? - ANSWER-None, driver is disqualified. What is the waiting period and maximum certification period for surgical correction of secondary hypertension? - ANSWER-3 months and 1 year post surgical correction What is the waiting period and maximum certification period for driver on anticoagulants for cardiovascular cause? - ANSWER-1 month stabilized and 1 year with monthly INRs What is the waiting period and maximum certification period for driver on anticoagulants for neurlogical condition? - ANSWER-None, driver is disqualified. 5 reasons to disqualify a driver with AAA - ANSWER-1. Symptomatic 2. AAA >5cm 3. AAA 4-5 cm and does not have clearance from a cardiologist 4. AAA increased in size 0.5cm in 6 months 5. Surgical repair was recommended but not done Maximum certification period for driver with AAA that is asymptomatic or <4cm, >4cm and <5cm but has clearance from cardiologist - ANSWER-1 year Maximum certification period for Acute DVT - ANSWER-1 year Maximum certification period for Chronic DVT - ANSWER-2 years Waiting period and maximum certification period for intermittent claudication if driver has no resting pain. - ANSWER-3 months for post-surgical repair and 1 year Waiting period and maximum certification for aneurysms of visceral, peripheral arteries or venous vessels - ANSWER-3 months post-surgical repair and 1 year with clearance from cardiologist Waiting period and maximum certification for peripheral vascular disease - ANSWER-3 months post-surgical repair and 1 year without resting pain Waiting period and maximum certification for pulmonary emboli - ANSWER-3 months with no pulmonary embolism and 1 year if asymptomatic Maximum certification period for superficial phlebitis - ANSWER-2 years Waiting period and maximum certification for thoracic aneurysm <3.5cm - ANSWER-3 months post surgical repair and 1 year True or false: having an ICD is automatic disqualification - ANSWER-true Min waiting period for pacemaker implantation for sinus node dysfunction or AV block - ANSWER-1 month Min waiting period for pacemaker implantation for neurocardiogenic syncope or hypersensitive carotid sinus with syncope - ANSWER-3 months In order for a driver to receive maximum certification period of 1 year for pacemaker the driver must: - ANSWER-Comply with pacemaker center scheduled function checks and provide documentation of pacemaker function checks at examination. Minimum waiting period for atrial fibrillation - ANSWER-1 month with adequate anticoagulation Minimum waiting period for atrial flutter - ANSWER-1 month post-isthmus ablation Minimum waiting period for AV nodal reentrant tachycardia, AV reentrant tachycardia and Wolff-Parkinson-White syndrome, Atrial tachycardia, Junctional tachycardia - ANSWER-1 month without symptoms Maximum certification period for SVT with adequate rate control, anticoagulation if indicated, and clearance from a cardiologist. - ANSWER-1 year Minimum waiting period for VT caused by coronary heart disease, right ventricular outflow VT, Idiopathic LV VT. - ANSWER-1 month after drug or other therapy Maximum certification for VT if patient is asymptomatic, NSVT with LVEF >40% and has clearance from a cardiologist - ANSWER-1 year Driver is to be disqualified if VT and the following: - ANSWER-symptomatic, sustained VT, NSVT with LVEF <40% or diagnosis of hypertrophic cardiomyopathy, long QT interval syndrome or Brugada syndrome Waiting period and maximum certification for Acute MI is - ANSWER-Waiting period 2 months post MI and maximum certification is 1 year What is required for initial certification following MI? - ANSWER-In-patient post-MI echocardiogram showing LVEF 40% What are the requirements for certifying driver with history of MI? - ANSWER-Asymptomatic, satisfactory ETT every 2 years, LVEF >/40%, no electrocardiogram ischemic changes and clearance by cardiologist Waiting period and maximum certification for angina in a driver without resting angina or change in angina pattern and 1 year with satisfactory ETT every 2 years and clearance by cardiologist - ANSWER-3 months CHD risk-equivalent conditions include: - ANSWER-DM, PVD, Framingham risk score predicting 20% CHD event risk over the next 10 years or being over 45 years of age with multiple risk factors for CHF Maximum certification of multiple CHD risk-equivalent is - ANSWER-1 year Waiting period and maximum certification for CABG if the driver is asymptomatic, LVEF >/40%, healed sternum and cleared by cardiology - ANSWER-3 months after CABG and 1 year 5 years post-CABG, what routine tests need to be completed - ANSWER-Annual ETT and imaging stress test if indicated What is the maximum certification period for driver with heart failure who is asymptomatic, has ETT >6 METS and LVEF >/40% - ANSWER-1 year Heart failure disqualifications are: - ANSWER-Symptomatic, asymptomatic with LVEF </ 50% and has ventricular arrhythmias or asymptomatic with LVEF <40% Driver with heart failure should obtain - ANSWER-ETT every 2 years, annual evaluation and clearance from cardiologist, echocardiogram and holter monitoring What is the waiting period and maximum certification for PCI if patient is asymptomatic and vascular access site is healed? - ANSWER-1 week and initial certification of 6 months followed by 1 year if ETT is satisfactory What follow up testing is required in driver undergoing PCI? - ANSWER-ETT 3 to 6 months post-PCI and bring results to 6 month follow up appointment (if inconclusive, imaging stress test may be indicated) Define Ebstein anomaly - ANSWER-Congenital heart disease resulting in downward displacement of the tricuspid valve. What is the maximum certification of Ebstein anomaly if the driver is asymptomatic, has mild tricuspid anomaly, mild cardiac enlargement and mild ventricular dysfunction. - ANSWER-1 year What disqualifies a driver with Ebstein anomaly? - ANSWER-Moderate or severe anomaly, intracardiac lesion, shunt, symptomatic arrhythmia, accessory conduction pathway What follow up testing is required in driver with Ebstein anomaly? - ANSWER-Annual cardiac clearance and echocardiogram Waiting period and maximum certification period for heart transplantation in driver who is asymptomatic, has cardiac clearance and no signs of transplant rejection - ANSWER-1 year and 6 months What myocardial diseases are disqualifying: - ANSWER-hypertrophic cardiomyopathy and restrictive cardiomyopathy Maximum certification for syncope in driver who has been treated as is now asymptomatic, is at low risk for recurrence and has cardiac clearance. - ANSWER-1 year Follow up evaluation for drivers with syncope - ANSWER-Annual evaluation by cardiologist Maximum certification for aortic regurgitation if the driver has mild aortic regurgitation that is asymptomatic or moderate aortic regurgitation that is asymptomatic with normal LV function, normal or mild LV enlargement - ANSWER-1 year Follow up evaluation for drivers with mild or moderate aortic regurgitation - ANSWER-Echocardiogram every 2 to 3 years Waiting period and maximum certification for severe aortic regurgitation if the driver is asymptomatic, normal LV function, minimal LV dilation (LVEDD </60mm and LVESD </50mm) - ANSWER-3 months if post-aortic valve repair and 6 months if not surgically repaired or 1 year if repaired What disqualifies a driver with severe aortic regurgitation - ANSWER-Symptomatic, unable to achieve workload > 6MET on Bruce protocol, LVEF <50%, LVEDD >70mm or LVES >55mm Follow up evaluation for drivers with severe aortic regurgitation - ANSWER-Echocardiogram every 6 to 12 months if LVEDD <60mm or LVESD <50mm or every 4-6 months if LVEDD =60mm or LVESD =50mm