NRCME Exam 2022/2023 Questions and Answers

NRCME Exam 2022/2023 Questions and Answers vision requirements - ANSWER-20/40 each eye and 20/40 both eyes peripheral vision - ANSWER-70 degrees Federal exemption for monocular vision: can certify for how long? - ANSWER-1 year hearing requirements - ANSWER-whisper at not less than 5 feet better ear, or average hearing loss no greater than 40 dB at 500Hz, 1000Hz, 2000 Hz. name 4 otic conditions that are automatic DQs - ANSWER-Meniere's, uncontrolled vertigo, labyrinthine fistula, nonfunctioning labyrinth Max cert period for Syncope - ANSWER-1 year (needs neurologist clearance) Post MI drivers can be certified for 1 year with all 5 of these criteria: (almost the same criteria for post CABG) (first 4 also apply for CHF drivers) - ANSWER-1. Asymptomatic 2. Tolerating meds 3. Satisfactory ETT with workload capacity of 6 METs (has to have this biennially) 4. LVEF >=40% 5. No ST depression on ECG - for post CABG this one is replaced by completely healed sternal incision Stable angina: max cert period - ANSWER-1 year minimum waiting period post CABG - ANSWER-3 months Min waiting period for post heart transplant - ANSWER-1 year Max cert period for post heart transplant - ANSWER-6 months Min waiting period post PCI (percutaneous coronary intervention) - ANSWER-1 week Min waiting period for pacemaker implantation for sinus node dysfunction - ANSWER-1 month Min waiting period for pacemaker implantation for neurocardiogenic syncope or hypersensitive carotid sinus with syncope - ANSWER-3 months Min waiting period post AAA repair - ANSWER-3 months Max cert period for being on anticoagulation for a CV condition - ANSWER-1 year 3 criteria for certification if patient on anticoagulation for a CV condition - ANSWER-1. Stable on meds for 1 month 2. Provide copy of INR at exam 3. Have INR checked and monitored at least monthly True or false: driver on anticoagulation for CVA can be certified for max 1 year - ANSWER-False. Should not be certified due to high risk of bleeding 5 reasons to DQ 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 Max size of a thoracic aneurysm that can be certified - ANSWER-3.5 cm Min waiting period for PE - ANSWER-3 months True or false: having an ICD is automatic DQ - ANSWER-true True or false: dx of severe aortic stenosis is automatic DQ - ANSWER-true Max certification post aortic valve repair - ANSWER-1 year Do not certify for moderate aortic stenosis if they have 1 of these 5 things - ANSWER-angina, CHF, A fib, LVEF <50%, thromboembolic disease How often to repeat echo for aortic stenosis? (answer for both mild and moderate AS) - ANSWER-Mild: 5 years moderate: 1-2 years Max certification for severe aortic regurgitation - ANSWER-6 months and must be asymptomatic, normal LV function, LVEDD <=60mm, LVESD <=50mm Max cert period for balloon mitral valvotomy - ANSWER-1 year Min waiting period for balloon mitral valvotomy - ANSWER-4 weeks BP above which you must treat and do one time 3 month certificate - ANSWER-160/100. For 140/90 and above up to this level, it says 3 month certificate but does not say must treat. BP above which you cannot certify until lowered below 140/90 - ANSWER-180/110 - and then this patient can only be certified for 6 months Max cert period for diabetic patients - ANSWER-Technically 2 years, but 1 year is RECOMMENDED. What the hell. The rule for DQ if they have history of hypoglycemic reactions - ANSWER-1 episode in 12 months resulting in seizure, LOC, etc; or 2 episodes in 5 years that are as above or also include loss of position sensation, orthostatic hypotension, etc. Max cert period for asthma - ANSWER-2 years Must DQ COPD patients if 1 of 3 things: - ANSWER-1. hypoxemia at rest 2. chronic resp failure 3. Continuing cough with cough syncope if FEV1 on pulm function testing is < (blank) % of predicted, then must also test ABG - ANSWER-65% Max cert period for CPAP - ANSWER-1 year (1 month waiting period after starting CPAP or 3 months after surgery) Should instruct drivers to refrain from driving for how many hours after cold or cough medicines? - ANSWER-12 hours How many of these rules are stupid and arbitrary as hell? - ANSWER-I'm gonna say 40% Max cert period for pulmonary hypertension - ANSWER-1 year 4 reasons to DQ a pulmonary hypertension patient - ANSWER-1. dyspnea at rest 2. dizziness 3. hypotension 4. PaO2 <65mmHg Name 3 reasons you should check PFTs/ spirometry prior to certifying - ANSWER-1. Hx of specific lung disease (asthma, CF, COPD) 2. symptoms of SOB, cough, chest tightness, wheezing, etc 3. Smokers over age 35 If pulse oximetry is less than blank, you have to do ABG - ANSWER-92% (you would do the pulse ox if FEV1 <65% of predicted or FEV1/FVC ratio <65%) Apnea-hypopnea index of [blank] or more episodes per hour is diagnostic of OSA - ANSWER-30 Min waiting period for diagnosis of epilepsy or viral encephalitis with early seizures - ANSWER-10 years Min waiting period for dx of bacterial meningitis with early seizures or single unprovoked seizures - ANSWER-5 years with no seizures and no seizure meds (or for single unprovoked seizure, they can be cleared by a neurologist sooner) Min waiting period for acute seizure secondary to acute structural insult to CNS - ANSWER-2 years Max certification for acute seizure secondary to acute structural insult to CNS - ANSWER-1 year Min waiting period for TBI with early seizures, stroke with risk for seizures, intracranial bleed with risk for seizures - ANSWER-5 years Min waiting period for TIA or stroke with no risk for seizures - ANSWER-1 year Min waiting period for vertigo/ dizziness caused by dx of BPV or peripheral vestibulopathy - ANSWER-2 months 6 neuromuscular conditions that are automatic DQ - ANSWER-1. congenital myopathies 2. metabolic muscle diseases 3. motor neuron diseases 4. muscular dystrophies 5. neuromuscular junction disorders 6. peripheral neuropathies Max certification for single unprovoked seizure - ANSWER-1 year Max certification for embolic/ thrombotic stroke - ANSWER-1 year and they have to be cleared by neuro Max certification for TIA - ANSWER-1 year If you have a fixed (not progressive) deficit of an extremity, you can be certified normally if you have this thing - ANSWER-Skill Performance Evaluation (SPE) certificate Max certification for adult ADHD - ANSWER-1 year (needs clearance from a mental health professional) Min waiting period for bipolar disorder (there are 2 different ones) - ANSWER-6 months after depressive episode with no suicidal behavior. 1 year after severe depressive episode, suicidal attempt, or manic episode Max certification for schizophrenia and related disorders - ANSWER-1 year, but it has to be well controlled (no side effects from meds, no active psychosis or compromised judgment) Max certification for personality disorders - ANSWER-1 year Max certification for alcoholism - ANSWER-2 years but only for history of alcoholism, not current dx of alcoholism max certification for history of drug abuse - ANSWER-2 years Glaucoma causes what main clinical concern? - ANSWER-loss of peripheral vision Diabetics on insulin who have an exemption certificate should test sugars when? - ANSWER-before driving and every 2-4 hours while driving Min waiting period for thoracic aneurysm repair - ANSWER-3 months Min waiting period for stable angina - ANSWER-3 months with no rest angina or change in pattern Min waiting period for post acute MI - ANSWER-2 months Max certification for history of stage 3 hypertension (>180/110) - ANSWER-6 months 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 Min waiting period for bypass graft in extremity - ANSW