NRCME TEST 118 Questions with Complete Answers

Driver's Information - Name, address, telephone numbers Social Security, DOB, Age, Sex Driver License Number, License Class, State of Issue New Certification, Recertification, Follow-Up Required Components of all Exams - Vision Hearing Blood Pressure/Pulse UA Who Can Sign in the Exam Form - Medical Examiner (CME) Optometrist Opthalmologist Non-Discretionary Standards = you must follow the regulation or guideline and may not vary from this - 1. Vision 2. Hearing 3. Epilepsy 4. Blood Pressure Vision - 1. Must be 20/40 in each and both eyes 2. Must have 70 degrees of peripheral vision 3. Distinguish signal red, green, and amber * If they do not meet these, they may apply for a vision exemption. Provide a copy of the certificate and check off "Accompanied by a ___ waiver/exemption". * May wear glasses or contacts and should mark this in the certification section Hearing - 1. Must have less than or equal to 40 db measured at 500 Hz, 1000 Hz, and 2000 Hz 2. Perceives whispered voice at 5 feet in at least 1 ear * If they use a hearing aide, mark it in the long form and PE section * If they do not meet the criteria, they can apply for a hearing exemption. Provide a copy of the certification and check off "Accompanied by a ___ waiver/exemption" * Also look at the tympanic membrane on every exam Conversion from ISO to ANSI - Substract 14 from the hearing loss at 500 Hz Subtract 10 from the hearing loss at 1000 Hz Subtract 8.5 from the hearing loss at 2000 Hz Add those numbers up and divide by 3 to obtain the avg hearing loss in ANSI UA - required on all exams - Specific Gravity - 1.005-1.030 Protein - negative Blood - negative Glucose - negative Epilepsy - By definition, epilepsy is 2 events or the use of anti-seizure meds Always disqualify the driver with a clinical diagnosis of epilepsy * If the driver suffers from epilepsy or has a seizure disorder from an unknown cause (controlled or uncontrolled), they may apply for a seizure exemption. Provide a copy of the certificate and check off "Accompanied by a __ waiver/exemption" Blood Pressure - Follow Stage 1, 2, or 3. Once diagnosed, they will always have a shortened certification time, usually 1 year, whether they are treated or not. They may treat with meds, diet or exercise. Health Hx - Note if the driver is a smoker or non-smoker and record this in the long form Regulations VS. Guidelines - Regulations are enacted by law Guidelines are intended for you to follow 1% Rule - If there is in the examiners opinion, greater than 1% chance in the next year of a sudden incapacitation, you must DQ the driver Certification: Benign hx, negative exam - 2 years Certification: Diabetes: Non-Insulin Dependent - 1 year Certification: Diabetes: With Insulin (Diabetic) Exemption or Waiver - 1 year Certification: Hearing Exemption - 1 year Certification: Epilepsy/Seizure Exemption - 1 year Certification: Other endocrine disorders - 2 years Certification: Mental Disorders - If able to certify, max 1 year during tx Certification: Vision Exemption - Certified for 1 year only Certification: BP - 1. Anyone with a hx of HTN (tx with med, diet or weight loss and exercise), and their BP is below 140/90 at the time of the exam, may be granted a 1 year certificate unless they have a hx of Stage 3 HTN. 2. With a hx of stage 3 HTN, then the max certification period is for 6 months only Stage 1 - 140-159/90-99 1. If this is the first time diagnosed, confirmed by 2 readings taken on the same day, grant a 1 year certificate 3. If they have a hx of HTN, such as a previous reading on another exam (you will notice they have a 1 year card already, or they are currently taking HTN meds, then they can only receive a 1 time 3 month certificate. - Within 3 months, they must have a BP reading from a provider of less than or equal to 140/90. - Date the card for the original date of the exam - If they do not lower their BP to less than or equal to 140/90 within the 3 month time frame, they will be disqualified * If it is greater than 3 months before they lower their BP to an acceptable level, they should undergo another examination Stage 2 - 160-179/100-109 - They are granted a 1 time 3 month certificate and follow the requirements for Stage 1 * The maximum certification will be for a 1 year Stage 3 - 180 or above/110 or above They are automatically disqualified until their BP is less than or equal to 140/90 * Their maximum certification will be for 6 months for the rest of the driver's career BP 2 year Certification - If the driver were to improve their health situation by loosing weight, exericse etc, and were taken off of their hypertensive medication, and it remained stable for a period of 2 years Certification of Cardiac conditions: Ischemic heart disease, valvular heart disease, congestive heart failure, cardiac arrhythmias including pace makers, congenital heart problems, peripheral vascular disease, including intermittent claudication that is asymptomatic at rest, DVT and pulmonary embolism, AAA, and those drivers with multiple coronary heart disease risk factors (modifiable and non modifiable) - Most will be certified for 1 year Certification: Heart Transplant - 6 months Certification: Some valvular conditions - May be less than 1 year Certification: PCI (angioplasty) - Initial certification is 3-6 months Certification: Respiratory Conditions - Infectious Diseases, Non-Infectious diseases, allergies, post pneumonectomy/ lung resection, trachestomy, primary and secondary lung carcinoma, pulmonary HTN, lung transplant - 2 years Certification: Obstructive Sleep Apnea, DVT, and Pulmonary thromboembolism - 1 year Certification on Abdominal Conditions: GU, GI, hematologic disorders, neoplastic disorders, and hernias - 2 years Certification on Orthopedic/Neurologic Conditions - 2 years Hx of embolic or thrombotic stroke - 1 year Hx of Intracerebral and Subarachnoid hemorrhage - 1 year Hx of TIA - 1 year Hx of mild or moderate TBI - 1 year Acute seizures - structural insult to the brain - 1 year FMCSA definition of epilepsy - 2 or more events or use of an anti-seizure medication to control seizures Epilepsy - if 1 event of unknown cause, and no anti-seizure medication is required - Wait 5 years Epilepsy - if from a known cause (med rxn, high fever), - Wait 0-6 months Epilepsy - if the driver has met or exeeded 10 years without the use of antiseizure med and has not suffered a seizure - Consider medication certification Severe depression/thoughts of suicide or suicide attempt - Wait 1 year Non-psychotic major depression, no suicide attempt - Wait 6 months Brief episode of psychosis - Wait 6 months Tx of Psychosis involves the use of electroconvulsive therapy - Wait 6 months