NRCME Medical Exam: Part III (ME Guidelines) Questions with Correct Solutions

What are the 3 areas considered when looking at safety implications for the driver? - Physical, Mental, and current medical treatment What aspects of physical symptoms should be considered by the medical examiner? - Symptoms - does a benign underlying condition have symptoms that interfere with driving? Incapacitation - is the onset of symptoms too rapid to be considered safe? What aspects of mental symptoms should be considered by the medical examiner? - Cognitive - can the driver process visual clues at an appropriate rate? Behavioral - is the driver's behavior appropriate and non-violent? What aspects of medical treatment should be considered by the medical examiner? - Effects - safer on the medication than off the medication? Side effects - do they interfere with safe driving? Section one of the medical examination report is filled out by whom? who is responsible for the accuracy of this information? - driver; ME Section two of the ME report is the health history. is the doctor required to discuss any portion of this section? - Yes, any box that is checked "yes" must be discussed. What should the doctor ask if "head/brain injuries" is checked "yes" - determine if the symptoms come in recurring episodes or if there are any residual physical, cognitive, or behavioral effects What should the doctor ask if "Seizures/epilepsy" is checked "yes" - - does the patient have a dx of epilepsy? (2+ unprovoked seizures) - this is disqualifying - write down type, duration, fq, and date What should the doctor ask if "eye disorders" is checked "yes" - ask about glare issues, changes in vision, dx, etc. What should the doctor ask if "ear disorders" is checked "yes" - changes in hearing, ringing, balance issues, dizziness, etc. What should the doctor ask if "CVD" is checked "yes" - -hx of CVD, syncope, dyspnea, CHF, angina, etc. - if s/s are present, the driver must be cleared by a cardiologist before being certified - if current dx of CVD, consult with their current physician and obtain documentation. What should the doctor ask if "heart surgery" is checked "yes" - -obtain heart surgery information including pertinent operative reports. it is mandatory to get documentation from the cardiologist prior to certification. - don't certify any driver with an ICD/pacemaker What should the doctor ask if "high blood pressure" is checked "yes" - make sure the medication isn't effecting the driver make sure it hasn't caused any organ damage including CVD What should the doctor ask if "musculoskeletal disease" is checked "yes" - check that the disease or medication wont cause sudden incapacitating effects on the driver. What should the doctor ask if "kidney disease" is checked "yes" - ask about renal failure, they cannot drive if on dialysis What should the doctor ask if "DM or elevated blood sugar" is checked "yes" - Ask about tx: diet, meds, byetta, or insulin If type I DM the me must finish the exam and check "meets standard but periodic monitoring is mandatory". due to "insulin tx". one year max cert, must be accompanied by a waiver. What should the doctor ask if "missing or impaired lime/digit" is checked "yes" - remember that an SPE is required for fixed deficits of the extremities. What should the doctor ask if "alcohol abuse" is checked "yes" - utilize CAGE questionnaire, refer to specialist if needed What should the doctor ask if "narcotics/habit forming drugs" is checked "yes" - dq driver if the driver's medication adversely impacts the ability of the driver to operate the vehicle safely. What 3 things should the doctor include when commenting on positive health hx items? - 1. nature of a positive hx and effect on driving 2. discussion about medication and tx effects/side effects 3. copy any supplementary medical reports obtained What is the required distant visual acuity in each eye? - 1. 20/40 snellen with or w/o corrective lenses in each eye 2. 20/40 binocular vision 3. monocular vision is automatically disqualifying