NRCME exam
A 22 year-old male contracted meningococcal meningitis from his college roommate,
discharged from the hospital 3 months ago. He brings no records with him. He is on no
medications, is otherwise healthy, and his physical examination is entirely normal. The correct
determination would be: - ANS-Obtain hospital records. If there was no seizure activity, he must
undergo a one year waiting period before he can be qualified, if there was seizure activity, he
must undergo a 5 year waiting period seizure free and off anticonvulsant medication before he
can be qualified.
A 35 year-old patient presents for initial certification. He has no known medical history. His
urinalysis reveals 3+ glycosuria. Which of the following next steps is most reasonable? -
ANS-Assign him a status of "Determination Pending" until further evaluation by his primary care
physician.
A 43 year-old generally healthy female bus driver indicates she is allergic to aspirin. Upon
further questioning, she relates that she had febrile seizures at age 2, and her mother was told
not to give her aspirin afterwards. She never had recurrence of the seizures nor any other
neurological sequelae. Her examination is normal. You determine: - ANS-Certify for 2 years.
A 43 year-old male driver has an otherwise normal exam except for amputation of the ring and
little fingers of the left hand. The driver: - ANS-Can be cleared for two years if his grip strength is
normal.
A 45 year-old man presents for initial certification. He states that at one time he "may" have
been diagnosed with diabetes, but is not taking any medication. Which of the following
mandatory in this patient to determine certification? - ANS-Urine for glucose.
A 46-year-old male driver presents for recertification. He has a history of chronic gastro
esophageal reflux disease. He takes esomeprazole (Nexium) and over-the-counter cimetidine
(Tagamet). He states that he feels fine, but has trouble finding foods that do not trigger his
GERD when he is on the road. Which of the following should the medical examiner do first? -
ANS-Correlate the GI history findings with the abdominal examination.
A 47 year-old driver with a Fixed Deficit of an Extremity should have a physical exam -
ANS-Biannually or more frequently if indicated.
A 50 year-old male smoker had a percutaneous coronary intervention procedure 2 weeks ago
after an abnormal stress test. He is asymptomatic, stage 2 HTN controlled on ramapril and
labetolol. What is the certification period? - ANS-Certify 6 months. Advise to have ETT before 6
month follow up. If he remains stable with a normal ETT, certify for one year.
, A 69 year-old male driver had a femoral-popliteal bypass 4 months ago with resolution of
chronic leg pain due to claudication. His surgeon clears him for driving. He is on coumadin with
INRs consistently in the therapeutic range since discharge. The correct determination is: -
ANS-Meets standards, qualified for one year.
A commercial driver was diagnosed with an acute DVT 3 months ago. He has been on warfarin
and his monthly INR has been between 2.0 and 3.0. You should: - ANS-Advise that he should
move and stretch his legs regularly while driving.
A DOT driver presents for his medical exam. On his history he advised that he regularly takes
Dextromethorphan. This should prompt the ME to do the following? - ANS-Counsel the driver
about not consuming the medication within 12 hours of driving.
A driver describes halos around lights at night and occasional mild headaches. This is
suggestive of what disease? - ANS-glaucoma
A driver has had his second spontaneous pneumothorax on the same side 3 months ago. There
has been no surgical intervention. The FVC is 68%. The correct determination in this case is: -
ANS-Do not certify until the condition has been corrected surgically.
A driver is disqualified on 3-11-13 due to benign positional vertigo. She returns on 6-20-13 with
a note from her ENT that she has been symptom free since 4-16-13. You would: - ANS-erform a
recertification exam. If qualified issue a two year certification.
A driver is found to have diminished central acuity during Snellen chart acuity testing. This is
suggestive of: - ANS-macular degeneration
A driver is taking Celexa for the treatment of what he calls a "mild depression". He reports he
has not considered or attempted suicide. The examiner should do what? - ANS-Temporarily
disqualify the driver until he obtains written clearance for the depression and the medication
from the treating provider.
A driver is unable to pick out the numbers in an Ishihara color blindness test. However, he is
able to distinguish red, green, and amber stoplights. Can he be certified? - ANS-He may be fully
qualified for 2 years.
A driver presents for clearance to return to driving a CMV six weeks after arthroscopic carpal
tunnel repair on his right hand. Can he be recertified if he passes the grip strength test, and, if
so, for how long? - ANS-2 years
A driver presents for her DOT medical exam. During the exam history it is revealed that the
driver is taken Lisinopril for hypertension, Simvastatin, and Antabuse. All other aspects of
history and exam were normal. What should the examiner do next: - ANS-Disqualify the driver.
A 22 year-old male contracted meningococcal meningitis from his college roommate,
discharged from the hospital 3 months ago. He brings no records with him. He is on no
medications, is otherwise healthy, and his physical examination is entirely normal. The correct
determination would be: - ANS-Obtain hospital records. If there was no seizure activity, he must
undergo a one year waiting period before he can be qualified, if there was seizure activity, he
must undergo a 5 year waiting period seizure free and off anticonvulsant medication before he
can be qualified.
A 35 year-old patient presents for initial certification. He has no known medical history. His
urinalysis reveals 3+ glycosuria. Which of the following next steps is most reasonable? -
ANS-Assign him a status of "Determination Pending" until further evaluation by his primary care
physician.
A 43 year-old generally healthy female bus driver indicates she is allergic to aspirin. Upon
further questioning, she relates that she had febrile seizures at age 2, and her mother was told
not to give her aspirin afterwards. She never had recurrence of the seizures nor any other
neurological sequelae. Her examination is normal. You determine: - ANS-Certify for 2 years.
A 43 year-old male driver has an otherwise normal exam except for amputation of the ring and
little fingers of the left hand. The driver: - ANS-Can be cleared for two years if his grip strength is
normal.
A 45 year-old man presents for initial certification. He states that at one time he "may" have
been diagnosed with diabetes, but is not taking any medication. Which of the following
mandatory in this patient to determine certification? - ANS-Urine for glucose.
A 46-year-old male driver presents for recertification. He has a history of chronic gastro
esophageal reflux disease. He takes esomeprazole (Nexium) and over-the-counter cimetidine
(Tagamet). He states that he feels fine, but has trouble finding foods that do not trigger his
GERD when he is on the road. Which of the following should the medical examiner do first? -
ANS-Correlate the GI history findings with the abdominal examination.
A 47 year-old driver with a Fixed Deficit of an Extremity should have a physical exam -
ANS-Biannually or more frequently if indicated.
A 50 year-old male smoker had a percutaneous coronary intervention procedure 2 weeks ago
after an abnormal stress test. He is asymptomatic, stage 2 HTN controlled on ramapril and
labetolol. What is the certification period? - ANS-Certify 6 months. Advise to have ETT before 6
month follow up. If he remains stable with a normal ETT, certify for one year.
, A 69 year-old male driver had a femoral-popliteal bypass 4 months ago with resolution of
chronic leg pain due to claudication. His surgeon clears him for driving. He is on coumadin with
INRs consistently in the therapeutic range since discharge. The correct determination is: -
ANS-Meets standards, qualified for one year.
A commercial driver was diagnosed with an acute DVT 3 months ago. He has been on warfarin
and his monthly INR has been between 2.0 and 3.0. You should: - ANS-Advise that he should
move and stretch his legs regularly while driving.
A DOT driver presents for his medical exam. On his history he advised that he regularly takes
Dextromethorphan. This should prompt the ME to do the following? - ANS-Counsel the driver
about not consuming the medication within 12 hours of driving.
A driver describes halos around lights at night and occasional mild headaches. This is
suggestive of what disease? - ANS-glaucoma
A driver has had his second spontaneous pneumothorax on the same side 3 months ago. There
has been no surgical intervention. The FVC is 68%. The correct determination in this case is: -
ANS-Do not certify until the condition has been corrected surgically.
A driver is disqualified on 3-11-13 due to benign positional vertigo. She returns on 6-20-13 with
a note from her ENT that she has been symptom free since 4-16-13. You would: - ANS-erform a
recertification exam. If qualified issue a two year certification.
A driver is found to have diminished central acuity during Snellen chart acuity testing. This is
suggestive of: - ANS-macular degeneration
A driver is taking Celexa for the treatment of what he calls a "mild depression". He reports he
has not considered or attempted suicide. The examiner should do what? - ANS-Temporarily
disqualify the driver until he obtains written clearance for the depression and the medication
from the treating provider.
A driver is unable to pick out the numbers in an Ishihara color blindness test. However, he is
able to distinguish red, green, and amber stoplights. Can he be certified? - ANS-He may be fully
qualified for 2 years.
A driver presents for clearance to return to driving a CMV six weeks after arthroscopic carpal
tunnel repair on his right hand. Can he be recertified if he passes the grip strength test, and, if
so, for how long? - ANS-2 years
A driver presents for her DOT medical exam. During the exam history it is revealed that the
driver is taken Lisinopril for hypertension, Simvastatin, and Antabuse. All other aspects of
history and exam were normal. What should the examiner do next: - ANS-Disqualify the driver.
