NRCME Study Sheet
3 requirements for a passing ETT - ANS-1. increased SBP of at least 20 without angina
2. workload capacity >6 METs
3. no significant ST depression
4 Non-Discretionary Standards - ANS-Epilepsy, Hearing, Vision, Insulin-Dependent DM
5 reasons to disqualify a driver with AAA - ANS-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
5 years post-CABG, what routine tests need to be completed - ANS-Annual ETT and imaging
stress test if indicated
A driver can take hypnotics if: the half life is less than __ hours, it is a __ dose, and if the driver
is taking it __ term, meaning less than __ weeks. - ANS-less than 5 hours, low dose, short term
(less than 2 weeks)
A driver has Cor Pulmonale, RVH, Dyspnea at rest, Dizziness, and Hypotension. Whats the plan
for him - ANS-DQ
A driver is post Angioplasty. He must have a __ month recertification exam after initial return to
driving. He must have ETT within __ months. The driver receives a __ year recertification if the
ETT is okay. Then the driver must get an ETT every __ years. - ANS-6 month recert exam for
post angioplasty, then get ETT within 6 months, then a 1 year recert if the ETT is okay, then ETT
every 2 years.
A driver is post Angioplasty. The driver can return to work when: he is __ week post-procedure,
__symptomatic, Is able to tolerate ____, and the __ ___ site is healed. - ANS-1 week post-pro,
Asymptomatic, tolerate meds, the inguinal entry site is healed
A driver with SUSTAINED V TACH and an EF of < 40% will be - ANS-DQ
Abdominal aneurysm - > 5 cm is __, < 4 cm is __ - ANS-> 5 = DQ, < 4 cm = 1 year
ABGs are indicated when pulse oximetry findings - ANS-<92%
ABGs are indicated when spirometry finds: - ANS-FEV1 <65% of predicted
,FEV1/FVC ratio <65%
Restrictive impairment is present and FVC is <60%
Afib risks include embolus or stroke. How long can the certificate be for? - ANS-1 year if rate
controlled via meds
Anticoagulation therapy - patient must be stable with therapy for at least __ month(s), provides a
copy if his __ at the exam, and has at least monthly __ monitoring - ANS-1 month, INR, INR
Antihistamines - as a rule, Antihistamines must cause no __. If there are narcotics and
antihistamines used together, driver cannot drive for __ hours. - ANS-Sleepiness, 12
Apnea-hypopnea index of [blank] or more episodes per hour is diagnostic of OSA - ANS-30
Are substance abuse, drugs, and alcohol a part of the NRCME examination? - ANS-NO
CHD risk-equivalent conditions include: - ANS-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
Classification of TBI - ANS-Severe-penetrates the dura and causes a loss of consciousness
lasting >24hrs
Moderate-does not penetrate the dura but causes loss of consciousness >30min but <24hrs
Mild-no dural penetration or loss of consciousness <30min
Define Ebstein anomaly - ANS-Congenital heart disease resulting in downward displacement of
the tricuspid valve.
Define Stage I Hypertension - ANS-BP greater than or equal to 140/90
Define Stage II hypertension. - ANS-BP is ≥ 160 to <180 SYSTOLIC, and is ≥100 to < 110
Diastolic
Define Stage III hypertension. - ANS-BP >180 Systolic and > 110 Diastolic
Disqualification for anxiolytic/sedative therapy - ANS-Use of a sedating anxiolytic
Disqualification for autonomic neuropathy - ANS-Cardiovascular autonomic neuropathy that
causes resting tachycardia or orthostatic blood pressure
Other autonomic neuropathy that interferes with driving
Disqualification for conditions associated with abnormal muscle activity - ANS-Myotonia
Isaac's syndrome
Stiff-man syndrome
, Disqualification for cor pulmonale - ANS-Dyspnea at rest, dizziness or hypotension
PaO2 <65mmhg
Disqualification for diabetes - ANS-Insulin
In the last 12 months experienced hypoglycemic reaction resulting in seizure, loss of
consciousness, need assistance from another person or period of impaired cognitive function
that occurred without warning
In the last 5 years had >/2 disqualifying hypoglycemic reactions
Loss of position sensation
Loss of pedal sensation
Resting tachycardia
Orthostatic hypotension
Dx of peripheral neuropathy or proliferative retinopathy
Disqualification for drug abuse - ANS-Schedule I substances, amphetamines, narcotics,
methadone or marijuana
Disqualification for mitral regurgitation - ANS-Symptoms, less than 6 METs on Bruce protocol,
ruptured chordae or flail leaflet, atrial fibrillation, LV dysfunction, thromboembolism and
pulmonary hypertension
Disqualification for pneumothorax - ANS-Not met certification parameters
History of 2 or more spontaneous pneumothoraces on same side without successful surgical
procedure to prevent recurrence
Hypoxemia at rest
Chronic respiratory failure
History of cough syncope
Disqualification for pulmonary hypertension - ANS-Dyspnea at rest, dizziness or hypotension
PaO2 <65mmhg
Disqualification for pulmonary tuberculosis - ANS-Advanced TB with respiratory insufficiency not
meeting PFT criteria
Chronic TB
Noncompliance with antitubercular therapy
Not completed streptomycin therapy
Residual 8th cranial nerve damage that affects balance and/or hearing to an extent that
interferes with safe driving
Disqualification of chronic sleep disorders - ANS-Hypoxemia at rest
Diagnosis of untreated symptomatic OSA, narcolepsy, primary alveolar hypoventilation
syndrome, idiopathic central nervous system hypersomnolence, restless leg syndrome
associated with EDS
3 requirements for a passing ETT - ANS-1. increased SBP of at least 20 without angina
2. workload capacity >6 METs
3. no significant ST depression
4 Non-Discretionary Standards - ANS-Epilepsy, Hearing, Vision, Insulin-Dependent DM
5 reasons to disqualify a driver with AAA - ANS-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
5 years post-CABG, what routine tests need to be completed - ANS-Annual ETT and imaging
stress test if indicated
A driver can take hypnotics if: the half life is less than __ hours, it is a __ dose, and if the driver
is taking it __ term, meaning less than __ weeks. - ANS-less than 5 hours, low dose, short term
(less than 2 weeks)
A driver has Cor Pulmonale, RVH, Dyspnea at rest, Dizziness, and Hypotension. Whats the plan
for him - ANS-DQ
A driver is post Angioplasty. He must have a __ month recertification exam after initial return to
driving. He must have ETT within __ months. The driver receives a __ year recertification if the
ETT is okay. Then the driver must get an ETT every __ years. - ANS-6 month recert exam for
post angioplasty, then get ETT within 6 months, then a 1 year recert if the ETT is okay, then ETT
every 2 years.
A driver is post Angioplasty. The driver can return to work when: he is __ week post-procedure,
__symptomatic, Is able to tolerate ____, and the __ ___ site is healed. - ANS-1 week post-pro,
Asymptomatic, tolerate meds, the inguinal entry site is healed
A driver with SUSTAINED V TACH and an EF of < 40% will be - ANS-DQ
Abdominal aneurysm - > 5 cm is __, < 4 cm is __ - ANS-> 5 = DQ, < 4 cm = 1 year
ABGs are indicated when pulse oximetry findings - ANS-<92%
ABGs are indicated when spirometry finds: - ANS-FEV1 <65% of predicted
,FEV1/FVC ratio <65%
Restrictive impairment is present and FVC is <60%
Afib risks include embolus or stroke. How long can the certificate be for? - ANS-1 year if rate
controlled via meds
Anticoagulation therapy - patient must be stable with therapy for at least __ month(s), provides a
copy if his __ at the exam, and has at least monthly __ monitoring - ANS-1 month, INR, INR
Antihistamines - as a rule, Antihistamines must cause no __. If there are narcotics and
antihistamines used together, driver cannot drive for __ hours. - ANS-Sleepiness, 12
Apnea-hypopnea index of [blank] or more episodes per hour is diagnostic of OSA - ANS-30
Are substance abuse, drugs, and alcohol a part of the NRCME examination? - ANS-NO
CHD risk-equivalent conditions include: - ANS-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
Classification of TBI - ANS-Severe-penetrates the dura and causes a loss of consciousness
lasting >24hrs
Moderate-does not penetrate the dura but causes loss of consciousness >30min but <24hrs
Mild-no dural penetration or loss of consciousness <30min
Define Ebstein anomaly - ANS-Congenital heart disease resulting in downward displacement of
the tricuspid valve.
Define Stage I Hypertension - ANS-BP greater than or equal to 140/90
Define Stage II hypertension. - ANS-BP is ≥ 160 to <180 SYSTOLIC, and is ≥100 to < 110
Diastolic
Define Stage III hypertension. - ANS-BP >180 Systolic and > 110 Diastolic
Disqualification for anxiolytic/sedative therapy - ANS-Use of a sedating anxiolytic
Disqualification for autonomic neuropathy - ANS-Cardiovascular autonomic neuropathy that
causes resting tachycardia or orthostatic blood pressure
Other autonomic neuropathy that interferes with driving
Disqualification for conditions associated with abnormal muscle activity - ANS-Myotonia
Isaac's syndrome
Stiff-man syndrome
, Disqualification for cor pulmonale - ANS-Dyspnea at rest, dizziness or hypotension
PaO2 <65mmhg
Disqualification for diabetes - ANS-Insulin
In the last 12 months experienced hypoglycemic reaction resulting in seizure, loss of
consciousness, need assistance from another person or period of impaired cognitive function
that occurred without warning
In the last 5 years had >/2 disqualifying hypoglycemic reactions
Loss of position sensation
Loss of pedal sensation
Resting tachycardia
Orthostatic hypotension
Dx of peripheral neuropathy or proliferative retinopathy
Disqualification for drug abuse - ANS-Schedule I substances, amphetamines, narcotics,
methadone or marijuana
Disqualification for mitral regurgitation - ANS-Symptoms, less than 6 METs on Bruce protocol,
ruptured chordae or flail leaflet, atrial fibrillation, LV dysfunction, thromboembolism and
pulmonary hypertension
Disqualification for pneumothorax - ANS-Not met certification parameters
History of 2 or more spontaneous pneumothoraces on same side without successful surgical
procedure to prevent recurrence
Hypoxemia at rest
Chronic respiratory failure
History of cough syncope
Disqualification for pulmonary hypertension - ANS-Dyspnea at rest, dizziness or hypotension
PaO2 <65mmhg
Disqualification for pulmonary tuberculosis - ANS-Advanced TB with respiratory insufficiency not
meeting PFT criteria
Chronic TB
Noncompliance with antitubercular therapy
Not completed streptomycin therapy
Residual 8th cranial nerve damage that affects balance and/or hearing to an extent that
interferes with safe driving
Disqualification of chronic sleep disorders - ANS-Hypoxemia at rest
Diagnosis of untreated symptomatic OSA, narcolepsy, primary alveolar hypoventilation
syndrome, idiopathic central nervous system hypersomnolence, restless leg syndrome
associated with EDS
