NRCME (DOT) Medical Examiner Certification
Exam 2026 – 2027 Update, Questions & Answers
(Verified Answers) With Rationales | Complete A+
Guide
1. A commercial driver with a history of type 2 diabetes mellitus presents for recertification.
Current medications include metformin 1000 mg twice daily and insulin glargine 20 units at
bedtime. Recent HbA1c is 7.8%. According to FMCSA guidelines, which of the following is the
most appropriate next step regarding certification?
A. Certify for 1 year with a requirement for quarterly HbA1c monitoring
B. Certify for 3 months and require a stable insulin regimen for 1 month prior to recertification
C. Deny certification due to use of insulin and HbA1c above 7.0%
D. Certify for 2 years with a requirement for annual ophthalmologic evaluation
Answer: B
Rationale: FMCSA regulations require that drivers using insulin have a stable regimen and no severe
hypoglycemic events for at least 1 month before certification. The 3-month certification allows for close
monitoring. Option A is incorrect because the HbA1c is elevated but not an automatic disqualifier.
Option C is incorrect because insulin use is not an absolute bar if managed properly. Option D is
incorrect because the certification period is shorter for insulin users.
2. A 55-year-old commercial driver has a blood pressure of 148/94 mm Hg on initial examination,
confirmed with a second reading after 15 minutes. The driver reports no history of hypertension
and is not on any antihypertensive medications. According to FMCSA guidelines, which
certification decision is most appropriate?
A. Certify for 1 year with a requirement for blood pressure recheck in 6 months
B. Certify for 3 months and require a letter from the treating physician documenting blood pressure control
C. Deny certification until blood pressure is below 140/90 mm Hg
D. Certify for 2 years as this is Stage 1 hypertension and does not affect driving safety
Answer: B
Rationale: A blood pressure of 148/94 is Stage 1 hypertension. FMCSA guidelines allow certification for
up to 3 months to allow time for evaluation and treatment. Option A is incorrect because a 1-year
certificate is not appropriate for new hypertension. Option C is incorrect because certification is not
automatically denied. Option D is incorrect because Stage 1 hypertension requires monitoring.
Page 1
,3. A 48-year-old commercial driver presents for a DOT physical. He has a history of obstructive
sleep apnea (OSA) and uses a CPAP machine with documented compliance (average use 6
hours/night, 80% of nights). He reports feeling well-rested. His BMI is 34 kg/m². What is the most
appropriate certification decision and follow-up?
A. Certify for 1 year with no further sleep evaluation required
B. Certify for 3 months and require repeat sleep study to confirm CPAP efficacy
C. Certify for 2 years with a requirement for annual CPAP compliance download review
D. Deny certification due to BMI > 33 kg/m² and history of OSA
Answer: C
Rationale: FMCSA guidelines allow certification for up to 2 years for drivers with OSA who demonstrate
satisfactory CPAP compliance ("e4 hours/night for "e70% of nights). Option A is incorrect because the
certification period can be longer than 1 year. Option B is incorrect because a repeat sleep study is not
required if compliance is documented. Option D is incorrect because OSA with good compliance is not
disqualifying.
4. A commercial driver with a history of a single unprovoked seizure 2 years ago is currently not
on any antiseizure medications and has been seizure-free. Neurologist evaluation notes a normal
EEG and MRI. According to FMCSA regulations, what is the minimum seizure-free period
required before certification can be considered?
A. 6 months
B. 1 year
C. 5 years
D. 10 years
Answer: C
Rationale: FMCSA requires a 5-year seizure-free period without medication for a driver with a single
unprovoked seizure to be eligible for certification. Options A and B are too short. Option D is longer
than required.
5. A driver undergoes a DOT physical and is found to have a corrected visual acuity of 20/40 in the
right eye and 20/50 in the left eye. The driver also has monocular vision due to a prior injury to the
left eye. Which of the following statements regarding vision requirements is correct?
A. The driver meets the minimum visual acuity standard of 20/40 in each eye and can be certified
B. The driver does not meet the standard because the left eye has worse than 20/40 vision
C. A driver with monocular vision must have 20/40 or better in the better eye and a field of vision of at least 70
degrees in that eye
D. A driver with monocular vision is automatically disqualified regardless of visual acuity
Answer: C
Rationale: FMCSA requires at least 20/40 vision in the better eye and a horizontal field of vision of at
least 70 degrees for monocular drivers. Option A is incorrect because the standard applies to the better
eye. Option B is incorrect because the requirement is for the better eye, not each eye. Option D is
incorrect because monocular vision is not an automatic disqualifier if standards are met.
Page 2
,6. A 62-year-old commercial driver with a history of coronary artery disease status post
drug-eluting stent placement 8 months ago presents for recertification. He is asymptomatic, has
normal left ventricular function, and is on aspirin and clopidogrel. According to FMCSA
guidelines, what is the minimum time after stent placement before certification can be considered,
and what is the recommended certification period?
A. 3 months; certify for 1 year
B. 6 months; certify for 2 years
C. 1 year; certify for 1 year
D. 2 years; certify for 1 year
Answer: C
Rationale: FMCSA requires a 1-year waiting period after drug-eluting stent placement before
certification, and then certification is for 1 year. Option A is too short. Option B is incorrect because the
waiting period is 1 year, not 6 months. Option D is incorrect because the waiting period is 1 year, not 2.
7. A driver with a history of deep vein thrombosis (DVT) and pulmonary embolism (PE) 6 months
ago is currently on warfarin with therapeutic INR. He has no residual symptoms. Which statement
is correct regarding certification?
A. Certification can be granted for 2 years if INR is stable
B. Certification is prohibited for any driver on anticoagulation
C. Certification may be considered after 1 year from the event with stable anticoagulation and no complications
D. Certification requires a waiver from the FMCSA
Answer: C
Rationale: FMCSA guidelines recommend a 1-year waiting period after a DVT/PE before certification,
provided anticoagulation is stable and there are no complications. Option A is incorrect because the
waiting period is 1 year. Option B is incorrect because anticoagulation is not an absolute bar. Option D
is incorrect because a waiver is not required.
8. A commercial driver presents for a DOT physical and reports a history of chronic low back pain
treated with opioid analgesics (oxycodone 10 mg every 6 hours as needed, average use 2 doses per
day). He has been on this regimen for 2 years. Which of the following is the most appropriate
action?
A. Certify for 1 year because the dose is stable and low
B. Deny certification because any use of opioids is disqualifying
C. Certify for 3 months and require a note from the treating physician regarding functional ability and safety
D. Certify for 2 years with a requirement for annual toxicology screening
Answer: C
Rationale: FMCSA regulations require that drivers using opioid analgesics be evaluated for safety and
functional impairment. A short-term certification (3 months) with a physician's note is appropriate.
Option A is incorrect because the certification period should be shorter. Option B is incorrect because
opioid use is not an automatic disqualifier if it does not impair driving. Option D is incorrect because a
2-year certification is too long.
Page 3
, 9. A driver has a history of bipolar I disorder and is currently stable on lithium and lamotrigine.
He reports no mood episodes in the past 3 years. A recent psychiatric evaluation confirms stability.
According to FMCSA guidelines, what is the most appropriate certification decision?
A. Certify for 1 year with a requirement for annual psychiatric evaluation
B. Certify for 2 years because the driver has been stable for 3 years
C. Deny certification because bipolar disorder is an automatic disqualifier
D. Certify for 3 months and require a drug screen to check lithium levels
Answer: A
Rationale: FMCSA guidelines allow certification for drivers with bipolar disorder if stable for at least 1
year, with annual psychiatric evaluation. Option B is incorrect because the certification period is
typically 1 year. Option C is incorrect because bipolar disorder is not an automatic disqualifier if
controlled. Option D is incorrect because a drug screen is not required.
10. A 50-year-old commercial driver has a BMI of 38 kg/m² and reports excessive daytime
sleepiness (Epworth Sleepiness Scale score 14). He has not been evaluated for sleep apnea. What is
the most appropriate action according to FMCSA guidelines?
A. Certify for 3 months and require a sleep study within that period
B. Certify for 1 year with a requirement for weight loss
C. Deny certification until a sleep study is performed and results reviewed
D. Certify for 2 years because BMI alone is not disqualifying
Answer: C
Rationale: FMCSA guidelines recommend that drivers with BMI "e 35 and symptoms of sleep apnea (e.g.,
excessive daytime sleepiness) should be evaluated before certification. Option A is incorrect because
certification should not be granted until sleep apnea is ruled out or treated. Option B is incorrect
because weight loss is not a substitute for evaluation. Option D is incorrect because symptoms plus high
BMI warrant evaluation.
11. A commercial driver with a history of type 2 diabetes is being evaluated for initial certification.
Current medications: metformin 1000 mg twice daily, empagliflozin 25 mg daily. HbA1c is 7.2%.
The driver reports no history of severe hypoglycemia. Urine dipstick shows trace ketones.
According to the latest FMCSA guidelines, which of the following is the most appropriate
certification decision?
A. Certify for 1 year with no restrictions
B. Certify for 1 year with a requirement for monthly blood glucose logs
C. Certify for 3 months pending endocrinology evaluation for ketones
D. Deny certification due to risk of euglycemic ketoacidosis
Answer: B
Rationale: The FMCSA allows certification for drivers with diabetes using insulin or non-insulin agents if
stable. An HbA1c of 7.2% is acceptable (<8% for most). Trace ketones on empagliflozin (SGLT2
inhibitor) may be benign but require monitoring; however, current guidelines do not mandate denial or
short-term certification solely for trace ketones without symptoms. Monthly logs are standard to ensure
glycemic stability.
Page 4
Exam 2026 – 2027 Update, Questions & Answers
(Verified Answers) With Rationales | Complete A+
Guide
1. A commercial driver with a history of type 2 diabetes mellitus presents for recertification.
Current medications include metformin 1000 mg twice daily and insulin glargine 20 units at
bedtime. Recent HbA1c is 7.8%. According to FMCSA guidelines, which of the following is the
most appropriate next step regarding certification?
A. Certify for 1 year with a requirement for quarterly HbA1c monitoring
B. Certify for 3 months and require a stable insulin regimen for 1 month prior to recertification
C. Deny certification due to use of insulin and HbA1c above 7.0%
D. Certify for 2 years with a requirement for annual ophthalmologic evaluation
Answer: B
Rationale: FMCSA regulations require that drivers using insulin have a stable regimen and no severe
hypoglycemic events for at least 1 month before certification. The 3-month certification allows for close
monitoring. Option A is incorrect because the HbA1c is elevated but not an automatic disqualifier.
Option C is incorrect because insulin use is not an absolute bar if managed properly. Option D is
incorrect because the certification period is shorter for insulin users.
2. A 55-year-old commercial driver has a blood pressure of 148/94 mm Hg on initial examination,
confirmed with a second reading after 15 minutes. The driver reports no history of hypertension
and is not on any antihypertensive medications. According to FMCSA guidelines, which
certification decision is most appropriate?
A. Certify for 1 year with a requirement for blood pressure recheck in 6 months
B. Certify for 3 months and require a letter from the treating physician documenting blood pressure control
C. Deny certification until blood pressure is below 140/90 mm Hg
D. Certify for 2 years as this is Stage 1 hypertension and does not affect driving safety
Answer: B
Rationale: A blood pressure of 148/94 is Stage 1 hypertension. FMCSA guidelines allow certification for
up to 3 months to allow time for evaluation and treatment. Option A is incorrect because a 1-year
certificate is not appropriate for new hypertension. Option C is incorrect because certification is not
automatically denied. Option D is incorrect because Stage 1 hypertension requires monitoring.
Page 1
,3. A 48-year-old commercial driver presents for a DOT physical. He has a history of obstructive
sleep apnea (OSA) and uses a CPAP machine with documented compliance (average use 6
hours/night, 80% of nights). He reports feeling well-rested. His BMI is 34 kg/m². What is the most
appropriate certification decision and follow-up?
A. Certify for 1 year with no further sleep evaluation required
B. Certify for 3 months and require repeat sleep study to confirm CPAP efficacy
C. Certify for 2 years with a requirement for annual CPAP compliance download review
D. Deny certification due to BMI > 33 kg/m² and history of OSA
Answer: C
Rationale: FMCSA guidelines allow certification for up to 2 years for drivers with OSA who demonstrate
satisfactory CPAP compliance ("e4 hours/night for "e70% of nights). Option A is incorrect because the
certification period can be longer than 1 year. Option B is incorrect because a repeat sleep study is not
required if compliance is documented. Option D is incorrect because OSA with good compliance is not
disqualifying.
4. A commercial driver with a history of a single unprovoked seizure 2 years ago is currently not
on any antiseizure medications and has been seizure-free. Neurologist evaluation notes a normal
EEG and MRI. According to FMCSA regulations, what is the minimum seizure-free period
required before certification can be considered?
A. 6 months
B. 1 year
C. 5 years
D. 10 years
Answer: C
Rationale: FMCSA requires a 5-year seizure-free period without medication for a driver with a single
unprovoked seizure to be eligible for certification. Options A and B are too short. Option D is longer
than required.
5. A driver undergoes a DOT physical and is found to have a corrected visual acuity of 20/40 in the
right eye and 20/50 in the left eye. The driver also has monocular vision due to a prior injury to the
left eye. Which of the following statements regarding vision requirements is correct?
A. The driver meets the minimum visual acuity standard of 20/40 in each eye and can be certified
B. The driver does not meet the standard because the left eye has worse than 20/40 vision
C. A driver with monocular vision must have 20/40 or better in the better eye and a field of vision of at least 70
degrees in that eye
D. A driver with monocular vision is automatically disqualified regardless of visual acuity
Answer: C
Rationale: FMCSA requires at least 20/40 vision in the better eye and a horizontal field of vision of at
least 70 degrees for monocular drivers. Option A is incorrect because the standard applies to the better
eye. Option B is incorrect because the requirement is for the better eye, not each eye. Option D is
incorrect because monocular vision is not an automatic disqualifier if standards are met.
Page 2
,6. A 62-year-old commercial driver with a history of coronary artery disease status post
drug-eluting stent placement 8 months ago presents for recertification. He is asymptomatic, has
normal left ventricular function, and is on aspirin and clopidogrel. According to FMCSA
guidelines, what is the minimum time after stent placement before certification can be considered,
and what is the recommended certification period?
A. 3 months; certify for 1 year
B. 6 months; certify for 2 years
C. 1 year; certify for 1 year
D. 2 years; certify for 1 year
Answer: C
Rationale: FMCSA requires a 1-year waiting period after drug-eluting stent placement before
certification, and then certification is for 1 year. Option A is too short. Option B is incorrect because the
waiting period is 1 year, not 6 months. Option D is incorrect because the waiting period is 1 year, not 2.
7. A driver with a history of deep vein thrombosis (DVT) and pulmonary embolism (PE) 6 months
ago is currently on warfarin with therapeutic INR. He has no residual symptoms. Which statement
is correct regarding certification?
A. Certification can be granted for 2 years if INR is stable
B. Certification is prohibited for any driver on anticoagulation
C. Certification may be considered after 1 year from the event with stable anticoagulation and no complications
D. Certification requires a waiver from the FMCSA
Answer: C
Rationale: FMCSA guidelines recommend a 1-year waiting period after a DVT/PE before certification,
provided anticoagulation is stable and there are no complications. Option A is incorrect because the
waiting period is 1 year. Option B is incorrect because anticoagulation is not an absolute bar. Option D
is incorrect because a waiver is not required.
8. A commercial driver presents for a DOT physical and reports a history of chronic low back pain
treated with opioid analgesics (oxycodone 10 mg every 6 hours as needed, average use 2 doses per
day). He has been on this regimen for 2 years. Which of the following is the most appropriate
action?
A. Certify for 1 year because the dose is stable and low
B. Deny certification because any use of opioids is disqualifying
C. Certify for 3 months and require a note from the treating physician regarding functional ability and safety
D. Certify for 2 years with a requirement for annual toxicology screening
Answer: C
Rationale: FMCSA regulations require that drivers using opioid analgesics be evaluated for safety and
functional impairment. A short-term certification (3 months) with a physician's note is appropriate.
Option A is incorrect because the certification period should be shorter. Option B is incorrect because
opioid use is not an automatic disqualifier if it does not impair driving. Option D is incorrect because a
2-year certification is too long.
Page 3
, 9. A driver has a history of bipolar I disorder and is currently stable on lithium and lamotrigine.
He reports no mood episodes in the past 3 years. A recent psychiatric evaluation confirms stability.
According to FMCSA guidelines, what is the most appropriate certification decision?
A. Certify for 1 year with a requirement for annual psychiatric evaluation
B. Certify for 2 years because the driver has been stable for 3 years
C. Deny certification because bipolar disorder is an automatic disqualifier
D. Certify for 3 months and require a drug screen to check lithium levels
Answer: A
Rationale: FMCSA guidelines allow certification for drivers with bipolar disorder if stable for at least 1
year, with annual psychiatric evaluation. Option B is incorrect because the certification period is
typically 1 year. Option C is incorrect because bipolar disorder is not an automatic disqualifier if
controlled. Option D is incorrect because a drug screen is not required.
10. A 50-year-old commercial driver has a BMI of 38 kg/m² and reports excessive daytime
sleepiness (Epworth Sleepiness Scale score 14). He has not been evaluated for sleep apnea. What is
the most appropriate action according to FMCSA guidelines?
A. Certify for 3 months and require a sleep study within that period
B. Certify for 1 year with a requirement for weight loss
C. Deny certification until a sleep study is performed and results reviewed
D. Certify for 2 years because BMI alone is not disqualifying
Answer: C
Rationale: FMCSA guidelines recommend that drivers with BMI "e 35 and symptoms of sleep apnea (e.g.,
excessive daytime sleepiness) should be evaluated before certification. Option A is incorrect because
certification should not be granted until sleep apnea is ruled out or treated. Option B is incorrect
because weight loss is not a substitute for evaluation. Option D is incorrect because symptoms plus high
BMI warrant evaluation.
11. A commercial driver with a history of type 2 diabetes is being evaluated for initial certification.
Current medications: metformin 1000 mg twice daily, empagliflozin 25 mg daily. HbA1c is 7.2%.
The driver reports no history of severe hypoglycemia. Urine dipstick shows trace ketones.
According to the latest FMCSA guidelines, which of the following is the most appropriate
certification decision?
A. Certify for 1 year with no restrictions
B. Certify for 1 year with a requirement for monthly blood glucose logs
C. Certify for 3 months pending endocrinology evaluation for ketones
D. Deny certification due to risk of euglycemic ketoacidosis
Answer: B
Rationale: The FMCSA allows certification for drivers with diabetes using insulin or non-insulin agents if
stable. An HbA1c of 7.2% is acceptable (<8% for most). Trace ketones on empagliflozin (SGLT2
inhibitor) may be benign but require monitoring; however, current guidelines do not mandate denial or
short-term certification solely for trace ketones without symptoms. Monthly logs are standard to ensure
glycemic stability.
Page 4
