2026 NRCME UPDATED TESTED MAIN QUESTIONS
AND ANSWERS SURE A+
✔✔Do not certify for moderate aortic stenosis if they have 1 of these 5 things -
✔✔angina, CHF, A fib, LVEF <50%, thromboembolic disease
✔✔How often to repeat echo for aortic stenosis? (answer for both mild and moderate
AS) - ✔✔Mild: 5 years
moderate: 1-2 years
✔✔Max certification for severe aortic regurgitation - ✔✔6 months and must be
asymptomatic, normal LV function, LVEDD <=60mm, LVESD <=50mm
✔✔Max cert period for balloon mitral valvotomy - ✔✔1 year
✔✔Min waiting period for balloon mitral valvotomy - ✔✔4 weeks
✔✔BP above which you must treat and do one time 3 month certificate - ✔✔160/100.
For 140/90 and above up to this level, it says 3 month certificate but does not say must
treat.
, ✔✔BP above which you cannot certify until lowered below 140/90 - ✔✔180/110 - and
then this patient can only be certified for 6 months
✔✔Max cert period for diabetic patients - ✔✔Technically 2 years, but 1 year is
RECOMMENDED. What the hell.
✔✔The rule for DQ if they have history of hypoglycemic reactions - ✔✔1 episode in 12
months resulting in seizure, LOC, etc; or 2 episodes in 5 years that are as above or also
include loss of position sensation, orthostatic hypotension, etc.
✔✔Max cert period for asthma - ✔✔2 years
✔✔Must DQ COPD patients if 1 of 3 things: - ✔✔1. hypoxemia at rest
2. chronic resp failure
3. Continuing cough with cough syncope
✔✔if FEV1 on pulm function testing is < (blank) % of predicted, then must also test ABG
- ✔✔65%
✔✔Max cert period for CPAP - ✔✔1 year (1 month waiting period after starting CPAP or
3 months after surgery)
✔✔Should instruct drivers to refrain from driving for how many hours after cold or cough
medicines? - ✔✔12 hours
✔✔How many of these rules are stupid and arbitrary as hell? - ✔✔I'm gonna say 40%
✔✔Max cert period for pulmonary hypertension - ✔✔1 year
✔✔4 reasons to DQ a pulmonary hypertension patient - ✔✔1. dyspnea at rest
2. dizziness
3. hypotension
4. PaO2 <65mmHg
✔✔Name 3 reasons you should check PFTs/ spirometry prior to certifying - ✔✔1. Hx of
specific lung disease (asthma, CF, COPD)
2. symptoms of SOB, cough, chest tightness, wheezing, etc
3. Smokers over age 35
✔✔If pulse oximetry is less than blank, you have to do ABG - ✔✔92% (you would do the
pulse ox if FEV1 <65% of predicted or FEV1/FVC ratio <65%)
✔✔Apnea-hypopnea index of [blank] or more episodes per hour is diagnostic of OSA -
✔✔30
AND ANSWERS SURE A+
✔✔Do not certify for moderate aortic stenosis if they have 1 of these 5 things -
✔✔angina, CHF, A fib, LVEF <50%, thromboembolic disease
✔✔How often to repeat echo for aortic stenosis? (answer for both mild and moderate
AS) - ✔✔Mild: 5 years
moderate: 1-2 years
✔✔Max certification for severe aortic regurgitation - ✔✔6 months and must be
asymptomatic, normal LV function, LVEDD <=60mm, LVESD <=50mm
✔✔Max cert period for balloon mitral valvotomy - ✔✔1 year
✔✔Min waiting period for balloon mitral valvotomy - ✔✔4 weeks
✔✔BP above which you must treat and do one time 3 month certificate - ✔✔160/100.
For 140/90 and above up to this level, it says 3 month certificate but does not say must
treat.
, ✔✔BP above which you cannot certify until lowered below 140/90 - ✔✔180/110 - and
then this patient can only be certified for 6 months
✔✔Max cert period for diabetic patients - ✔✔Technically 2 years, but 1 year is
RECOMMENDED. What the hell.
✔✔The rule for DQ if they have history of hypoglycemic reactions - ✔✔1 episode in 12
months resulting in seizure, LOC, etc; or 2 episodes in 5 years that are as above or also
include loss of position sensation, orthostatic hypotension, etc.
✔✔Max cert period for asthma - ✔✔2 years
✔✔Must DQ COPD patients if 1 of 3 things: - ✔✔1. hypoxemia at rest
2. chronic resp failure
3. Continuing cough with cough syncope
✔✔if FEV1 on pulm function testing is < (blank) % of predicted, then must also test ABG
- ✔✔65%
✔✔Max cert period for CPAP - ✔✔1 year (1 month waiting period after starting CPAP or
3 months after surgery)
✔✔Should instruct drivers to refrain from driving for how many hours after cold or cough
medicines? - ✔✔12 hours
✔✔How many of these rules are stupid and arbitrary as hell? - ✔✔I'm gonna say 40%
✔✔Max cert period for pulmonary hypertension - ✔✔1 year
✔✔4 reasons to DQ a pulmonary hypertension patient - ✔✔1. dyspnea at rest
2. dizziness
3. hypotension
4. PaO2 <65mmHg
✔✔Name 3 reasons you should check PFTs/ spirometry prior to certifying - ✔✔1. Hx of
specific lung disease (asthma, CF, COPD)
2. symptoms of SOB, cough, chest tightness, wheezing, etc
3. Smokers over age 35
✔✔If pulse oximetry is less than blank, you have to do ABG - ✔✔92% (you would do the
pulse ox if FEV1 <65% of predicted or FEV1/FVC ratio <65%)
✔✔Apnea-hypopnea index of [blank] or more episodes per hour is diagnostic of OSA -
✔✔30
