NRCME DOT Medical Examiner Certification
Exam Review | Complete Test Bank with Practice
Questions, Verified Answers & Brief Rationales |
Latest 2026/2027 Edition
Question 1
The driver presents with a SPE Certificate. The Medical Examiner's next step should be:
A. Notify the FMCSA
B. Proceed with the examination
C. Perform functional testing
D. Refer the driver to orthopedics
Answer: B
Rationale: The Medical Examiner's responsibility is to examine the driver, document
findings, and if a SPE Certificate is required, document on the Medical Examiner's
Certificate that the driver is qualified if "Accompanied by a Skill Performance Evaluation
(SPE) Certificate." The driver applies to FMCSA for the SPE Certificate.
Question 2
A 21-year-old driver presents with a history of ADHD for 10 years, taking stable dosing
of Adderall. He describes no side effects. Which of the following is true?
A. A significant percentage of individuals with adult ADHD show a moderate to marked
degree of improvement on central nervous system stimulant medication
B. ADHD is a disqualifying condition
C. Adderall is a Schedule 1 drug
D. Medical Examiners should test for serum drug levels of Adderall
Answer: A
Rationale: Stimulant medication for ADHD likely reduces increased crash risk. ADHD
is not disqualifying. Adderall is Schedule II. Serum drug levels cannot distinguish
between licit and illicit use.
Question 3
Which of the following is the most important examination finding that requires
additional evaluation?
pg. 1
,A. Acrochordon
B. Hyperopia
C. Palpable calf cords
D. Verruca vulgaris
Answer: C
Rationale: Palpable calf cords are an important possible indication of deep vein
thrombosis (DVT) and must be further evaluated before certification. Skin tags and
warts pose no significant risk. Hyperopia affects near vision only.
Question 4
The driver reports taking Digoxin. What findings would raise the most significant
concerns regarding certification?
A. Arrhythmias
B. Anorexia
C. Nausea and vomiting
D. Diarrhea
Answer: A
Rationale: Digoxin toxicity can trigger fatal arrhythmias. While anorexia, nausea,
vomiting, and diarrhea can occur with digoxin use, arrhythmias pose the greatest risk
for sudden incapacitation.
Question 5
The driver is taking theophylline. Which of the following is not true?
A. Serum levels may be checked
B. The primary indication for theophylline is in the treatment of neurological conditions
C. Cardiac toxicity is a significant risk of theophylline use
D. Theophylline can be administered orally or intravenously (IV)
Answer: B
Rationale: Theophylline is used for respiratory diseases (COPD and asthma), not
neurological conditions. Cardiac arrhythmias are a serious complication. Serum levels
should be monitored with therapy changes.
Question 6
The driver is taking Celexa and melatonin. The Medical Examiner should:
A. Advise the driver to only take these medications more than 12 hours before driving
pg. 2
,B. Advise the driver to stop melatonin as it can cause drowsiness
C. Recommend an alternative to Celexa
D. Advise the driver to discuss benzodiazepines as an alternative treatment with the
driver's prescribing provider
Answer: A
Rationale: Sedating effects of Celexa and melatonin manifest within first hours of use.
Medical Examiners should rarely make specific treatment recommendations.
Benzodiazepines have high risks of dependence and impairment.
Question 7
The driver tells the Medical Examiner he has recently been prescribed contact lenses. He
notes that after 3-4 hours of use the contacts cause irritation and he has to take them
out. The driver passes the vision test only with contacts and does not have eyeglasses.
The Medical Examiner should:
A. Advise the driver to carry a spare pair of contact lenses
B. Certify the driver wearing corrective lenses
C. Refer the driver for evaluation under the Alternative Vision Qualification standard
D. Certify the driver without qualifications
Answer: B
Rationale: Driver meets certification requirements for vision wearing corrective
lenses. The "best" answer would be to disqualify and require glasses, but among
available choices, certifying with corrective lenses is correct.
Question 8
The driver does not indicate any medical conditions on health history. During the exam
the Medical Examiner notes the presence of a hearing aid in one ear. The driver says
that he doesn't need the hearing aid to drive and doesn't think it should be required. The
next step for the Medical Examiner is:
A. Test the driver's hearing without the hearing aid
B. Examine the driver's ears
C. Refer the driver for hearing assessment by a specialist with specialized audiometric
testing capabilities for testing drivers while wearing a hearing aid
D. Certify the driver with the qualification "wearing hearing aid"
Answer: A
pg. 3
, Rationale: Test hearing without hearing aid first. If driver passes, no further testing
needed. If fails, test with hearing aid using whisper test. If fails with hearing aid, refer
for specialist audiometric testing.
Question 9
A driver has an indication for obtaining a cardiac stress test. If the driver is not taking a
beta blocker, what is the percentage of maximum heart rate that the driver should meet
to indicate a satisfactory stress test?
A. 60%
B. 75%
C. 85%
D. 100%
Answer: C
Rationale: The target heart rate for a cardiac stress test is 85% of the maximum heart
rate predicted for the driver's age.
Question 10
The driver is missing the 4th finger of his right hand. The Medical Examiner should:
A. Refer for orthopedic evaluation
B. Indicate the driver will need a SPE Certificate
C. Test the driver's grasp and prehension
D. Disqualify the driver
Answer: C
Rationale: Test grasp and prehension manually or with dynamometer. SPE
Certificates are only for loss of hand, foot, or extremity (loss of all 5 fingers or 5 toes),
not single digits.
Question 11
The driver describes a history of dizzy spells. Which examination finding is not
indicated?
A. Test the driver for nystagmus
B. Romberg testing
C. Orthostatic blood pressure measurements
D. Liver and spleen palpation
Answer: D
pg. 4
Exam Review | Complete Test Bank with Practice
Questions, Verified Answers & Brief Rationales |
Latest 2026/2027 Edition
Question 1
The driver presents with a SPE Certificate. The Medical Examiner's next step should be:
A. Notify the FMCSA
B. Proceed with the examination
C. Perform functional testing
D. Refer the driver to orthopedics
Answer: B
Rationale: The Medical Examiner's responsibility is to examine the driver, document
findings, and if a SPE Certificate is required, document on the Medical Examiner's
Certificate that the driver is qualified if "Accompanied by a Skill Performance Evaluation
(SPE) Certificate." The driver applies to FMCSA for the SPE Certificate.
Question 2
A 21-year-old driver presents with a history of ADHD for 10 years, taking stable dosing
of Adderall. He describes no side effects. Which of the following is true?
A. A significant percentage of individuals with adult ADHD show a moderate to marked
degree of improvement on central nervous system stimulant medication
B. ADHD is a disqualifying condition
C. Adderall is a Schedule 1 drug
D. Medical Examiners should test for serum drug levels of Adderall
Answer: A
Rationale: Stimulant medication for ADHD likely reduces increased crash risk. ADHD
is not disqualifying. Adderall is Schedule II. Serum drug levels cannot distinguish
between licit and illicit use.
Question 3
Which of the following is the most important examination finding that requires
additional evaluation?
pg. 1
,A. Acrochordon
B. Hyperopia
C. Palpable calf cords
D. Verruca vulgaris
Answer: C
Rationale: Palpable calf cords are an important possible indication of deep vein
thrombosis (DVT) and must be further evaluated before certification. Skin tags and
warts pose no significant risk. Hyperopia affects near vision only.
Question 4
The driver reports taking Digoxin. What findings would raise the most significant
concerns regarding certification?
A. Arrhythmias
B. Anorexia
C. Nausea and vomiting
D. Diarrhea
Answer: A
Rationale: Digoxin toxicity can trigger fatal arrhythmias. While anorexia, nausea,
vomiting, and diarrhea can occur with digoxin use, arrhythmias pose the greatest risk
for sudden incapacitation.
Question 5
The driver is taking theophylline. Which of the following is not true?
A. Serum levels may be checked
B. The primary indication for theophylline is in the treatment of neurological conditions
C. Cardiac toxicity is a significant risk of theophylline use
D. Theophylline can be administered orally or intravenously (IV)
Answer: B
Rationale: Theophylline is used for respiratory diseases (COPD and asthma), not
neurological conditions. Cardiac arrhythmias are a serious complication. Serum levels
should be monitored with therapy changes.
Question 6
The driver is taking Celexa and melatonin. The Medical Examiner should:
A. Advise the driver to only take these medications more than 12 hours before driving
pg. 2
,B. Advise the driver to stop melatonin as it can cause drowsiness
C. Recommend an alternative to Celexa
D. Advise the driver to discuss benzodiazepines as an alternative treatment with the
driver's prescribing provider
Answer: A
Rationale: Sedating effects of Celexa and melatonin manifest within first hours of use.
Medical Examiners should rarely make specific treatment recommendations.
Benzodiazepines have high risks of dependence and impairment.
Question 7
The driver tells the Medical Examiner he has recently been prescribed contact lenses. He
notes that after 3-4 hours of use the contacts cause irritation and he has to take them
out. The driver passes the vision test only with contacts and does not have eyeglasses.
The Medical Examiner should:
A. Advise the driver to carry a spare pair of contact lenses
B. Certify the driver wearing corrective lenses
C. Refer the driver for evaluation under the Alternative Vision Qualification standard
D. Certify the driver without qualifications
Answer: B
Rationale: Driver meets certification requirements for vision wearing corrective
lenses. The "best" answer would be to disqualify and require glasses, but among
available choices, certifying with corrective lenses is correct.
Question 8
The driver does not indicate any medical conditions on health history. During the exam
the Medical Examiner notes the presence of a hearing aid in one ear. The driver says
that he doesn't need the hearing aid to drive and doesn't think it should be required. The
next step for the Medical Examiner is:
A. Test the driver's hearing without the hearing aid
B. Examine the driver's ears
C. Refer the driver for hearing assessment by a specialist with specialized audiometric
testing capabilities for testing drivers while wearing a hearing aid
D. Certify the driver with the qualification "wearing hearing aid"
Answer: A
pg. 3
, Rationale: Test hearing without hearing aid first. If driver passes, no further testing
needed. If fails, test with hearing aid using whisper test. If fails with hearing aid, refer
for specialist audiometric testing.
Question 9
A driver has an indication for obtaining a cardiac stress test. If the driver is not taking a
beta blocker, what is the percentage of maximum heart rate that the driver should meet
to indicate a satisfactory stress test?
A. 60%
B. 75%
C. 85%
D. 100%
Answer: C
Rationale: The target heart rate for a cardiac stress test is 85% of the maximum heart
rate predicted for the driver's age.
Question 10
The driver is missing the 4th finger of his right hand. The Medical Examiner should:
A. Refer for orthopedic evaluation
B. Indicate the driver will need a SPE Certificate
C. Test the driver's grasp and prehension
D. Disqualify the driver
Answer: C
Rationale: Test grasp and prehension manually or with dynamometer. SPE
Certificates are only for loss of hand, foot, or extremity (loss of all 5 fingers or 5 toes),
not single digits.
Question 11
The driver describes a history of dizzy spells. Which examination finding is not
indicated?
A. Test the driver for nystagmus
B. Romberg testing
C. Orthostatic blood pressure measurements
D. Liver and spleen palpation
Answer: D
pg. 4
