DOT NRCME TRAINING INSTITUTE MATERIAL 2024-
2025EXAM QUESTIONS WITH CORRECT ANSWERS GRADED
A+
Patient example:
Karen, recertification exam
42 y/o female
No health history, no medications.
Vision acuity: right 20/20, left 20/30. Both 20/20. Horizontal field of vision Rt 80 degrees,
Lt 80 degrees. Not corrected vision.
No monocular vision.
No hearing aids, Whisper test 5' bilaterally. N/A audiometric testing
UA: spec grav 1.020, protein 1+, blood 4+, glucose neg.
Hgb 12.4
BP 134/88, P 80, regular.
PE: on 4th day of menses with heavy bleeding. Advised to consult PCP or GYN for eval
of excessive bleeding that could lead to anemia, leading to fatigue that would affect her
driving. - CORRECT ANSWER✔✔Two year certification - no disqualifying health
history or PE abnormalities.
Ask about medication use, including OTC medications.
ME obtained hemoglobin testing based on PE findings. (not required)
The ME should correctly note the body system in which there was an abnormal finding.
The note reflects inquiry as to the affect on driving ability and is also supported by Hgb
test results. ME also documented medical follow up advice.
Who can perform the vision portion of the interstate CMV driver physical examination? -
CORRECT ANSWER✔✔The certified ME, optometrist, or an opthalmologist. If the
specialist provider performs the exam, they should complete and sign the provider's
information on the report form and provide the results.
To pass the interstate CMV driver vision exam, a visual acuity of ___/___corrected or
uncorrected is required. - CORRECT ANSWER✔✔20/40 on Snellen chart in each eye
individually AND in both eyes combined.
What eye conditions must the ME ask the driver about and if indicated, request
specialist evaluation? - CORRECT ANSWER✔✔Retinopathy, cataracts, aphakia,
glaucoma, and macular degeneration.
Pt example:
Mr. Brown, 48 y/o male. No current meds, injury 5 years ago. Hunting accident 2 years
ago with facial trauma and left orbital fracture. Presented a "may drive" note from eye
surgeon (dated 3 months prior to examination). Uncorrected vision, right eye 20/20. left
eye 20/40. Both 20/20. Horizontal field of vision Right 80 degrees, left eye is
,inconclusive. No monocular vision. No hearing aids. Whisper test 5' bilaterally. N/A
audiometric test. UA normal. BP 122/74, p 80, regular. - CORRECT ANSWER✔✔
Exam findings: Left eye muscles do not move eye to the left, discussed disqualification
pending eye exam by specialist. Explained the specialist will get precise visual field
measurements. Provided driver with appropriate medical release and copy of medical
exam report with vision section highlighted.
Driver does not meet requirements. He is pending specialist vision exam. Diminished
vision in left eye noted. Pt could be functionally monocular.
What is the purpose of the interstate CMV driver physical examination? - CORRECT
ANSWER✔✔To detect the presence of physical, mental, or organic conditions of such
character and extent as to affect the driver ability to operate a CMV safely. This exam is
for public safety determination and is considered by FMCSA to be a "medical fitness for
duty" examination.
Examples of "yes" answers for hearing and ears on the health history that may require
further examination before a certification decision can be made - CORRECT ANSWER
✔✔Ear disorders
Loss of hearing
Loss of balance
Pt example:
Pt has hearing of 4' in left and right ears. Do they meet the hearing standards? -
CORRECT ANSWER✔✔No, hearing minimum for whisper test is equal or greater than
5' in the better ear. This driver needs an audiometric hearing test.
Pt example:
Does this driver meet hearing standards for interstate CMV driver certification?
Audiometric test results - [Hearing loss in decibles 500 Hz, 1,000 Hz, 2,000 Hz]
Right ear: 30, 45, 40
Left ear: 45, 45, 35 - CORRECT ANSWER✔✔Yes, the average hearing loss in the
right ear is less than 40 dB.
Rt ear average is 38.33 = pass
Lt ear average is 41.67 = fail
*only one ear has to meet requirement of less than 40 dB of hearing loss
Pt example:
Mr. Chin, 54 y/o male
Admits loss of hearing. No medications.
History of frequent ear infections in childhood, multiple TM ruptures and infections in
elementary and middle school. He has "always been hard of hearing" in his left ear.
Uncorrected vision acuity, right eye 20/30. left eye 20/30. Both 20/30. Horizontal field of
vision 90 degrees bilaterally. No monocular vision.
No hearing aids used for test.
Whisper test - right ear 5', left ear 3'.
UA normal
, BP 134/80, P 86, regular - CORRECT ANSWER✔✔PE comments:
Right ear passed forced whisper test, left ear failed. The left TM is misshapen and
scarred. PND noted.
Certify Mr. Chin for two years. To meet certification requirements, he only has to pass
hearing test in one ear. Mr. Chin passed with his right ear. There were no other medical
findings that would warrant a more frequent follow-up.
If forced whisper test would have been 4', 3', he would have be referred for audiometric
testing. He only has to pass one test with one ear to meet the hearing standard.
What problems with the test environment exist with the forced whisper tests that do not
exist with audiometric tests? - CORRECT ANSWER✔✔Many variables that can impact
the validity of the test, such as estimating the distance instead of measuring, performing
the test in a room with poor acoustics or subject to outside noise or other distractions.
The ME should attempt to control as many of the variables as possible, so the test is
given as consistently as possible.
Should the ME advise Mr. Chin to see a specialist because of future hearing problems?
- CORRECT ANSWER✔✔No, his hearing loss in the left ear is stable for years. Mr.
Chin should be educated on ways to preserve the hearing in his better ear, he is at risk
for noise induced hearing loss..
Can an interstate CMV driver who has had an acute MI be qualified to drive? -
CORRECT ANSWER✔✔Yes, if the AMI was at least two months prior to the date of
the driver physical examination, the driver meets all recommended cardiac qualification
criteria.
A patient provides the ME with a copy of records from cardiologist, indicating a
diagnosis of CHF and EF of 38%. Can he be certified? - CORRECT ANSWER✔✔No,
EF% must be greater than 40% to be certified.
What criteria must be met in order for the FMCSA ME to qualify a driver with a known
diagnosis of CHF? - CORRECT ANSWER✔✔Pt must be asymptomatic, have no
ventricular arrhythmia, have a left ventricular EF greater than 40%, be under the care of
a cardiologist or appropriate medical professional.
Should the following patients be certified or medically disdqualified?
1. PCI 9 months ago, no cardio follow up, no ETT
2. CABG 4 months ago, echo and 3 months showed LVEF 55%, cleared by cardiologist,
no chest pain.
3. CHF with dyspnea at rest.
4. Driver with increasing angina lasting 20 minutes after tarping a load, unresponsive to
Nitroglycerin. - CORRECT ANSWER✔✔1. Disqualified, after PCI should have cardio
follow up and ETT 3-6 months post PCI.
2. Medically qualified, CABG may be qualified at 3 months post-op if asymptomatic,
LVEF >40%, and meets all other recommendations (qualify with annual certification).
3. Medically disqualified, a driver with symptomatic CHF is not medically fit for duty.
2025EXAM QUESTIONS WITH CORRECT ANSWERS GRADED
A+
Patient example:
Karen, recertification exam
42 y/o female
No health history, no medications.
Vision acuity: right 20/20, left 20/30. Both 20/20. Horizontal field of vision Rt 80 degrees,
Lt 80 degrees. Not corrected vision.
No monocular vision.
No hearing aids, Whisper test 5' bilaterally. N/A audiometric testing
UA: spec grav 1.020, protein 1+, blood 4+, glucose neg.
Hgb 12.4
BP 134/88, P 80, regular.
PE: on 4th day of menses with heavy bleeding. Advised to consult PCP or GYN for eval
of excessive bleeding that could lead to anemia, leading to fatigue that would affect her
driving. - CORRECT ANSWER✔✔Two year certification - no disqualifying health
history or PE abnormalities.
Ask about medication use, including OTC medications.
ME obtained hemoglobin testing based on PE findings. (not required)
The ME should correctly note the body system in which there was an abnormal finding.
The note reflects inquiry as to the affect on driving ability and is also supported by Hgb
test results. ME also documented medical follow up advice.
Who can perform the vision portion of the interstate CMV driver physical examination? -
CORRECT ANSWER✔✔The certified ME, optometrist, or an opthalmologist. If the
specialist provider performs the exam, they should complete and sign the provider's
information on the report form and provide the results.
To pass the interstate CMV driver vision exam, a visual acuity of ___/___corrected or
uncorrected is required. - CORRECT ANSWER✔✔20/40 on Snellen chart in each eye
individually AND in both eyes combined.
What eye conditions must the ME ask the driver about and if indicated, request
specialist evaluation? - CORRECT ANSWER✔✔Retinopathy, cataracts, aphakia,
glaucoma, and macular degeneration.
Pt example:
Mr. Brown, 48 y/o male. No current meds, injury 5 years ago. Hunting accident 2 years
ago with facial trauma and left orbital fracture. Presented a "may drive" note from eye
surgeon (dated 3 months prior to examination). Uncorrected vision, right eye 20/20. left
eye 20/40. Both 20/20. Horizontal field of vision Right 80 degrees, left eye is
,inconclusive. No monocular vision. No hearing aids. Whisper test 5' bilaterally. N/A
audiometric test. UA normal. BP 122/74, p 80, regular. - CORRECT ANSWER✔✔
Exam findings: Left eye muscles do not move eye to the left, discussed disqualification
pending eye exam by specialist. Explained the specialist will get precise visual field
measurements. Provided driver with appropriate medical release and copy of medical
exam report with vision section highlighted.
Driver does not meet requirements. He is pending specialist vision exam. Diminished
vision in left eye noted. Pt could be functionally monocular.
What is the purpose of the interstate CMV driver physical examination? - CORRECT
ANSWER✔✔To detect the presence of physical, mental, or organic conditions of such
character and extent as to affect the driver ability to operate a CMV safely. This exam is
for public safety determination and is considered by FMCSA to be a "medical fitness for
duty" examination.
Examples of "yes" answers for hearing and ears on the health history that may require
further examination before a certification decision can be made - CORRECT ANSWER
✔✔Ear disorders
Loss of hearing
Loss of balance
Pt example:
Pt has hearing of 4' in left and right ears. Do they meet the hearing standards? -
CORRECT ANSWER✔✔No, hearing minimum for whisper test is equal or greater than
5' in the better ear. This driver needs an audiometric hearing test.
Pt example:
Does this driver meet hearing standards for interstate CMV driver certification?
Audiometric test results - [Hearing loss in decibles 500 Hz, 1,000 Hz, 2,000 Hz]
Right ear: 30, 45, 40
Left ear: 45, 45, 35 - CORRECT ANSWER✔✔Yes, the average hearing loss in the
right ear is less than 40 dB.
Rt ear average is 38.33 = pass
Lt ear average is 41.67 = fail
*only one ear has to meet requirement of less than 40 dB of hearing loss
Pt example:
Mr. Chin, 54 y/o male
Admits loss of hearing. No medications.
History of frequent ear infections in childhood, multiple TM ruptures and infections in
elementary and middle school. He has "always been hard of hearing" in his left ear.
Uncorrected vision acuity, right eye 20/30. left eye 20/30. Both 20/30. Horizontal field of
vision 90 degrees bilaterally. No monocular vision.
No hearing aids used for test.
Whisper test - right ear 5', left ear 3'.
UA normal
, BP 134/80, P 86, regular - CORRECT ANSWER✔✔PE comments:
Right ear passed forced whisper test, left ear failed. The left TM is misshapen and
scarred. PND noted.
Certify Mr. Chin for two years. To meet certification requirements, he only has to pass
hearing test in one ear. Mr. Chin passed with his right ear. There were no other medical
findings that would warrant a more frequent follow-up.
If forced whisper test would have been 4', 3', he would have be referred for audiometric
testing. He only has to pass one test with one ear to meet the hearing standard.
What problems with the test environment exist with the forced whisper tests that do not
exist with audiometric tests? - CORRECT ANSWER✔✔Many variables that can impact
the validity of the test, such as estimating the distance instead of measuring, performing
the test in a room with poor acoustics or subject to outside noise or other distractions.
The ME should attempt to control as many of the variables as possible, so the test is
given as consistently as possible.
Should the ME advise Mr. Chin to see a specialist because of future hearing problems?
- CORRECT ANSWER✔✔No, his hearing loss in the left ear is stable for years. Mr.
Chin should be educated on ways to preserve the hearing in his better ear, he is at risk
for noise induced hearing loss..
Can an interstate CMV driver who has had an acute MI be qualified to drive? -
CORRECT ANSWER✔✔Yes, if the AMI was at least two months prior to the date of
the driver physical examination, the driver meets all recommended cardiac qualification
criteria.
A patient provides the ME with a copy of records from cardiologist, indicating a
diagnosis of CHF and EF of 38%. Can he be certified? - CORRECT ANSWER✔✔No,
EF% must be greater than 40% to be certified.
What criteria must be met in order for the FMCSA ME to qualify a driver with a known
diagnosis of CHF? - CORRECT ANSWER✔✔Pt must be asymptomatic, have no
ventricular arrhythmia, have a left ventricular EF greater than 40%, be under the care of
a cardiologist or appropriate medical professional.
Should the following patients be certified or medically disdqualified?
1. PCI 9 months ago, no cardio follow up, no ETT
2. CABG 4 months ago, echo and 3 months showed LVEF 55%, cleared by cardiologist,
no chest pain.
3. CHF with dyspnea at rest.
4. Driver with increasing angina lasting 20 minutes after tarping a load, unresponsive to
Nitroglycerin. - CORRECT ANSWER✔✔1. Disqualified, after PCI should have cardio
follow up and ETT 3-6 months post PCI.
2. Medically qualified, CABG may be qualified at 3 months post-op if asymptomatic,
LVEF >40%, and meets all other recommendations (qualify with annual certification).
3. Medically disqualified, a driver with symptomatic CHF is not medically fit for duty.
