NRCME Question bank review 2022/2023 with correct Answers

Driver 6 weeks post-MI, has cardio cleared to return to work without restrictions. ETT 12 METs, echo EF 65%. Examiner should: - ANSWER-temporarily disqualify driver until driver meets waiting period of 2 months driver is distant, lacks eye contact and shows absolutely no emotional response during the exam. The examiner's best response should be: - ANSWER-disqualify and refer to SAP prior to consideration (flat affect seen in severe depression and schizophrenia) A driver has a blood pressure of 136/92 mm Hg. This is what stage of HTN? - ANSWER-Stage I. BP 140-159/*90-99* A driver is taking Celexa for the treatment of what he calls a "mild depression." He reports he has not considered or attempted suicide. The examiner should? - ANSWER-Temporarily disqualify the driver until he obtains written clearance for the depression and the medication from the treating provider. Medical clearance is required for all mental health disorders A driver reports that he had a hunting accident wherein he suffered a left orbital fracture. He presents a note at the time of the examination from an ophthalmologist stating "may drive". His exam is unremarkable except for a limitation in peripheral vision in his left eye, which was inconclusive. His distance vision was 20/20 right and 20/40 left. The medical examiner should? - ANSWER-Disqualify the driver pending vision exam to determine if meets peripheral vision requirements A driver is taking Topamax for the treatment of migraine headaches. He reports good management of his headaches and they never seem to interfere with his driving ability with the medication. The medical examiner should - ANSWER-Obtain medical clearance for the condition and the medication Topamax is a medication that is used for seizure control. The examiner should confirm with the prescribing provider that the driver does not take it to control seizures. Positive Babinski"reflex indicates what? What is examiner's next step? - ANSWER-indicative of abnormalities in the motor control pathways leading from the cerebral cortex; obtain clearance from a neurologist prior to reconsidering the driver for certification Epilepsy 14 years ago but stopped taking antiepileptic medication on his own 11 years ago. Has not seen a neurologist nor a health care provider in over 10 years and reports no seizures during this period. The examiner should: - ANSWER-Disqualify driver. Even though the driver reports exceeding the 10-year waiting period, it was not under medical supervision and the driver discontinued medication use and treatment outside of medical oversight. Waiting period following MI - ANSWER-2 months Waiting period following CABG - ANSWER-3 months The driver uses hearing aids during the whisper test. He is able to hear at 5 feet on the right and 4 feet on the left. Certification or no? - ANSWER-Certify x 2 yrs. The driver is able to use hearing aids during the whisper test (and this should be marked on the form). A driver must only qualify in 1 ear to certify. Moderate TBI that occurred 3 years ago. neurologist confirmed no seizures and cleared driver. Examiner should - ANSWER-certify x 1 yr waiting period is 2 years, max cert for mod TBI without seizure is 1 yr. Waiting period and max cert in driver with depression with suicide attempt 10 months ago. Reports feeling fine now and compliant with meds. Examiner should - ANSWER-Disqualify. Waiting period is 1 yr, max cert 1 yr history a back injury that had occurred 4 years earlier. He states that he was out of work following back surgery for over a year, but since has returned to driving and his last certification was good for 2 years. He lists as his only medication Oxycodone, which he takes only as needed. He reports seeing his "pain doctor" every few months for evaluation. He also reports he has had a steroid injection (series of 3) about a year ago, which "helped a lot." The examiner should: - ANSWER-Request medical clearance. waiting period for ECT - ANSWER-6 months; maintenance ECT is disqualifying SPE for below knee amputation, max cert for? - ANSWER-2 yrs MI 6 months ago. How often for recertification? How often for ETT for monitoring? - ANSWER-Annual recert; ETT every 2 years Which stage of hypertension calls for a medical certificate that expires in one year? - ANSWER-Stage 2 A driver has a limitation of 35 degrees of cervical rotation to the right and left but can view both side mirrors. What is the next best step? - ANSWER-The FMCSA has not adopted a standard cervical range of motion guideline for drivers. However, drivers must be able to view both mirrors. If the driver can rotate the spine as needed to see both mirrors s/he can be certified for *up to 2 years*. Dx: A-fib. +anticoagulant. Waiting time? Max cert? Monitoring? - ANSWER-1 month; 1 year cert; monthly INR When a driver who wears a hearing aid is unable to pass a forced whisper test, referral to which of the following is required? a. An audiologist. b. An otolaryngologist. c. A hearing aid center. - ANSWER-All of the above waiting period post-PCI - ANSWER-1 week A driver has a fixed deficit that is less than the whole hand. Which of the following is true regarding certification of this driver? a. The driver requires a Skill Performance Evaluation (SPE) certificate. b. As a medical examiner, you determine if the severity of a fixed deficit that is less than the whole hand is medically disqualifying unless the driver has an SPE certificate. c. The patient requires referral to an orthopedic surgeon who understands the nature of commercial motor vehicle driving. d. NONE of the above are correct. - ANSWER-As a medical examiner, you determine if the severity of a fixed deficit that is less than the whole hand is medically disqualifying unless the driver has an SPE certificate. UA indicates glycosuria, next step? - ANSWER-obtain fingerstick blood glucose You are required to perform a urinalysis (dip stick) as a part of every driver certification and recertification medical examination. An abnormal result for which of the following mandates temporary disqualification? a. Protein. b. Blood. c. Glucose. d. None of the above. - ANSWER-none What is the minimum waiting period following surgical repair of an aneurysm? Max cert? - ANSWER-3 months, 1 yr In what case should you mark an exam as "incomplete examination"? - ANSWER-When driver leaves before completion of exam. What HgbA1C level is indicative of a diagnosis of diabetes? - ANSWER-6.5% Driver has been taking medication for hypertension for 3 years. Inconsistent about taking the medication. Today BP is 146/96 mm Hg. What should be done? - ANSWER-give one time 3 months cert to lower BP 140/90 Driver has no previous diagnosis of hypertension. Today BP is 146/88 mm Hg. What certificate time should be given? - ANSWER-1 year A driver denies using illegal drugs, but he looks haggard and has fresh needle sticks on his forearm. Can you order lab testing for drugs? - ANSWER-Yes. This is outside of standard DOT drug testing, but a non-DOT drug test can be ordered. Refusal to test is a failure What is the maximum allowable BMI to qualify driver? - ANSWER-There is no standard Marijuana is considered which schedule drug - ANSWER-schedule 1 Which of these is INTRAstate (as opposed to interstate) commerce? a. UPS driver delivers packages from far and wide within a single city. b. A semi driver drives a long-haul route from Florida to Texas. c. A commercial driver makes a run from New Orleans, LA to Monroe, LA, but passes through Mississippi on the route. - ANSWER-All of these are inTERstate not intrastate An obese driver's urinalysis shows 500mg/dL of glucose. He claims he is not diabetic, but it is simply because of the 20-ounce bottle of soda he drank in the hour before the test. What should be done? - ANSWER-Fingerstick blood glucose. BP 164/90 mmHg during DOT exam in January. Given a 3-month certificate. Returns in March, having lost 10 pounds and starting an anti-hypertensive medication. His blood pressure is now found to be 136/84 mm Hg. How should you proceed? - ANSWER-Certify for 9 months from today's date. When calculating expiration date, use initial examination in January. 3 months certificate counts towards the one max year certification after successfully lowering BP 140/90 cortical or subcortical stroke waiting period - ANSWER-5 years, due to risk of seizure (1 year waiting for brainstem or cerebellar strokes) It is generally accepted that a HgbA1C above what level indicates poor control of diabetes? - ANSWER-10% On examination, the medical examiner palpates an enlarged liver on a driver and find signs suggestive of early hepatic failure. The medical examiner should: a. Order an abdominal ultrasound as a first step. b. Order an abdominal CT scan as a first step. c. Order a set of Liver Function Tests as a first step. d. Refer the driver to his Primary Care Provider. - ANSWER-d. refer to PCP The medical examiner's responsibility is to determine a driver's fitness to operate a commercial vehicle. It is not to diagnose or prescribe medication. A 20-year-old person approaches you and asks you to perform a medical examination for him as he is planning to apply for an interstate CMV driver job advertised by a local transportation company. According to the FMCSA standards, a person under 21 is not eligible to work as an interstate CMV driver; however, you can still perform the examination because: a. The person is only applying for the job and not yet employed. b. There's no indication that he intends to work as an interstate CMVdriver. c. It is not your responsibility to ensure that the person meets the age requirements. d. From his physical appearance he seems quite healthy. - ANSWER-Per the FMCSA, it is the *responsibility of the motor carrier* to ensure that their interstate CMV drivers meet the age requirements. As a certified medical examiner, you can perform the driver physical examination for any person who requests it. If a medical examiner has a reasonable suspicion that a driver has violated federal guidelines regarding alcohol consumption, the driver: a. Must be disqualified. b. May be certified following residential substance abuse treatment. c. May be certified following a one-month waiting period. d. Must submit to alcohol testing. - ANSWER-If a medical examiner has a reasonable suspicion that a driver has violated federal guidelines regarding alcohol consumption, the driver must submit to alcohol testing. Per FMCSA's guidelines, persons with a thoracic aortic aneurysm of less than ___ cm may be certified (how often) after thorough evaluation and ruling out of any associated cardiovascular diseases. - ANSWER-3.5; annually A driver with a heart transplant must be reexamined and recertified by a cardiovascular specialist how often? - ANSWER-every 6 months max cert in hx of migraine - ANSWER-2 years waiting period for ADHD treated with stimulant - ANSWER-no waiting period Chronic kidney failure for which is undergoes hemodialysis three times each week. His treating physician provided him with a medical report indicating that he can work normally except on the days he is undergoing dialysis. He is also suffering from hypertension. Examiner should - ANSWER-Disqualify; drivers with stage 5 chronic kidney disease, requiring dialysis, must be disqualified. In general, persons who undergo dialysis are prone to fatigue and sleepiness, which jeopardize their ability to drive safely. A driver with diabetes mellitus should also be examined for which of the following? a. Migraines. b. Autonomic neuropathy. c. Restless leg syndrome. - ANSWER-all of the above In the event that a medical examiner examines a driver and finds the driver to have high blood pressure, the medical examiner should: a. Refer the driver to a specialist. b. Diagnose the driver. c. Prescribe medication to treat the condition. d. None of the above - ANSWER-refer; duty of medical examiner is NOT to diagnose or prescribe medication The Medical Examiner's Certificate, Form MCSA-5876, expires (when) on the date written on the form. - ANSWER-at midnight he medical examiner is required to report the results of all examinations conducted on the CMV Driver Medical Examination Results Form, MCSA-(?), through the individual National Registry account by midnight (local time) of the next calendar day following the examination. - ANSWER-5850 Which of the following medical conditions, is regulation and non-discretionary for the medical examiner per FMCSA standards for driver qualification determination: a. Hearing Loss 40 dB on average for 500, 1000 and 2000 Hz in both ears. b. Grade 3 Hypertension untreated. c. Asthma requiring daily medication and an inhaler. d. Obstructive Sleep Apnea prescribed a dental appliance. - ANSWER-Hearing Loss 40 dB on average for 500, 1000 and 2000 Hz in both ears. The __ and __ criteria are regulatory, not guidance. - ANSWER-vision and hearing driver is taking Metformin for the treatment of diabetes, disulfiram (Antabuse) for chronic alcohol use, and rosuvastatin (Crestor) to reduce serum cholesterol levels. He reports no side effects from any of the medications. The rest of the examination is unremarkable. The examiner should: - ANSWER-Disqualify the driver and refer to a DOT substance abuse professional A motor carrier calls to request a copy of one of its driver's Medical Examination Report F. What is the next step? - ANSWER-Contact the driver and obtain a signed release of medical information prior to sending the form to the employer The driver was disqualified on the examination date 4/16/2017 due to diagnosis of benign positional vertigo 3/15/2011. He returns to medical examiner for certification exam on 5/20/2017 and has been asymptomatic since 3/11/2017. He is qualified for two years. What date should be noted as ME certificate expiration? - ANSWER-5/20/2019 waiting period and max cert for PE - ANSWER-3 months; 1 year waiting period for a driver sustained a closed head injury in a MVA with LOC ~15 seconds. CT scan of his head was normal; course was not complicated by the development of seizures. - ANSWER-no waiting period since this is considered a mild TBI without sz (mild = no dural penetration, LOC 30 mins) A driver presents for a certification exam and notes that he chews tobacco. On examination you find several oral lesions. You should: - ANSWER-Certify the driver, recommending a referral to a dentist and noting this on the chart. Oral lesions does not compromise safe driving. On dipstick urinalysis performed as part of the DOT exam, a driver is found to have 1+ proteinuria. A reasonable next test would be: - ANSWER-serum Cr (first sign of nephropathy commonly is the development of proteinuria) Which of the following lab values warrants disqualification? a. Serum Sodium = 128 mEq/L. b. Hemoglobin A1C = 11. c. Serum creatinine = 9 mg/dL. d. Serum potassium = 3.1 mEq/L - ANSWER-serum creatinine of 9 mg/dL indicated renal failure to a degree that dialysis is likely warranted. Dialysis is disqualifying. A driver reports recently completing a drug rehabilitation program. Which of the following is needed before you can certify this driver? a. Clearance by a substance abuse professional. b. A six month waiting period. c. Evaluation and clearance by a board-certified psychiatrist. d. All of the above. - ANSWER-clearance by SAP Which of the following is NOT documented on the medical evaluation report form? a. Driver height. b. Driver weight. c. Driver respiratory rate. d. All of the above are documented. - ANSWER-RR not documented (Driver weight, height, blood pressure, and heart rate are all documented on the MER) Grip strength of 8lb. Certify? - ANSWER-The FMCSA notes that grip strength must be adequate for the driver to safely perform all tasks required of a CMV driver. However, the FMCSA does not mandate any minimum threshold of grip strength. Average grip strength of a man is *105-113 lbs*. Therefore, a grip strength of only 8 lbs. would have to be considered so minimal as to not allow safe driving of a CMV. Select the correct statement regarding the Medical Evaluation Report Form (MER) and the Medical Examiner's Certificate (MEC): a. On the MER, you are required to enter the enter the uncorrected vision of a driver who wears contacts, in addition to the corrected vision. b. You must enter your license number in addition to your NRCME ID number on the MEC. c. You must denote on the MER if the driver used a hearing aid for the hearing test and, if so, for which ear(s). d. All of the above are correct. - ANSWER-c. Denote on MER if driver uses hearing aid. The MER has a field for the provider's license number, but not the MEC. You do not record uncorrected vision for a driver using corrective lenses. How many "yes" responses to CAGE questionnaire suggest that the possibility of alcoholism should be investigated further? - ANSWER-two Which standard or guideline allows Medical Examiner discretion? a. Blood pressure. b. Epilepsy. c. Hearing. - ANSWER-blood pressure The medical examiner must follow the seizure/epilepsy, hearing non-discretionary standards. There are Federal exemptions available for each of the non-discretionary standards. . A driver has one ear canal completely plugged with wax but both ears pass the hearing standard. The medical exam is otherwise normal. What is the next step? - ANSWER-Determination Pending until wax is removed since ME has to view tympanic membrane and auditory canal prior to issuing MEC. The driver admits during the examination that he drinks frequently, usually only on the weekends, maybe a total 12 to 14 beers each week to help him unwind. The examiner provides a "CAGE" questionnaire and the driver scores a 1 on the questionnaire. The rest of the examination is unremarkable. The examiner should: - ANSWER-certify for 2 years Despite admitting to drinking up to 14 beers a week, with less than a score of 2 on the CAGE questionnaire, and showing no other clinical evidence to indicate a current active diagnosis of alcoholism, the driver would be certified for up to 2 years. When asked to differentiate traffic signal green, red, and amber using colored cards, the driver can differentiate which color is which, but reports that the red card actually appears "greenish grey" and green card appears "grayish". What is the next step? - ANSWER-Certify for 2 years. To pass the color vision standard, drivers are only required to differentiate traffic signal green, red and amber. It does not matter what color they actually report seeing. BP 148/88 no previous hx of HTN; rest of the examination is unremarkable. - ANSWER-The driver suffers from Stage 1 hypertension. There is no previous history of hypertension, the driver may be certified for 1 year. painless gradual loss of night vision, peripheral vision, and decreased color discrimination. Distance visual acuity has not changed. - ANSWER-glaucoma slow progressive diminished distance visual acuity and glare particularly at night from oncoming headlights and decreased contrast - ANSWER-cataracts Functional evaluation of hand function in a CMV driver is based upon: a. Grip and hand strength. b. Prehension and power grasping. c. Power grasping and finger strength. d. Hand grip and power grasping. - ANSWER-prehension and power grasping Who gets the original copy of the exam report form that is used during medical exam? a. The Driver. b. The Motor Carrier. c. The Medical Examiner. d. It doesn't matter. - ANSWER-the ME A driver currently does not meet the visual acuity requirement but states that he is going to have lasik surgery in the next month. What is the next best step? - ANSWER-complete the exam and disqualify driver because the vision standard is a non-discretionary standard. The driver can return after the procedure for another certification exam. A driver returns to work after a two week absence due to a respiratory illness. He presents a note from his physician that he was unable to work as a truck driver because of the illness and is now cleared for returning to work. His medical certificate expires in 3 months. The driver: a. Should be allowed to return to work based on his physician's note. B. Should undergo a new commercial driver examination. C. May only be qualified for one year. D. Can return to work at the discretion of the motor carrier - ANSWER-undergo new exam AAA without cardiologist clearance if less than -- cm - ANSWER-4 Which of the following is true regarding the Medical Examination Certificate? A. The medical examiner completes the certificate and provides a copy to the driver and a copy to the employer. B. A release form is required to provide the certificate to the employer. C. Only the driver needs a copy of the certificate if the employer has a copy of the medical examination report form. D. The employer must keep both the medical examination report form and the certificate on file. - ANSWER-medical examiner completes the certificate and provides a copy to the driver and a copy to the employer max cert for OSA - ANSWER-1 yr waiting period for prosthetic valve - ANSWER-3 months Regulation 49CFR391.64 allows driving within an exempt intracity zone, which refers to which type of geographical area: - ANSWER-municipality