NRCME Medical Exam
The driver presents with a SPE Certificate. The Medical Examiner's next step should be: - correct answer -Proceed with the examination.
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. - correct answer -A significant percentage of individuals with adult ADHD show a moderate to marked degree of improvement on central nervous system stimulant medication
Which of the following is the most important examination finding that requires additional evaluation? a. Acrochordon. b. Hyperopia.
c. Palpable calf cords. d. Verruca vulgaris. - correct answer -Palpable calf cords
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. - correct answer -Arrhythmias.
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 - correct answer -The primary indication for theophylline is in the treatment of neurological conditions.
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. 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 - correct answer -Advise the driver to only take these medications more than 12 hours before driving.
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 - correct answer -Certify the driver wearing corrective lenses.
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 - correct answer -Test the driver's hearing without the hearing aid. 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%. - correct answer -85%
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 - correct answer -Test the driver's grasp and prehension.
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 - correct answer -Liver and spleen palpation
Guidance (not regulatory) recommendations are that drivers with dizziness or vertigo should not be qualified until the driver has achieved a 2-month symptom free interval regardless of examination findings.
Vision testing may be performed by: a. The Medical Examiner, an optometrist, or ophthalmologist. b. Only an ophthalmologist. c. Only the Medical Examiner. d. Only an optometrist - correct answer -The Medical Examiner, an optometrist, or ophthalmologist
The driver has 1,000 ng/ml of glucose on urinalysis. What is the next appropriate step for the Medical Examiner?
a. Disqualify the driver. b. Refer the driver for evaluation by a kidney specialist. c. Refer the driver for evaluation under the Insulin-Treated Diabetes Alternative Qualification Standard. d. Recommend the driver check blood glucose 4x per day. - correct answer -Recommend the driver check blood glucose 4x per day.
The driver presents after having had a PCI procedure 3 days prior. The driver indicates no symptoms and
has a letter from his cardiologist indicating he is cleared to drive. The Medical Examiner should:
a. Have the driver return for evaluation at least 3 weeks after the date of the PCI. b. Refer the driver for a cardiac stress test. c. Certify the driver for 6 months. d. Certify the driver for 2 years - correct answer -Have the driver return for evaluation at least 3 weeks after the date of the PCI
- Current FMCSA guidelines in the reference table in the 2022 Draft version of the Medical Examiner's Handbook include: Asymptomatic; Minimum 3 weeks after elective procedure; LVEF > 40%; Adherence to cardiovascular specialist-recommended appropriate medical therapy for a minimum of 1 year after receiving drug-eluting stent; Clearance by cardiologist.
The driver describes alcohol use including 2 drinks a night during the week and a 6 pack on the weekends. The Medical Examiner's next step should be to:
The driver presents with a SPE Certificate. The Medical Examiner's next step should be: - correct answer -Proceed with the examination.
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. - correct answer -A significant percentage of individuals with adult ADHD show a moderate to marked degree of improvement on central nervous system stimulant medication
Which of the following is the most important examination finding that requires additional evaluation? a. Acrochordon. b. Hyperopia.
c. Palpable calf cords. d. Verruca vulgaris. - correct answer -Palpable calf cords
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. - correct answer -Arrhythmias.
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 - correct answer -The primary indication for theophylline is in the treatment of neurological conditions.
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. 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 - correct answer -Advise the driver to only take these medications more than 12 hours before driving.
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 - correct answer -Certify the driver wearing corrective lenses.
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 - correct answer -Test the driver's hearing without the hearing aid. 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%. - correct answer -85%
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 - correct answer -Test the driver's grasp and prehension.
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 - correct answer -Liver and spleen palpation
Guidance (not regulatory) recommendations are that drivers with dizziness or vertigo should not be qualified until the driver has achieved a 2-month symptom free interval regardless of examination findings.
Vision testing may be performed by: a. The Medical Examiner, an optometrist, or ophthalmologist. b. Only an ophthalmologist. c. Only the Medical Examiner. d. Only an optometrist - correct answer -The Medical Examiner, an optometrist, or ophthalmologist
The driver has 1,000 ng/ml of glucose on urinalysis. What is the next appropriate step for the Medical Examiner?
a. Disqualify the driver. b. Refer the driver for evaluation by a kidney specialist. c. Refer the driver for evaluation under the Insulin-Treated Diabetes Alternative Qualification Standard. d. Recommend the driver check blood glucose 4x per day. - correct answer -Recommend the driver check blood glucose 4x per day.
The driver presents after having had a PCI procedure 3 days prior. The driver indicates no symptoms and
has a letter from his cardiologist indicating he is cleared to drive. The Medical Examiner should:
a. Have the driver return for evaluation at least 3 weeks after the date of the PCI. b. Refer the driver for a cardiac stress test. c. Certify the driver for 6 months. d. Certify the driver for 2 years - correct answer -Have the driver return for evaluation at least 3 weeks after the date of the PCI
- Current FMCSA guidelines in the reference table in the 2022 Draft version of the Medical Examiner's Handbook include: Asymptomatic; Minimum 3 weeks after elective procedure; LVEF > 40%; Adherence to cardiovascular specialist-recommended appropriate medical therapy for a minimum of 1 year after receiving drug-eluting stent; Clearance by cardiologist.
The driver describes alcohol use including 2 drinks a night during the week and a 6 pack on the weekends. The Medical Examiner's next step should be to:
