NRCME Test Bank with Explanations 100% ACCURATE GRADE A+ GUARANTEED

1. An unrestricted Commercial Motor Vehicle Driver Medical Certificate must be renewed: A. Annually B. Every Two Years C. Every Four Years D. Whenever the State Issued Driver's License is renewed B. Every two years 2 years is the max for a healthy person 2. A driver presents with history of an isolated TIA 6 months ago. He has a return to work letter from his primary care provider (PCP) and neurologist. He is taking and tolerating well hydrochlorothiazide and simvastatin. All other aspects of the exam and history were normal. What should the medical examiner do next? A. Certify driver for 1 year B. Disqualify driver for now C. Certify driver for 3 months D. Certify driver for 2 years B. Disqualify the driver for now The waiting period is 1 year for Transient ischemic attack, stroke, or intracerebral or subarachnoid hemorrhages with no risk for seizures. 3. FMCSA regulates interstate commercial operation including the: A. Driver B. Vehicle C. Motor Carrier D. All of above D. All of the above Self-explanatory 4. During the CMV exam, a driver perceived a whispered voice at 5 feet in his left year and 4 feet in his right year. Exam was otherwise normal. What do you do as the medical examiner? A. Required audiometric test to determine the extent of hearing loss in left ear B. Certify driver for 2 years C. Certify driver for 1 year D. Disqualify driver B. Certify the driver for 2 years. Passing the forced whisper test at 5 ft in at least 1 ear is good enough. 5. Which of the following is an assessment of L4 nerve root pathology? A. Plantar flexion B. Patellar reflex C. Hip extension D. Babinski reflex B. Patellar Reflex ("Knee-Jerk Reflex") Patellar Reflex = L3-L4 (Primarily the L4) Plantar Flexion = S1-S2 (Tibial nerve) Hip Extension = L4-L5 (via the gluteal nerve) Babinski Reflex (Plantar Flexion) = upper motor neuron lesion 6. A driver presents for medical exam and reports being a smoker and having frequent shortness of breath. What do you do next? A. Order an ECG B. Refer to a pulmonologist C. Order a spirometer test D. Provide 1 year certification C. Order a spirometry test Obvious difficulty breathing in a resting position is an indicator for additional pulmonary function tests. If the forced expiratory volume in the first second of expiration (FEV1) is less than 65% of that predicted, arterial blood gas measurements should be evaluated. NOTE: Smokers have a high incidence of COPD, yet individuals may have a significant reduction in lung function without symptoms. Spirometry should be performed in all smokers over the age of 35 years. You should obtain forced expiratory volume in the first second of expiration (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio when any of the following indicators are present: • History of any specific lung disease. • Symptoms of shortness of breath, cough, chest tightness, or wheezing. • Cigarette smoking in drivers 35 years of age or older. No further testing is necessary if the lung function is normal and no other abnormality is suspected. Abnormal lung function should be further evaluated. 7. According to regulation, which of the following must be evaluated as part of the eye exam? A. Pupil reaction B. Iris symmetry C. Conjunctiva injection D. Tonometry pressure A. Pupil reaction Pupil reaction is neurological. Iris symmetry is cosmetic Conjunctiva injection is usually for infections Tonometry pressure is for intraocular pressure, usually measured by optometrists/ophthalmologists. 8. Continued certification of NRCE Medical Examiners requires all EXCEPT which of the following? A. Periodic training at least every five years B. Completion of recertification test every five years C. Completion of certification test every 10 years D. Electronic transmission to FMCSA CMV Medical Examination Results at least monthly B. Completion of recertification test every 5 years - Online training every 5 years. - You need to re-certify every 10 years. - You need to submit your CMV medical exam results each month to the FMCSA. In December 2016, FMCSA issued a statement that it will be the sole provider of the required 5-year refresher training, and it will provide the training online at no cost to Certified Medical Examiners. Certified Medical Examiners who are eligible for the 5-year periodic online training will be notified by FMCSA when the training is available and the examiner is able to access the training site. Training providers associated with the initial 10-year certification process are not involved with the refresher training and will not contact Certified Medical Examiners regarding the required 5-year refresher training. Certified medical examiners agree to keep their National Registry accounts up to date (licenses, training, records etc.) and to transmit at least monthly results of all CMV driver exams performed to FMCSA via the National Registry System. 9. A driver presents for recertification. The only condition he lists is GERD, for which he takes OTC omeprazole. He says that when he is driving and eating fast foods, he is more likely to have heartburn than when off‐duty. You should: A. Request recent UGI results B. Correlate history with abdominal exam C. Certify for one year with restricted diet D. Discuss alternative employment B. Correlate history with abdominal exam. GERD and PPIs are not reasons to disqualify or certify someone for less than the max 2 years. Make sure there's not an AAA or some other etiology. 10. Which of the following findings is disqualifying? A. Oxygen saturation 90% B. LVEF 40% C. FEV 68% predicted D. All of the above A. Oxygen saturation 90% - If oximetry is less than 92%, the driver must have an ABG analysis. - Left ventricular ejection fraction. A driver must have an LVEF greater than or equal to 40%. - Forced expiratory volume in the first second of expiration (FEV1). A driver must have FEV1 of 65% or higher. 11. The driver presents for recertification and submits an ultrasound report indicating an abdominal aortic aneurysm from two months ago, shortly before he had surgical correction. He has surgical clearance and says he is doing well, has no symptoms. You should: A. Certify for 1 year B. Certify for 2 years C. Inform the driver of the 3 month waiting period before he can be certified D. Inform the driver of the 6 month waiting period before he can be certified C. Inform the driver of the 3-month waiting period before he can be certified. Abdominal Aortic Aneurysm • Waiting period: minimum 3 months for post-surgical repair of an aneurysm • Maximum certification period — 1 year Recommend to certify if: The AAA is: • Less than 4 cm and the driver is asymptomatic. • Greater than 4 cm but less than 5 cm and the driver is asymptomatic and has clearance from a cardiovascular specialist who understands the functions and demands of commercial driving. • Surgically repaired and the driver meets post-surgical repair of aneurysm guidelines. Recommend not to certify if: The driver has: • Symptoms, regardless of AAA size. • Recommendation for surgical repair, regardless of AAA size, from a cardiovascular specialist who understands the functions and demands of commercial driving. The AAA: • Is greater than 4 cm but less than 5 cm and driver does not have medical clearance for commercial driving from a cardiovascular specialist. • Is greater than or equal to 5 cm. • Has increased more than 0.5 cm during a 6 month period, regardless of size. 12. The driver takes diphenhydramine twice a day to treat nasal congestion. What must you document in order to certify? A. Take the lowest dose effective on days when driving B. Cannot drive within 12 hours of taking diphenhydramine C. Cannot drive within 6 hours of taking diphenhydramine D. Diphenhydramine is disqualifying B. Cannot drive within 12 hours of taking diphenhydramine. Minimum — The driver should abstain from medication for 12 hours prior to operating a vehicle when taking 1st-generation antihistamines 13. The driver has a history of carpal tunnel repair of her right hand 2 months ago. Her grip strengths are symmetrical and strong. What is necessary in order to qualify this driver? A. Must first complete a 3‐month post‐op waiting period B. Document her findings for 1‐year certification C. Document her findings for 2‐year certification D. Request that an SPE be obtained before certification C. Document her findings for 2-year certification Repaired carpal tunnel should not be a progressive neurological issue or a fixed deficit that requires an SPE. The medical examiner would confirm that the driver meets standards by testing to determine if grip strength, prehension, sensation, and range of motion are sufficient to control the steering wheel and shifting gears, as well as to perform other job tasks. The driver can be certified for two years, as long as she meets all other qualification standards. 14. Which of the following abdominal complaints is most likely to be incapacitating? A. IBS B. GERD C. Urinary tract infection D. Nephrolithiasis D. Nephrolithiasis Kidney stones are more serious that the other diseases, and I'm assuming that the pain could be more distracting/debilitating than the other 3 conditions. 15. The waiting period for benign positional vertigo is: A. 1 month B. 2 months C. 3 months D. 6 months B. 2 months Vertigo Vertigo is generally caused by an inner ear abnormality. Uncontrolled vertigo is disqualifying. - The Conference on Neurological Disorders and Commercial Drivers report recommends that the driver may be certified after completing at least 2 months symptom free with a diagnosis of: • Benign positional vertigo. • Acute and chronic peripheral vestibulopathy (damage to balance part of inner ear) Labyrinthine Fistula - The Conference on Neurological Disorders and Commercial Drivers report recommends disqualification when there is a diagnosis of labyrinthine fistula. Nonfunctioning Labyrinth - The Conference on Neurological Disorders and Commercial Drivers report recommends disqualification when there is a diagnosis of nonfunctioning labyrinth. 16. The driver's BP is 148/96. You verify her history, which indicates she has no prior history of hypertension. If otherwise qualified, you may certify her for: A. 3 months B. 6 months C. 1 year D. 2 years C. 1 year Stage 1 Hypertension ------------------------ - BP measurement greater than or equal to 140/90 and less than 160/100. Maximum certification period — 1 year OR one time for 3 months Recommend to certify for 1 year if: - It is the first examination at which the driver has BP equivalent to stage 1 hypertension and the driver: • Has no history of hypertension. • Does not use antihypertensive medication to control BP. Recommend to certify one time for 3 months if: The driver has: • Already was given a 1-year certificate for untreated stage 1 hypertension. • Not been prescribed antihypertensive medication to control high BP. Recommend not to certify if: The driver has: • Was already given a one-time, 3-month certificate for elevated BP or hypertension but still has BP greater than 140/90 today. • A history of stage 3 hypertension and a BP greater than 140/90 today. • BP greater than or equal to 180/110, regardless of any other considerations. Stage 2 Hypertension ------------------------- - BP measurement greater than or equal to 160/100 and less than 180/110. Maximum certification period — One time for 3 months Recommend to certify if: It is the first examination at which the driver has BP equivalent to stage 2 hypertension and the driver: • Has no history of hypertension. • Does not use antihypertensive medication to control BP. The driver: • Has a diagnosis of hypertension treated with medication. • Tolerates treatment with no side effects that interfere with driving. NOTE: Advise the driver issued a one-time, 3-month certificate that: • To qualify at follow-up, BP should be at or less than 140/90. • If the driver at follow-up qualifies, a 1-year certificate will be issued from the date of the initial examination, not the expiration date of the one-time, 3-month certificate. • If the driver fails to lower BP by the expiration date of the one-time, 3-month certificate, the driver will be disqualified until BP is at or less than 140/90 at examination. Recommend not to certify if: • The driver was already given a one-time, 3-month certificate for stage 2 hypertension but still has BP greater than 140/90 today. • Has a history of stage 3 hypertension and has BP greater than 140/90 today • Has BP greater than or equal to 180/110 today, regardless of any other considerations. Stage 3 Hypertension ------------------------- - BP measurement greater than or equal to 180/110. - Symptoms: -- Meningismus, acute neurological deficits, abrupt onset of shortness of breath, or severe, ripping back or chest pain could signal an impending hypertensive catastrophe that requires immediate cessation of driving and emergency medical care. -- Symptoms of hypertensive urgency such as headache and nausea are likely to be more subtle, subacute in onset, and more amenable to treatment than a hypertensive emergency. Maximum certification period — 6 months with history of stage 3 hypertension Recommend to certify if: - Not applicable. Recommend not to certify if: - The driver has BP equal to stage 3 hypertension, regardless of history or treatment. NOTE: The driver is at risk for an acute hypertensive event and should be advised to seek, or should be provided immediate medical attention and must be medically disqualified. Monitoring/Testing Before the driver who is disqualified for stage 3 hypertension can be considered for recertification (maximum 6 months), the driver must, at examination have: • BP at or less than 140/90. • BP treatment that is well tolerated. At future semi-annual examinations, if BP is equivalent to stage 1 or stage 2 hypertension, on a case-by-case basis, you should determine the appropriate use of the one-time, 3-month certificate in accordance with stage 1 or stage 2 hypertension guidelines. 17. The driver's current BP is 135/76. Your records indicate at history of Stage III hypertension 4 years ago. The maximum certification for this driver is: A. 3 months B. 6 months C. 1 year D. 2 years B. 6 months If a driver has any history of Stage 3 hypertension (180+/110+), the maximum certification time will be 6 months, regardless of how well they are today or how well they have been doing since then. 18. The driver presents for examination with a recent history (five weeks ago) of pneumothorax. He has no prior history of pneumothorax. In order to be considered medically qualified, his forced vital capacity (FVC) should be greater than: A. 40% B. 55% C. 65% D. 90% C. 65% The minimum Forced Vital Capacity (FVC) to be certified is 65%. 19. The recommended waiting period (WP) and certification period (CP) for a driver following surgical correction for intermittent claudication are: A. WP 1 month, CP 6 months B. WP 3 months, CP 1 year C. WP 3 months, CP 2 years D. WP 6 months, CP 2 years B. WP 3 months, CP 1 year Intermittent claudication is the primary symptom of peripheral vascular disease of the lower extremities. Intermittent Claudication Waiting period Minimum — 3 months for post-surgical repair You should not certify the driver until etiology is confirmed and treatment has been shown to be adequate/effective, safe, and stable. Maximum certification — 1 year Recommend to certify if: The driver, following surgery has: • Relief of symptoms. • No other disqualifying cardiovascular disease. Recommend not to certify if: • The driver has pain at rest. 20. Which of the following are disqualifying? A. Pacemaker B. Implanted defibrillator C. Both a and b D. Neither B. Implanted Defibrillator Implantable Cardioverter-Defibrillators - Implantable Cardioverter-Defibrillators (ICD) are electronic devices that treat cardiac arrest, ventricular fibrillation, and ventricular tachycardia through the delivery of rapid pacing stimuli or shock therapy. - They are separate from Pacemakers. Pacemakers treat bradycardia. - ICDs treat but do not prevent arrhythmias. Therefore, the driver remains at risk for syncope. The management of the underlying disease is not effective enough for the driver to meet cardiovascular qualification requirements. Combination ICD/pacemaker devices are also ineffective in preventing incapacitating cardiac arrhythmia events. Waiting Period: Not applicable. Recommend to certify if: - Not applicable. Recommend not to certify if: The driver has an: • ICD. • ICD/pacemaker combination device. 21. Five years post‐CABG, the driver must provide a copy of _________ in order to qualify for recertification A. Ultrasound B. EKG C. Lipid profile D. ETT D. ETT (Exercise Tolerance Test) Coronary artery bypass grafting (CABG) surgery is frequently the preferred choice of therapy for individuals with multi-vessel coronary heart disease, narrowing of the proximal left main coronary artery, and extensive atherosclerosis in the presence of left