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NRCME Test Bank with Explanations Questions and Answers fully solved
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NRCME Test Bank with Explanations
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NRCME Test Bank with Explanations1. 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 - answer 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 - answer 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 - answer 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 - answer 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 - answer 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 - answer 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 - answer 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 - answer 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 - answer 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 - answer 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 - answer 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.
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