SAMPLE NRCME EXAM

1. 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:

a. Temporarily disqualify the driver until he obtains written clearance for the depression and

the medication from the treating provider. b. Certify the driver for a period of 1 year. c. Certify the driver for a period of 2 years. d. Disqualify the driver until he is no longer requiring medication for the treatment of

depression.

2. The following statements are true concerning hearing requirements of commercial drivers EXCEPT:

a. Hearing aids may not be worn during the forced whisper test. b. Either the forced whisper or audiometry tests may be performed first. c. The forced whisper test is passed if one ear perceives the forced whisper at 5 feet. d. Administration of both tests is only necessary if the first test is failed.

3. What is the maximum length of time a driver can remain in determination pending status?

a. 30 days. b. 45 days. c. 2 months. d. 6 months.

4. A driver has had his second spontaneous pneumothorax on the same side 3 months ago. There has been no surgical intervention. The FVC is 68%. The correct determination in this case is:

a. Do not certify until the condition has been corrected surgically. b. Certify for one year since pulmonary functions show FVC > 65%. c. Certify for one year if pulse ox is > 92%. d. Certify for one year if the driver is adequately anticoagulated with INRs in the

therapeutic range.

5. The driver reports a suicide attempt 6 months earlier, following the break-up of his marriage. He notedseeing a psychiatrist and he takes Citalopram daily and he reports he feels fine now and is moving on withhis life. He provides a release from his doctor that he may return to work without restrictions. Themedical examiner should?

a. Disqualify the driver.b. Require a CAGE questionnaire.c. Certify the driver for 1 year.d. Certify the driver for 2 years.

6. A driver with an Abnormal Aortic Aneurysm (AAA) can be certified:

a. For 2 years if less than 4 cm and asymptomaticb. For 1 year if between 4 and 5 cm, asymptomatic, with a recommendation from a cardiovascular

specialist who understands the functions and demands of commercial driving.c. For 2 years after surgical repair, after a 2 month waiting period.d. For 1 year after surgical repair, after a 2 month waiting period.

7. Which of the following is false concerning additional information the driver is to provide for any “yes”responses on the history section of the examinationform?

a. Any limitations resulting from current or previous conditions.b. Must list diagnosis and date of onset of the condition.c. Must list treating provider contact information.d. Must list only prescription medications, not vitamins or supplements.

8. Upon examination of a 46-year-old male smoker, you detect an irregularly irregular heart rhythm.The rate is 140 bpm. This is unknown to the driver and he denies any symptoms of lightheadedness,shortness of breath, dizziness, palpitations, nor any cardiac history. You would:

a. Disqualify and refer to his PMD or cardiologist for further evaluation.b. Order an ECG, cardiac ECHO, pulse ox and give a 3 month card pending results.c. Give a 3 month certification pending evaluation by his PMD.d. Give a 1 year certification and require cardiology evaluation upon recertification.

9. Which cardiac condition is disqualifying?

a. Ebstein anomaly. b. c. Mitral valve prolapse. d. Aortic valve repair for aortic stenosis 4 months prior to exam.

10. Central vision loss is a finding suggestive of:

a. b. Cataracts. c. Glaucoma. d. All of the above.

11. A driver was discharged from the hospital 10 weeks ago, after an MI. He is asymptomatic and has a note from the cardiologist that he had a satisfactory in office ETT the week prior to your examination and that he may drive. His pre-discharge ECHO shows an EF of 45%. His examination is normal. Your determination:

a. Disqualified until satisfies 3 month waiting period, follow up in 3-4 weeks, certify for 1 year if

remains stable. b. Disqualified due to ejection fraction < 60%. c. d. Qualified for two years after follow up in one month to satisfy the 3-month waiting period.

12. Concerning the medical certificate, which is false?

a. Provide the original to the driver being examined. b. Retain a copy for at least 3 years. c.

d. The driver must carry the original certificate during operation of a CMV. driver. You may not provide a copy to the current or prospective employer, they must get it from the

Qualified for one year.

Macular degeneration.

Hypertrophic cardiomyopathy.

13. Which of the following is an assessment of L4 nerve root pathology?

a. Plantar flexion. b. Patellar reflex. c. Hip Extension. d. Big toe extension.

14. Indicators for referring a driver for pulmonary function testing include:

a. A history of COPD. b. Symptoms of wheezing. c. Cigarette smoking in drivers 35 years of age or older. d. All the above.

15. How soon may a driver be certified after coronary artery bypass grafting (CABG) surgery?

a. 1 month if the graft was less than 5 vessels. b. 3 months with clearance by a cardiologist, resting echocardiogram with an LVEF >40% after

CABG, and asymptomatic status with no angina. c. 6 months but only after he is cleared by his cardiologist. d. Not sooner than 1 year regardless of how many vessels were bypassed.

16. A driver presents for his DOT physical. He notes occasional lower back pain. A lateral pulsation is palpated approximately 2 inches superior of the umbilicus. Auscultation in this area reveals an obvious bruit. What is the most important next step?

a. Schedule an ultrasound. b. Arrange for immediate transport to an Emergency Department. c. Refer to a general surgeon. d. Refer to a vascular surgeon.

17. Arriving for a recertification exam, a 48 year-old male non-smoker is 5’4”, 275lbs. His supervisor callsyou ahead of time stating he recently went off the side of the road crashing into a guard rail. Therewere no injuries and the truck sustained only minor damage. When the medical assistant goes tobring him back, he is found asleep, snoring in the waiting room and she needs to wake him by gentlyshaking him by the shoulder. She reports this to you. When you arrive in the exam room the patientappears to be nodding off while sitting on the exam table. Upon further questioning, he admits thathis wife frequently elbows him because of his snoring and that he gasps and snorts in his sleep.When asked, he denies nodding off while driving. His exam is notable for obesity, Mallampati 4oropharynx, HTN controlled with 2 medications, otherwise normal. Appropriate next steps:

a. Order a pulmonary function test and a pulse ox. If FEV1 < 65% or O2 Sat < 92%, disqualifyand refer to pulmonology.

b. Temporarily certify for 3 months and refer to PMD for sleep study.c. Disqualify and refer to PMD for sleep study.d. Administer the Epworth Sleepiness scale. If negative, certify for one year, if positive,

disqualify and send for sleep study.

18. Physical qualifications for vision regulations include allbut:

a. Distant visual acuity of at least 20/40 (Snellen) in each eye without corrective lenses orvisual acuity separately corrected to 20/40 (Snellen) or better with corrective lenses.

b. Distant binocular acuity of at least 20/40 (Snellen) in both eyes with or without correctivelenses.

c. Field of vision of at least 85 degrees in the horizontal meridian in each eyed. The ability to recognize the colors of traffic signals and devices showing standard red,

green and amber.

19. A 69-year-old male driver had a femoral-popliteal bypass 4 months ago, with resolution of chronicleg pain due to claudication. His surgeon clears him for driving. He is on coumadin with INRsconsistently in the therapeutic range since discharge. The correct determination is:

a. Meets standards, qualified for 2 year certificate.b. Meets standards, qualified for one year.c. Disqualify due to coumadin usage.d. Temporarily certify 3 months to evaluate INRs while back at work, then certify for one

year if stable.

20. Drivers must have the following physical abilities except:

a. Grip strength.b. Upper body strength.c. Ability to lift 70 lbs. frequently.d. Balance and flexibility.

21. A driver returns to work after a two-week absence due to a respiratory illness. He presents a notefrom his physician that he was unable to work as a truck driver because of the illness and is nowcleared 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.

22. The medical examiner cannot certify a driver if the driver has been diagnosed with:

a. Schizophrenia.b. Meniere’s disease.c. A labyrinthine fistula.d. Any of the above

23. A driver is found to have diminished central acuity during Snellen chart acuity testing. This issuggestive of:

a. Macular degeneration.b. Glaucoma.c. Cataracts.d. Scleritis.

24. 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.

25. As the medical examiner you notice a patient’s urinalysis is positive for 3+ protein. You should:

a. Do nothing as this is not uncommon. b. Sign off on the examination. c. Determine if additional evaluation is required and request or recommend primary care provider

follow-up. d. Inquire if the patient has been eating a lot of carbohydrates recently.

26. The regulatory non-discretionary standards include:

a. Vision, hearing, blood pressure and seizure disorders. b. Vision, hearing, and epilepsy. c. Vision, hearing, blood pressure and diabetes. d. Vision, hearing, blood pressure and epilepsy.

27. 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 CMV driver. c. It is not your responsibility to ensure that the person meets the age requirements. d. From his physical appearance he seems quite healthy.

28. A 47 year-old driver with a Fixed Deficit of an Extremity should have a physical exam:

a. Only once since the condition will never change. b. Every 8 months. c. Biannually or more frequently if indicated. d. Every year.

29. A driver with an abdominal aortic aneurysm may be certified for one year without clearance from a vascular specialist if the AAA is asymptomatic and:

a. Less than 4cm in size. b. Less than 5 cm in size. c. Less than 6 cm in size. d. May not be certified until the AAA is surgically repaired.

30. A driver with coronary heart disease has been recently prescribed Flecainide (2 monthsago) with good control of non-sustained ventricular tachycardia. His ETT/ECHO shows tolerance to 6 mets and an EF of 38%. He is asymptomatic and has a note from the cardiologist that he may drive. His examination is normal. Your determination:

a. Disqualified due to ejection fraction below 40% b. Disqualified due to Flecainide. c. Qualified for one year. d. Qualified for one year after follow up in one month to satisfy the 3 month waiting period.

31. A number of requirements must be met in order for a driver to pass a vision exam and be certified. Which of the following would prevent a driver from being certified by a medical examiner?

a. Binocular acuity of at least 20/40 b. Distant visual acuity of at least 20/40 in each eye c. Horizontal field of vision of at least 70° measured in each eye d. Inability to distinguish among traffic devices showing red, amber, and green colors

32. 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.

33. Select the correct statement:

a. A driver with an ICD in place cannot be certified. b. A driver with an ICD/pacemaker device may be certified for driving if the pacemaker has been

checked within the last 6 months. c. A driver with a pacemaker in place for AV block cannot be certified. d. All of the above are correct.

34. A driver with COPD should not be certified if his ABG reveals:

a. A PaO2 of 70 at an altitude below 5,000 feet. b. A PaO2 of 63 at an altitude above 5,000 feet. c. A PaO2 of 66 at an altitude above 5,000 feet. d. A PaO2 of 64 at an altitude below 5,000 feet.

35. What is the required waiting period before a driver can be certified following coronary artery bypass grafting?

a. One week. b. Three weeks. c. One month. d. Three months.

36. Drivers with hearing aids:

a. Are not qualified to drive commercially.b. May use hearing aids to undergo the forced whisper test.c. Must be evaluated by an audiologist.d. Must have no greater than 40 decibel loss with or without hearing aids in both ears.

37. Guidance recommends drivers not be certified with all the following conditions except:

a. Uncontrolled vertigo.b. Meniere’s disease.c. Labyrinthine fistula.d. Otitis Media.

38. FMCSA defines a severe hypoglycemic reaction as one that results in:

a. Seizure.b. Need of assistance from another person.c. Period of impaired cognitive function that occurs without warning.d. All of the above.

39. A driver with Stage 3 hypertension (greater than or equal to 180/110):

a. Is disqualified.b. Can be given a 3 month certification if this is the first time the blood pressure has been elevated.c. Can be given a one year certification.d. Can be given a 3 month certification if this is a recertification exam, but not if it a new

certification.

40. A driver is unable to pick out the numbers in an Ishihara color blindness test. However, he is able todistinguish red, green, and amber stoplights. Which of the following is accurate?

a. He may be fully qualified for 2 years.b. He is disqualified.c. He requires evaluation and clearance by an ophthalmologist.d. He may be certified for only 3 months.

41. Which is true concerning the Skilled Performance Evaluation (SPE)?

a. An SPE may be used to evaluate fixed deficits of the extremities.b. An SPE may be used to evaluate weakness caused by chronic conditions such as muscular

dystrophy or Parkinson’s.c. The examiner performs the SPE only if the driver is otherwise qualified.d. An SPE should be performed for drivers with abnormalities such as clubbing, edema, or

neurological conditions affecting the extremities.

42. After undergoing ablation for atrial fibrillation, what is the minimum waiting period before a drivercan be certified?

a. 1 month.b. 3 months.c. 6 monthsd. 12 months

43. Allergic Rhinitis involving inflammation of the nasal portion of the upper respiratory tract rarelyrenders a driver incapable of operating a commercial vehicle. A driver may be certified with allergicrhinitis and:

a. Severe conjunctivitis affecting visionb. Uncontrollable sneezing fits.c. Nasal steroid sprays and non-sedating antihistamines.d. Sinusitis with severe headaches.

44. When completing the commercial driver examination form for a driver withhypertension with aone time, 3-month certificate:

a. Issue a one year certification from today’s date if BP is now below 140/90.Issue a one year certification from the original exam date if BP is now below 140/90.b.

c. Issue another 3-month certificate

d. Issue a 6-month certification.

45. Sleep Apnea:

a. Is always disqualifying.b. May not be disqualifying if the patient shows that he is compliant with treatment and that the

treatment is effective.c. Is not a consideration if the driver only drives within his home state.d. Only found in obese male drivers who are smokers.

46. A driver with a recent diagnosis of congestive heart failure and known ventriculararrhythmias may be certified for driving if his left ventricular ejection fraction is at least:

a. 35%b. 40%c. 45%d. 50%

47. Which is true of FMCSA Driver Exemption Programs?

a. An examiner may certify a driver with a hearing exemption for two years.b. An examiner may certify a driver with a seizure exemption for two years.c. An examiner may certify a driver with a Skilled Performance Exemption for two years.d. All of the above are correct.

48. A 43 year-old generally healthy female bus driver indicates she is allergic to aspirin. Upon furtherquestioning, she relates that she had febrile seizures at age 2, and her mother was told not to giveher aspirin afterwards. She never had recurrence of the seizures nor any other neurologicalsequelae. Her examination is normal. Youdetermine:

a. Certify for 2 years.b. Disqualified due to history of seizures.c. Temporarily certify for 3 months pending neurological clearance.d. Certify annually if no further seizure history.

49. Individuals with chronic schizophrenia:

a. Should not be considered medically qualified for commercial driving.b. Can be medically cleared if they are not currently taking any medication.c. Can be cleared but only for 6 month periods.d. Can be cleared if they are taking medication.

50. The medical examiner should ask the driver about all of the following conditions and refer forspecialist evaluation except:

a. Retinopathy.b. Cataracts.c. Macular degeneration.d. Conjunctivitis.

51. The Medical Examiner’s Certificate requires documentation of:

a. The Medical Examiner’s license number.b. Address of the employer of the driver.c. The date of expiration of the Medical Examiner’s FMCSA certification.d. All the above

52. A 62 year-old male driver marks “yes” under cardiac surgery and has circled “pacemaker” and “yes” to “fainting and dizziness” on the history section of his DOT form. Further history reveals he had combination ICD-pacemaker implantation 7 weeks ago for Ventricular tachycardia after a syncopal episode. He has a clearance letter from cardiologist indicating he can drive. He is asymptomatic and has had no further syncopal episodes. You determine:

a. Meets standards, but must have a 3 month waiting period. You schedule a follow up for 6

weeks, and if stable, certify for one year. b. Meets standards, but must have a 3 month waiting period. You schedule a follow up for 6

weeks, and if stable, certify for two years. c. Meets standards, satisfies the one month waiting period, certify for one year. d. ICD-Pacemaker is disqualifying.

53. A 43 year-old male driver has an otherwise normal exam except for amputation of the ring and little fingers of the left hand. The driver:

a. Needs to undergo a one-time SPE examination. b. Can be cleared for one year if his grip strength is normal. c. Can be cleared for two years if his grip strength is normal. d. Needs to undergo an annual SPE examination.

54. A 22 year-old male contracted meningococcal meningitis from his college roommate, discharged from the hospital 3 months ago. He brings no records with him. He is on no medications, is otherwise healthy, and his physical examination is entirely normal. The correct determination would be:

a. Get a note from the neurologist indicating he can drive a commercial vehicle, then certify for 2

years. b. Obtain hospital records. If there was no seizure activity, he must undergo a one year waiting

period before he can be qualified, if there was seizure activity, he must undergo a 2 year waiting period seizure free and off anticonvulsant medication before he can be qualified.

c. Obtain hospital records. If there was no seizure activity, he must undergo a one year waiting period before he can be qualified, if there was seizure activity, he must undergo a 5 year waiting period seizure free and off anticonvulsant medication before he can be qualified.

a. Obtain hospital records. If there was no seizure activity, he must undergo a 3 month waiting period before he can be qualified, if there was seizure activity, he must undergo a 2 year waiting period seizure free and off anticonvulsant medicating before he can be qualified.

55. For how long must you retain a copy of the driver’s medical records, including the certificate?

a. 1 year. b. 2 years. c. 3 years. d. 4 years.

56. Which condition is disqualifying:

a. Kidney dialysis. b. A pacemaker. c. COPD. d. Chronic low back pain.

57. When completing the commercial driver examination form for a driver with stage 3 hypertension:

a. A 6 month recertification - fill out a new form, check “follow up,” do a complete examination. b. A 6 month recertification - fill out a new form, check “follow up,” don’t need a complete

examination, just document any new/pertinent information in the comments section. c. A 6 month recertification - fill out a new form, check “recertification,” don’t need a complete

examination, just document any new/pertinent information in the comments section. d. A 6 month recertification - fill out a new form, check “recertification,” do a complete

examination.

58. A 3-month certificate:

a. Is issued when BP is greater than 140/90 and may be renewed consecutively. b. Is issued one time for any BP greater than 140/90. c. Is issued only once in a lifetime. d. Is issued for the first time a driver exhibits stage 2 hypertension.

59. Which of the following is true regarding certification of the driver who uses a hearing aid?

a. The examiner should advise the driver to carry a spare power source for the hearing aid. b. The driver must carry a back-up hearing aid while driving, and he must pass the

hearing exam with both the usual hearing aid and the back-up. c. The medical examiner must refer the driver to an audiologist for testing. d. The driver must pass the hearing standard with both ears.

60. The medical examiner should be most concerned regarding the medical fitness for duty for which of the following commercial drivers?

a. A 33 year-old male with a 15 lb. weight loss in the last 3 months. b. A 62 year-old female with a 20 lb. weight gain in the last 6 weeks. c. A 25 year-old woman with the onset of frequent, severe headaches in the last week. d. A 46 year-old man with a known a recent diagnosis of Barret’s esophagus.

61. Which is the correct determination:

a. Initial certification exam, BP 168/104, treated. Issue 3 month certificate. Returns with BP 138/88, issue one year certificate from date of original exam.

b. Initial certification exam, BP 168/104, treated. Issue 3 month certificate. Returns with BP 138/88, issue two year certificate from date of original exam.

c. Initial certification exam, BP 168/104, treated. Issue 3 month certificate. Returns with BP 146/92, issue additional 3 month certificate

d. Initial certification exam, BP 168/104, treated. Issue one year certificate. Returns with BP 146/92, issue 3 month certificate.

62. The SPE certificate is valid for a period not to exceed years from date of issue?

a. 1 year. b. 2 years. c. 3 years. d. 5 years.

63. A potential driver is examined and is shown to have a blood pressure of 165/90 mm Hg. What is the next step for the medical examiner in this instance?

a. Immediately disqualify the driver. b. Refer the driver to the nearest Emergency Department. c. Document the driver’s blood pressure with the FMCSA. d. Perform a second measurement of the driver’s blood pressure later in the exam.

64. Which of the following is FALSE?

a. A New certification requires a full examination. b. A Recertification only requires a limited examination. c. A Follow up is a continuation of a New or Recertification and does not require a physical

examination. d. Either a new certification or a recertification may be for a maximum of 2 years.

65. You should refer a driver who exhibits evidence of which of the following disorders for follow-up care and evaluation by an appropriate specialist or primary care provider?

a. Macular degeneration. b. Bacterial conjunctivitis. c. Episcleritis. d. All of the above.

66. A driver with a history of epilepsy must wait a minimum of how long before consideration may be given to certification?

a. One-year seizure free and off anticonvulsant medication b. Five years seizure free and off anticonvulsant medication c. Ten years seizure free and off anticonvulsant medication d. The driver cannot be certified

If the underlying condition causing the seizures has been corrected and is now stable, he may

67. Routine required diagnostic testing for commercial drivers includes all but which of the following:

a. Vision testing by Snellen or Titmus. b. Hearing test. c. Urinalysis . d. ECG

68. A 57 year-old male driver underwent a 3 week hospitalization, discharged 4 months ago for pyelonephritis and sepsis. While in the ICU he became hypotensive on several occasions and experienced generalized seizure activity during those episodes. Seizure activity resolved as he became normotensive, and did not require anticonvulsant medication after discharge. A note from the neurologist confirms this. The prostatic hypertrophy leading to bladder outflow obstruction and the pyelonephritis has been successfully treated with Flomax. He now presents for his re- certification exam. A note from his nephrologist states he may drive. His examination is unremarkable, with normal vision, hearing, BP and a urinalysis showing only trace protein. The correct determination in this case is:

a. Disqualify until mandatory waiting period of 1 year after seizure activity has passed. b. Disqualify until mandatory waiting period of 2 years after seizure activity has passed. c. Temporarily certify for 3 months. If he remains seizure free, certify for one year. d.

be certified for up to 2 years, or shorter periods at the discretion of the medical examiner.

69. Which is true of the FMCSA vision waiver program?

a. There are a small number of drivers remaining from the mid-90’s waiver program. b. There is an ongoing waiver program which current drivers may apply for if they are otherwise

qualified. c. Any driver with monocular vision may be issued a waiver by the medical examiner if they are

otherwise qualified. d. Drivers with the waiver can be certified for a 2 year maximum certification period.

70. A screening pulse oximetry below what level mandates an ABG analysis?

a. 96%. b. 94%. c. 92%. d. 90%.

71. A driver presents for initial certification. During an exam you discover a large right reducible inguinal hernia on a driver. The driver has known about it for some time and says it only bothers him if he lifts something heavy. He has not had it evaluated before but says the last time he had his physical by his own doctor, he didn’t make a big deal about it. You should:

a. Refer him for evaluation and hold certification until the etiology is confirmed and treatment

has been shown to be adequate/effective, safe and stable. b. Clear him since his personal physician didn’t feel it was it was urgent. c. Clear him but inform him you will only give him a license for one year. d. Since it only bothers him when he lifts and doesn’t bother him while he drives, he can be

cleared to drive.

72. During the physical examination on a driver in whom you have psychological concerns, the questions you should ask

a. Should be tailored to the type of mental disorder you are considering. b. Should be the same questions as you would ask for any individual who is be assessed for

psychological concerns. c. Should not include any questions regarding psychological disorders since this is HIPPA

protected information. d. Can only be asked if the patient has a history of documented mental disorders in the past.

73. After examining a driver, the Medical Examiner strongly feels that the driver is fit for commercial driving, even though he does not meet all standards per FMCSA regulations. The Medical Examiner should:

a. Apply for the process of conflict resolution, and in the meantime, certify the driver as

qualified. b. Apply for the process of conflict resolution, and in the meantime, disqualify the driver. c. Certify the driver as fit for duty and attach an explanatory statement. d. Disqualify the driver and explain that the regulations are legal requirements.

74. When audiometry is used to test a driver’s hearing:

a. The driver passes if there is no greater than 40dB average loss over 500, 1000 and 2000 Hz in thebetter ear.

b. The driver passes if there is no greater than 40dB average loss over 500, 1000 and 2000 Hz in thebetter ear. If hearing aids are worn, both ears must pass.

c. The driver passes if there is no greater than 40dB average loss over 2000, 3000 and 4000 Hz in thebetter ear.

d. The driver passes if there is no greater than 40dB average loss over 500, 1000 and 2000 Hz in bothears.

75. To meet the Federal hearing standard, the driver must successfully complete one hearing test withone ear, either the forced whisper test of the audiometric test. Which is true of the audiometric test:

a. Results are recorded according to the American National Standards Institute (ANSI).b. Although frequently recorded, the results for the 4,000 Hz test are not included in calculating the

results for the hearing standard.c. The driver will usually have to go to an audiologist or hearing aid center for testing with a hearing

aid, but this is not mandatory.d. All the above are correct.

76. Which of the following test must be documented as part of the urinalysis when evaluating acommercial driver?

a. Bilirubin.b. Protein.c. Leukocyte esterase.d. Nitrites.

77. FMCSA recommends that a driver taking an incretin mimetic provide a written statement fromthe treating health care professional. The written statement should:

a. Describe driver tolerance to the medication.b. Indicate how frequently the driver is monitored for adequate blood glucose control.c. Include efficacy of treatment.d. All the above.

78. During the examination, the examiner notices that the driver is distant and has a flataffect/expression, and lacks eye contact during the exam. The examiner should?

a. Provide the driver with a “CAGE” questionnaire.b. Require an SPE and certify the driver with a 3-month certificatec. Certify the driver with a 1-year certificate.d. Refer him/her to a mental health profession prior to consideration for certification.

79. Which of the following medications is most noted to cause drowsiness and impaired driving

a. Concerta.b. Prozc.c. Toprol.d. Xanax.

80. A 35 year-old patient presents for initial certification. He has no known medical history. Hisurinalysis reveals 3+ glycosuria. Which of the following next steps is most reasonable?

a. Give a one year recertification.b. Give a 3 month recertification.c. Contact the driver’s PCP.d. Disqualify.

81. A DOT driver presents for his medical exam. On his history he advised that he regularly takesDextromethorphan. This should prompt the ME to do the following?

a. Give a one year recertification.b. Give a 3-month recertification.c. Counsel the driver about not consuming the medication within 12 hours of driving.d. Disqualify.

82. Regarding a patient with known COPD, a screening pulse oximetry and/or arterial blood gasanalysis are indicated when pulmonary function test reveal:

a. An FEV1 less than 65% of the predicted value.b. An FEV1/FVC ratio less than 75%.c. An FVC is less than 60%.d. Any of the above mandate a screening pulse oximetry or ABG.

83. During the DOT exam a driver perceives a whispered voice at 5 feet in his left ear and 4 feet in his right ear. This is an otherwise normal/unremarkable exam. All other aspects of his physical examination are unremarkable. As the examiner what would you do next?

a. Require an audiometric test to determine the extent of hearing loss in his left ear. b. Certify the driver for 2 years. c. Certify the driver for 1 year. d. Permanently disqualify the driver.

84. Which of the following is classified as a Schedule 1 drug?

a. Oxycodone. b. Ambien. c. Ativan. d. Heroin.

85. A driver presenting for his medical exam reports being a smoker and out of breath often. What do you do next?

a. Order an EKG. b. Refer to the emergency department. c. Order spirometery. d. Provide a 1 year certification.

86. What is the waiting period for certification following percutaneous coronary intervention?

a. A minimum one week post-procedure. b. A minimum two weeks post-procedure. c. A minimum four weeks post-procedure. d. A minimum six weeks post-procedure.

87. Checking for pupillary equality is a required part of the examination. On a driver’s exam, you notice that the pupils are of different diameters, but both react appropriately to light. This is consistent with:

a. Horner’s syndrome. b. Anisocoria. c. 3rd Cranial Nerve palsy. d. Glaucoma.

88. A driver presents for his DOT exam. He had a myocardial infarction 5 week previous to the exam. He presents with a return to work letter from his cardiologist with no restrictions. Testing information included revealed that the driver was able to reach 12 METS and his left ventricular ejection fraction was 65%. Based off this information what certification decision should be made by the examiner?

a. Certify for a one-time interval of 3 months. b. Qualify the driver for 2 years. c. Qualify the driver for 1 year. d. Temporarily disqualify the driver.

89. Which of the following lab values are abnormal and potentially disqualifying?

a. HbA1c 11%. b. Hematocrit 40%. c. AST/SGOT 30 mg/ml. d. ESR 12 mm/Hr.

90. A driver presents for her DOT medical exam. During the exam history it is revealed that the driver is taken Lisinopril for hypertension, Simvastatin, and Antabuse. All other aspects of history and exam were normal. What should the examiner donext:

a. Disqualify the driver. b. Provide a one-time 3 month certification. c. Certify the driver for 1 year. d. Certify the driver for 2 years.

91. A driver describes halos around lights at night and occasional mild headaches. This is suggestive of:

a. Glaucoma.b. TIA.c. Horner’s syndrome.d. Atypical epilepsy.

92. On examination of a driver, you note xanthelasma palpebrarum. Which of the following testsshould be obtained?

a. Serum lipids and cholesterol.b. Blood pressure in both arms.c. Serum creatinine.d. Chest X-ray.

93. A driver presents with a blood pressure of 138/91. What is this?

a. Prehypertension.b. Stage 1 Hypertension.c. Stage 2 Hypertension.d. Stage 3 Hypertension.

94. A driver presents post operation of the cervical spine. Which of the following may be a reason fordisqualification?

a. Less than 45-degree cervical rotation.b. Residual pain that is intermittent after working long hours.c. Normal findings and a release from his surgeon but failed to complete physical therapy.d. Pain at the CT junction with maximum extension.

95. A driver presents with a history of taking medical marijuana. He has a prescription for this.What is the certification interval for this driver?

a. 3 month certification.b. 1 year certification.c. 2 year certification.d. Disqualification.

96. The waiting period for certification of a driver is a minimum of one year after which of thefollowing?

a. Bacterial meningitis without early seizures.b. Viral encephalitis with early seizures.c. Post-surgical removal of a spinal tumor.d. Moderate traumatic brain injury.

97. A driver presents with a history of being tired and having difficulty staying awake during the day,snoring at night, and being obese. What would be the best decision?

a. Disqualify.b. Provide a 3 month temporary certification.c. Provide a 1 year certification.d. Provide a 2 year certification.

98. The most common cause of retinopathy is diabetes mellitus. A characteristic finding consistent withthis diagnosis is:

a. Intraretinal hemorrhage.b. Pale retina.c. Retinal exudates.d. Elevated intraocular pressure.

99. A driver presents with a history of depression. He reports having a suicide attempt 10 months agoafter his son died in a car accident. The best decision for the examiner would be which of thefollowing?

a. Temporarily disqualify the driver.b. Obtain a clearance letter from the driver’s treatment provider.c. Certify for 1 year.d. Certify for 2 years.

100. A driver presents with a history of an isolated TIA 6 months previously. He presents with a returnto work letter from his primary care physician and his neurologist. The driver is takingHydrochlorothiazide and Simvastatin. All other aspects of the exam and history were normal.What should the examiner do next?

a. Certify the driver for 1 year.b. Temporarily disqualify the driver.c. Certify the driver for 3 months.d. Certify the driver for 2 years.

101. Upon examination of a commercial driver, you note scarring of the tympanic membranes. Youshould:

a. Disqualify the driver.b. Document this finding.c. Hold off on certifying the driver pending ENT evaluation.d. Hold off on certifying the driver pending evaluation by primary care physician.

102. According to FMCSA regulations, medical qualification for two years can be given to a driver whohas:

a. An SPE certificate for a left below the knee amputation.b. Hypertension.c. A recent diagnosis of Lewy body dementia.d. Documented medical marijuana use for pain control.

103. A driver presents to your clinic for an initial DOT certification. On examination, you determine thathis liver is enlarged. He has not complaints and his exam is otherwise normal. As the medicalexaminer, you should:

a. Order a chemistry panel and liver function tests.b. Disqualify the driver from driving a commercial motor vehicle.c. Order an abdominal ultrasound.d. Advise that the patient follow up with his primary care physician.

104. A commercial driver was diagnosed with an acute DVT 3 months ago. He has been on warfarin and his monthly INR has been between 2.0 and 3.0. You should:

a. Advised him to increase his warfarin dose.b. Recommend that he undergo INR testing weekly.c. Advise that he should move and stretch his legs regularly while driving.d. Add low dose aspirin to his current regimen.

105. A 46-year-old male driver presents for recertification. He has a history of chronic gastro esophageal reflux disease. He takes esomeprazole (Nexium) and over-the-counter cimetidine(Tagamet). He states that he feels fine, but has trouble finding foods that do not trigger hisGERD when he is on the road. Which of the following should the medical examiner do first?

a. Disqualify the driver until he has a nutritional consultation.b. Certify the driver and advise him to carry non-triggering foods in a cooler.c. Contact the driver's physician and request an upper GI study.d. Correlate the GI history findings with the abdominal examination.

106. What is the maximum certification period for Obstructive Sleep Apnea?

a. 6 monthsb. 12 monthsc. 18 monthsd. 24 months

107. According to medical guidance, for which of the following diagnosed neurological conditions is the driver considered medically unqualified fordriving?

a. Dementia. b. A history of a subarachnoid hemorrhage five years ago. c. Transient ischemic attacks greater than one year ago. d. All the above.

108. A driver presents for clearance to return to driving a CMV six weeks after arthroscopic carpal tunnel repair on his right hand. Can he be recertified if he passes the grip strength test, and, if so, for how long?

a. No, he cannot be certified. b. 6 months. c. One year. d. 2 years.

109. Chuck is a CMV driver who presents for recertification. He has a history of frequent ear infections in childhood. He had multiple tympanic membrane ruptures and infections in elementary school and into his middle-school years. He has “always” been “hard of hearing” in his left ear. On exam you note his L tympanic membrane is scarred and misshapen and he has post-nasal drainage. Which of the following is the appropriate procedure and/or determination for this driver:

a. Whisper test L ear - 3 feet, R ear - 5 feet, he passes the hearing exam and is issued a 2 year certificate.

b. Whisper test L ear - 3 feet, R ear - 5 feet, he passes the hearing exam but is issued a 3 month certificate to follow up on the post nasal drainage as this could affect his hearing.

c. Whisper test L ear - 3 feet, R ear - 5 feet, he passes the hearing exam and is issued a 3 month certificate pending ENT evaluation.

d. Whisper test L ear - 3 feet, R ear - 5 feet, order audiometry exam.

110. A driver is disqualified on 3-11-13 due to benign positional vertigo. She returns on 6-20-13 with a note from her ENT that she has been symptom free since 4-16-13. You would:

a. Perform a recertification exam. If qualified, issue a one year certification. b. Disqualify as the waiting period for benign positional vertigo is 3 months symptom free. c. Perform a recertification exam. If qualified issue a two year certification. d. Perform a follow up exam, document the 2 month symptom free waiting period and the note

from the ENT in the comments section of the examination form. Certify for one year from the date of the original examination.

111. A driver with Atrial Fibrillation and good rate control:

a. Cannot be certified. b. Can be certified for 2 years after one month waiting period for stable anticoagulation therapy. c. Can be certified for 1 year after one month waiting period for stable anticoagulation therapy. d. Can be certified for 1 years after 3 month waiting period for stable anticoagulation therapy.

112. A 70 year-old driver fails his eye exam. He returns after seeing his ophthalmolgist with a new pair of telescopic lenses and a note from the ophthalmologist stating the patient can drive. As the medical examiner you should:

a. Perform a recertification exam and if he passes the vision requirements, certify for one year,

requiring ophthalmology examination annually. b. Request specialized visual field exam from the ophthalmologist to assess level of redirection of

peripheral vision from the new lenses. c. Disqualify, telescopic lenses are not acceptable for commercial driving. d. If he is otherwise qualified, refer to FMCSA for a vision exemption.

113. The exercise tolerance test is the most common test used to evaluate workload capacity and detect cardiac abnormalities. The driver should be able to:

a. Exercise to a workload capacity greater than 6 Metabolic Equivalents (METs) (through Bruce

protocol stage II or equivalent). b. Attain a heart rate greater than or equal to 85% of predicted maximum (unless on beta

blockers). c. Have a rise in systolic blood pressure greater than or equal to 20 mm Hg without angina. d. All the above.

114. After a TIA a driver may not be certified if he/she:

a. Has not completed a 5 year waiting period seizure free and off anticonvulsants. b. Has not completed a one year waiting period seizure free and off anticonvulsants. c. Has not completed a 3 month waiting period seizure free and off anticonvulsants. d. Has not had an MRI and an EEG.

115. Following acute myocardial infarction, the waiting period is a minimum of 2 months before the commercial driver can be considered for certification. The driver must have a post-MI echocardiogram demonstrating an EF of at least:

a. 30%. b. 35%. c. 40%. d. 50%.

116. A 56 year-old man presents for initial certification. He has no documented medical history. He is noted to have a 40 pack-year history of smoking. Which of the following should you obtain?

a. A chest X-ray. b. Pulmonary function testing. c. Arterial blood gas. d. Exercise stress test.

117. Recommend not to certify a driver with a history of COPD if:

a. Pulse oximetry is less than 93%. b. PaO2 is less than 65 mm Hg at altitudes below 5,000 feet. c. FVC is less than 75%. d. Audible wheezing is present on examination.

118. A 21 year-old man presents for first-time certification. He has a long-standing history of ADHD and is taking methylphenidate. You should:

a. Disqualify the driver, explaining that use of such stimulants is cause for disqualification. b. Verify the diagnosis of adult ADHD and request evaluation from an appropriate mental health

professional. c. Obtain a urine drug screen. d. Certify the driver for 6 months, pending re-evaluation.

119. What is the required waiting period following cardiac valve replacement (prosthetic valve)?

a. One month. b. Three months. c. Six months. d. One year.

120. A 60 year-old driver with Parkinson’s Disease exhibits rigidity of his lower legs, and a mild tremor. His risk to the public as a commercial motor vehicle driver is considered:

a. Mild. b. Moderate. c. High, but he can be certified to drive. d. High, and he cannot be certified to drive.

121. Which of the following conditions documented on the health history should prompt the medical examiner to obtain further information?

a. History of Hepatitis A. b. GERD. c. Cirrhosis. d. History of appendectomy.

122. What is the required waiting period before a driver with a history of a transient ischemic attack can be considered for certification to drive a commercial motor vehicle?

a. One month. b. Six months. c. One year. d. Two years.

123. The medical examiner should educate the driver to refrain from operating a vehicle for at least how long after taking a medication with sedating side effects?

a. 6 hours. b. 8 hours. c. 12 hours. d. 24 hours.

124. Regulation 49CFR391.64 allows driving within an exempt intracity zone, which refers to which type of geographical area:

a. Municipality. b. State. c. Two contiguous states. d. Three contiguous states.

125. A driver with a history of diabetes and hypertension describes recurrent light headedness while driving in his truck. It has been over 100°F and the cab has no air conditioning. You should advise him to:

a. Increase his oral hypoglycemic dose. b. Decrease his anti-hypertensive dose. c. Monitor his fluid intake. d. Find a new job.

126. A driver describes gradual peripheral vision loss and seeing halos. This suggests the development of:

a. Glaucoma. b. Macular degeneration. c. Cataracts. d. Aphakia.

127. A driver is taking Lasix. Which of the following should be closely monitored?

a. Serum sodium. b. Serum potassium. c. Serum chloride. d. Serum calcium.