NRCME Practice Test

FMCSA has two medical driver exemption programs: Federal Vision Exemption Program (established in 1998) and Diabetes Exemption Program (established in September of 2003). The medical examiner determines whether the driver would be otherwise qualified if accompanied by the Federal vision or diabetes exemption. As a result of the exemptions, the driver must an annual medical examination for maintenance and renewal of the exemption.

While all of the questions are recommended to ask, the only question that is necessary is to see if the driver has glycosuria (dip stick urinalysis). It is recommended, though, to ask about carrying rescue glucose while driving, using incretin mimetic, and routinely monitoring his or her blood glucose level.

The driver must have at least 20/40 distant visual acuity in each eye with or without correction. 20/20 and 20/10 are higher standards than necessary. Lastly, 20/60 is not a high enough acuity standard.

Due to specifically the colors of a stoplight and most road signs, it is necessary for a driver to be able to recognize the colors amber, red, and green. Blue is not a necessary color to recognize in traffic signals and devices.

Medical certificates for drivers with Stage 1 hypertension expire after a year.  Stage 2 hypertension results in a one-time, three-month medical certificate.  Stage 3 corresponds to a medical certificate, good for 6 months from date of examination if the reading is less than or equal to 140/90.  Lastly, Stage 4 hypertension doesn’t exist.

When a medical examiner observes that a driver has a blood pressure reading of 160/100 (or any reading above 139/89), it is vital that the examiner take a second measurement later in the examination.  But, since the driver had no prior knowledge of such blood pressure, it is important for the examiner to refer him or her to a primary care provider.  It is not the job of the medical examiner to diagnose or treat the underlying disease.  Thus, it is important for the driver to see someone who can diagnose and treat such a disease before proceeding in the certification process.

When looking at the cardiovascular health of a driver, the fundamental question is whether the driver has a cardiovascular disease that increases the risk of sudden death or incapacitation, creating a danger to the safety and health of the driver, as well as the public sharing the road.  While history and family history of such diseases are important, they are not the fundamental questions necessary about which to ask.

Obesity and a sedentary lifestyle increase the risk of cardiovascular diseases.  Driving stressors can lead to increased neurosympathetic and adrenocortical catecholamine and cortisol release.  Also, exposed environmental stressors that are detrimental to the cardiovascular system.  However, the long hours and rotating work schedules do not predispose a driver for increased risks of cardiovascular disease.

An implantable cardioverter-defibrillator is An electronic device that treats cardiac arrest, ventricular fibrillation, and ventricular tachycardia through the delivery of rapid pacing stimuli or shock therapy.  A pacemaker is an implantable device designed to treat bradycardia.  Also, supraventricular tachycardia is a type of arrhythmia that is usually not considered a risk for sudden death.  Lastly, ventricular arrhythmia is a type of arrhythmia categorized as ventricular fibrillation and ventricular tachycardia and is responsible for the majority of instances of cardiac sudden death.

ICDs do treat arrhythmias, but they do not prevent them.  So, the driver remains at risk for syncope.  The management of the underlying disease is in fact not effective enough for the driver to meet cardiovascular qualification requirement.  Lastly, combination ICD/pacemaker devices are also ineffective in preventing incapacitation cardiac and arrhythmia events.

Asthma, carcinoma, and chronic bronchitis are all respiratory conditions that interfere with oxygen exchange and could result in gradual or sudden incapacitation.  Mitral regurgitation is actually a heart condition, not a respiratory condition.

While it is recommended to ask, it is not required that the medical examiner ask about the driver’s smoking habits.  The other questions are necessary questions to ask during a medical examination.

There is not in fact a maximum (or minimum) height (or weight) requirement for drivers.  For each body system, mark “Yes” on the Report Form if abnormalities are detected or “No” if the body system is normal.  The medical examiner must document all abnormal findings on the Report Form, even if they are not disqualifying.  Lastly, the individual parts of the body system are categorized numerically.

1 refers to General Appearance, 3 refers to Ears, 5 refers to Heart, and 7 refers to Abdomen and viscera.

The symptoms of headaches, vertigo, and dizziness are typically inconsequential, but they still constitute a problem for a driver. Headache and chronic “nagging” pain may be present to such a degree that certification for driving is inadvisable.  Also, medication used to treat headaches may further interfere with safe driving.  Lastly, disorders with incapacitating symptoms, even if periodic or in the early stages of disease, warrant the decision to not certify the driver.

Types of vertigo and dizziness with incapacitating symptoms interfere with cognitive abilities, judgment, attention, concentration, and sensory or motor functions. However, it does not necessarily interfere with staying awake.

Drivers with an active psychotic disorder will exhibit unpredictable behavior, accompanied with poor judgment.  Drivers with a mood disorder will exhibit slower reaction times during a depressive episode and gradiosity, impulsiveness, irritability, and aggressiveness during a manic episode.  Lastly, drivers with personality disorders may exhibit inflexibility and maladaptive behaviors, along with an increased rash rate.

Guidelines recommend a case-by-case assessment of drivers treated with antidepressant medication.  With long-term use of antidepressants, most drivers tend to develop a tolerance to the sedative effects.  First generation antidepressants, which include tricyclics such as amitriptyline and imipramine, have consistently been shown to interfere with safe driving.  Lastly, second generation antidepressants, including fluoxetine and venlafaxine, have fewer side effects and are generally safe.