NRCME Exam Flashcards

Q: How many questions are on the NRCME certification test?

The NRCME certification test has 120 multiple-choice items: 100 scored items plus 20 unscored pilot items that are not identified to the candidate, so every item should be treated as if it counts.

Q: What score do I need to pass the NRCME exam?

FMCSA sets the passing standard at 71% on the 100 scored items — 71 of 100 correct. The 20 pilot items do not count toward the score in either direction.

Q: What is the NRCME pass rate?

FMCSA does not publish a current first-time pass-rate figure for the NRCME certification test.

Q: How often must NRCME certification be renewed?

Certified medical examiners must complete 5-year refresher training and retake and pass the certification test again within the 9-to-10-year window to remain listed on the National Registry.

Q: What forms does an NRCME-certified examiner complete?

The two core forms are the MCSA-5875 Medical Examination Report (MER), which documents the full physical examination, and the MCSA-5876 Medical Examiner's Certificate (MEC), issued to the driver only when qualified.

Question 1

SAFETEA-LU & the National Registry

Accepted Answer

Public Law 109-59 (Aug 10, 2005), Section 4116(a), directed FMCSA to create the National Registry of Certified Medical Examiners; the directive is codified at 49 U.S.C. 31149.

Question 2

National Registry compliance deadline

Accepted Answer

Since May 21, 2014, an interstate CMV driver's medical certificate is valid only if issued by a medical examiner listed on the FMCSA National Registry.

Question 3

Who is eligible to become a certified ME (49 CFR 390.103)?

Accepted Answer

An advanced practice nurse (APN), doctor of chiropractic (DC), MD, DO, physician assistant (PA), or other medical professional state law authorizes to perform physical examinations.

Question 4

ME refresher & recertification cycle (49 CFR 390.111)

Accepted Answer

A 5-year refresher training (completed 4-5 years after issuance) and a 10-year recertification test (completed 9-10 years after issuance) are required to remain listed on the National Registry.

Question 5

NRCME certification test format

Accepted Answer

120 total items (100 scored + 20 unscored pilot), 2-hour time limit, 71% passing score on scored items. Domain I (Driver's Medical Information) = 70 items; Domain II (Determination of Qualifications & Disposition) = 30 items.

Question 6

Non-delegable ME responsibilities

Accepted Answer

Only the ME may review/discuss health-history answers, perform the body-system exam, order diagnostics/referrals, make the qualification determination, and sign the MER and MEC. Support staff may take vitals, specimens, and screening data under supervision.

Question 7

Form MCSA-5875, Section 1 vs Section 2

Accepted Answer

Section 1 is the driver-completed, signed health-history questionnaire. Section 2 is the ME-completed Examination Report documenting vitals, urinalysis, vision/hearing, body-system findings, and the determination.

Question 8

Driver health-history questionnaire size

Accepted Answer

Section 1 of Form MCSA-5875 asks 32 numbered yes/no health-history questions, plus separate items on surgical history and current medications, signed and dated by the driver.

Question 9

Form MCSA-5875

Accepted Answer

The Medical Examination Report (MER) — the ME's complete clinical record of the DOT physical, covering 14 numbered body systems plus vitals, urinalysis, vision, and hearing. It stays in the ME's own files, not with the driver.

Question 10

Form MCSA-5876

Accepted Answer

The Medical Examiner's Certificate (MEC) — issued to the driver only when found qualified, with or without restrictions. No certificate is issued if the driver is not qualified.

Question 11

MER/MEC recordkeeping requirement (49 CFR 391.43)

Accepted Answer

The ME must retain the original MER (MCSA-5875) and a copy of the MEC (MCSA-5876) for at least 3 years from the date of the examination.

Question 12

Reporting exam results to FMCSA

Accepted Answer

The ME must electronically transmit exam results to the FMCSA National Registry by midnight (local time) of the next calendar day after completing the exam.

Question 13

Vital signs recorded on the MER

Accepted Answer

Pulse rate (numeric) and pulse rhythm (a separate regular Yes/No field), height, weight, and sitting blood pressure (systolic/diastolic); a second BP reading is optional but prudent if the first is elevated.

Question 14

BMI on the DOT physical

Accepted Answer

Body Mass Index is calculated from recorded height and weight but is not itself a numbered MER field. It is a screening cue for obstructive sleep apnea and cardiovascular risk, not a standalone disqualifier.

Question 15

MER urinalysis

Accepted Answer

A screening dipstick test recording 4 values: specific gravity, protein, blood, and glucose (sugar). It is NOT a drug test; abnormal results may indicate a need for further testing (e.g., diabetes, kidney disease).

Question 16

Where is a hernia finding recorded on Form MCSA-5875?

Accepted Answer

Under item 9, Genito-urinary system including hernias — not under the Abdomen line item, even though it is discovered during the abdominal exam.

Question 17

Core vision standard — 49 CFR 391.41(b)(10)

Accepted Answer

Distant visual acuity of at least 20/40 (Snellen) in each eye individually and binocularly, with or without corrective lenses; standard testing distance is 20 feet.

Question 18

Vision field of view & color recognition

Accepted Answer

Horizontal field of vision of at least 70 degrees in EACH eye, plus the ability to recognize red, green, and amber traffic-signal colors — both independently required alongside acuity.

Question 19

Alternative Vision Standard (effective March 22, 2022)

Accepted Answer

Replaced the federal vision exemption program. If the better eye independently meets 20/40 acuity, a 70° field, color recognition, and the deficiency is stable, the ME may certify (with an ophthalmologist/optometrist's Form MCSA-5871) for up to 1 year.

Question 20

First-time Alternative Vision Standard certification

Accepted Answer

A driver certified under the Alternative Vision Standard for the first time must satisfactorily complete a road test administered by the employing motor carrier before operating in interstate commerce.

Question 21

Hearing standard — 49 CFR 391.41(b)(11)

Accepted Answer

Either/or test in the BETTER ear, with or without a hearing aid: first perceive a forced-whispered voice at not less than 5 feet, OR have an average hearing loss no greater than 40 dB at 500/1,000/2,000 Hz.

Question 22

Audiometric calibration standard for hearing testing

Accepted Answer

The audiometric device must be calibrated to American National Standard (formerly ASA Standard) Z24.5—1951.

Question 23

FMCSA hearing exemption program

Accepted Answer

For drivers who fail both the whisper and audiometric paths; an active, case-by-case federal exemption program (unlike vision and diabetes, which now use direct ME-certification pathways). A granted exemption is valid for 2 years.

Question 24

Cardiovascular standard — 49 CFR 391.41(b)(4)

Accepted Answer

Disqualifies a current clinical diagnosis of myocardial infarction, angina pectoris, coronary insufficiency, thrombosis, or other cardiovascular disease known to be accompanied by syncope, dyspnea, collapse, or congestive cardiac failure.

Question 25

Post-MI advisory waiting period

Accepted Answer

Minimum 2-month wait after acute MI before recertification consideration; expect a satisfactory exercise tolerance test 4-6 weeks post-MI, an ejection fraction of at least 40%, and biennial ETT thereafter.

Question 26

CABG and coronary stent advisory waiting periods

Accepted Answer

Coronary artery bypass graft surgery: minimum 3-month wait with cardiology clearance. Coronary artery stent: minimum 1-week wait (longer if tied to an MI).

Question 27

"Known to be accompanied by" (cardiovascular standard)

Accepted Answer

Covers cardiovascular disease currently producing syncope, dyspnea, collapse, or CHF, AND disease likely to cause those symptoms even if it hasn't yet — not every past cardiac diagnosis.

Question 28

Respiratory standard — 49 CFR 391.41(b)(5)

Accepted Answer

No established medical history or clinical diagnosis of a respiratory dysfunction likely to interfere with the ability to safely control and drive a CMV. A functional standard, not a blanket bar on any respiratory diagnosis.

Question 29

OSA screening under FMCSA rules

Accepted Answer

FMCSA sets no single mandatory OSA screening test, BMI cutoff, or AHI threshold. The 2024 Medical Examiner's Handbook directs a multiple-risk-factor clinical judgment approach.

Question 30

AHI (Apnea-Hypopnea Index) severity classification

Accepted Answer

Mild = 5-14 events/hour; Moderate = 15-29 events/hour; Severe = 30 or more events/hour.

Question 31

CPAP compliance criteria for a certified OSA driver

Accepted Answer

All 4 must be met together: at least 4 hours/night of use, on at least 70% of monitored nights, residual AHI below 5, and mask leak under 24 L/min.

Question 32

Hypertension Stage 1 (Medical Examiner's Handbook advisory criteria)

Accepted Answer

Systolic 140-159 and/or diastolic 90-99. Certify for 1 year; recheck annually with a goal of 140/90 or below.

Question 33

Hypertension Stage 2

Accepted Answer

Systolic 160-179 and/or diastolic 100-109. One-time 3-month certificate to start/adjust treatment; if well tolerated and at or below 140/90 at recheck, certify for the remaining portion of the 1-year cycle.

Question 34

Hypertension Stage 3

Accepted Answer

Systolic 180 or higher and/or diastolic 110 or higher. Not qualified, even briefly, until BP is reduced to 140/90 or below and treatment is well tolerated; then certify for 6 months, with rechecks every 6 months.

Question 35

How to stage a blood pressure reading with mixed values

Accepted Answer

Classify by the HIGHER of the systolic or diastolic reading — e.g., 165/92 is Stage 2 because systolic (165) falls in the 160-179 range, even though diastolic alone would only reach Stage 1.

Question 36

2018 ITDM final rule

Accepted Answer

Effective November 19, 2018; replaced the federal insulin exemption program with direct ME certification for insulin-treated diabetes under 49 CFR 391.46.

Question 37

Form MCSA-5870

Accepted Answer

Insulin-Treated Diabetes Mellitus Assessment Form, completed by the driver's TREATING CLINICIAN (not the ME). Must reach the ME within 45 calendar days of the clinician's signature.

Question 38

Maximum certification interval for insulin-treated diabetes

Accepted Answer

12 months — half the standard 24-month maximum; the driver returns annually with a fresh exam and a new MCSA-5870.

Question 39

MCSA-5870 clinical requirements

Accepted Answer

At least 3 months of blood-glucose self-monitoring records, a recent HbA1c (within the preceding 3 months), and no severe hypoglycemic episode (requiring assistance, or causing loss of consciousness, seizure, or coma) in the preceding 3 months.

Question 40

Epilepsy/seizure disorder & antiseizure medication — 49 CFR 391.41(b)(8)

Accepted Answer

A driver currently on antiseizure medication for a diagnosed seizure disorder does NOT meet the base standard, regardless of how well seizures are controlled, absent a federal exemption.

Question 41

Off-medication seizure-free waiting periods (Medical Advisory Criteria)

Accepted Answer

10 or more years off antiseizure medication for established epilepsy; 5 or more years off medication for a single unprovoked seizure without an epilepsy diagnosis.

Question 42

391.41(b)(7) vs 391.41(b)(8)

Accepted Answer

(b)(7) covers rheumatic, arthritic, orthopedic, muscular, neuromuscular, or vascular disease interfering with vehicle control (e.g., MS, Parkinson's, residual stroke deficits). (b)(8) is the narrower epilepsy/loss-of-consciousness standard.

Question 43

Skill Performance Evaluation (SPE) certificate — 49 CFR 391.49

Accepted Answer

Granted by FMCSA (not the ME) for drivers who fail the limb-loss/limb-impairment standards (391.41(b)(1)-(2)). Valid up to 2 years, interstate/foreign commerce only; documented as a restriction on the MEC.

Question 44

2024 SPE upper-limb amendment (Nov 18, 2024)

Accepted Answer

Upper-limb SPE applicants must demonstrate BOTH precision prehension (small controls) and power grasp prehension (steering, gear shift) with each hand, using a prosthesis or orthotic if needed.

Question 45

Psychiatric standard — 49 CFR 391.41(b)(9)

Accepted Answer

Disqualifies a mental, nervous, organic, or functional disease or psychiatric disorder likely to interfere with safe driving. No codified numeric threshold — a case-by-case functional assessment; a diagnosis alone does not automatically disqualify.

Question 46

Reassessment for drivers with a history of psychotic-feature illness

Accepted Answer

FMCSA advisory guidance recommends mental-health specialist evaluation and clearance for commercial driving at least every 2 years.

Question 47

Marijuana and Schedule I drugs — 49 CFR 391.41(b)(12)

Accepted Answer

Use of any Schedule I substance (21 CFR 1308.11), including marijuana, is disqualifying regardless of state legalization. CBD products under 0.3% THC are not Schedule I and not automatically disqualifying.

Question 48

Methadone/buprenorphine-naloxone (MAT) and alcoholism — 391.41(b)(12)-(13)

Accepted Answer

Methadone and buprenorphine-naloxone are not automatically disqualifying; the ME evaluates case-by-case with the prescribing clinician's input. A CURRENT clinical diagnosis of alcoholism (391.41(b)(13)) is automatically disqualifying.

Question 49

Four DOT physical determination outcomes

Accepted Answer

Qualified; qualified with restrictions (e.g., corrective lenses, hearing aid, SPE certificate, exempt intracity zone); temporarily disqualified (pending information or treatment); not qualified.

Question 50

Federal maximum certification interval — 49 CFR 391.45

Accepted Answer

24 months is the ceiling for any Medical Examiner's Certificate. When a driver has multiple monitored conditions, the MOST RESTRICTIVE interval among them governs — intervals are never averaged.

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