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A 47-year-old commercial driver presents for a recertification exam. Which question is MOST important for the medical examiner to ask first when establishing the driver's medical history?

What is your current diet and exercise routine?

Have you had any changes in your medical conditions, medications, or hospitalizations since your last DOT physical?

How many miles do you drive per week?

Do you have any concerns about your current employer?

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2026 Statistics

Key Facts: NRCME Exam

120

Total Exam Items

FMCSA NRCME

100

Scored Items

FMCSA NRCME

Pilot Items (Unscored)

FMCSA NRCME

71%

Passing Score

FMCSA cut score

2 hours

Time Limit

FMCSA NRCME

10 years

Recertification Cycle

FMCSA

12 hrs / 5 yrs

Continuing Education

FMCSA

100

Practice Questions Here

OpenExamPrep

The NRCME certification test has 120 multiple-choice items (100 scored + 20 unscored pilot), a 2-hour time limit, and a 71% cut score on the 100 scored items. Two domains are tested: Driver's Medical Information (history, physical exam, diagnostics, documentation) and Determination of Driver's Medical Fitness (counseling, risk assessment, certification outcomes). Approximately 30-40% of items are clinical and test understanding of the medical examiner role rather than treatment. Initial certification is valid for 10 years and requires 12 CE hours every 5 years to maintain.

Sample NRCME Practice Questions

Try these sample questions to test your NRCME exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 47-year-old commercial driver presents for a recertification exam. Which question is MOST important for the medical examiner to ask first when establishing the driver's medical history?

A.What is your current diet and exercise routine?

B.Have you had any changes in your medical conditions, medications, or hospitalizations since your last DOT physical?

C.How many miles do you drive per week?

D.Do you have any concerns about your current employer?

Explanation: The medical examiner's primary history-taking responsibility is to identify any new or changed conditions that could affect safe CMV operation since the prior certification. Hospitalizations, new diagnoses, new medications, and worsening of monitored conditions are all relevant to the qualification decision under 49 CFR 391.41.

2During the medical history portion of a CMV driver examination, the driver reports taking three medications but cannot recall the names. What is the BEST next step for the medical examiner?

A.Document 'unknown medications' and proceed with the examination

B.Defer the certification decision and request a written list from the driver's pharmacy or treating clinician

C.Disqualify the driver immediately for incomplete history

D.Estimate the medications based on the driver's reported conditions

Explanation: FMCSA requires the medical examiner to base certification on a complete and accurate medical history. When medication names cannot be verified at the visit, the examiner should defer the decision and request documentation from the pharmacy or prescriber rather than guess or proceed without information.

3A driver discloses that he was previously denied certification by another medical examiner six months ago for uncontrolled hypertension. What is the appropriate response of the current medical examiner?

A.Ignore the prior denial — each exam is independent

B.Review the prior MER (MCSA-5875) and any documentation of treatment, monitor compliance, and assess current status before certifying

C.Automatically deny certification because of the prior denial

D.Issue a 3-month certificate without further evaluation

Explanation: Prior certification outcomes are part of the relevant medical history. The examiner should obtain prior records (MER and any specialist documentation), confirm whether the underlying condition has been adequately treated, and use current findings to drive the decision. Each exam is not 'independent' — patterns of prior monitoring inform the current risk assessment.

4A driver brings his spouse to the examination because he 'forgets things.' During the visit, the spouse answers most history questions for him. What should the medical examiner do?

A.Accept the spouse's answers since spouses know the driver best

B.Conduct the history privately with the driver, document any cognitive concerns, and consider deferral or specialist referral if cognition is in question

C.Refuse to examine the driver

D.Skip the history and rely only on the physical exam

Explanation: Surrogate-only history is a red flag for cognitive impairment, which is potentially disqualifying under 49 CFR 391.41(b)(9) for any condition that interferes with safe CMV operation. The examiner should interview the driver directly, document any cognitive concerns, and refer for formal cognitive assessment if needed before certifying.

5Which of the following is NOT routinely part of the driver identification step on the MCSA-5875 (MER) form?

A.Driver's full name and date of birth

B.Commercial driver's license number and state of issuance

C.Driver's spouse's medical history

D.Driver's address and contact information

Explanation: Identification fields on the MCSA-5875 cover the driver's name, date of birth, address, contact information, and CDL number/state. Family medical history may inform clinical judgment in narrow areas but is not part of the identification block, and a spouse's medical history is not collected on the MER.

6A driver reports a single seizure five years ago following a head injury, with no recurrence and no current anti-seizure medication. He is otherwise healthy. What is the appropriate certification approach?

A.Certify for 24 months without further evaluation

B.Disqualify per 49 CFR 391.41(b)(8) regarding epilepsy/seizure disorders, and inform the driver about the FMCSA Seizure Exemption Program

C.Certify for 3 months pending a neurology note

D.Issue a Skill Performance Evaluation (SPE) certificate

Explanation: 49 CFR 391.41(b)(8) disqualifies any driver with an established medical history or clinical diagnosis of epilepsy or any other condition likely to cause loss of consciousness. A single post-traumatic seizure is reviewed under the Seizure Exemption Program; the examiner cannot grant the exemption directly but should educate the driver about the federal program.

7A driver discloses a 20-year history of major depressive disorder, currently treated with a stable dose of an SSRI for the past three years with no hospitalizations and no suicidal ideation. The driver is functioning well. What is the appropriate examiner action?

A.Disqualify the driver because of the psychiatric diagnosis

B.Review functional status and treatment stability; if stable and not interfering with safe driving, the driver may be certified — typically with a shorter monitoring interval

C.Certify for 24 months without further evaluation

D.Refer to a psychiatrist for emergency evaluation

Explanation: A psychiatric diagnosis itself is not automatically disqualifying. The examiner evaluates functional status, treatment stability, side-effect profile of medications, and any history of safety-relevant events. A driver who is stable on long-standing therapy may be certified, often with a shorter interval to monitor continued stability.

8A driver's history reveals a 25 pack-year smoking history, daytime sleepiness, witnessed apneas (per spouse), and a body mass index of 36 kg/m². Which next step is BEST supported by FMCSA Medical Examiner Handbook guidance?

A.Certify for 24 months and counsel on weight loss

B.Defer certification pending in-laboratory or home sleep study evaluation for obstructive sleep apnea

C.Issue a 3-month certificate and recheck weight

D.Disqualify the driver permanently

Explanation: FMCSA Medical Examiner Handbook guidance lists witnessed apneas, excessive daytime sleepiness, BMI ≥ 33 with other risk factors, and similar findings as triggers for sleep-apnea evaluation. The appropriate action is to defer certification pending a sleep study rather than certify a driver with untreated, suspected moderate-to-severe OSA.

9Which of the following is the MOST appropriate way for the medical examiner to handle a driver's stated unwillingness to disclose certain medical conditions?

A.Certify based on observed exam findings only

B.Inform the driver that knowingly omitting medical information is a falsification of a federal form and decline to certify until honest disclosure is made

C.Issue a 3-month interval to encourage cooperation

D.Allow the driver to skip questions but document them as 'normal'

Explanation: The MCSA-5875 includes the driver's signed health-history attestation. Knowingly providing false information on a federal form is a violation. The examiner should explain the consequence and decline to certify until accurate disclosure is provided, rather than guessing or marking items 'normal.'

10A driver reports a recent admission for chest pain that turned out to be non-cardiac. He has stress-test documentation showing no ischemia. The medical examiner SHOULD:

A.Refuse to certify because of the admission

B.Review the discharge summary and stress-test report, and use those findings together with the current exam to make the certification decision

C.Certify for 24 months with no further questions

D.Order a repeat stress test in the office

Explanation: The medical examiner is not required to repeat tests already performed by treating clinicians. Reviewing the discharge summary and the existing stress test, then integrating those findings with the current exam, is consistent with the examiner's role. Recent admissions are part of the relevant history; the disposition of the admission drives the decision.

About the NRCME Exam

The FMCSA Medical Examiner Certification Test (NRCME) certifies clinicians to perform commercial driver physical examinations under 49 CFR 391.41-49. Passing demonstrates knowledge of the medical examiner role, FMCSA medical advisory criteria, certification intervals, and the MCSA-5875 (MER) and MCSA-5876 (MEC) documentation workflow.

Assessment

100 scored items + 20 unscored pilot items

Time Limit

2 hours

Passing Score

71% (on 100 scored items)

Exam Fee

$300-$400 (training + initial test, combined) (FMCSA / National Registry of Certified Medical Examiners)

NRCME Exam Content Outline

~50-60%

Driver's Medical Information

Identification & history; physical examination & evaluation (vision 20/40, lateral field 70°, color recognition; hearing forced-whisper at 5 ft or 40 dB average at 500/1000/2000 Hz); diagnostic tests (urinalysis, EKG, polysomnography, A1C, BNP, stress testing) and specialist referrals; documentation including the MCSA-5875 MER and MCSA-5876 MEC.

~40-50%

Determination of Driver's Medical Fitness

Health education counseling on lifestyle, smoking, weight, and fatigue; risk assessment integrating clinical findings with the workload of CMV operation; certification outcomes including 24-month standard and shorter 3/6/12-month intervals; federal exemption programs (vision, diabetes, seizure, hearing) and the SPE certificate.

How to Pass the NRCME Exam

What You Need to Know

Passing score: 71% (on 100 scored items)
Assessment: 100 scored items + 20 unscored pilot items
Time limit: 2 hours
Exam fee: $300-$400 (training + initial test, combined)

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

NRCME Study Tips from Top Performers

1Study the medical examiner role explicitly — the test rewards thinking like a gatekeeper, not a treating clinician. Many wrong answers describe what a primary-care physician would do.

2Memorize the core thresholds: distant vision 20/40 each eye and with both, lateral field 70° in the horizontal meridian, hearing forced-whisper at 5 ft (or audiometric 40 dB average at 500/1000/2000 Hz), BP thresholds (Stage 1 at 140-159/90-99 still allows 1-year cert), A1C policy for insulin-treated diabetes, and BMI/neck-circumference triggers for sleep-apnea screening.

3Drill the certification interval logic: when do you certify for 24 months vs 12, 6, 3 months, or deny? Stable vs progressive disease and need for monitoring drive the answer.

4Learn the federal exemption programs (vision, diabetes, seizure, hearing) and the SPE Certificate (Skill Performance Evaluation) so you can recognize when a driver may still qualify despite a disqualifying condition.

5Practice MCSA-5875 (MER) and MCSA-5876 (MEC) workflow questions until you know which form gets which information and how long records must be retained.

6Use timed mixed-domain practice — the real test blends history, exam, diagnostics, documentation, and certification decisions into single scenario items.

Frequently Asked Questions

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. The pilot items are mixed in and not identified, so candidates should treat every item as scored. The 71% passing standard applies only to the 100 scored items.

What score do I need to pass the NRCME exam?

FMCSA sets the cut score at 71% on the 100 scored items, which means 71 of 100 scored questions answered correctly. The 20 pilot items are not counted toward the score in either direction.

Who is eligible to take the NRCME certification test?

Eligible health professionals include MDs, DOs, PAs, NPs/APRNs, and DCs who hold an active state license or registration permitting them to perform commercial driver physical examinations. Candidates must first complete an FMCSA-accepted training course and obtain a National Registry number.

How often must NRCME certification be renewed?

Certified medical examiners must retake and pass the certification test every 10 years to maintain active status on the National Registry. They must also complete 12 hours of FMCSA-accepted continuing education every 5 years between certification cycles.

What forms does an NRCME-certified examiner complete?

The two core forms are the MCSA-5875 Medical Examination Report (MER) Form, which documents the full physical examination, and the MCSA-5876 Medical Examiner's Certificate (MEC), which is the wallet-sized certification card issued to qualified drivers.

What is the standard CMV driver certification interval?

The standard maximum certification interval is 24 months for a fully qualified driver with no monitoring conditions. Shorter intervals of 3, 6, or 12 months are issued when conditions like hypertension, diabetes, or sleep apnea require periodic recheck before the next full physical.