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NRCME Exam 2023 Questions with correct Answers

Driver's Information - ANSWER-Name, address, telephone numbers Social Security, DOB, Age, Sex Driver License Number, License Class, State of Issue New C... [Show More] ertification, Recertification, Follow-Up Required Components of all Exams - ANSWER-Vision Hearing Blood Pressure/Pulse UA Who Can Sign in the Exam Form - ANSWER-Medical Examiner (CME) Optometrist Opthalmologist Non-Discretionary Standards = you must follow the regulation or guideline and may not vary from this - ANSWER-1. Vision 2. Hearing 3. Epilepsy 4. Blood Pressure Vision - ANSWER-1. Must be 20/40 in each and both eyes 2. Must have 70 degrees of peripheral vision 3. Distinguish signal red, green, and amber * If they do not meet these, they may apply for a vision exemption. Provide a copy of the certificate and check off "Accompanied by a ___ waiver/exemption". * May wear glasses or contacts and should mark this in the certification section Hearing - ANSWER-1. Must have less than or equal to 40 db measured at 500 Hz, 1000 Hz, and 2000 Hz 2. Perceives whispered voice at 5 feet in at least 1 ear * If they use a hearing aide, mark it in the long form and PE section * If they do not meet the criteria, they can apply for a hearing exemption. Provide a copy of the certification and check off "Accompanied by a ___ waiver/exemption" * Also look at the tympanic membrane on every exam Conversion from ISO to ANSI - ANSWER-Substract 14 from the hearing loss at 500 Hz Subtract 10 from the hearing loss at 1000 Hz Subtract 8.5 from the hearing loss at 2000 Hz Add those numbers up and divide by 3 to obtain the avg hearing loss in ANSI UA - required on all exams - ANSWER-Specific Gravity - 1.005-1.030 Protein - negative Blood - negative Glucose - negative Epilepsy - ANSWER-By definition, epilepsy is 2 events or the use of anti-seizure meds Always disqualify the driver with a clinical diagnosis of epilepsy * If the driver suffers from epilepsy or has a seizure disorder from an unknown cause (controlled or uncontrolled), they may apply for a seizure exemption. Provide a copy of the certificate and check off "Accompanied by a __ waiver/exemption" Blood Pressure - ANSWER-Follow Stage 1, 2, or 3. Once diagnosed, they will always have a shortened certification time, usually 1 year, whether they are treated or not. They may treat with meds, diet or exercise. Health Hx - ANSWER-Note if the driver is a smoker or non-smoker and record this in the long form Regulations VS. Guidelines - ANSWER-Regulations are enacted by law Guidelines are intended for you to follow 1% Rule - ANSWER-If there is in the examiners opinion, greater than 1% chance in the next year of a sudden incapacitation, you must DQ the driver Certification: Benign hx, negative exam - ANSWER-2 years Certification: Diabetes: Non-Insulin Dependent - ANSWER-1 year Certification: Diabetes: With Insulin (Diabetic) Exemption or Waiver - ANSWER-1 year Certification: Hearing Exemption - ANSWER-1 year Certification: Epilepsy/Seizure Exemption - ANSWER-1 year Certification: Other endocrine disorders - ANSWER-2 years Certification: Mental Disorders - ANSWER-If able to certify, max 1 year during tx Certification: Vision Exemption - ANSWER-Certified for 1 year only Certification: BP - ANSWER-1. Anyone with a hx of HTN (tx with med, diet or weight loss and exercise), and their BP is below 140/90 at the time of the exam, may be granted a 1 year certificate unless they have a hx of Stage 3 HTN. 2. With a hx of stage 3 HTN, then the max certification period is for 6 months only Stage 1 - ANSWER-140-159/90-99 1. If this is the first time diagnosed, confirmed by 2 readings taken on the same day, grant a 1 year certificate 3. If they have a hx of HTN, such as a previous reading on another exam (you will notice they have a 1 year card already, or they are currently taking HTN meds, then they can only receive a 1 time 3 month certificate. - Within 3 months, they must have a BP reading from a provider of less than or equal to 140/90. - Date the card for the original date of the exam - If they do not lower their BP to less than or equal to 140/90 within the 3 month time frame, they will be disqualified * If it is greater than 3 months before they lower their BP to an acceptable level, they should undergo another examination Stage 2 - ANSWER-160-179/100-109 - They are granted a 1 time 3 month certificate and follow the requirements for Stage 1 * The maximum certification will be for a 1 year Stage 3 - ANSWER-180 or above/110 or above They are automatically disqualified until their BP is less than or equal to 140/90 * Their maximum certification will be for 6 months for the rest of the driver's career BP 2 year Certification - ANSWER-If the driver were to improve their health situation by loosing weight, exericse etc, and were taken off of their hypertensive medication, and it remained stable for a period of 2 years Certification of Cardiac conditions: Ischemic heart disease, valvular heart disease, congestive heart failure, cardiac arrhythmias including pace makers, congenital heart problems, peripheral vascular disease, including intermittent claudication that is asymptomatic at rest, DVT and pulmonary embolism, AAA, and those drivers with multiple coronary heart disease risk factors (modifiable and non modifiable) - ANSWER-Most will be certified for 1 year Certification: Heart Transplant - ANSWER-6 months Certification: Some valvular conditions - ANSWER-May be less than 1 year Certification: PCI (angioplasty) - ANSWER-Initial certification is 3-6 months Certification: Respiratory Conditions - Infectious Diseases, Non-Infectious diseases, allergies, post pneumonectomy/ lung resection, trachestomy, primary and secondary lung carcinoma, pulmonary HTN, lung transplant - ANSWER-2 years Certification: Obstructive Sleep Apnea, DVT, and Pulmonary thromboembolism - ANSWER-1 year Certification on Abdominal Conditions: GU, GI, hematologic disorders, neoplastic disorders, and hernias - ANSWER-2 years Certification on Orthopedic/Neurologic Conditions - ANSWER-2 years Hx of embolic or thrombotic stroke - ANSWER-1 year Hx of Intracerebral and Subarachnoid hemorrhage - ANSWER-1 year Hx of TIA - ANSWER-1 year Hx of mild or moderate TBI - ANSWER-1 year Acute seizures - structural insult to the brain - ANSWER-1 year FMCSA definition of epilepsy - ANSWER-2 or more events or use of an anti-seizure medication to control seizures Epilepsy - if 1 event of unknown cause, and no anti-seizure medication is required - ANSWER-Wait 5 years Epilepsy - if from a known cause (med rxn, high fever), - ANSWER-Wait 0-6 months Epilepsy - if the driver has met or exeeded 10 years without the use of antiseizure med and has not suffered a seizure - ANSWER-Consider medication certification Severe depression/thoughts of suicide or suicide attempt - ANSWER-Wait 1 year Non-psychotic major depression, no suicide attempt - ANSWER-Wait 6 months Brief episode of psychosis - ANSWER-Wait 6 months Tx of Psychosis involves the use of electroconvulsive therapy - ANSWER-Wait 6 months Post MI - ANSWER-Wait 2 months PCI (angioplasty) - ANSWER-Wait 1 week Most surgical procedures except heart transplant - ANSWER-Wait 3 months Heart Transplant - ANSWER-Wait 1 year Post-percutaneous balloon mitral valvotomy - ANSWER-Wait 4 weeks Surgical Commissurotomy (valvular procedure) - ANSWER-Wait 4 weeks Post Balloon Valvuloplasty - ANSWER-Wait 1 month Pacemaker for sinus node dysfunction, and AV block - ANSWER-Wait 1 month All other pacemakers - ANSWER-Wait 3 months Anticoagulation therapy - ANSWER-Wait 1 month Pulmonary Embolism/Deep Vein Thrombosis - ANSWER-Wait 3 months Definition of OSA - ANSWER-30 hypo-apnea events per hour OSA Waiting Period - ANSWER-Wait 1 month with CPAP, Wait 3 months with surgery Use of Chantix for smoking after discontinuing use - ANSWER-Wait 2 weeks Neuro disorders without risk of seizures - ANSWER-Wait 1 year Neuro disorders with risk of seizures - ANSWER-Wait 5 years Stroke with risk of seizures - ANSWER-Wait 5 years TIA - ANSWER-Wait 1 year Intracerebra or Subarachnoid hemorrhage - ANSWER-Wait 5 years Surgically repaired AV malformation or aneurysm with no seizure risk - ANSWER-Wait 1 year Surgically removed infratentorial meningiomas, acustic neromas, pituitary adenomas, and benign spinal tumors - ANSWER-Wait 2 years Surgically removed supratentorial or spinal tumors - ANSWER-Wait 2 years Viral encephalitis with early seizures - ANSWER-Wait 10 years Bacterial encephalitis with early seizures - ANSWER-Wait 5 years Infection of the CNS (bacteria meningitis, viral encephalitis without early seizures) - ANSWER-Wait 1 year Mild Traumatic Brain Injury (TBI) without early seizures - ANSWER-Wait 1 year Mild TBI with early seizures - ANSWER-Wait 2 years Moderate TBI without early seizures - ANSWER-Wait 2 years Moderate TBI with early seizures - ANSWER-Wait 5 years Benign Paroxysmal Vertigo and Vestibulopathy - ANSWER-2 months Normal A1C - ANSWER-4-6.5 Any 10 or below is certifiable Exercise Tolerance Test - ANSWER-Required for all Ischemic heart disease Must be above 6 METS Able to exceed 85% of age predicted maximal heart rate or ventricular dysrrythmia Must be done twice a year INR - ANSWER-Must be done monthly and maintain 2-3 and be stable CPAP - ANSWER-Must be at least 70% PFT - ANSWER-FEV1 minimum 65% FVC minimum 60% FEV1/FVC minimum 65% Pulse Ox minimum 92% ABGs minimum 65% Folstein test or Mini Mental State Exam - ANSWER-A score of 25 or greater out of 30 indicates they meet needed conginitive requirements Diabetes Counseling - ANSWER-1. Advice the driver to carry a form of a rapidly absorbing glucose, self-monitoring kit 2. Self-monitor blood glucose levels 1 hour before driving and 1 time every 4 hours 3. The driver should also plan to submit blood glucose monitoring logs at the time of the exam to the medical examinder Vision Counseling - ANSWER-Those who need corrective lenses, bring a spare pair of glasses Contact users should also have a spare of glasses Drivers who use monovision (one contact lens for distance, and one for near vision) cannot certify and must be counseled that this is not allowed Hearing Aides Counseling - ANSWER-Should bring a spare power source 12 Hour Rule - ANSWER-Many OTC decongestants and narcotic cough syrups cause drowsiness. A driver should not drive for 12 hours following using such meds Hx of DVT Counseling - ANSWER-Inform driver of risks of prolonged inactivity Diabetic Waiver - ANSWER-Grandfathered program that has been discontinued but there still exists a small number of waivers, which are granted within the driver population Diabetic Exemption - ANSWER-If the driver is an insulin dependent diabetic, they may apply for a waiver from the FMCSA, exemption program To apply, the driver will need contact info to obtain info on the exemption program, a copy of the Medical Certification Card and Medical Examination (Long) Form both marked "accompanied by an insulin waiver/exemption" Vision Exemption - ANSWER-If the driver does not meet the minimum vision requirements, they may apply for a vision exemption. Must provide a card and long form marked accompanied by a vision waiver/exemption Neurologic Waiver - ANSWER-For minor MS and malignant tumors (marked on the medical certification card and exam form "accompanied by a neurologic waiver/exemption" SPE - ANSWER-Required for loss of limb or limb impairment with a fixed deficit The first, second, and third digits are most important for prehensal ability and grip strength, with the fourth and fifth being less important When the driver is missing only a part of their hand, determine if the driver's grip strength and prehensal ability is adequate enough to drive If SPE is needed, provide a card and form and "accompanied by an SPE" SPE is good for 2 years as long as there are no other conditions or tx that would affect this Diabetes Insulin Dependent without an exemption or waiver - ANSWER-Disqualify Epilepsy - ANSWER-Disqualify Schizophrenia - ANSWER-Disqualify Flat or blunt affect - ANSWER-Disqualify Active Psychosis - ANSWER-Disqualify Active drug or alcohol abuse - ANSWER-Disqualify Monocular Driver - ANSWER-Disqualify without a waiver or exemption Stage 3 BP - ANSWER-Disqualify until it is below 140/90 If the driver is provided with a 1 time 3 month certificate, and the 3 months expires prior to them lowering their blood pressure to 140/90, they should undergo a new exam Pulse Rates - ANSWER-Disqualify when below 60 and above 100 ICD: Implantable Cardioverter Defibrillator - ANSWER-Disqaulify Grade 3 or above Murmur - ANSWER-Disqualify Left ventricular hypertrophy, if does not meet minimum required testing requirements, or is symptomatic - ANSWER-Disqualify Cor pulmonale - ANSWER-Disqualify AAA or thoracic aneurysm that exceeds 5 cm (3.5 cm for thoracic aneurysm or there is a greater than .5 cm increase in size over a 6 month time frame - ANSWER-Disqualify Intermittent claudication - ANSWER-Disqualify if pain at rest Respiratory conditions to DQ - ANSWER-TB during active tx Chronic TB tx with Streptomucin COPD with cough syncope 2 or more spontaneous pneumothorax on the same side Bronchiectasis with hemoptysis Narcolepsy Abdomina, GU to DQ - ANSWER-Renal Failure End Stage kidney disease Hernias - non reducible and symptomatic (pain on exertion) Hematologic, GI, GU disorders based on severity, episodic nature and side effects of tx Neoplastic disease Orthopedic Conditions to DQ - ANSWER-Loss or impairment of limb (fixed deficit), without SPE Any current limitation or disability that may impact the safe operation of a CMV Cervical Rotation must be examined to determine if the driver has enough rotation to see their mirrors and to change lanes They should exhibit 45 degrees to the left and 30 degrees to the right, but this is not defined by regulation [Show Less]

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