NRCME Question bank review 2022/2023 with correct Answers Driver 6 weeks post-MI, has cardio cleared to return to work without restrictions. ETT 12 METs, echo EF 65%. Examiner should: - ANSWER-temporarily disqualify driver until driver meets waiting period of 2 months driver is distant, lacks eye contact and shows absolutely no emotional response during the exam. The examiner's best response should be: - ANSWER-disqualify and refer to SAP prior to consideration (flat affect seen in severe depression and schizophrenia) A driver has a blood pressure of 136/92 mm Hg. This is what stage of HTN? - ANSWER-Stage I. BP 140-159/*90-99* 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? - ANSWERTemporarily disqualify the driver until he obtains written clearance for the depression and the medication from the treating provider. Medical clearance is required for all mental health disorders A driver reports that he had a hunting accident wherein he suffered a left orbital fracture. He presents a note at the time of the examination from an ophthalmologist stating "may drive". His exam is unremarkable except for a limitation in peripheral vision in his left eye, which was inconclusive. His distance vision was 20/20 right and 20/40 left. The medical examiner should? - ANSWER-Disqualify the driver pending vision exam to determine if meets peripheral vision requirements A driver is taking Topamax for the treatment of migraine headaches. He reports good management of his headaches and they never seem to interfere with his driving ability with the medication. The medical examiner should - ANSWER-Obtain medical clearance for the condition and the medication Topamax is a medication that is used for seizure control. The examiner should confirm with the prescribing provider that the driver does not take it to control seizures. Positive Babinski"reflex indicates what? What is examiner's next step? - ANSWERindicative of abnormalities in the motor control pathways leading from the cerebral cortex; obtain clearance from a neurologist prior to reconsidering the driver for certification Epilepsy 14 years ago but stopped taking antiepileptic medication on his own 11 years ago. Has not seen a neurologist nor a health care provider in over 10 years and reports no seizures during this period. The examiner should: - ANSWER-Disqualify driver. Even though the driver reports exceeding the 10-year waiting period, it was not under medical supervision and the driver discontinued medication use and treatment outside of medical oversight. Waiting period following MI - ANSWER-2 months Waiting period following CABG - ANSWER-3 months The driver uses hearing aids during the whisper test. He is able to hear at 5 feet on the right and 4 feet on the left. Certification or no? - ANSWER-Certify x 2 yrs. The driver is able to use hearing aids during the whisper test (and this should be marked on the form). A driver must only qualify in 1 ear to certify. Moderate TBI that occurred 3 years ago. neurologist confirmed no seizures and cleared driver. Examiner should - ANSWER-certify x 1 yr waiting period is 2 years, max cert for mod TBI without seizure is 1 yr. Waiting period and max cert in driver with depression with suicide attempt 10 months ago. Reports feeling fine now and compliant with meds. Examiner should - ANSWERDisqualify. Waiting period is 1 yr, max cert 1 yr history a back injury that had occurred 4 years earlier. He states that he was out of work following back surgery for over a year, but since has returned to driving and his last certification was good for 2 years. He lists as his only medication Oxycodone, which he takes only as needed. He reports seeing his "pain doctor" every few months for evaluation. He also reports he has had a steroid injection (series of 3) about a year ago, which "helped a lot." The examiner should: - ANSWER-Request medical clearance. waiting period for ECT - ANSWER-6 months; maintenance ECT is disqualifying SPE for below knee amputation, max cert for? - ANSWER-2 yrs MI 6 months ago. How often for recertification? How often for ETT for monitoring? - ANSWER-Annual recert; ETT every 2 years Which stage of hypertension calls for a medical certificate that expires in one year? - ANSWER-Stage 2 A driver has a limitation of 35 degrees of cervical rotation to the right and left but can view both side mirrors. What is the next best step? - ANSWER-The FMCSA has not adopted a standard cervical range of motion guideline for drivers. However, drivers must be able to view both mirrors. If the driver can rotate the spine as needed to see both mirrors s/he can be certified for *up to 2 years*.