NRCME - National Registry of Certified Medical Examiners Musculoskeletal System Assessment Questions and Answers

Question 1

A 45-year-old driver presents for a recertification exam.
He has a below-the-knee amputation of his left leg and has been using a prosthesis for over 10 years with no issues.
He operates a vehicle with an automatic transmission.
He does not have an FMCSA-issued Skill Performance Evaluation (SPE) certificate.
What is the most appropriate action for the medical examiner?

Accepted Answer

Disqualify the driver until he obtains a Skill Performance Evaluation (SPE) certificate.

Answer

Certify the driver for two years since the condition is stable and he uses a prosthesis.

Answer

Issue a one-year certification contingent on an evaluation from a physical therapist.

Answer

Certify the driver but restrict him to intrastate driving only.

Question 2

When assessing a driver's hands and fingers, which two functions are critical for determining physical qualification under 49 CFR 391.41(b)(2)?

Accepted Answer

Prehension and power grasping.

Answer

Fine motor dexterity and flexion.

Answer

Adduction and abduction.

Answer

Supination and pronation.

Question 3

A 58-year-old CMV driver reports a history of chronic low back pain following a lumbar fusion surgery performed three years ago. He is not taking any narcotic pain medication and reports his pain is well-controlled. On examination, he has a full range of motion of his extremities but has mildly limited lumbar flexion. What is the most important factor for the medical examiner to consider for certification?

Accepted Answer

Whether the condition is stable and does not interfere with safe driving functions.

Answer

The date of his last surgical follow-up appointment.

Answer

The driver's self-reported pain score on a 1-10 scale.

Answer

The presence of a visible surgical scar on his back.

Question 4

A driver with a fixed deficit of the right arm and hand due to a previous injury is seeking a Skill Performance Evaluation (SPE) certificate. As part of the application process, who must complete the medical evaluation summary?

Accepted Answer

A board-certified physiatrist or orthopedic surgeon.

Answer

The Certified Medical Examiner performing the DOT physical.

Answer

The driver's primary care physician.

Answer

Any licensed physical or occupational therapist.

Question 5

Which of the following musculoskeletal conditions requires the most careful evaluation for potential sudden incapacitation while driving?

Accepted Answer

Rheumatoid arthritis with acute inflammatory flare-ups.

Answer

Osteoarthritis of the knee with mild pain.

Answer

Healed Colles' fracture of the wrist from one year ago.

Answer

Scoliosis with a 15-degree curvature.

Question 6

A commercial driver has lost the index and middle fingers on their right hand but retains a functional thumb, ring finger, and little finger. The medical examiner determines this impairment does not interfere with power grasp or prehension. What is the correct course of action?

Accepted Answer

Qualify the driver, as the functional standard for grasp and prehension is met.

Answer

Disqualify the driver as any loss of fingers requires an SPE certificate.

Answer

Issue a 3-month temporary certificate pending a road test.

Answer

Refer the driver to the FMCSA for a mandatory waiver.