NRCME Cheat Sheet 2026

The 30 highest-yield NRCME facts, distilled from real exam questions. Print it, save it as a PDF, or study it here — free, no sign-up.

1. A driver presents with a valid Medical Examiner's Certificate but the issuing CME is no longer on the National Registry. What is the status of that certificate? → It is immediately invalid
2. Which metabolic condition, if causing symptomatic hypoglycemia, would most likely disqualify a commercial driver? → Insulinoma causing recurrent unpredictable hypoglycemia
3. Which of the following musculoskeletal conditions requires the most careful evaluation for potential sudden incapacitation while driving? → Rheumatoid arthritis with acute inflammatory flare-ups.
4. A medical examiner finds 3+ protein and 2+ glucose on a driver's urinalysis during the DOT physical. What is the most appropriate course of action? → Defer certification pending further evaluation of both findings
5. Which federal form must a certified medical examiner use to document a DOT physical examination? → MCSA-5875
6. A driver discloses use of a legally prescribed medication during the DOT physical. What is the CME's responsibility? → Evaluate whether the medication or underlying condition disqualifies the driver
7. When assessing a driver's hands and fingers, which two functions are critical for determining physical qualification under 49 CFR 391.41(b)(2)? → Prehension and power grasping.
8. Which blood pressure measurement taken during the DOT physical would result in a one-year certification period? → 155/95 mmHg
9. Which of the following is NOT a required component of the DOT physical examination? → Electrocardiogram (ECG)
10. A driver with well-controlled gout reports no acute episodes in the past year and takes allopurinol daily. What certification decision is appropriate? → Certify if no functional impairment affecting vehicle operation
11. Which of the following colors is not necessary to be able to distinguish and recognize in traffic signals and devices? → Blue
12. Which of the following is a medical examiner required to inquire about from a driver with diabetes mellitus? → If the driver has glycosuria
13. Under 49 CFR 391.43, which of the following is NOT part of the standard DOT urinalysis dipstick panel required during the commercial driver medical examination? → Urine creatinine concentration
14. A driver reports a history of adrenal insufficiency (Addison's disease) managed with hydrocortisone. What is the CME's primary concern? → Possibility of acute adrenal crisis causing sudden incapacitation
15. A driver with well-controlled type 2 diabetes managed by diet alone, with no complications, presents for a DOT physical. What certification is appropriate? → Certify for up to 2 years if otherwise qualified, with no additional restriction
16. What does the CME certify by signing the MCSA-5875 Medical Examination Report? → The driver meets or does not meet the physical qualification standards under 49 CFR 391.41
17. When performing the DOT physical examination, which component is used to assess the driver's abdominal organs and hernia status? → Palpation and visual inspection
18. A commercial driver is diagnosed with hypothyroidism and is currently euthyroid on levothyroxine. What is the appropriate certification decision? → Certify if well-controlled with no disqualifying side effects
19. When conducting a vision examination, a driver must have at least what distant visual acuity in each eye with or without correction? → 20/40
20. All but which of the following are respiratory conditions that interfere with oxygen exchange and could result in gradual or sudden incapacitation? → Mitral regurgitation
21. Which of the following psychiatric conditions is generally considered disqualifying for a CMV driver, with very limited exceptions? → A current diagnosis of Schizophrenia
22. A CMV driver's urinalysis shows 2+ glucose. What is the most appropriate next step for the medical examiner? → Investigate further for diabetes mellitus before making a certification decision
23. What is the maximum certification period a CME may issue for a commercial driver who meets all FMCSA medical standards? → 2 years
24. A commercial driver undergoing a DOT physical has a urinalysis positive for blood (hematuria). What should the medical examiner do? → Investigate the cause of hematuria before making a certification decision
25. The FMCSA provides exemption programs for which of the following? → Vision and Diabetes
26. When a DOT urinalysis shows very low specific gravity (1.001–1.003), which condition should the examiner consider? → Diabetes insipidus or polydipsia affecting urine dilution
27. Which statement best describes the purpose of the urinalysis in the FMCSA commercial driver medical examination? → It screens for medical conditions that may affect driving safety
28. Which of the following is true in regard to an implantable cardioverter-defibrillator? → Drivers are at a risk for syncope
29. A CME is conducting a DOT physical for an interstate commercial driver. Which record retention requirement applies to the completed MCSA-5875? → 3 years
30. If a medical examiner uses the number 1 during the physical examination, the medical examiner is indicating which of the following parts of the body system? → General Appearance