Drug Abuse and Alcoholism Flashcards
7 cards from real NRCME practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Drug Abuse and Alcoholism flashcards as text
A commercial driver reports taking tramadol prescribed by their physician for back pain. How should the medical examiner address this?
Answer: Disqualify the driver because tramadol is a Schedule IV opioid-like analgesic affecting alertness
Tramadol is a Schedule IV controlled substance with CNS-depressant and opioid-like properties that would disqualify a CMV driver under FMCSA advisory criteria.
Which finding on liver function tests is most suggestive of alcoholic liver disease in a CMV driver being evaluated?
Answer: AST:ALT ratio greater than 2:1
An AST:ALT ratio greater than 2:1 is a classic pattern seen in alcoholic liver disease due to alcohol's toxic effect on mitochondria elevating AST disproportionately.
Under DOT regulations, which party is responsible for verifying that a covered employee has completed the SAP process before returning to safety-sensitive duty?
Answer: The employer, who must receive written documentation from the SAP
The employer bears the legal responsibility to receive and verify the SAP's written documentation before allowing the driver to resume safety-sensitive functions.
What is the cutoff concentration for a confirmed positive THC (marijuana) result on a DOT urine drug test?
Answer: 15 ng/mL on GC-MS confirmatory testing
DOT requires an initial immunoassay screen at 50 ng/mL, with GC-MS confirmation at 15 ng/mL to report a positive result.
A driver tells the medical examiner they stopped drinking alcohol 3 months ago after a DUI conviction. Which evaluation approach is most appropriate?
Answer: Obtain collateral history, review records, and consider specialist evaluation before certifying
A recent DUI with only 3 months of self-reported sobriety warrants thorough evaluation including collateral records and possible specialist referral before certification.
Which drug of abuse most commonly produces horizontal gaze nystagmus (HGN) detectable during a standard neurological examination?
Answer: Alcohol and PCP (phencyclidine)
Alcohol and PCP are the substances most reliably associated with horizontal gaze nystagmus, which is why HGN is a standard roadside sobriety test.
A driver's random drug test returns positive for cocaine metabolites. The driver claims they used numbing gel containing benzocaine at the dentist. How should this claim be evaluated?
Answer: Reject the explanation because benzocaine does not produce cocaine metabolites detected by DOT testing
Benzocaine is a local anesthetic that does not produce benzoylecgonine, the specific cocaine metabolite measured in DOT testing; this explanation is pharmacologically invalid.