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Respiratory Health and Sleep Apnea 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 Respiratory Health and Sleep Apnea flashcards as text

  1. The FMCSA recommends that medical examiners use which tool to systematically screen commercial drivers for OSA risk?

    Answer: A multivariate risk assessment combining BMI, neck circumference, and symptoms

    FMCSA guidance endorses using multiple risk factors—including BMI, neck circumference, blood pressure, and reported symptoms—rather than any single tool alone.

  2. Which arterial blood gas pattern most strongly suggests chronic respiratory failure in a driver with advanced COPD?

    Answer: PaO2 58 mmHg, PaCO2 52 mmHg, pH 7.36 with elevated HCO3

    Hypoxemia with hypercapnia and compensatory metabolic alkalosis (elevated bicarbonate, near-normal pH) indicates chronic ventilatory failure.

  3. A driver reports using a mandibular advancement device (MAD) for mild OSA. What documentation should the medical examiner request?

    Answer: Post-treatment sleep study confirming AHI reduction to acceptable levels

    Objective evidence of treatment efficacy—via repeat sleep study showing AHI reduction—is required, not just documentation of device ownership.

  4. Hypoxic vasoconstriction in the pulmonary vasculature, triggered by OSA-related desaturation, most directly leads to which complication?

    Answer: Pulmonary hypertension

    Chronic hypoxic pulmonary vasoconstriction raises pulmonary artery pressure, ultimately causing pulmonary hypertension and right ventricular strain.

  5. A driver's home sleep test shows an AHI of 8 events/hour but the device flagged 40% of the study as artifact. What is the best course of action?

    Answer: Repeat the sleep study—either HSAT or in-lab PSG—due to inadequate data quality

    High artifact rates in a home sleep test render results unreliable; a repeat study is needed to obtain valid diagnostic data.

  6. Which of the following is NOT a recognized consequence of untreated severe OSA relevant to commercial driver safety?

    Answer: Improved night vision due to hyperventilation-induced pupil dilation

    Untreated OSA does not improve night vision; rather it causes neurocognitive deficits, metabolic dysfunction, and cardiovascular disease that impair driving safety.

  7. A driver taking theophylline for COPD management reports palpitations and tremor. These symptoms are most relevant to the NRCME exam because they suggest:

    Answer: Theophylline toxicity, which may cause cardiac arrhythmias disqualifying the driver

    Theophylline has a narrow therapeutic index; toxicity can precipitate serious arrhythmias, seizures, and syncope that directly endanger commercial vehicle operation.