NRCME Physical Examination Procedures and Forms 4

Question 1

A commercial driver presents for a DOT physical with a resting blood pressure of 152/96 mmHg. He reports being on a new antihypertensive medication for three weeks but forgot its name. After re-measurement, BP is 149/94 mmHg. Which of the following correctly describes the certification action and required follow-up?

Accepted Answer

Issue a one-time 3-month certificate to allow treatment stabilization, after which a full 2-year certification requires BP below 140/90 mmHg

Answer

FMCSA guidelines classify BP 140-159/90-99 as Stage 1 hypertension. The driver is currently in Stage 1 (marginally, confirmed on re-test) but has newly initiated treatment. The correct protocol is a one-time 3-month certificate. If at the follow-up visit BP is below 140/90 mmHg, a full 2-year certificate can be issued. Documentation of medication name is helpful but not a disqualifying prerequisite — the examiner can note 'antihypertensive, unknown name per driver' on the form.

Question 2

During a DOT physical, the medical examiner documents a driver's far visual acuity as 20/30 in the right eye, 20/50 in the left eye, and 20/25 in both eyes together (with corrective lenses). Which determination is correct?

Accepted Answer

The driver fails the vision standard due to the left eye being worse than 20/40 and must obtain a Federal Vision Exemption

Answer

FMCSA 49 CFR 391.41(b)(10) requires far visual acuity of at least 20/40 in EACH eye with or without corrective lenses. The left eye at 20/50 (even with correction) fails the individual-eye standard. The driver does not meet the vision standard and would need to apply for a Federal Vision Exemption to continue driving commercially. The examiner should not certify under the standard certificate pathway.

Question 3

A 58-year-old CDL driver with a documented history of a single unprovoked seizure 4 years ago has been seizure-free and off anticonvulsant medication for 3 years. His neurologist provides a letter stating he has a 'low risk of recurrence.' Under FMCSA standards, what is the examiner's correct action?

Accepted Answer

Disqualify the driver and advise him to apply for an individual Federal Exemption through the FMCSA exemption program

Answer

FMCSA 49 CFR 391.41(b)(8) disqualifies any person who has a 'established medical history or clinical diagnosis of epilepsy or any other condition which is likely to cause loss of consciousness or any loss of control.' A single unprovoked seizure constitutes an established history per FMCSA advisory criteria. The standard does not allow certification regardless of seizure-free duration or medication status via the normal certificate pathway. The driver must seek relief through the Federal Exemption program. Neurologist opinions, however supportive, do not override the regulatory standard for the medical examiner's certification decision.

Question 4

When completing the MCSA-5875 (Federal Motor Carrier Safety Administration Medical Examination Report), which of the following represents a documentation error that could constitute grounds for medical examiner decertification?

Accepted Answer

Certifying a driver without recording the examining room blood pressure and pulse values, relying solely on a nurse-obtained triage reading taken 30 minutes prior

Answer

The MCSA-5875 requires the medical examiner — not ancillary staff — to perform and document the physical examination findings, including vital signs. Relying solely on a triage reading obtained by nursing staff without repeating or confirming vital signs during the actual examination constitutes a failure to personally perform the required examination. This can be grounds for decertification as it violates NRCME standards requiring the CME to personally conduct the examination. Using WNL shorthand is generally acceptable practice; leaving the vitamin section blank is minor; performing only specific gravity without other dipstick values may be incomplete but is not the most severe documentation violation listed.

Question 5

A driver presents for a DOT physical examination and discloses a diagnosis of obstructive sleep apnea (OSA) treated with CPAP therapy. He brings documentation showing an AHI of 4 events/hour on his most recent 90-day CPAP compliance report, with 94% usage (≥4 hours/night). His Epworth Sleepiness Scale score today is 7. What is the most defensible certification decision?

Accepted Answer

Certify for one year maximum with the condition that the driver must provide updated CPAP compliance data at each annual examination

Answer

FMCSA does not have a formal OSA regulation but relies on advisory criteria. A driver with diagnosed OSA who is adequately treated (AHI <5 on therapy, good compliance ≥4 hrs/night on ≥70% of nights, no residual excessive sleepiness — ESS ≤10) meets the standard for certification. However, the maximum certificate length for a driver with a condition requiring monitoring (OSA on CPAP) is one year, not two, to allow the examiner to re-evaluate compliance and symptom control annually. Mandatory PSG is not required when home CPAP data is available and within normal limits. A 6-month certificate is not mandatory when the driver demonstrates good control.

NRCME - National Registry of Certified Medical Examiners Practice Test

NRCME - National Registry of Certified Medical Examiners Practice Test

NRCME Physical Examination Procedures and Forms 4