NRCME Drug Abuse and Alcoholism 4

Question 1

A commercial driver reports taking tramadol prescribed by their physician for back pain. How should the medical examiner address this?

Accepted Answer

Disqualify the driver because tramadol is a Schedule IV opioid-like analgesic affecting alertness

Answer

Tramadol is a Schedule IV controlled substance with CNS-depressant and opioid-like properties that would disqualify a CMV driver under FMCSA advisory criteria.

Question 2

Which finding on liver function tests is most suggestive of alcoholic liver disease in a CMV driver being evaluated?

Accepted Answer

AST:ALT ratio greater than 2:1

Answer

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.

Question 3

Under DOT regulations, which party is responsible for verifying that a covered employee has completed the SAP process before returning to safety-sensitive duty?

Accepted Answer

The employer, who must receive written documentation from the SAP

Answer

The employer bears the legal responsibility to receive and verify the SAP's written documentation before allowing the driver to resume safety-sensitive functions.

Question 4

What is the cutoff concentration for a confirmed positive THC (marijuana) result on a DOT urine drug test?

Accepted Answer

15 ng/mL on GC-MS confirmatory testing

Answer

DOT requires an initial immunoassay screen at 50 ng/mL, with GC-MS confirmation at 15 ng/mL to report a positive result.

Question 5

A driver tells the medical examiner they stopped drinking alcohol 3 months ago after a DUI conviction. Which evaluation approach is most appropriate?

Accepted Answer

Obtain collateral history, review records, and consider specialist evaluation before certifying

Answer

A recent DUI with only 3 months of self-reported sobriety warrants thorough evaluation including collateral records and possible specialist referral before certification.

NRCME - National Registry of Certified Medical Examiners Practice Test

NRCME - National Registry of Certified Medical Examiners Practice Test

NRCME Drug Abuse and Alcoholism 4