NRCME Drug Abuse and Alcoholism 5 — Questions and Answers
Question 1: Which of the following best describes the role of the Medical Review Officer (MRO) in DOT drug testing?
- A licensed physician who reviews positive lab results and contacts the driver to verify alternative medical explanations (Correct answer)
- A laboratory technician who confirms positive immunoassay screens by GC-MS
- An FMCSA-appointed federal official who adjudicates contested results
- A substance abuse professional who recommends treatment following a positive test
Correct answer: A licensed physician who reviews positive lab results and contacts the driver to verify alternative medical explanations
The MRO is a licensed physician who receives lab results, contacts drivers to evaluate legitimate medical explanations, and reports final results to employers.
Question 2: Which physiological effect of alcohol intoxication most directly increases the risk of a CMV accident on a highway?
- Increased reaction time and impaired divided-attention performance (Correct answer)
- Hypertension and cardiac arrhythmia
- Peripheral neuropathy reducing grip strength
- Dehydration impairing thermoregulation
Correct answer: Increased reaction time and impaired divided-attention performance
Alcohol prolongs reaction time and degrades the ability to simultaneously monitor multiple driving cues, directly increasing collision risk.
Question 3: A driver with a past opioid use disorder has been in full sustained remission for 4 years, is no longer on any medications, and has no relapses. What is the FMCSA's stance on certification?
- The driver may be certified if the medical examiner determines the condition is well-controlled and poses no driving safety risk (Correct answer)
- The driver is permanently disqualified once an opioid use disorder diagnosis is documented
- The driver must have a 10-year remission period before re-certification is considered
- The driver can only be certified for intrastate operations
Correct answer: The driver may be certified if the medical examiner determines the condition is well-controlled and poses no driving safety risk
FMCSA advisory criteria allow certification when a history of substance use disorder is in full remission and the medical examiner determines there is no current safety risk.
Question 4: Which cannabinoid is responsible for the psychoactive effects of marijuana and is the primary analyte measured in DOT urine testing?
- Delta-9-THC metabolite (11-nor-9-carboxy-THC) (Correct answer)
- Cannabidiol (CBD)
- Cannabinol (CBN)
- Delta-8-THC in its parent form
Correct answer: Delta-9-THC metabolite (11-nor-9-carboxy-THC)
DOT urine drug tests detect 11-nor-9-carboxy-THC (THC-COOH), the primary urinary metabolite of delta-9-THC that indicates marijuana use.
Question 5: Which clinical sign most strongly suggests methamphetamine intoxication in a driver undergoing reasonable suspicion evaluation?
- Dilated pupils, elevated heart rate, pressured speech, and diaphoresis (Correct answer)
- Pinpoint pupils, bradycardia, and respiratory depression
- Horizontal nystagmus and ataxia with normal vital signs
- Conjunctival injection, increased appetite, and slowed reaction time
Correct answer: Dilated pupils, elevated heart rate, pressured speech, and diaphoresis
Methamphetamine is a stimulant causing sympathomimetic signs including mydriasis, tachycardia, pressured speech, and sweating.
Question 6: Under 49 CFR Part 382, how many substances are included in the standard DOT urine drug testing panel?
- Five drug classes: marijuana, cocaine, opioids, amphetamines, and phencyclidine (Correct answer)
- Eight drug classes including barbiturates and benzodiazepines
- Ten drug classes including alcohol and nicotine
- Three drug classes: marijuana, cocaine, and opioids only
Correct answer: Five drug classes: marijuana, cocaine, opioids, amphetamines, and phencyclidine
The standard DOT 5-panel urine test covers marijuana (THC), cocaine, opioids, amphetamines/methamphetamine, and phencyclidine (PCP).
Question 7: A driver discloses that they drink two glasses of wine each night to 'wind down' before sleep. What is the most appropriate medical examiner action?
- Screen further using a validated tool (e.g., AUDIT-C) to assess for alcohol use disorder (Correct answer)
- Certify the driver because moderate drinking is not federally prohibited
- Disqualify the driver immediately based on the self-disclosure
- Document the disclosure and take no further action unless the driver tests positive
Correct answer: Screen further using a validated tool (e.g., AUDIT-C) to assess for alcohol use disorder
Nightly alcohol use warrants structured screening with validated tools like the AUDIT-C to determine whether the pattern meets criteria for alcohol use disorder before making a certification decision.
NRCME Drug Abuse and Alcoholism 5
Which of the following best describes the role of the Medical Review Officer (MRO) in DOT drug testing?