NRCME Musculoskeletal System Assessment 2 — Questions and Answers
Question 1: A commercial driver reports chronic low back pain radiating down the left leg to the foot. Which finding would most likely disqualify them from CMV operation?
- Mild lumbar paraspinal muscle tenderness
- Loss of ankle dorsiflexion strength (1/5) with foot drop (Correct answer)
- Positive straight leg raise at 70 degrees
- Mild reduction in lumbar flexion range of motion
Correct answer: Loss of ankle dorsiflexion strength (1/5) with foot drop
Foot drop due to severe motor deficit (1/5 strength) impairs safe vehicle operation and would disqualify the driver.
Question 2: Which of the following best describes the FMCSA standard for evaluating a driver with a limb amputation?
- All amputees are automatically disqualified from CMV driving
- Amputees may drive if they obtain a Skill Performance Evaluation (SPE) certificate (Correct answer)
- Upper limb amputees are disqualified but lower limb amputees may drive without restriction
- Amputees must demonstrate 20/20 corrected vision before certification
Correct answer: Amputees may drive if they obtain a Skill Performance Evaluation (SPE) certificate
Drivers with limb loss or impairment may qualify through the SPE certificate program if they can safely operate a CMV.
Question 3: During musculoskeletal examination, a driver demonstrates inability to perform a single-leg stance on the right for more than 2 seconds. What is the primary safety concern?
- Increased risk of occupational back injury
- Impaired balance affecting emergency egress and safe boarding/alighting (Correct answer)
- Reduced endurance for long-haul driving
- Risk of developing bilateral knee osteoarthritis
Correct answer: Impaired balance affecting emergency egress and safe boarding/alighting
Poor single-leg balance raises concerns about safe emergency egress and the ability to board/alight from a CMV safely.
Question 4: A truck driver has a history of cervical spine fusion at C5-C6. Which examination finding would be most concerning for certification?
- Mild residual neck stiffness with preserved lateral rotation to 45 degrees bilaterally
- Cervical rotation limited to 15 degrees bilaterally with inability to check blind spots (Correct answer)
- A well-healed surgical scar over the posterior cervical spine
- Mild trapezius tightness without neurological deficits
Correct answer: Cervical rotation limited to 15 degrees bilaterally with inability to check blind spots
Severely restricted cervical rotation prevents adequate blind-spot checking, directly impairing safe driving ability.
Question 5: Which condition involving the wrist and hand would most likely be disqualifying for a commercial driver without further evaluation?
- A healed distal radius fracture with full grip strength
- Severe bilateral carpal tunnel syndrome causing grip weakness and loss of sensation in both hands (Correct answer)
- Mild trigger finger affecting the non-dominant index finger
- A ganglion cyst on the dorsum of the wrist with no functional impairment
Correct answer: Severe bilateral carpal tunnel syndrome causing grip weakness and loss of sensation in both hands
Bilateral grip weakness and sensory loss from severe carpal tunnel syndrome significantly impairs steering control and safe CMV operation.
Question 6: A driver presents with a history of total hip replacement 8 months ago. What is the most important factor in determining fitness for duty?
- The specific prosthesis brand used during surgery
- Functional recovery including strength, range of motion, and ability to operate vehicle controls (Correct answer)
- Whether the surgery was performed under general or regional anesthesia
- The driver's age at time of surgery
Correct answer: Functional recovery including strength, range of motion, and ability to operate vehicle controls
Post-surgical functional recovery — including adequate strength, ROM, and ability to safely use vehicle controls — determines fitness for CMV operation.
Question 7: When evaluating grip strength in a commercial driver, which side should be tested first according to standard examination protocol?
- The dominant hand should always be tested first (Correct answer)
- The non-dominant hand should be tested first to establish a baseline
- Both hands should be tested simultaneously
- The side with reported symptoms or complaint should be tested last
Correct answer: The dominant hand should always be tested first
Standard protocol typically begins with the dominant hand to establish the expected baseline for comparison with the non-dominant side.
NRCME Musculoskeletal System Assessment 2
A commercial driver reports chronic low back pain radiating down the left leg to the foot.
Which finding would most likely disqualify them from CMV operation?