NRCME Physical Examination Procedures and Forms 4 — Questions and Answers
Question 1: When documenting blood pressure on the MCSA-5875 form, which finding requires immediate disqualification without treatment?
- Systolic 140-149 mmHg
- Diastolic 90-99 mmHg
- Systolic ≥180 or diastolic ≥110 mmHg (Correct answer)
- Systolic 150-159 mmHg
Correct answer: Systolic ≥180 or diastolic ≥110 mmHg
A blood pressure of ≥180 systolic or ≥110 diastolic requires immediate disqualification until adequately treated and controlled.
Question 2: A CME is examining a driver and notes the driver uses a hearing aid. What is the correct documentation procedure?
- Disqualify the driver automatically
- Note the device and test hearing with the aid in place (Correct answer)
- Retest without the hearing aid only
- Refer to an audiologist before completing the exam
Correct answer: Note the device and test hearing with the aid in place
Drivers may use hearing aids, and the examination should document the device and assess hearing ability with the aid worn.
Question 3: Which section of the MCSA-5875 Medical Examiner Certificate requires the CME's National Registry number?
- Section 1 – Driver Information
- Section 3 – Medical History
- The certification/signature block (Correct answer)
- Section 6 – Laboratory and Other Test Findings
Correct answer: The certification/signature block
The CME must enter their National Registry number in the certification and signature block to validate the medical certificate.
Question 4: During the neurological examination of a CMV driver, the CME observes a resting tremor and pill-rolling movements. What is the most appropriate next step?
- Issue a 1-year certificate with annual monitoring
- Complete the exam and note findings; determine if condition is controlled
- Immediately disqualify and report to FMCSA
- Refer for neurological evaluation before making a certification decision (Correct answer)
Correct answer: Refer for neurological evaluation before making a certification decision
Signs suggestive of Parkinson's disease require specialist evaluation to assess functional impact before a certification determination can be made.
Question 5: What is the correct procedure when a driver presents with a medical variance (exemption or SPE certificate) during the NRCME physical examination?
- Disregard the exemption and apply standard criteria
- Review the variance document and examine the driver against the conditions of the exemption (Correct answer)
- Automatically certify for the maximum 2-year period
- Contact FMCSA before proceeding with the examination
Correct answer: Review the variance document and examine the driver against the conditions of the exemption
The CME must review the exemption or SPE certificate and conduct the examination in accordance with the specific conditions and limitations granted.
Question 6: When performing the physical examination, at what point should the CME review the driver's completed health history form (Section 4)?
- After completing the physical exam
- Before beginning the physical examination (Correct answer)
- Only if the driver reports symptoms
- During documentation after the exam
Correct answer: Before beginning the physical examination
The CME should review the driver's self-reported health history before the physical examination to guide clinical evaluation.
Question 7: A driver's urinalysis on the MCSA-5875 shows 2+ proteinuria. What is the most appropriate action?
- Automatically disqualify the driver
- Issue a 1-year certificate
- Note the finding and evaluate for underlying renal disease before certifying (Correct answer)
- Repeat the urine dipstick immediately and use the second result
Correct answer: Note the finding and evaluate for underlying renal disease before certifying
Significant proteinuria warrants further evaluation for underlying renal or systemic disease before a certification decision is made.
NRCME Physical Examination Procedures and Forms 4
When documenting blood pressure on the MCSA-5875 form, which finding requires immediate disqualification without treatment?