NRCME Respiratory Health and Sleep Apnea 5

Question 1

The FMCSA recommends that medical examiners use which tool to systematically screen commercial drivers for OSA risk?

Accepted Answer

A multivariate risk assessment combining BMI, neck circumference, and symptoms

Answer

FMCSA guidance endorses using multiple risk factors—including BMI, neck circumference, blood pressure, and reported symptoms—rather than any single tool alone.

Question 2

Which arterial blood gas pattern most strongly suggests chronic respiratory failure in a driver with advanced COPD?

Accepted Answer

PaO2 58 mmHg, PaCO2 52 mmHg, pH 7.36 with elevated HCO3

Answer

Hypoxemia with hypercapnia and compensatory metabolic alkalosis (elevated bicarbonate, near-normal pH) indicates chronic ventilatory failure.

Question 3

A driver reports using a mandibular advancement device (MAD) for mild OSA. What documentation should the medical examiner request?

Accepted Answer

Post-treatment sleep study confirming AHI reduction to acceptable levels

Answer

Objective evidence of treatment efficacy—via repeat sleep study showing AHI reduction—is required, not just documentation of device ownership.

Question 4

Hypoxic vasoconstriction in the pulmonary vasculature, triggered by OSA-related desaturation, most directly leads to which complication?

Accepted Answer

Pulmonary hypertension

Answer

Chronic hypoxic pulmonary vasoconstriction raises pulmonary artery pressure, ultimately causing pulmonary hypertension and right ventricular strain.

Question 5

A driver's home sleep test shows an AHI of 8 events/hour but the device flagged 40% of the study as artifact. What is the best course of action?

Accepted Answer

Repeat the sleep study—either HSAT or in-lab PSG—due to inadequate data quality

Answer

High artifact rates in a home sleep test render results unreliable; a repeat study is needed to obtain valid diagnostic data.

NRCME - National Registry of Certified Medical Examiners Practice Test

NRCME - National Registry of Certified Medical Examiners Practice Test

NRCME Respiratory Health and Sleep Apnea 5