NRCME Urinalysis and Renal Disorders 2

Question 1

A CMV driver has been diagnosed with Stage 3 chronic kidney disease (eGFR 30–59 mL/min/1.73m²) but is otherwise stable and asymptomatic. What is the most appropriate certification approach?

Accepted Answer

Evaluate overall functional status and consider shorter certification with monitoring

Answer

Permanent disqualification regardless of stability

Answer

Certify for up to 2 years with no follow-up needed

Answer

Immediate referral for dialysis before any certification

Question 2

A commercial driver on maintenance hemodialysis for end-stage renal disease (ESRD) applies for a DOT medical certificate. Which of the following statements is most accurate?

Accepted Answer

ESRD requiring dialysis generally disqualifies a driver due to the unpredictable nature of the condition

Answer

Dialysis patients are automatically certified for 1 year

Answer

Dialysis is only disqualifying if sessions occur more than three times per week

Answer

The driver may be certified if sessions are scheduled on weekends only

Question 3

Which urinalysis finding is most consistent with a urinary tract infection (UTI) in a commercial driver during a DOT physical?

Accepted Answer

Positive nitrites and leukocyte esterase

Answer

Specific gravity of 1.025

Answer

Glucose 1+ with no protein

Answer

Specific gravity of 1.005 only

Question 4

A CMV driver taking an ACE inhibitor for proteinuric chronic kidney disease presents for his DOT physical. What is the medical examiner's primary concern regarding this medication?

Accepted Answer

The examiner must assess whether the drug causes hypotension or other side effects that impair driving

Answer

ACE inhibitors are not approved for CMV drivers under any circumstances

Answer

ACE inhibitors automatically extend the certification period to 3 years

Answer

The medication negates the need for urinalysis

Question 5

During a DOT physical, a urinalysis reveals bilirubin in the urine. What should the medical examiner suspect?

Accepted Answer

Hepatic or biliary disease affecting liver function

Answer

Renal tubular acidosis

Answer

Benign prostatic hyperplasia

Answer

Dehydration artifact only

Question 6

A commercial driver with a solitary functioning kidney and a normal eGFR, no proteinuria, and well-controlled blood pressure presents for DOT certification. What is the appropriate action?

Accepted Answer

Certify for up to 2 years if renal function is normal and the driver is otherwise qualified

Answer

Permanent disqualification — one kidney is always disqualifying

Answer

Certify only for interstate driving, not intrastate

Answer

Require a Federal exemption before any certification can be issued

Question 7

When a DOT urinalysis shows very low specific gravity (1.001–1.003), which condition should the examiner consider?

Accepted Answer

Diabetes insipidus or polydipsia affecting urine dilution

Answer

Dehydration and urinary concentration

Answer

Urinary tract infection

Answer

Acute kidney injury from rhabdomyolysis