NRCME Urinalysis and Renal Disorders 3

Question 1

Under 49 CFR 391.43, which of the following is NOT part of the standard DOT urinalysis dipstick panel required during the commercial driver medical examination?

Accepted Answer

Urine creatinine concentration

Answer

Protein (albumin)

Answer

Glucose (sugar)

Answer

Specific gravity

Question 2

A medical examiner finds 3+ protein and 2+ glucose on a driver's urinalysis during the DOT physical. What is the most appropriate course of action?

Accepted Answer

Defer certification pending further evaluation of both findings

Answer

Certify for 1 year and recheck at next exam

Answer

Certify immediately because these findings are common in truck drivers

Answer

Issue a 90-day certificate without further workup

Question 3

A CMV driver has successfully received a kidney transplant 18 months ago with stable graft function (eGFR 65), no rejection episodes, and is on stable immunosuppressive therapy. What is the most likely certification outcome?

Accepted Answer

Certification is possible if the driver meets all other standards and the examiner evaluates medication side effects

Answer

Permanent disqualification due to transplant history

Answer

Automatic 2-year certification with no restrictions needed

Answer

Certification only through a Federal exemption program

Question 4

Which of the following best describes the FMCSA's position on proteinuria discovered during a CMV driver's urinalysis?

Accepted Answer

Transient proteinuria from exertion or fever requires no further action if confirmed to be benign

Answer

Any degree of proteinuria is permanently disqualifying

Answer

Proteinuria findings are always ignored unless accompanied by hematuria

Answer

Proteinuria automatically triggers a Federal exemption review

Question 5

A commercial driver with polycystic kidney disease (PKD) and mildly reduced eGFR (62 mL/min) but no hypertension, no pain episodes, and no aneurysms is evaluated for DOT certification. What is the examiner's approach?

Accepted Answer

Evaluate functional status, blood pressure control, and related complications before deciding on certification

Answer

Automatic disqualification for any genetic kidney disorder

Answer

Certify for 2 years without any additional requirements

Answer

Require proof of genetic testing before issuing any certificate

Question 6

Which of the following scenarios would most warrant deferring a commercial driver's DOT certification due to renal findings?

Accepted Answer

A driver with new-onset 3+ proteinuria and an eGFR of 28 not previously evaluated by a physician

Answer

A driver with a urinalysis showing specific gravity of 1.020 and no other abnormalities

Answer

A driver with a history of a single kidney stone 10 years ago, now asymptomatic

Answer

A driver with trace glucose after a high-carbohydrate meal

Question 7

During the DOT physical, the medical examiner discovers that a driver's urine dipstick is positive for urobilinogen. What does this finding suggest?

Accepted Answer

Increased red blood cell destruction or hepatic disease affecting bilirubin processing

Answer

Primary renal failure causing tubular dysfunction

Answer

Urinary tract infection from gram-negative organisms

Answer

Dehydration causing highly concentrated urine