USCIS Civil Surgeon Designation Knowledge Assessment — Questions and Answers

Question 1: For influenza vaccination during immigration exams, what is the correct requirement?

Optional for all applicants
Required only for applicants over 65
Required only during influenza season (October–March) (Correct answer)
Required year-round regardless of season

Correct answer: Required only during influenza season (October–March)

Influenza vaccine is required only during the flu season, typically from October through March in the US.

Question 2: What does USCIS require a civil surgeon to do before examining a minor applicant without a parent or legal guardian present?

Ensure a parent or guardian provides written consent and ideally is present, or follow applicable legal requirements (Correct answer)
Contact USCIS for special authorization
Refuse to conduct the examination
Proceed with the exam if the minor is over age 14

Correct answer: Ensure a parent or guardian provides written consent and ideally is present, or follow applicable legal requirements

Minors generally require parental or guardian consent before a medical examination; civil surgeons should follow applicable legal and ethical consent requirements.

Question 3: What is a key obligation civil surgeons have to maintain their USCIS designation?

Maintain board certification in infectious disease
Submit annual reports to USCIS listing all exams performed
Comply with CDC Technical Instructions and USCIS policies for conducting immigration medical exams (Correct answer)
Perform a minimum of 50 immigration exams per year

Correct answer: Comply with CDC Technical Instructions and USCIS policies for conducting immigration medical exams

Designated civil surgeons must follow CDC Technical Instructions and USCIS policies; failure to do so can result in loss of designation.

Question 4: What additional evaluation is required if an applicant has a positive IGRA or TST result during the immigration medical examination?

HIV testing and CD4 count
Chest X-ray to evaluate for active pulmonary tuberculosis (Correct answer)
Immediate deportation proceedings
Bronchoscopy and sputum culture

Correct answer: Chest X-ray to evaluate for active pulmonary tuberculosis

A positive IGRA or TST result requires a chest X-ray to evaluate for signs of active pulmonary tuberculosis, which is a communicable disease of public health significance and a Class A condition.

Question 5: Which CDC publication provides civil surgeons with the detailed protocols for conducting immigration medical examinations?

USPSTF Clinical Guidelines
MMWR Weekly Report
CDC Pink Book (Epidemiology and Prevention of Vaccine-Preventable Diseases)
CDC Technical Instructions for Civil Surgeons (Correct answer)

Correct answer: CDC Technical Instructions for Civil Surgeons

The CDC Technical Instructions for Civil Surgeons is the definitive guide outlining all procedures, tests, and documentation requirements for immigration exams.

Question 6: Who retains the original completed Form I-693 — the civil surgeon, the applicant, or USCIS?

A copy goes to all three parties simultaneously
USCIS receives it directly from the civil surgeon
The civil surgeon retains the original
The applicant retains and submits it to USCIS (Correct answer)

Correct answer: The applicant retains and submits it to USCIS

The applicant receives the sealed Form I-693 from the civil surgeon and submits it to USCIS with their adjustment of status application.

Question 7: What is the civil surgeon's responsibility if an applicant presents with symptoms of an active communicable disease of public health significance during the exam?

Report the case to local or state public health authorities and withhold Form I-693 pending full evaluation (Correct answer)
Complete Form I-693 and note the symptoms as Class B
Send the applicant to an emergency room without completing the exam
Issue Form I-693 and attach a medical referral note

Correct answer: Report the case to local or state public health authorities and withhold Form I-693 pending full evaluation

Civil surgeons must report notifiable communicable diseases to public health authorities and must not finalize Form I-693 until an appropriate evaluation is completed.

Question 8: How is remission from drug addiction assessed in the immigration medical context?

Completion of any drug rehabilitation program
No current abuse and a documented period of sustained remission, assessed by the civil surgeon or specialist (Correct answer)
A letter from the applicant's attorney
A single negative urine drug screen

Correct answer: No current abuse and a documented period of sustained remission, assessed by the civil surgeon or specialist

Sustained remission from drug addiction is evaluated based on the absence of current use and documented history of recovery, not a single test.

Question 9: In what manner must Form I-693 be submitted to USCIS?

Scanned and uploaded to the USCIS online portal by the applicant
Mailed directly to USCIS by the civil surgeon
Faxed to the USCIS field office
In a sealed envelope signed by the civil surgeon across the seal (Correct answer)

Correct answer: In a sealed envelope signed by the civil surgeon across the seal

The completed Form I-693 must be given to the applicant in a sealed envelope with the civil surgeon's signature across the seal to maintain confidentiality and integrity.

Question 10: Can an applicant review their completed Form I-693 before it is sealed by the civil surgeon?

Yes, the applicant has the right to review and ask questions before sealing (Correct answer)
No, the form is confidential and cannot be shown to the applicant
Only the applicant's attorney may review it
Only if the applicant requests a copy in writing

Correct answer: Yes, the applicant has the right to review and ask questions before sealing

The civil surgeon should review the findings with the applicant prior to sealing the form, allowing the applicant to ask questions about their results.

Question 11: What action should a civil surgeon take if they discover they made an error on a sealed Form I-693?

Simply cross out the error on the sealed form
Contact USCIS to request a correction without a new exam
Complete a new Form I-693 with the corrected information and re-seal it (Correct answer)
Ask the applicant to note the correction in their cover letter

Correct answer: Complete a new Form I-693 with the corrected information and re-seal it

Errors on Form I-693 require completing a new, corrected form rather than altering the sealed document.

Question 12: What action should a civil surgeon take if an applicant discloses current use of an illegal controlled substance?

Counsel the applicant and schedule a follow-up exam
Report the disclosure to local law enforcement
Note it as Class B and recommend treatment
Classify as Class A – Drug Abuse on Form I-693 (Correct answer)

Correct answer: Classify as Class A – Drug Abuse on Form I-693

Current drug abuse of a controlled substance is a Class A condition and must be so documented on Form I-693.

Question 13: Which category of medical conditions found during a USCIS immigration medical exam renders an applicant inadmissible?

Class C conditions
Class B conditions
Class A conditions (Correct answer)
Class D conditions

Correct answer: Class A conditions

Class A medical conditions are grounds of inadmissibility under U.S. immigration law and include communicable diseases of public health significance, failure to have required vaccinations, and physical or mental disorders with harmful behavior.

Question 14: What standard diagnostic manual does USCIS instruct civil surgeons to use when classifying mental disorders?

NIMH Diagnostic Guidelines
WHO Classification of Mental Disorders
ICD-10 only
DSM (Diagnostic and Statistical Manual of Mental Disorders) (Correct answer)

Correct answer: DSM (Diagnostic and Statistical Manual of Mental Disorders)

Civil surgeons are instructed to use DSM criteria when classifying mental disorders for the immigration medical evaluation.

Question 15: What should a civil surgeon do if an applicant refuses to be tested for syphilis?

Reschedule the exam and require compliance before proceeding
Cancel the entire exam and notify USCIS
Complete the exam without syphilis testing and submit the form
Document the refusal on Form I-693 and note that the required test was not performed (Correct answer)

Correct answer: Document the refusal on Form I-693 and note that the required test was not performed

If an applicant refuses mandatory testing, the civil surgeon must document the refusal on Form I-693, which will affect the completeness of the exam record.

Question 16: Which communicable diseases are classified as 'quarantinable diseases' by executive order and are automatically Class A for immigration?

HIV, hepatitis B, and hepatitis C
Cholera, plague, smallpox, yellow fever, and viral hemorrhagic fevers (Correct answer)
Influenza, hepatitis A, and norovirus
Measles, mumps, and rubella

Correct answer: Cholera, plague, smallpox, yellow fever, and viral hemorrhagic fevers

Executive Order 13295 designates cholera, plague, smallpox, yellow fever, and viral hemorrhagic fevers as quarantinable diseases, all of which are Class A for immigration.

Question 17: During the physical examination component of the immigration medical exam, which body system is NOT explicitly required to be evaluated?

Neurological system
Lymph nodes
Dental/oral cavity (Correct answer)
Cardiovascular system

Correct answer: Dental/oral cavity

While civil surgeons perform a comprehensive exam, a full dental evaluation is not among the explicitly required body system assessments in the USCIS Technical Instructions for the immigration medical exam.

Question 18: Alcohol use disorder is evaluated in which section of the immigration medical examination?

Part 5 – Mental Disorders and Substance Abuse (Correct answer)
Part 3 – Sexually Transmitted Infections
Part 2 – Medical History
Part 4 – Tuberculosis Evaluation

Correct answer: Part 5 – Mental Disorders and Substance Abuse

Alcohol use disorder falls under substance abuse and is evaluated and documented in Part 5 of Form I-693.

Question 19: How many doses of MMR (measles, mumps, rubella) vaccine are generally required to meet USCIS vaccination requirements?

1 dose
3 doses
2 doses (Correct answer)
4 doses

Correct answer: 2 doses

USCIS generally requires documentation of 2 doses of MMR vaccine, consistent with the U.S. childhood immunization schedule, unless serologic evidence of immunity is documented.

Question 20: What is a key aspect of a Pediatrician's role during well-child visits?

Assessing academic performance
Conducting routine health screenings and vaccinations (Correct answer)
Discussing retirement plans
Administering psychological tests

Correct answer: Conducting routine health screenings and vaccinations

During well-child visits, a key aspect of a Pediatrician's role is to conduct routine health screenings, assess developmental milestones, and administer recommended vaccinations. These visits are crucial for preventive care, early detection of issues, and ensuring children stay healthy and protected against diseases.

Question 21: What is the primary reason that HIV is no longer a Class A condition for US immigration?

CDC determined HIV is not transmitted by casual contact in immigration settings
HIV was removed from the list of communicable diseases of public health significance in 2010 (Correct answer)
Congress passed legislation removing HIV in 2008 effective 2010
HIV can now be fully cured with antiviral therapy

Correct answer: HIV was removed from the list of communicable diseases of public health significance in 2010

Effective January 4, 2010, HIV was removed from the list of communicable diseases of public health significance, ending its status as a ground of inadmissibility.

Question 22: Which tuberculosis test is considered an acceptable alternative to the tuberculin skin test (TST) in immigration medical exams?

QuantiFERON-TB skin patch
Sputum culture
Interferon-Gamma Release Assay (IGRA) (Correct answer)
Chest X-ray alone

Correct answer: Interferon-Gamma Release Assay (IGRA)

IGRA (such as QuantiFERON-TB Gold or T-SPOT.TB) is an acceptable blood-based alternative to the TST for detecting latent TB infection.

Question 23: What does a Class B1 tuberculosis designation mean in the immigration context?

TB that is fully cured with no follow-up needed
Extrapulmonary TB only
Latent TB with no chest X-ray abnormality
Pulmonary TB, active but not suspected infectious, or TB requiring follow-up evaluation (Correct answer)

Correct answer: Pulmonary TB, active but not suspected infectious, or TB requiring follow-up evaluation

Class B1 TB designates pulmonary TB that is active but not currently suspected to be infectious, or cases that require further evaluation.

Question 24: Which professionals can serve as Panel Physicians?

Any healthcare worker
Only DOs
Only MDs
MDs, DOs, and certain other licensed health professionals (Correct answer)

Correct answer: MDs, DOs, and certain other licensed health professionals

Panel Physicians are typically Medical Doctors (MDs) or Doctors of Osteopathic Medicine (DOs). However, in some locations, other licensed health professionals, such as those with equivalent medical degrees recognized by the U.S. government, may also be designated to perform these specific immigration medical examinations.

Question 25: Where are Panel Physicians usually located?

Only in U.S. embassies
Any healthcare facility
In designated clinics in the applicant's home country (Correct answer)
Only in academic hospitals

Correct answer: In designated clinics in the applicant's home country

Panel Physicians are usually located in designated clinics within the applicant's home country or country of residence, outside of the United States. This arrangement allows visa applicants to complete their required medical examinations locally before their visa interview at a U.S. embassy or consulate.

Question 26: Which document provides the authoritative guidelines that civil surgeons must follow when performing immigration medical examinations?

CDC Yellow Book for International Travel
USCIS Technical Instructions for Civil Surgeons (Correct answer)
American College of Physicians Clinical Guidelines
The INA Section 212 regulations only

Correct answer: USCIS Technical Instructions for Civil Surgeons

The USCIS Technical Instructions for Civil Surgeons provide the authoritative, detailed requirements for conducting immigration medical examinations, including examination procedures, testing protocols, and documentation standards.

Question 27: Which federal law requires USCIS to mandate vaccinations for immigration medical exams?

Public Health Service Act
Homeland Security Act
Affordable Care Act
Immigration and Nationality Act (INA) (Correct answer)

Correct answer: Immigration and Nationality Act (INA)

The Immigration and Nationality Act (INA) requires applicants to receive vaccinations against vaccine-preventable diseases as a condition of admission.

Question 28: Who appoints Civil Surgeons in the United States?

American Medical Association (AMA)
U.S. Department of Health
U.S. Citizenship and Immigration Services (USCIS) (Correct answer)
Centers for Disease Control and Prevention (CDC)

Correct answer: U.S. Citizenship and Immigration Services (USCIS)

USCIS designates Civil Surgeons to perform medical exams for immigration applicants.

Question 29: What distinguishes a Class A medical condition from a Class B medical condition in immigration exams?

Class A is curable; Class B is chronic
Class A requires surgery; Class B requires medication only
Class A is for adults and Class B is for children
Class A conditions make an applicant inadmissible; Class B conditions are notable but not automatically disqualifying (Correct answer)

Correct answer: Class A conditions make an applicant inadmissible; Class B conditions are notable but not automatically disqualifying

Class A conditions render an applicant inadmissible to the US, while Class B conditions are medically significant departures from normal health that do not automatically bar admission.

Question 30: What follow-up is required after an immigration applicant is treated for Class A syphilis before their case is adjudicated?

A waiting period of one year before reapplying
Documentation of completed treatment and follow-up serologic testing to confirm response (Correct answer)
Immediate re-examination by a second civil surgeon
Submission of a waiver application to USCIS

Correct answer: Documentation of completed treatment and follow-up serologic testing to confirm response

After treatment for Class A syphilis, the applicant must provide documentation of completed treatment and serologic evidence of treatment response.

Question 31: What is the minimum years of professional experience typically required for a physician to apply for civil surgeon designation?

4 years of professional experience after completing training (Correct answer)
10 years in general practice
Board certification with no minimum experience years
1 year of professional experience

Correct answer: 4 years of professional experience after completing training

USCIS generally requires that applicants for civil surgeon designation have at least 4 years of professional experience in the practice of medicine.

Question 32: What is the civil surgeon's role when evaluating an applicant for mental health conditions during the immigration exam?

Provide full psychiatric treatment
Diagnose all DSM-5 conditions and report them to USCIS
Conduct formal neuropsychological testing for all applicants
Screen for mental disorders and assess whether harmful behavior is present or likely to recur (Correct answer)

Correct answer: Screen for mental disorders and assess whether harmful behavior is present or likely to recur

The civil surgeon screens for mental disorders and evaluates whether any identified disorder is associated with harmful behavior, not to provide treatment or diagnose all conditions.

Question 33: Which mental health professional credential is acceptable for the specialist evaluation of an immigration applicant referred by a civil surgeon?

A certified addiction counselor without a doctoral degree
Only a board-certified psychiatrist
A licensed psychiatrist or licensed clinical psychologist (Correct answer)
Any licensed social worker

Correct answer: A licensed psychiatrist or licensed clinical psychologist

Referrals for mental health specialist evaluation should go to licensed psychiatrists or licensed clinical psychologists qualified to make DSM-based diagnoses.

Question 34: When performing the tuberculin skin test (TST), how many hours after placement must the result be read?

Immediately after placement
1 week after placement
48–72 hours after placement (Correct answer)
24 hours after placement

Correct answer: 48–72 hours after placement

The TST must be read between 48 and 72 hours after intradermal placement to accurately measure induration.

Question 35: If a civil surgeon's designation expires while an applicant's Form I-693 is still valid, is the form still acceptable?

Yes, as long as the form was signed while the civil surgeon's designation was active (Correct answer)
Only if the applicant can prove they cannot access another civil surgeon
Only if USCIS issues a waiver
No, the form becomes invalid when the civil surgeon's designation expires

Correct answer: Yes, as long as the form was signed while the civil surgeon's designation was active

A Form I-693 remains valid if it was properly completed and signed while the civil surgeon held an active USCIS designation, even if the designation later expires.

Question 36: What language assistance must a civil surgeon provide to an applicant who does not speak English?

Require the applicant to bring their own interpreter
Proceed with written communication only
Decline the examination if no English is spoken
Use an interpreter or other language assistance to ensure the applicant understands the exam and provides accurate history (Correct answer)

Correct answer: Use an interpreter or other language assistance to ensure the applicant understands the exam and provides accurate history

Civil surgeons are expected to provide or arrange language assistance to ensure accurate history-taking and that applicants understand the examination process.

Question 37: Which body issues technical instructions guiding civil surgeons on mental health evaluations for immigration?

American Psychiatric Association
CDC Division of Global Migration and Quarantine (DGMQ) (Correct answer)
USCIS directly via Form I-693 instructions only
Department of Justice

Correct answer: CDC Division of Global Migration and Quarantine (DGMQ)

CDC's Division of Global Migration and Quarantine publishes the Technical Instructions that guide civil surgeons on all aspects of the immigration medical exam, including mental health.

Question 38: What is the TST induration threshold considered positive for recent TB converters or those with known TB exposure?

5 mm or more
15 mm or more
10 mm or more (Correct answer)
Any measurable induration

Correct answer: 10 mm or more

For recent TB converters or close contacts of infectious TB cases, 10 mm of induration is the threshold for a positive TST result.

Question 39: Who is authorized to conduct the immigration medical examination and complete Form I-693?

A USCIS-designated civil surgeon (Correct answer)
A foreign-licensed doctor with US work authorization
A state health department physician
Any licensed US physician

Correct answer: A USCIS-designated civil surgeon

Only a physician specifically designated by USCIS as a civil surgeon is authorized to conduct the immigration medical exam and complete Form I-693.

Question 40: Which of the following vaccines is NOT currently required for immigration medical exams in the US?

Hepatitis B vaccine
MMR vaccine
Varicella vaccine
Typhoid vaccine (Correct answer)

Correct answer: Typhoid vaccine

Typhoid vaccine is not on the USCIS/ACIP required list for immigration medical exams, unlike hepatitis B, MMR, and varicella.

Question 41: Who is authorized to perform the immigration medical examination for applicants adjusting status inside the United States?

USCIS-designated civil surgeons only (Correct answer)
Any licensed physician
Any board-certified internist
State health department physicians

Correct answer: USCIS-designated civil surgeons only

Only USCIS-designated civil surgeons are authorized to perform immigration medical examinations for applicants adjusting their status within the United States.

Question 42: An immigration applicant tests positive on the initial RPR syphilis screen. What is the next required step?

Repeat the RPR test twice before confirming
Perform a confirmatory treponemal test (e.g., FTA-ABS or TP-PA) (Correct answer)
Immediately classify as Class A and recommend treatment
Refer to infectious disease specialist before completing Form I-693

Correct answer: Perform a confirmatory treponemal test (e.g., FTA-ABS or TP-PA)

A reactive RPR must be confirmed with a treponemal-specific test to distinguish true syphilis from biological false-positive reactions.

Question 43: Which of the following is included as a Class A medical condition that makes an applicant inadmissible?

Seasonal allergies
Type 2 diabetes mellitus
Controlled hypertension
Drug addiction or abuse (Correct answer)

Correct answer: Drug addiction or abuse

Drug addiction or abuse is classified as a Class A medical condition, making an applicant inadmissible to the United States under INA section 212(a)(1).

Question 44: How long is a completed Form I-693 valid from the date of the civil surgeon's signature?

6 months
1 year
2 years (Correct answer)
5 years

Correct answer: 2 years

A completed Form I-693 is generally valid for 2 years from the date the civil surgeon signs it, provided it is submitted to USCIS within that period.

Question 45: What resource can applicants use to locate a USCIS-designated civil surgeon near them?

State medical board directories
American Medical Association physician finder
CDC clinic locator
The USCIS civil surgeon locator tool on the USCIS website (Correct answer)

Correct answer: The USCIS civil surgeon locator tool on the USCIS website

USCIS maintains a searchable locator tool on its official website that allows applicants to find designated civil surgeons by zip code.

Question 46: How frequently does the USCIS civil surgeon designation need to be renewed?

Every 5 years
Every 2 years
Designation does not automatically expire but must be maintained through ongoing compliance (Correct answer)
Every year with an annual attestation

Correct answer: Designation does not automatically expire but must be maintained through ongoing compliance

Civil surgeon designation does not have a fixed expiration date but can be revoked for non-compliance; USCIS periodically reviews designations.

Question 47: A past history of drug abuse that is now in full sustained remission should be documented as which class on Form I-693?

Class A – Drug Abuse
Class C – Drug History, Resolved
Class B – Drug Abuse, in Remission (Correct answer)
No notation needed if fully resolved

Correct answer: Class B – Drug Abuse, in Remission

A history of drug abuse in sustained remission is classified as Class B on Form I-693, which is notable but not grounds for inadmissibility.

Question 48: Which type of documentation may a civil surgeon request to verify an applicant's identity before conducting the immigration medical exam?

USCIS receipt notice alone
Social Security number only
Government-issued photo identification such as a passport or state ID (Correct answer)
No identification is required by USCIS

Correct answer: Government-issued photo identification such as a passport or state ID

Civil surgeons should verify the applicant's identity using government-issued photo identification to ensure the exam is conducted for the correct individual.

Question 49: What must a civil surgeon include when documenting a Class A medical condition on Form I-693?

The applicant's insurance information
A referral letter to a specialist
The specific diagnosis, supporting test results, and a statement of inadmissibility (Correct answer)
Only the diagnosis name

Correct answer: The specific diagnosis, supporting test results, and a statement of inadmissibility

A Class A condition requires the civil surgeon to document the specific diagnosis, supporting evidence (test results), and indicate that the condition renders the applicant inadmissible.

Question 50: Civil Surgeons perform immigration medical exams for which form?

Form I-130
Form I-94
Form I-140
Form I-693 (Correct answer)

Correct answer: Form I-693

Form I-693 is the Report of Medical Examination and Vaccination Record used by Civil Surgeons.

Question 51: If a civil surgeon suspects an applicant has an active communicable disease of public health significance, what immediate action is required?

Contact USCIS directly to have the applicant detained
Refer the applicant for further evaluation and do not issue Form I-693 until the workup is complete (Correct answer)
Issue Form I-693 with a Class A notation and allow the applicant to seek treatment independently
Complete the form and include a note suggesting follow-up

Correct answer: Refer the applicant for further evaluation and do not issue Form I-693 until the workup is complete

When a Class A communicable disease is suspected, the civil surgeon must complete a thorough workup before completing Form I-693, not issue an incomplete form.

Question 52: What is the civil surgeon's responsibility regarding record retention for Form I-693?

Keep a copy of Form I-693 in the applicant's file for at least 2 years (Correct answer)
Send a copy to CDC within 30 days
No retention required after submission
Retain indefinitely in a USCIS-approved database

Correct answer: Keep a copy of Form I-693 in the applicant's file for at least 2 years

Civil surgeons are required to retain a copy of Form I-693 in the applicant's records for a minimum of 2 years.

Question 53: What is the civil surgeon required to do if an applicant is a child under age 11 and cannot complete the standard TB screening protocol?

Skip TB screening entirely for children under 11
Follow age-appropriate USCIS Technical Instructions for pediatric TB evaluation (Correct answer)
Refer the child to an infectious disease specialist before completing the exam
Require the parent or guardian to sign a TB exposure waiver

Correct answer: Follow age-appropriate USCIS Technical Instructions for pediatric TB evaluation

Civil surgeons must follow age-specific protocols outlined in the USCIS Technical Instructions, which provide modified TB screening approaches for young children who may not be appropriate candidates for standard adult protocols.

Question 54: What happens if an applicant's Form I-693 expires before USCIS adjudicates their case?

The civil surgeon can re-sign the existing form
The applicant must submit an affidavit explaining the delay
USCIS automatically extends the validity
The applicant must undergo a new medical examination with a civil surgeon (Correct answer)

Correct answer: The applicant must undergo a new medical examination with a civil surgeon

If Form I-693 expires, the applicant must schedule a new immigration medical exam with a civil surgeon to obtain a current form.

Question 55: What should a civil surgeon do if an applicant presents with documented proof of prior vaccination series completed abroad?

Require all vaccinations to be repeated regardless of prior documentation
Accept valid written documentation and record it on Form I-693 without repeating vaccines (Correct answer)
Refer the applicant to the CDC for verification of foreign vaccination records
Disregard foreign vaccination records and start the series fresh

Correct answer: Accept valid written documentation and record it on Form I-693 without repeating vaccines

Civil surgeons may accept valid written documentation of vaccinations completed abroad and record them on Form I-693, avoiding unnecessary repeat vaccinations when records meet acceptability standards.

Question 56: What is the primary focus of a Pediatrician's practice?

Pediatric surgery
Adult medicine
Geriatric care
Child and adolescent health (Correct answer)

Correct answer: Child and adolescent health

A Pediatrician's primary focus is on the physical, mental, and emotional health of infants, children, and adolescents. They specialize in the unique healthcare needs of this age group, from birth through young adulthood, providing comprehensive medical care.

Question 57: What is the definition of 'drug addiction' for immigration medical exam purposes?

Physical dependence on any prescription medication
A pattern of pathological substance use causing impaired functioning or distress, meeting DSM criteria for substance use disorder (Correct answer)
Any use of drugs more than once per month
Use of marijuana in states where it is not legally permitted

Correct answer: A pattern of pathological substance use causing impaired functioning or distress, meeting DSM criteria for substance use disorder

Drug addiction for immigration purposes means a substance use disorder meeting DSM diagnostic criteria, involving pathological use patterns and functional impairment.

Question 58: Which government agency grants civil surgeon designation to physicians in the United States?

U.S. Citizenship and Immigration Services (USCIS) (Correct answer)
Centers for Disease Control and Prevention (CDC)
American Medical Association (AMA)
Department of Health and Human Services (HHS)

Correct answer: U.S. Citizenship and Immigration Services (USCIS)

USCIS designates civil surgeons through its field offices; it is not the CDC or AMA that grants this specific immigration-exam authority.

Question 59: If an applicant denies substance abuse history but exhibits signs of impairment during the exam, what should the civil surgeon do?

Refuse to complete the examination
Accept the denial and complete the form without further inquiry
Document the clinical observations and consider ordering drug toxicology screening if clinically warranted (Correct answer)
Contact USCIS immediately for guidance

Correct answer: Document the clinical observations and consider ordering drug toxicology screening if clinically warranted

When objective signs contradict the applicant's denial, the civil surgeon should document findings and may pursue additional clinical evaluation, including toxicology testing.

Question 60: Which type of substance abuse finding is considered a Class A condition for immigration?

Any past recreational drug use
Use of prescription medications for pain management
Alcohol use disorder in remission for 2+ years
Current drug abuse or addiction to a controlled substance (Correct answer)

Correct answer: Current drug abuse or addiction to a controlled substance

Active drug abuse or drug addiction to a controlled substance is a Class A condition; historical abuse in sustained remission is not automatically disqualifying.

Question 61: What is the significance of the civil surgeon's signature and date on Form I-693 for validity purposes?

The date only affects the vaccination record section
The form is valid from the date the applicant submits it to USCIS
The signature and date start the 2-year validity clock for the form (Correct answer)
USCIS determines validity from the date of the blood draw, not the signature

Correct answer: The signature and date start the 2-year validity clock for the form

The 2-year validity period of Form I-693 begins on the date the civil surgeon signs the form, making the signature date critical for determining expiration.

Question 62: What should a civil surgeon do if an adult applicant has no vaccination records and no serologic evidence of immunity?

Vaccinate according to the catch-up immunization schedule (Correct answer)
Mark the applicant as inadmissible pending vaccination
Skip vaccinations if the applicant is over 18
Defer vaccination to the applicant's personal physician

Correct answer: Vaccinate according to the catch-up immunization schedule

Without documentation or serologic proof of immunity, the civil surgeon must administer vaccines per the ACIP catch-up schedule.

Question 63: What serological test is required for applicants 15 years of age and older during the immigration medical examination?

HIV antibody test
Gonorrhea culture
Hepatitis B surface antigen
Syphilis serology (RPR or VDRL) (Correct answer)

Correct answer: Syphilis serology (RPR or VDRL)

Syphilis serology using RPR or VDRL testing is required for all applicants 15 years of age and older as part of the USCIS immigration medical examination.

Question 64: What is the civil surgeon's responsibility after USCIS adjudicates an applicant's case?

Only retain records if the applicant's case was denied
Retain the applicant's medical records for the required period (at least 2 years) regardless of adjudication outcome (Correct answer)
Transfer all records to USCIS upon adjudication
Destroy the medical records once USCIS notifies of approval

Correct answer: Retain the applicant's medical records for the required period (at least 2 years) regardless of adjudication outcome

Civil surgeons must retain copies of Form I-693 and supporting medical records for at least 2 years regardless of the adjudication outcome.

Question 65: What must a civil surgeon certify by signing Form I-693?

That the applicant is admissible to the United States
That the applicant has received all required vaccinations
That all laboratory tests were personally performed by the civil surgeon
That the examination was performed and the results are accurate and complete to the best of their knowledge (Correct answer)

Correct answer: That the examination was performed and the results are accurate and complete to the best of their knowledge

By signing Form I-693, the civil surgeon certifies that they performed the examination and that all information recorded is accurate and complete to their best knowledge.

Question 66: What notation must the civil surgeon include when documenting a finding of active tuberculosis disease on Form I-693?

Class A – Tuberculosis, Active Disease, with supporting diagnostic results (Correct answer)
Class D – Potential Tuberculosis
Class B1 – Tuberculosis, Pulmonary
Class C – Inactive Tuberculosis

Correct answer: Class A – Tuberculosis, Active Disease, with supporting diagnostic results

Active tuberculosis disease must be classified as a Class A condition on Form I-693, with diagnostic findings documented to support inadmissibility.

Question 67: What CDC schedule do civil surgeons use as the basis for required vaccinations?

World Health Organization (WHO) schedule
American Academy of Pediatrics (AAP) schedule
Advisory Committee on Immunization Practices (ACIP) schedule (Correct answer)
Department of Defense immunization schedule

Correct answer: Advisory Committee on Immunization Practices (ACIP) schedule

Civil surgeons must follow the ACIP-recommended immunization schedule, which is endorsed by CDC for all required vaccines.

Question 68: Which of the following is a common role of a Pediatrician?

Performing adult surgeries
Diagnosing geriatric conditions
Conducting physical exams for adults
Prescribing medication for chronic illnesses (Correct answer)

Correct answer: Prescribing medication for chronic illnesses

A common role of a Pediatrician is to diagnose and treat a wide range of acute and chronic illnesses specific to children. This includes prescribing appropriate medications, managing long-term conditions like asthma or diabetes, and providing guidance on preventive care.

Question 69: Which vaccine is specifically required for applicants aged 11–12 years during the immigration medical exam?

Rotavirus
HPV
Hepatitis A
Tdap (tetanus, diphtheria, pertussis) (Correct answer)

Correct answer: Tdap (tetanus, diphtheria, pertussis)

Tdap is the recommended booster for preteens aged 11–12, and it is required during immigration medical exams for that age group.

Question 70: What does 'harmful behavior' mean in the context of immigration mental health evaluation?

Behavior that results in arrest or criminal charges only
Any behavior that violates local laws
Any behavior requiring emergency psychiatric intervention
Behavior that poses a threat to the property, safety, or welfare of the applicant or others (Correct answer)

Correct answer: Behavior that poses a threat to the property, safety, or welfare of the applicant or others

USCIS defines harmful behavior as behavior that is or has been a threat to the property, safety, or welfare of the individual or others.

Question 71: Hansen's disease (leprosy) is a Class A communicable disease for immigration purposes. Which form of the disease triggers inadmissibility?

Any form of leprosy regardless of infectivity
Non-infectious (tuberculoid) leprosy
Infectious (lepromatous) leprosy (Correct answer)
Only leprosy with documented transmission

Correct answer: Infectious (lepromatous) leprosy

Only infectious (lepromatous) leprosy is classified as a Class A condition; non-infectious forms are classified as Class B.

Question 72: How long is a completed Form I-693 valid after the civil surgeon signs it?

1 year from the date of the exam
2 years from the date of the civil surgeon's signature (Correct answer)
Indefinitely until USCIS requests a new one
6 months from the date of filing

Correct answer: 2 years from the date of the civil surgeon's signature

Form I-693 is valid for 2 years from the date the civil surgeon signs and dates the form.

Question 73: If an applicant has a contraindication to MMR vaccine, what must the civil surgeon do?

Document the contraindication on Form I-693 and note why the vaccine was not given (Correct answer)
Administer the vaccine anyway and monitor for reactions
Automatically deny the medical exam
Refer the applicant to a specialist before completing the form

Correct answer: Document the contraindication on Form I-693 and note why the vaccine was not given

When a contraindication exists, the civil surgeon must document it on Form I-693, explaining the medical reason the vaccine was not administered.

Question 74: Which part of Form I-693 addresses mental disorders and substance abuse history?

Part 5 – Mental Disorders and Substance Abuse (Correct answer)
Part 2 – Medical History
Part 7 – Civil Surgeon Certification
Part 1 – Applicant Information

Correct answer: Part 5 – Mental Disorders and Substance Abuse

Part 5 of Form I-693 is specifically designated for documenting findings related to mental disorders and substance abuse.

Question 75: Can an applicant receive a waiver for a Class A mental health or substance abuse condition?

Only if the applicant agrees to mandatory treatment in the US
Only if the condition is in complete remission for 10 years
Yes, waivers may be granted by USCIS under specific circumstances (Correct answer)
No, Class A mental health conditions are never waivable

Correct answer: Yes, waivers may be granted by USCIS under specific circumstances

USCIS may grant waivers for Class A mental health and substance abuse conditions, taking into account factors such as remission, treatment history, and public safety.

Question 76: Which section of Form I-693 records the results of the tuberculosis evaluation?

Part 2 – Medical History
Part 4 – Tuberculosis (TB) Evaluation (Correct answer)
Part 1 – Applicant Information
Part 6 – Vaccination Record

Correct answer: Part 4 – Tuberculosis (TB) Evaluation

Part 4 of Form I-693 is dedicated to recording all tuberculosis evaluation findings, including TST and IGRA results.

Question 77: Which of the following physicians CANNOT perform immigration medical exams in the United States?

A board-certified internist who is also a designated civil surgeon
A family physician designated as a civil surgeon
A USCIS-designated civil surgeon with a D.O. degree
A licensed US physician who has not been designated by USCIS as a civil surgeon (Correct answer)

Correct answer: A licensed US physician who has not been designated by USCIS as a civil surgeon

Only USCIS-designated civil surgeons may perform immigration medical exams; a licensed physician who lacks USCIS designation is not authorized.

Question 78: At what age does gonorrhea testing become required during immigration medical exams?

All ages
21 years and older
15 years and older (Correct answer)
18 years and older

Correct answer: 15 years and older

Gonorrhea testing is required for all applicants aged 15 and older as part of the mandatory communicable disease screening.

Question 79: At what age does the hepatitis A vaccine become required for immigration medical exams?

11–12 years
12–23 months (Correct answer)
6–10 years
2–5 years

Correct answer: 12–23 months

Hepatitis A vaccination is required beginning at 12–23 months of age as part of the standard childhood immunization schedule.

Question 80: How do Designated Physicians contribute to the immigration process?

By conducting initial visa interviews
By providing legal advice on immigration
By approving visa applications
By evaluating applicants’ health and reporting findings (Correct answer)

Correct answer: By evaluating applicants’ health and reporting findings

Designated Physicians contribute to the immigration process by conducting thorough medical examinations and reporting their findings to USCIS. Their evaluations help determine if an applicant has any health conditions that could pose a public health risk or make them inadmissible, playing a critical role in the adjudication of immigration benefits.

Question 81: Which condition found during the immigration medical examination is an absolute Class A bar to admissibility with no waiver available?

Controlled schizophrenia without harmful behavior
Latent tuberculosis infection (LTBI)
History of alcohol use disorder in remission
Active tuberculosis that is contagious (Correct answer)

Correct answer: Active tuberculosis that is contagious

Active, contagious tuberculosis is a Class A communicable disease of public health significance that renders an applicant inadmissible, and treatment and proof of cure are required before a waiver can be considered.

Question 82: Which form is used by the civil surgeon to document vaccination history during an immigration medical exam?

Form DS-5540
Form I-693 (Correct answer)
Form I-131
Form I-797

Correct answer: Form I-693

Form I-693 (Report of Medical Examination and Vaccination Record) is the official document used to record vaccination history.

Question 83: Which vaccine series requires a two-dose schedule for individuals 13 years and older who have never been vaccinated for varicella?

Varicella (chickenpox) vaccine (Correct answer)
HPV vaccine
Meningococcal vaccine
Hepatitis A vaccine

Correct answer: Varicella (chickenpox) vaccine

Individuals aged 13 and older who have no history of varicella disease or vaccination need two doses of varicella vaccine.

Question 84: What is the civil surgeon's obligation if an applicant cannot afford the cost of required vaccinations?

Waive vaccination requirements for financial hardship cases
Administer vaccines at no cost as required by USCIS
Report the applicant to USCIS as non-compliant
Direct the applicant to public health clinics or programs that may provide low-cost or free vaccines (Correct answer)

Correct answer: Direct the applicant to public health clinics or programs that may provide low-cost or free vaccines

While USCIS does not require civil surgeons to provide free vaccines, civil surgeons may refer applicants to public health resources for low-cost vaccination options.

Question 85: Which USCIS form is used by civil surgeons to document the results of an immigration medical examination?

Form I-131
Form I-485
Form I-693 (Correct answer)
Form I-765

Correct answer: Form I-693

Form I-693, Report of Medical Examination and Vaccination Record, is the official USCIS form completed by civil surgeons to document immigration medical examination findings.

Question 86: Under USCIS immigration law, which of the following would NOT be a Class A mental health condition?

Bipolar disorder with a recent history of self-harm
Generalized anxiety disorder with no history of harmful behavior (Correct answer)
Schizophrenia with documented history of violent outbursts
Active methamphetamine addiction

Correct answer: Generalized anxiety disorder with no history of harmful behavior

Generalized anxiety disorder without any harmful behavior history does not meet the Class A threshold, which requires a link to harmful behavior.

Question 87: What action can USCIS take if a civil surgeon is found to be not following required exam protocols?

Refer the case to the state medical board only
Require the physician to retake the designation exam
Issue a warning letter with no further action for first offense
Revoke or suspend the physician's civil surgeon designation (Correct answer)

Correct answer: Revoke or suspend the physician's civil surgeon designation

USCIS has the authority to revoke or suspend a civil surgeon's designation for failure to follow required protocols or for other violations of USCIS policies.

Question 88: What is the purpose of the mental disorder and substance abuse section on Form I-693 in relation to public safety?

To assess insurance eligibility for mental health services post-admission
To screen for any diagnosed psychiatric condition, regardless of behavior
To identify conditions linked to harmful behavior that may pose a risk to public safety in the US (Correct answer)
To ensure all applicants receive mental health treatment before admission

Correct answer: To identify conditions linked to harmful behavior that may pose a risk to public safety in the US

The mental health section of Form I-693 is designed to identify whether an applicant's condition is associated with harmful behavior, thereby protecting public safety.

Question 89: What is the required syphilis test used in immigration medical exams?

Darkfield microscopy
A nontreponemal test (RPR or VDRL) followed by a treponemal confirmatory test if reactive (Correct answer)
ELISA for syphilis antibodies
Only a treponemal-specific test (FTA-ABS)

Correct answer: A nontreponemal test (RPR or VDRL) followed by a treponemal confirmatory test if reactive

Syphilis screening uses a nontreponemal test (RPR or VDRL), and any reactive result must be confirmed with a treponemal test.

Question 90: What information must be documented when a civil surgeon determines an applicant has a Class A mental health condition?

The specific diagnosis, the nature of the harmful behavior, and supporting clinical observations (Correct answer)
The applicant's self-reported psychiatric history
Only the diagnosis name
A referral to a psychiatrist and a follow-up appointment date

Correct answer: The specific diagnosis, the nature of the harmful behavior, and supporting clinical observations

A Class A mental health finding requires the diagnosis, a description of the harmful behavior that qualifies it as Class A, and clinical observations supporting the determination.

Question 91: What information must the civil surgeon include when completing the examination findings section of Form I-693 for a healthy applicant with no findings?

Only complete the vaccination section and sign the form
Document normal findings for each required examination area and affirm no Class A or B conditions (Correct answer)
Write 'see attached records' without completing the form directly
Leave all medical fields blank to indicate normal exam

Correct answer: Document normal findings for each required examination area and affirm no Class A or B conditions

Civil surgeons must affirmatively document normal or negative findings for each required examination category on Form I-693 and attest that no Class A or Class B conditions were identified.

Question 92: When can a civil surgeon delegate portions of the immigration physical examination to another health professional?

Civil surgeons cannot delegate any part of the exam
Any portion can be delegated to any licensed healthcare worker
The entire exam may be delegated to a nurse practitioner
Only for specific components (like phlebotomy or vision screening), not for the overall exam or certification (Correct answer)

Correct answer: Only for specific components (like phlebotomy or vision screening), not for the overall exam or certification

Civil surgeons may delegate specific clinical tasks (such as blood draws) to qualified staff, but the overall examination and Form I-693 certification must be done by the civil surgeon personally.

Question 93: A physician has been designated as a civil surgeon but moves to a different city. What must they do to continue performing immigration exams at the new location?

Reapply for civil surgeon designation from scratch
Obtain a new state medical license only
Notify USCIS of the change of address to update their designation information (Correct answer)
No action is needed; the designation is valid nationwide

Correct answer: Notify USCIS of the change of address to update their designation information

Civil surgeons must keep their contact information with USCIS current, including notifying USCIS of address changes, to maintain accurate designation records.

Question 94: If a civil surgeon identifies possible mental health concerns beyond their expertise, what should they do?

Automatically classify the applicant as Class A
Defer the entire exam until the applicant provides psychiatric records
Refer the applicant to a licensed mental health professional for further evaluation before completing Part 5 of Form I-693 (Correct answer)
Complete the form based on their initial impression only

Correct answer: Refer the applicant to a licensed mental health professional for further evaluation before completing Part 5 of Form I-693

Civil surgeons who identify mental health concerns requiring expert assessment should refer to a mental health professional before completing the mental health portion of Form I-693.

Question 95: What must a civil surgeon do if an applicant has a documented history of prior varicella disease?

Order a varicella titer test only
Administer the varicella vaccine regardless
Defer the decision to USCIS
Document the history and waive the varicella vaccine (Correct answer)

Correct answer: Document the history and waive the varicella vaccine

A reliable history of prior varicella disease is considered acceptable evidence of immunity, and the civil surgeon may document this to waive the vaccine.

Question 96: Under what circumstances does a mental disorder constitute a Class A condition for immigration purposes?

Whenever any DSM-5 diagnosis is present
When the applicant takes any psychotropic medication
When the disorder is associated with harmful behavior or a history of harmful behavior (Correct answer)
Only when the applicant has been hospitalized for psychiatric care

Correct answer: When the disorder is associated with harmful behavior or a history of harmful behavior

A mental disorder is a Class A condition only when it is associated with harmful behavior (to self or others) or there is a history of such behavior.

Question 97: What is one reason an applicant might need to see a Designated Physician?

To receive financial counseling
To file an immigration application
To address a specific medical concern or condition (Correct answer)
To get a visa interview

Correct answer: To address a specific medical concern or condition

An applicant might need to see a Designated Physician (civil surgeon) when applying for adjustment of status to become a lawful permanent resident while in the U.S. This examination is required to ensure the applicant does not have any medical conditions that would render them inadmissible under immigration law, addressing any specific health concerns relevant to their application.

Question 98: For which population is a chest X-ray required as part of the tuberculosis evaluation during immigration exams?

Applicants aged 15 and older with a positive TST or IGRA (Correct answer)
All applicants regardless of age or TST results
Only applicants with respiratory symptoms
Only applicants born in high-TB-burden countries

Correct answer: Applicants aged 15 and older with a positive TST or IGRA

A chest X-ray is required for applicants aged 15 and older who have a positive TST or IGRA result to evaluate for pulmonary tuberculosis disease.

Question 99: Which disease classification applies to an applicant found to have active, infectious tuberculosis?

Class A – Communicable Disease of Public Health Significance (Correct answer)
Class C – TB, No Current Disease
Class B1 – TB, Pulmonary, Active, Not Suspected Infectious
Class B2 – TB, Extrapulmonary

Correct answer: Class A – Communicable Disease of Public Health Significance

Active, infectious TB is classified as a Class A communicable disease of public health significance, rendering the applicant inadmissible.

Question 100: Which document accompanies Form I-693 when a civil surgeon finds a Class B condition?

A written medical follow-up recommendation or notation on the form itself (Correct answer)
A mandatory denial letter from USCIS
A CDC quarantine order
A mandatory surgical pre-authorization form

Correct answer: A written medical follow-up recommendation or notation on the form itself

For Class B conditions, the civil surgeon notes the condition on Form I-693 and may include a recommendation for follow-up care, but no separate denial document is issued.

USCIS Civil Surgeon Designation Knowledge Assessment

Evaluates physician knowledge of USCIS immigration medical examination requirements, including Form I-693 completion, infectious disease screening, mental health evaluation, vaccination requirements, and CDC Technical Instructions for civil surgeons.

Questions

35 min

Time Limit

70%

To Pass

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These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

Sources & references

Exam facts on this page (fees, format, dates, passing scores) are checked against these official sources; the date is our last check. Editorial policy

uscis.gov — Test delivery, eligibility · verified Oct 2026
ecfr.gov — Fees · verified Oct 2026