Question Composition:

The NRCME certification test is composed of 120 multiple choice questions. One hundred of the questions are graded, the other 20 are being evaluated for future tests. You can’t tell the difference. The passing score for all test versions is 71%.

Instructions are to choose the most correct answer. Test questions have purposely been written to have distractors in both the questions and answers to lead you away from the most correct answer. Some questions are written to downplay or conceal the real issue. We have tried to make our questions similar to what you will see on the real test. In this way, we hope the practice test will be an effective tool. Make sure you read the comments that accompany each question.

Many of the questions will feel like they were taken from a medical board exam. As the range of medical conditions is so vast, it is virtually impossible to cover this type of information in our training. We have included supplemental content withing the training that will help with your prepararation.

Where to Focus?

Do not focus on waiting periods. There will likely be questions covering all subject matters but here is a list of subjects to focus on by level of importance:
1. Vision
– Standard for visual acuity, field of vision
– Alternate vision standard for monocular vision (when to use MCSA-5871)
– Conditions such as cataracts, glaucoma, and retinopathy
– The difference between anisocoria, Horner’s syndrome, & CN III palsy

2. Hearing
– Guidelines for both whisper and audiometric testing
– Conversion of ISO to ANSI
– Otic diseases: Meniere’s, Vertigo

3. SPE
– What conditions does this apply to? How long to certify?

4. Diabetes
– Knowledge surrounding insulin use and form MCSA-5870
– What is a severe hypoglycemic episode and what are the guidelines?

5. Musculoskeletal conditions
– Normal ROM of shoulder
– Deep Tendon Reflexes: decreased vs spastic, conditions/nerve root affecting the tendon reflex

6. Abdomen
– Organs of the abdomen and their location. (Liver, spleen, pancreas, kidneys, abdominal aorta, intestines, appendix)
– The most common diseases and symptoms affecting these organs

7. Neurological conditions
– Stroke = 1-year waiting period
– Which nerve root innervates which part of the body
– Seizures: provoked vs unprovoked, waiting periods, seizure exemption, medication = Depakote
– Parkinson’s: Sinemet, certify with mild symptoms

8. Medications
– For medical conditions that may alter qualification status, know the most commonly prescribed medications associated with that condition
– Focus on opioids and mental health medications

9. Respiratory conditions
– PFT’s (Pulse Ox, Spirometry, ABG) – When to order and what are normal findings?
– Sleep Apnea
a. Risk factors/When to order sleep study
b. Sleep study results (AHI)

10. Cardiovascular
– Medications Coumadin, Xarelto/Pradaxa/Eliquis, Digoxin/Amiodarone
– Hypertension

Labs/Testing Results:

1. If an option is to order a specific lab or test, seriously consider marking this as your answer – even over the option of a referral.
2. Understand the “order of testing” that should be utilized, such as when to order a pulmonary function test, HbA1c, thyroid panel, etc..
3. Know the normal values of these tests (UA, HbA1c, Spirometry, ABG, Audiometry).


When given the option to refer to the driver’s PCP vs a specialist, always choose the appropriate specialist.

Exemptions/Alternate Standards:

1. Know the regulations and guidelines surrounding the hearing exemption, seizure exemption, skilled performance evaluation (SPE), insulin-treated diabetes mellitus, and the alternate vision standard.
2. Hearing:
a. What is the next step when a driver does not pass the whisper test, audiometric, or open field testing, with our without the use of hearing aides?
b. Be able to read and analyze an audiogram report (click here for audiogram information) and be able to determine which ear(s) meet the hearing requirement.
c. Know how to convert ISO values into ANSI values.

General Information:

Before beginning the test, take the opportunity to spend up to 15 minutes learning the computer system to take the test.  This 15 minutes does not come out of the two hours you have to complete the exam.  Learn to put a question into the “Uncertain” file if you are unsure of the answer. When you get to the end of the test, you will want to review those questions you weren’t sure about. Only after you have completed the exam, and reviewed any questions you weren’t sure about, should you take time to make comments regarding a question.  Making comments regarding a question comes out of the time you have to take the test.  Some say that using the mouse during the test is the easiest and quickest.

While taking the test, if you are unable to immediately identify the correct answer, go back and re- read the question very closely. If a second reading does not seem to help, make your best choice for the answer, and save the question into the review list and come back to it after you have worked through the complete test. Do not spend too much time on any one question. It’s important to move deliberately through the test.

At the end of two hours, or when you exit the test, you will get a score. The passing score for that test will be displayed along with your score. If you do not pass, you will be able to reschedule online the following day. There is no waiting period before you can retake the test.

After taking the National Registry certification test, if you notice questions that you found were particularly challenging or that you feel should be better covered in the training or practice test, please feel free to contact us at