NRCME Test Key Insights

Key Insights into the NRCME Test

Everything you should know as a medical examiner is not necessarily the same as what should be known for the test. These insights below were created to help to span the gap. Also, our practice tests are loaded with questions that are very similar to what will be found on the exam.

Answer each question as though you are the driver’s PCP who is also their medical examiner.

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

If an option is to order or perform a specific lab or test, seriously consider marking this as your answer

Understand the “order of testing” that should be utilized

  • When to order a specific lab test such as a pulmonary function test (PFT), basic metabolic panel (BMP), complete metabolic panel (CMP), or a complete blood count (CBC). For example, a CMP contains the information needed monitor liver function, but a BMP does not. If you’re only interested in kidney function, you would order a BMP or solely a creatinine level.

Know the normal values of the possible tests performed (HbA1c, UA, ABG, Spirometry, Audiometry, CBC, BMP)

Certification Intervals

There are only a handful of conditions in which the FMCSA handbook provides a specific certification interval.
  • Insulin-treated diabetes mellitus: 1 year
  • An uncontrolled diabetic (with or without insulin) can be given a 3-month certificate. There can be consecutive 3-month certificates according to the MEs discretion.
  • Seizure exemption: 1 year; Exemption is valid for two years.
  • Hearing exemption: 2 years
  • SPE: 2 years
  • Alternative vision standard: 1 year
  • Hypertension: 1 year (even if they are well-controlled)
  • Exempt intra-city zone: 1 year

If on an exam question, you have the option to choose between a 1 or 2-year certification, and the condition is not listed in the above list, neither of those options is likely the correct answer.

Example: During the examination, a driver is found to have a positive “Babinski” reflex. The examiner should:

A. Certify the driver for 1 year
B. Certify the driver for 2 years
C. Council the driver to obtain an SPE
D. Disqualify the driver until they have a neurological consultation

Here are some additional points to remember as you prepare for the test:

Know which number applies to which body system on the exam form

1 is general, 2 is skin, 3 is eyes, 4 is ears, 5 is mouth/throat, etc.

Vision

  • Note: The Jaeger vision chart measures near vision and is NOT a part of the physical exam
  • Know how conditions such as cataracts, glaucoma, and retinopathy affect vision
  • Xanthopsia is a dominantly yellow bias in vision due to a yellowing of the optical media of the eye predominantly caused by digoxin
  • Xanthelasma Palpebrarum is a benign condition of soft yellow plaques on the inner aspect of the eyes. It is linked to conditions such as hyperlipidemia, diabetes, and thyroid dysfunction
  • Strabismus is also known as cross-eyed
  • Amblyopia is also known as lazy eye
  • Nystagmus is an involuntary, rapid and repetitive movement of the eyes

Hearing

  • Nondiscretionary standard
  • What does ANSI and ISO stand for
  • To pass the audiometric test, you must have < 40dB of hearing loss
  • Hearing aides: must carry spare battery or spare hearing aide; Audiomentric test must be open field
  • (click here for audiogram information)
  • Hearing Exemption

Skilled Performance Evaluation (SPE)

  • What are the criteria to be eligible to apply?
  • Upper vs lower extremity eligibility
  • SPE required for any personal assistive device (brace, prosthetic, orthosis, etc.)

Diabetes

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

Musculoskeletal Conditions

  • Normal ROM of shoulder
  • Deep Tendon Reflexes: decreased vs spastic and conditions that affect DTRs
  • Jobe’s test is to diagnose anterior shoulder instability
  • Hawkins–Kennedy Test is used to evaluate for muscular impingement of the shoulder due to injury
  • Lasègue test (straight leg raise) is used to determine whether a patient with low back pain has an underlying nerve root sensitivity, often located at L5
  • Phalen’s maneuver is a diagnostic test for carpal tunnel syndrome
  • Anterior Drawer and Lachman tests are used to assess for possible rupture of the ACL of the knee

Abdomen

  • Organs of the abdomen and their location. (Liver, spleen, pancreas, kidneys, abdominal aorta, intestines, appendix)
  • What labs test for which organs?
  • The most common diseases and symptoms affecting these organ
  • What conditions affecting these organs is most concerning? (Cirrhosis vs liver cancer vs pancreatitis vs appendicitis, etc.)

Neurological Conditions

  • Nerve roots and myotomes
  • Seizures (nondiscretionary standard): provoked vs unprovoked, waiting periods, seizure exemption, medication = Depakote
  • Parkinson’s: Sinemet, certify with mild symptoms. What are mild symptoms?
  • Rhomberg’s test is used to check balance by having them stand with the feet together and the eyes closed and evaluating for any sway in their stance

Medications

  • Lithium, Tegretol, and Coumadin need lab monitoring
  • Anticoagulants are not disqualifying
  • The only absolutely disqualifying medication is marijauna
  • Know medications created to treat a certian condition but are commonly prescribed for other conditions (Lamotrigine is an anticonvolsant commonly prescribed for Bipolar or other mental health conditions. Same as for Topamax, commonly used for headaches. The anti-depressant Wellbutrin (Bupropion) is commonly prescribed for smoking cessation.)
  • Focus on opioids and mental health medications (Zyprexa is for schizophrenia)

Respiratory Conditions

  • PFT (Pulse Ox, Spirometry, ABG) “acceptable” values
  • When to order and what are normal findings?
  • Guidelines/recommendations surrounding smoking
  • Sleep Apnea
    1. a. Risk factors/When to order sleep study
    2. b. Sleep study results (AHI)
    3. c. Monitoring compliance

Cardiovascular

  • Normal ETT results
  • Coumadin: INR 2-3
  • Xarelto/Pradaxa/Eliquis affect kidneys, consider checking creatinine
  • Digoxin is derived from Digitalis. It is used for arrhythmias; It can cause xanthopsia which is a dominantly yellow bias in vision due to a yellowing of the optical media of the eye
  • Hypertension guidelines

Question Composition:

The certifcation exam questions have been written with 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 sample exams will be an effective tool. Make sure you read the explantations that accompany each question.

General Information:

The NRCME certification test is composed of 120 multiple choice questions for which you have two hours to complete. 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.

Before beginning the test, you are given the opportunity to spend up to 15 minutes to learn the testing system. This does not count towards the time you have to complete the exam. Learn to put a question into the “Uncertain” file if you are unsure of the answer. Time allowing, you can review those questions. Do not take time to make comments regarding the test until you have reviewed these questions. Making comments comes out of the time you have to take the test.

If you are unsure about a question, still mark an answer and place that question into the review list. Then 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.

You will receive your score upon completing the test. 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.

Remember to Pace Yourself!

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 contact@TeamCME.com.