KEY INSIGHTS INTO THE NRCME TEST

Our training exceeds the FMCSA core curriculum and covers everything you should know as a medical examiner. This is not necessarily the same as what should be known for the test. These insights 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)

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

– The standard for visual acuity, field of vision
– Alternate vision standard for monocular vision and MCSA-5871
– 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 less than or equal to 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 conditions does this apply to? How long to certify?

  • 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 organs

  • Neurological Conditions

– Stroke: Consider “best practice” as a 1-year waiting period
– Nerve roots and myotomes
– Seizures (nondiscretionary standard): provoked vs unprovoked, waiting periods, seizure exemption, medication = Depakote
– Parkinson’s: Sinemet, certify with 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 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’s (Pulse Ox, Spirometry, ABG) – When to order and what are normal findings?
– Guidelines/recommendations surrounding smoking
– Sleep Apnea
a. Risk factors/When to order sleep study
b. Sleep study results (AHI)
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:

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.

General Information:

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. 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.

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.