Story from a DOT medical examiner candidate having trouble passing the NRCME exam to get on the National Registry of Certified Medical Examiners:

I have taken and FAILED the Medical Examiner Certification Test with a score of 68% X 2!!!! I am embarrassed beyond belief as I need this certification for my new job. I attended a live certification class, reviewed the FMCSA Handbook, paid for and reviewed a bank of practice questions, and created my own study guide without success.

Further, I have never had any issues taking and/or passing any other exam throughout my nursing career.

Here are a few examples from the exam that I questioned:

*Stage 1 Hypertension, no history, new certification according to the form

A) Attain 2ndBP or B) Give one year certification

*Buccal lesions:

A) Dentist or B) Otolaryngology

*Symptomatic Carpal Tunnel

A) Nerve conduction study or B) Surgeon

*Questionable balance

A) Heel to toe or B) Romberg

*Urine glucose > 400

A) Random glucose or ???

*Significant discrepancy in strength; Left vs. Right

A) Assess grip strength or B) Disqualify

I’m at a loss and looking for help. Please advise!

I’ve heard this a few times before – smart colleagues who have no trouble passing other tests having trouble here with the NRCME.

I think because there is so much confusion and controversy regarding regulation vs. recommendations or advisory that it trips people up.

The course I am medical director for is the NADME.org course.

If you find yourself in this predicament, I have several free resources which may help with your education:

The NRCME Seminar series is a paid in depth course that dives into many of the gray areas of DOT exams.

As for the topic questions, I’ll try to answer but not quite sure I get all the issues referred to–

*Stage 1 Hypertension, no history, new certification according to the form

A) Attain 2nd BP or B) Give one year certification

The general best practice for a driver with stage 1 hypertension has been to give one year certification for <140/90, and to require subsequent evaluation and BP readings if > 140/90 with 3 mo certification to recheck status.

*Buccal lesions:

A) Dentist or B) Otolaryngology

I haven’t seen this question before, I suspect it is a “test question”.  A  driver is not usually going to be disqualified for a buccal lesion without other disease manifestations.  If there is any concern you would submit a “determination pending” to get more information or a short term certification.

*Symptomatic Carpal Tunnel

A) Nerve conduction study or B) Surgeon

The issue on  certification of  the driver is whether there is sufficient grip strength to operate a commercial motor vehicle.  If not, they are disqualified and referred for further evaluation, which could be either nerve conduction study or surgical eval, so not sure what you are asking here,

If a driver has peripheral neuropathy from diabetes, that is considered disqualifying.

*Questionable balance

A) Heel to toe or B) Romberg

A driver with balance or dizziness issues is disqualified until diagnosis is known and the issues/symptoms are resolved.  Heel to toe and Romberg testing on examination are both appropriate standard assessments of neurological function and should be performed on every examination.

Failing this should be disqualified and referred for neurological evaluation.

Recall as the examiner, you are not diagnosing.  If you find abnormalities on exam you may order additional testing or refer to the appropriate specialist to gather additional information and diagnoses before making your determination.

*Urine glucose > 400

A) Random glucose or ???

There is no set cutoff for a specific glucose value.  The FMCSA rule is whether the driver has diabetes requiring insulin treatment.

If you find glucosuria on the dipstick test and you do a random fingerstick test resulting in >400, you may want to disqualify until you have a diagnosis and treatment plan with the PCP.  If the driver seems otherwise stable and a normal exam, you may submit a “determination pending” until you receive additional information from the treating physician.

*Significant discrepancy in strength; Left vs. Right

A) Assess grip strength or B) Disqualify

The rule is if the driver has any impairment of a hand or foot which would interfere with safe operation of a commercial motor vehicle they may not be qualified.

If the grip strength is considered adequate by the examiner they may be qualified.  If the grip strength discrepancy is significant enough to be concerned that a neurological event has occurred such as a stroke, this would need to be further evaluated before certification.

Applying to the National Registry of Certified Medical Examiners

  1. Complete the required training at NADME.org BEFORE registering with the NRCME.
  2. Go to the following link to register https://sfm.fmcsa.dot.gov/nrcme/register.
  3. Receive welcome email with unique National Registry number.
  4. Take and pass the National Registry Medical Examiner certification test.  The certification test is offered by the testing organizations provided in the links below.  Using these links, you will find the process and contact information necessary for you to contact the testing organization directly to schedule the examination.
  5. Once you have submitted the required information, FMCSA has verified your ability conduct physical examinations with your state licensing board, and FMCSA has received passing test results from the testing organization, FMCSA will conduct a final evaluation of your application to become a certified Medical Examiner.
  6. FMCSA will notify you via email when the certification process is complete.  You will receive an email with an official certificate indicating your status as a certified Medical Examiner listed on the National Registry.  Medical Examiners are not permitted to conduct physical qualification examinations of interstate commercial motor vehicle drivers until the official certificate has been received via email.