NRCME 2026/2027 TEST BANK | Page 1 of 52
FMCSA Standards | 49 CFR Part 391 | Comprehensive Exam
Preparation
1. Who is responsible for determining medical fitness for
commercial motor vehicle (CMV) drivers?
Answer: The National Registry Medical Examiner (NRCME-certified)
conducts the physical examination and makes the determination. The
FMCSA sets the standards (49 CFR Part 391), but the examiner makes
the clinical judgment.
2. What federal regulation governs physical qualifications for CMV
drivers?
Answer: 49 CFR Part 391, Subpart E — Physical Qualifications and
Examinations. Specifically, §391.41 lists the standards; §391.43
describes the examination procedure.
3. How long is a standard CMV medical certificate valid?
Answer: Up to 24 months (2 years), unless the medical examiner
determines a shorter certification period is medically necessary (e.g., 3,
6, or 12 months for monitored conditions).
4. What form is used for the DOT physical examination?
Answer: MCSA-5875 (Federal Motor Carrier Safety Administration
Medical Examination Report for Commercial Motor Vehicle Drivers) —
replaced the older MCS-150 in 2015.
5. What form constitutes the medical certificate given to the driver?
Answer: MCSA-5876, the Medical Examiner's Certificate (MEC). It must
be carried by the driver in the CMV (or CDL drivers have it on their
license).
6. What is the National Registry of Certified Medical Examiners
(NRCME)?
Answer: A Federal program (49 CFR Part 390) requiring medical
examiners who perform DOT physicals for CMV drivers to be trained and
, NRCME 2026/2027 TEST BANK | Page 2 of 52
certified. Established in 2012, mandatory compliance since May 21,
2014.
7. How often must a listed NRCME medical examiner be recertified?
Answer: Every 10 years, the examiner must complete training and pass
a new certification exam. However, annual reporting/fees and periodic
audits apply.
8. Within how many days must a completed medical examination
report be submitted to the FMCSA clearinghouse?
Answer: Within 3 business days of completing the examination, the
medical examiner must transmit the results to the NRCME registry.
9. What is an 'interstate' CMV driver?
Answer: A driver who operates a CMV in commerce that crosses state
lines or operates in interstate commerce, including routes that begin and
end in the same state but pass through another.
10. Is a DOT physical required for intrastate CMV drivers?
Answer: Not federally — intrastate drivers are regulated by state laws.
However, many states adopt the federal standards. Interstate drivers are
always subject to FMCSA standards.
11. What defines a Commercial Motor Vehicle (CMV) requiring a
DOT physical?
Answer: Any vehicle used in interstate commerce that: (1) weighs
≥10,001 lbs GVWR, (2) is designed to transport ≥9 passengers for
compensation, (3) transports ≥16 passengers not for compensation, or
(4) transports hazardous materials requiring placarding.
12. Can a medical examiner issue a certificate if the driver does not
meet all federal physical qualification standards?
Answer: No, unless the driver has an FMCSA exemption (e.g., vision,
diabetes, limb exemption programs) or a Skills Performance Evaluation
(SPE) certificate. Without an exemption, the driver must meet all
standards.
13. What is a Skills Performance Evaluation (SPE) Certificate?
Answer: An FMCSA-issued certificate allowing a driver with a limb
impairment to operate a CMV if they demonstrate safe driving ability.
, NRCME 2026/2027 TEST BANK | Page 3 of 52
The examiner must note this on the medical certificate and cannot certify
without FMCSA approval.
14. What should a medical examiner do if a driver's condition is
uncertain and requires specialist evaluation?
Answer: Defer certification (pending) and request additional medical
information from the treating specialist. Do not certify until sufficient
medical data is available to make a sound judgment.
15. What must a medical examiner do if they determine a driver
does not meet FMCSA standards?
Answer: Issue a 'not qualified' determination on MCSA-5875, document
the disqualifying condition, and notify the driver. They should not issue a
Medical Examiner's Certificate (MCSA-5876).
16. How should a medical examiner handle a driver who admits to
using a Schedule I controlled substance?
Answer: The driver is medically disqualified. Schedule I substances
(e.g., heroin, marijuana regardless of state law) are prohibited. The
examiner documents the disqualification and does not certify the driver.
17. What is the purpose of the FMCSA Medical Review Board
(MRB)?
Answer: An advisory committee that provides recommendations to
FMCSA on medical standards for CMV drivers. It reviews evidence and
helps update the Medical Examiner Handbook.
18. Can a driver with insulin-treated diabetes mellitus (ITDM) obtain
a federal medical certificate?
Answer: Yes, under the FMCSA ITDM Exemption Program. The driver
must apply for and receive an exemption, then the examiner can certify
with conditions including annual endocrinologist review and no severe
hypoglycemic episodes.
19. What must be documented if a medical examiner issues a
certificate for less than 24 months?
Answer: The specific condition requiring monitoring must be
documented, along with the rationale for the shorter certification period.
The examiner checks the appropriate box on MCSA-5876.
20. Can a chiropractor perform DOT physical examinations?
, NRCME 2026/2027 TEST BANK | Page 4 of 52
Answer: No. Only licensed medical doctors (MD), doctors of osteopathic
medicine (DO), physician assistants (PA), advanced practice registered
nurses (APRN), and doctors of chiropractic (DC) — wait, DCs ARE
included per FMCSA. Yes, licensed DCs may perform DOT physicals if
registered on the NRCME.
21. What is the FMCSA Clearinghouse?
Answer: A secure online database that retains records of CMV drivers'
drug and alcohol program violations. Medical examiners must check it;
employers must query it before hire and annually. It is separate from the
NRCME registry.
22. A driver presents with a state-issued medical waiver. Should the
examiner honor it for federal certification?
Answer: No. State waivers/exemptions do not apply to federal
(interstate) CMV certification. Only FMCSA-issued exemptions are
recognized. The driver must meet federal standards or obtain an FMCSA
exemption.
23. What happens to the medical examiner's certification if they fail
to meet NRCME requirements?
Answer: The examiner is removed from the National Registry, cannot
perform DOT physicals, and may face civil monetary penalties.
Reinstatement requires meeting all requirements again.
24. How must a medical examiner handle a driver taking methadone
for opioid use disorder?
Answer: The driver is not qualified to operate a CMV. Methadone is a
Schedule II narcotic. FMCSA does not currently have an exemption
program for narcotics including methadone used in MAT.
25. What is the medical examiner's obligation if a currently certified
driver later develops a disqualifying condition?
Answer: The certificate does not self-revoke. The driver has a legal
obligation to report changes. However, if the examiner becomes aware
(e.g., through a return visit), they should note the disqualifying condition
and not re-certify at the next exam.
26. Are ophthalmologists allowed to certify CMV drivers
independently regarding vision?
FMCSA Standards | 49 CFR Part 391 | Comprehensive Exam
Preparation
1. Who is responsible for determining medical fitness for
commercial motor vehicle (CMV) drivers?
Answer: The National Registry Medical Examiner (NRCME-certified)
conducts the physical examination and makes the determination. The
FMCSA sets the standards (49 CFR Part 391), but the examiner makes
the clinical judgment.
2. What federal regulation governs physical qualifications for CMV
drivers?
Answer: 49 CFR Part 391, Subpart E — Physical Qualifications and
Examinations. Specifically, §391.41 lists the standards; §391.43
describes the examination procedure.
3. How long is a standard CMV medical certificate valid?
Answer: Up to 24 months (2 years), unless the medical examiner
determines a shorter certification period is medically necessary (e.g., 3,
6, or 12 months for monitored conditions).
4. What form is used for the DOT physical examination?
Answer: MCSA-5875 (Federal Motor Carrier Safety Administration
Medical Examination Report for Commercial Motor Vehicle Drivers) —
replaced the older MCS-150 in 2015.
5. What form constitutes the medical certificate given to the driver?
Answer: MCSA-5876, the Medical Examiner's Certificate (MEC). It must
be carried by the driver in the CMV (or CDL drivers have it on their
license).
6. What is the National Registry of Certified Medical Examiners
(NRCME)?
Answer: A Federal program (49 CFR Part 390) requiring medical
examiners who perform DOT physicals for CMV drivers to be trained and
, NRCME 2026/2027 TEST BANK | Page 2 of 52
certified. Established in 2012, mandatory compliance since May 21,
2014.
7. How often must a listed NRCME medical examiner be recertified?
Answer: Every 10 years, the examiner must complete training and pass
a new certification exam. However, annual reporting/fees and periodic
audits apply.
8. Within how many days must a completed medical examination
report be submitted to the FMCSA clearinghouse?
Answer: Within 3 business days of completing the examination, the
medical examiner must transmit the results to the NRCME registry.
9. What is an 'interstate' CMV driver?
Answer: A driver who operates a CMV in commerce that crosses state
lines or operates in interstate commerce, including routes that begin and
end in the same state but pass through another.
10. Is a DOT physical required for intrastate CMV drivers?
Answer: Not federally — intrastate drivers are regulated by state laws.
However, many states adopt the federal standards. Interstate drivers are
always subject to FMCSA standards.
11. What defines a Commercial Motor Vehicle (CMV) requiring a
DOT physical?
Answer: Any vehicle used in interstate commerce that: (1) weighs
≥10,001 lbs GVWR, (2) is designed to transport ≥9 passengers for
compensation, (3) transports ≥16 passengers not for compensation, or
(4) transports hazardous materials requiring placarding.
12. Can a medical examiner issue a certificate if the driver does not
meet all federal physical qualification standards?
Answer: No, unless the driver has an FMCSA exemption (e.g., vision,
diabetes, limb exemption programs) or a Skills Performance Evaluation
(SPE) certificate. Without an exemption, the driver must meet all
standards.
13. What is a Skills Performance Evaluation (SPE) Certificate?
Answer: An FMCSA-issued certificate allowing a driver with a limb
impairment to operate a CMV if they demonstrate safe driving ability.
, NRCME 2026/2027 TEST BANK | Page 3 of 52
The examiner must note this on the medical certificate and cannot certify
without FMCSA approval.
14. What should a medical examiner do if a driver's condition is
uncertain and requires specialist evaluation?
Answer: Defer certification (pending) and request additional medical
information from the treating specialist. Do not certify until sufficient
medical data is available to make a sound judgment.
15. What must a medical examiner do if they determine a driver
does not meet FMCSA standards?
Answer: Issue a 'not qualified' determination on MCSA-5875, document
the disqualifying condition, and notify the driver. They should not issue a
Medical Examiner's Certificate (MCSA-5876).
16. How should a medical examiner handle a driver who admits to
using a Schedule I controlled substance?
Answer: The driver is medically disqualified. Schedule I substances
(e.g., heroin, marijuana regardless of state law) are prohibited. The
examiner documents the disqualification and does not certify the driver.
17. What is the purpose of the FMCSA Medical Review Board
(MRB)?
Answer: An advisory committee that provides recommendations to
FMCSA on medical standards for CMV drivers. It reviews evidence and
helps update the Medical Examiner Handbook.
18. Can a driver with insulin-treated diabetes mellitus (ITDM) obtain
a federal medical certificate?
Answer: Yes, under the FMCSA ITDM Exemption Program. The driver
must apply for and receive an exemption, then the examiner can certify
with conditions including annual endocrinologist review and no severe
hypoglycemic episodes.
19. What must be documented if a medical examiner issues a
certificate for less than 24 months?
Answer: The specific condition requiring monitoring must be
documented, along with the rationale for the shorter certification period.
The examiner checks the appropriate box on MCSA-5876.
20. Can a chiropractor perform DOT physical examinations?
, NRCME 2026/2027 TEST BANK | Page 4 of 52
Answer: No. Only licensed medical doctors (MD), doctors of osteopathic
medicine (DO), physician assistants (PA), advanced practice registered
nurses (APRN), and doctors of chiropractic (DC) — wait, DCs ARE
included per FMCSA. Yes, licensed DCs may perform DOT physicals if
registered on the NRCME.
21. What is the FMCSA Clearinghouse?
Answer: A secure online database that retains records of CMV drivers'
drug and alcohol program violations. Medical examiners must check it;
employers must query it before hire and annually. It is separate from the
NRCME registry.
22. A driver presents with a state-issued medical waiver. Should the
examiner honor it for federal certification?
Answer: No. State waivers/exemptions do not apply to federal
(interstate) CMV certification. Only FMCSA-issued exemptions are
recognized. The driver must meet federal standards or obtain an FMCSA
exemption.
23. What happens to the medical examiner's certification if they fail
to meet NRCME requirements?
Answer: The examiner is removed from the National Registry, cannot
perform DOT physicals, and may face civil monetary penalties.
Reinstatement requires meeting all requirements again.
24. How must a medical examiner handle a driver taking methadone
for opioid use disorder?
Answer: The driver is not qualified to operate a CMV. Methadone is a
Schedule II narcotic. FMCSA does not currently have an exemption
program for narcotics including methadone used in MAT.
25. What is the medical examiner's obligation if a currently certified
driver later develops a disqualifying condition?
Answer: The certificate does not self-revoke. The driver has a legal
obligation to report changes. However, if the examiner becomes aware
(e.g., through a return visit), they should note the disqualifying condition
and not re-certify at the next exam.
26. Are ophthalmologists allowed to certify CMV drivers
independently regarding vision?
