NRCME DOT PHYSICAL EXAMINATION
NRCME Certification Examination
Federal Motor Carrier Safety Administration (FMCSA) Certification Exam
2026/2027 Comprehensive Study Guide | 260 MCQ Revision Questions with
Answers & Rationales
1. According to FMCSA regulations, a commercial motor vehicle (CMV) is defined as a
motor vehicle used in interstate commerce to transport passengers or property that meets
which of the following criteria?
A. Weighs more than 5,000 lbs gross vehicle weight rating B. Has a gross vehicle weight rating
or gross combination weight rating of 10,001 lbs or more, is designed to transport 16 or more
passengers including the driver, or transports hazardous materials requiring placarding C.
Weighs more than 8,000 lbs and travels more than 100 miles D. Is registered in more than one
state and weighs over 6,000 lbs
Correct Answer: B
Rationale: Per 49 CFR 390.5, a CMV is defined as any self-propelled or towed motor
vehicle used on a highway in interstate commerce to transport passengers or property
when: (1) the vehicle has a GVWR or GCWR of 10,001 lbs or more; (2) the vehicle is
designed or used to transport more than 8 passengers (including the driver) for
compensation; (3) the vehicle is designed or used to transport more than 15 passengers
without compensation; or (4) the vehicle is used in transporting hazardous materials in a
quantity requiring placarding. Understanding the CMV definition is fundamental to the
NRCME exam.
2. Which federal regulation governs the physical qualifications and examinations for
commercial motor vehicle drivers?
A. 49 CFR Part 380 B. 49 CFR Part 391, Subpart E C. 49 CFR Part 395 D. 49 CFR Part 382
Correct Answer: B
Rationale: 49 CFR Part 391, Subpart E contains the physical qualifications and
examinations for commercial motor vehicle drivers. Section 391.41 outlines the physical
qualification standards, 391.43 describes the medical examination requirements, 391.45
specifies who must be medically examined, and 391.49 provides the alternative physical
,qualification standards. Part 380 covers special training requirements, Part 395 covers
hours of service, and Part 382 covers controlled substance and alcohol testing.
3. A Medical Examiner (ME) has completed a DOT physical examination. The driver's
Medical Examiner's Certificate is valid for a maximum period of:
A. 1 year B. 2 years C. 3 years D. 5 years
Correct Answer: B
Rationale: Per 49 CFR 391.45(b), a Medical Examiner's Certificate is valid for a maximum
of 24 months (2 years). However, the ME may issue a certificate for a shorter period when
a condition requires more frequent monitoring (e.g., 3 months, 6 months, or 1 year).
Conditions that commonly warrant shorter certificate periods include well-controlled
hypertension, sleep apnea on CPAP therapy, and diabetes managed with insulin. The ME
must exercise clinical judgment to determine the appropriate certification period.
4. Which of the following blood pressure readings would qualify a driver for a 1-year
Medical Examiner's Certificate according to FMCSA hypertension guidelines?
A. 130/85 mmHg B. 140/90 mmHg C. 148/94 mmHg D. 160/95 mmHg
Correct Answer: C
Rationale: FMCSA hypertension guidelines for CMV drivers: Stage 1 HTN (SBP 140–159
or DBP 90–99 mmHg) → certify for 1 year; Stage 2 HTN (SBP 160–179 or DBP 100–109
mmHg) → certify for 1 year, treatment recommended; Stage 3 HTN (SBP ≥180 or DBP
≥110 mmHg) → disqualify until treated and BP stable. A reading of 148/94 falls in the
Stage 1 range (SBP 140–159) which qualifies for a 1-year certificate. A reading of 130/85
qualifies for a full 2-year certificate. The BP 160/95 falls in Stage 2 (SBP 160–179) which
also certifies for 1 year but requires follow-up.
5. A driver presents with a blood pressure of 182/104 mmHg at the DOT physical
examination. The MOST appropriate action by the Medical Examiner is:
A. Certify for 2 years as this is close to normal B. Certify for 1 year and recommend treatment C.
Disqualify the driver until blood pressure is treated and at an acceptable level — recheck at one-
time examination D. Refer to the driver's physician without taking any action
Correct Answer: C
,Rationale: Per FMCSA guidelines, Stage 3 hypertension is defined as SBP ≥180 mmHg OR
DBP ≥110 mmHg. This driver has SBP 182 mmHg which meets Stage 3 criteria. The driver
should be disqualified, treated, and once BP is reduced to Stage 2 or below (SBP <180 and
DBP <110), a one-time 3-month certificate may be issued to confirm treatment efficacy. If
follow-up BP is at or below Stage 1 levels (SBP ≤159), a full 1-year certificate can then be
issued. The ME should not certify a driver with Stage 3 hypertension.
6. According to FMCSA visual acuity standards, a CMV driver must have:
A. 20/20 vision in both eyes with or without correction B. Distant visual acuity of at least 20/40
in each eye with or without corrective lenses, and at least 70-degree field of vision in horizontal
meridian in each eye C. 20/30 vision in the better eye and 20/60 in the worse eye D. 20/40 in the
better eye only; the worse eye has no minimum requirement
Correct Answer: B
Rationale: Per 49 CFR 391.41(b)(10), a CMV driver must have: (1) Distant visual acuity of
at least 20/40 in each eye with or without corrective lenses; (2) Field of vision of at least 70
degrees in the horizontal meridian in each eye; (3) Ability to recognize standard red, green,
and amber colors as used in traffic control devices. Both eyes must meet the 20/40 standard
independently. If corrective lenses are required, the driver must wear them while driving
and carry a spare pair. Monocular drivers do not meet this standard and require an
FMCSA exemption.
7. A driver has 20/200 vision in the right eye and 20/30 vision in the left eye with correction.
How should the Medical Examiner proceed?
A. Certify the driver as the better eye meets the standard B. Certify for 1 year with a vision
restriction C. The driver does not meet federal vision standards and cannot be certified without
an FMCSA Federal Vision Exemption D. Issue a limited certification allowing daytime driving
only
Correct Answer: C
Rationale: The FMCSA vision standard requires at least 20/40 in EACH eye
independently. This driver has 20/200 in the right eye, which fails the per-eye standard
regardless of the left eye performance. The driver does not meet the federal vision standard
and cannot be federally certified. The driver may apply for an FMCSA Federal Vision
Exemption, which allows monocular drivers and those who fail the per-eye standard to
operate CMVs if they meet additional safety criteria. Some states have grandfathered in
drivers with vision impairment through the "grandfather" provision — but these are state-
specific. Without an exemption, this driver is federally disqualified.
, 8. According to FMCSA hearing standards, a driver must be able to:
A. Hear a forced whispered voice in the better ear at 20 feet without a hearing aid B. Hear a
forced whispered voice in the better ear at not less than 5 feet with or without a hearing aid, or if
tested by audiometric device, does not have average hearing loss in the better ear greater than 40
dB C. Hear conversational speech at 10 feet with both ears D. Pass a pure-tone audiogram at all
frequencies
Correct Answer: B
Rationale: Per 49 CFR 391.41(b)(11), a driver must perceive a forced whispered voice in
the better ear at not less than 5 feet with or without the use of a hearing aid, or, if tested by
use of a standard pure tone audiometer, does not have average hearing loss in the better
ear greater than 40 decibels (hearing level in the ISO 1964 revised standard), with or
without a hearing aid when the audiometric device is calibrated to American National
Standard (formerly combatted ASA standard Z24.5 — 1951). Hearing aids are permitted.
The whisper test is performed at 5 feet (not 20 feet).
9. Which of the following conditions is an ABSOLUTE disqualifier for CMV drivers under
FMCSA regulations with NO exemption process available?
A. Insulin-treated diabetes mellitus B. Loss of a foot, leg, hand, or arm C. Use of Schedule I
controlled substances or any amphetamine, narcotic, or habit-forming drug not prescribed by a
licensed physician D. Epilepsy
Correct Answer: C
Rationale: Per 49 CFR 391.41(b)(12), a driver is disqualified if they use a Schedule I
controlled substance (e.g., heroin, marijuana, ecstasy), amphetamines, narcotics, or any
other habit-forming drug. Unlike many other disqualifying conditions, there is no
exemption process for current illegal drug use or use of Schedule I substances. Insulin-
treated diabetes (ITDM) has an exemption program. Loss of a limb has an alternative
qualification/skills performance evaluation (SPE) process. Epilepsy has an exemption
program. Drug disqualification is absolute for Schedule I substances and illegal drug use.
10. A driver is taking methadone for opioid use disorder treatment. How should the
Medical Examiner handle this situation?
A. Certify the driver if the methadone dose is stable B. Certify for 1 year with quarterly urine
drug screens C. The driver does not meet federal standards — methadone is a narcotic and
NRCME Certification Examination
Federal Motor Carrier Safety Administration (FMCSA) Certification Exam
2026/2027 Comprehensive Study Guide | 260 MCQ Revision Questions with
Answers & Rationales
1. According to FMCSA regulations, a commercial motor vehicle (CMV) is defined as a
motor vehicle used in interstate commerce to transport passengers or property that meets
which of the following criteria?
A. Weighs more than 5,000 lbs gross vehicle weight rating B. Has a gross vehicle weight rating
or gross combination weight rating of 10,001 lbs or more, is designed to transport 16 or more
passengers including the driver, or transports hazardous materials requiring placarding C.
Weighs more than 8,000 lbs and travels more than 100 miles D. Is registered in more than one
state and weighs over 6,000 lbs
Correct Answer: B
Rationale: Per 49 CFR 390.5, a CMV is defined as any self-propelled or towed motor
vehicle used on a highway in interstate commerce to transport passengers or property
when: (1) the vehicle has a GVWR or GCWR of 10,001 lbs or more; (2) the vehicle is
designed or used to transport more than 8 passengers (including the driver) for
compensation; (3) the vehicle is designed or used to transport more than 15 passengers
without compensation; or (4) the vehicle is used in transporting hazardous materials in a
quantity requiring placarding. Understanding the CMV definition is fundamental to the
NRCME exam.
2. Which federal regulation governs the physical qualifications and examinations for
commercial motor vehicle drivers?
A. 49 CFR Part 380 B. 49 CFR Part 391, Subpart E C. 49 CFR Part 395 D. 49 CFR Part 382
Correct Answer: B
Rationale: 49 CFR Part 391, Subpart E contains the physical qualifications and
examinations for commercial motor vehicle drivers. Section 391.41 outlines the physical
qualification standards, 391.43 describes the medical examination requirements, 391.45
specifies who must be medically examined, and 391.49 provides the alternative physical
,qualification standards. Part 380 covers special training requirements, Part 395 covers
hours of service, and Part 382 covers controlled substance and alcohol testing.
3. A Medical Examiner (ME) has completed a DOT physical examination. The driver's
Medical Examiner's Certificate is valid for a maximum period of:
A. 1 year B. 2 years C. 3 years D. 5 years
Correct Answer: B
Rationale: Per 49 CFR 391.45(b), a Medical Examiner's Certificate is valid for a maximum
of 24 months (2 years). However, the ME may issue a certificate for a shorter period when
a condition requires more frequent monitoring (e.g., 3 months, 6 months, or 1 year).
Conditions that commonly warrant shorter certificate periods include well-controlled
hypertension, sleep apnea on CPAP therapy, and diabetes managed with insulin. The ME
must exercise clinical judgment to determine the appropriate certification period.
4. Which of the following blood pressure readings would qualify a driver for a 1-year
Medical Examiner's Certificate according to FMCSA hypertension guidelines?
A. 130/85 mmHg B. 140/90 mmHg C. 148/94 mmHg D. 160/95 mmHg
Correct Answer: C
Rationale: FMCSA hypertension guidelines for CMV drivers: Stage 1 HTN (SBP 140–159
or DBP 90–99 mmHg) → certify for 1 year; Stage 2 HTN (SBP 160–179 or DBP 100–109
mmHg) → certify for 1 year, treatment recommended; Stage 3 HTN (SBP ≥180 or DBP
≥110 mmHg) → disqualify until treated and BP stable. A reading of 148/94 falls in the
Stage 1 range (SBP 140–159) which qualifies for a 1-year certificate. A reading of 130/85
qualifies for a full 2-year certificate. The BP 160/95 falls in Stage 2 (SBP 160–179) which
also certifies for 1 year but requires follow-up.
5. A driver presents with a blood pressure of 182/104 mmHg at the DOT physical
examination. The MOST appropriate action by the Medical Examiner is:
A. Certify for 2 years as this is close to normal B. Certify for 1 year and recommend treatment C.
Disqualify the driver until blood pressure is treated and at an acceptable level — recheck at one-
time examination D. Refer to the driver's physician without taking any action
Correct Answer: C
,Rationale: Per FMCSA guidelines, Stage 3 hypertension is defined as SBP ≥180 mmHg OR
DBP ≥110 mmHg. This driver has SBP 182 mmHg which meets Stage 3 criteria. The driver
should be disqualified, treated, and once BP is reduced to Stage 2 or below (SBP <180 and
DBP <110), a one-time 3-month certificate may be issued to confirm treatment efficacy. If
follow-up BP is at or below Stage 1 levels (SBP ≤159), a full 1-year certificate can then be
issued. The ME should not certify a driver with Stage 3 hypertension.
6. According to FMCSA visual acuity standards, a CMV driver must have:
A. 20/20 vision in both eyes with or without correction B. Distant visual acuity of at least 20/40
in each eye with or without corrective lenses, and at least 70-degree field of vision in horizontal
meridian in each eye C. 20/30 vision in the better eye and 20/60 in the worse eye D. 20/40 in the
better eye only; the worse eye has no minimum requirement
Correct Answer: B
Rationale: Per 49 CFR 391.41(b)(10), a CMV driver must have: (1) Distant visual acuity of
at least 20/40 in each eye with or without corrective lenses; (2) Field of vision of at least 70
degrees in the horizontal meridian in each eye; (3) Ability to recognize standard red, green,
and amber colors as used in traffic control devices. Both eyes must meet the 20/40 standard
independently. If corrective lenses are required, the driver must wear them while driving
and carry a spare pair. Monocular drivers do not meet this standard and require an
FMCSA exemption.
7. A driver has 20/200 vision in the right eye and 20/30 vision in the left eye with correction.
How should the Medical Examiner proceed?
A. Certify the driver as the better eye meets the standard B. Certify for 1 year with a vision
restriction C. The driver does not meet federal vision standards and cannot be certified without
an FMCSA Federal Vision Exemption D. Issue a limited certification allowing daytime driving
only
Correct Answer: C
Rationale: The FMCSA vision standard requires at least 20/40 in EACH eye
independently. This driver has 20/200 in the right eye, which fails the per-eye standard
regardless of the left eye performance. The driver does not meet the federal vision standard
and cannot be federally certified. The driver may apply for an FMCSA Federal Vision
Exemption, which allows monocular drivers and those who fail the per-eye standard to
operate CMVs if they meet additional safety criteria. Some states have grandfathered in
drivers with vision impairment through the "grandfather" provision — but these are state-
specific. Without an exemption, this driver is federally disqualified.
, 8. According to FMCSA hearing standards, a driver must be able to:
A. Hear a forced whispered voice in the better ear at 20 feet without a hearing aid B. Hear a
forced whispered voice in the better ear at not less than 5 feet with or without a hearing aid, or if
tested by audiometric device, does not have average hearing loss in the better ear greater than 40
dB C. Hear conversational speech at 10 feet with both ears D. Pass a pure-tone audiogram at all
frequencies
Correct Answer: B
Rationale: Per 49 CFR 391.41(b)(11), a driver must perceive a forced whispered voice in
the better ear at not less than 5 feet with or without the use of a hearing aid, or, if tested by
use of a standard pure tone audiometer, does not have average hearing loss in the better
ear greater than 40 decibels (hearing level in the ISO 1964 revised standard), with or
without a hearing aid when the audiometric device is calibrated to American National
Standard (formerly combatted ASA standard Z24.5 — 1951). Hearing aids are permitted.
The whisper test is performed at 5 feet (not 20 feet).
9. Which of the following conditions is an ABSOLUTE disqualifier for CMV drivers under
FMCSA regulations with NO exemption process available?
A. Insulin-treated diabetes mellitus B. Loss of a foot, leg, hand, or arm C. Use of Schedule I
controlled substances or any amphetamine, narcotic, or habit-forming drug not prescribed by a
licensed physician D. Epilepsy
Correct Answer: C
Rationale: Per 49 CFR 391.41(b)(12), a driver is disqualified if they use a Schedule I
controlled substance (e.g., heroin, marijuana, ecstasy), amphetamines, narcotics, or any
other habit-forming drug. Unlike many other disqualifying conditions, there is no
exemption process for current illegal drug use or use of Schedule I substances. Insulin-
treated diabetes (ITDM) has an exemption program. Loss of a limb has an alternative
qualification/skills performance evaluation (SPE) process. Epilepsy has an exemption
program. Drug disqualification is absolute for Schedule I substances and illegal drug use.
10. A driver is taking methadone for opioid use disorder treatment. How should the
Medical Examiner handle this situation?
A. Certify the driver if the methadone dose is stable B. Certify for 1 year with quarterly urine
drug screens C. The driver does not meet federal standards — methadone is a narcotic and
