Medical Review Officer (MRO) Exam A & B
2026/2027 | 300+ Complete Questions and
Correct Answers Updated Study Guide for
Certification Success and High Pass Score
Medical Review Officer (MRO) Exam A & B 2026/2027
300+ Complete Questions and Correct Answers | Updated Study Guide
• This study guide contains 300 expertly curated multiple-choice questions covering
all core MRO certification domains, each with a clearly highlighted correct answer
and detailed EXPERT RATIONALE to reinforce understanding.
• Use this material by attempting each question independently before checking the
answer, focusing extra review time on any EXPERT RATIONALE you find unfamiliar
— this method maximizes retention and exam readiness.
1. What is the primary role of a Medical Review Officer (MRO)?
A. To collect urine specimens from employees
B. To discipline employees who test positive for drugs
C. To report all positive results directly to law enforcement
D. To manage the drug testing laboratory
E. To receive and review laboratory results of drug tests and determine their
medical validity
Correct Answer: E
EXPERT RATIONALE: The MRO is a licensed physician responsible for receiving
and reviewing laboratory results from drug testing programs and evaluating those
results for medical validity, legal defensibility, and accuracy, including consideration
of legitimate medical explanations.
,2. Under DOT regulations, which federal agency oversees MRO certification
requirements?
A. DEA
B. FDA
C. DOT through SAMHSA guidelines
D. OSHA
E. CDC
Correct Answer: C
EXPERT RATIONALE: The Department of Transportation (DOT), in conjunction
with SAMHSA guidelines, governs MRO qualifications and workplace drug testing
standards under 49 CFR Part 40.
3. Which specimen type is the standard required by DOT regulations for
workplace drug testing?
A. Blood
B. Saliva
C. Hair
D. Urine
E. Sweat patch
Correct Answer: D
EXPERT RATIONALE: DOT regulations under 49 CFR Part 40 mandate urine as
the standard specimen for federal workplace drug testing programs.
4. Which of the following drugs is NOT included in the standard DOT 5-panel
drug test?
A. Marijuana (THC)
,B. Cocaine
C. Benzodiazepines
D. Amphetamines
E. Phencyclidine (PCP)
Correct Answer: C
EXPERT RATIONALE: The DOT 5-panel test covers marijuana, cocaine, opioids,
amphetamines, and PCP. Benzodiazepines are not included in the standard DOT
panel.
5. What is the MRO's responsibility when a donor provides a medical
explanation for a positive drug test result?
A. Automatically report the result as positive
B. Ignore the explanation and report as confirmed positive
C. Defer the case to law enforcement
D. Require a blood test to confirm
E. Evaluate the medical explanation and determine if it is a legitimate medical
use
Correct Answer: E
EXPERT RATIONALE: The MRO must conduct a medical interview and evaluate
any legitimate medical explanation offered by the donor before making a final
determination on the result.
6. What is the initial screening cutoff concentration for marijuana (THC)
metabolites in urine under DOT regulations?
A. 25 ng/mL
B. 100 ng/mL
, C. 50 ng/mL
D. 75 ng/mL
E. 10 ng/mL
Correct Answer: C
EXPERT RATIONALE: The DOT-mandated initial screening cutoff for marijuana
metabolites (THCA) in urine is 50 ng/mL, with a confirmation cutoff of 15 ng/mL by
GC-MS.
7. What confirmatory test method is required by DOT for positive drug test
results?
A. Immunoassay
B. Thin-layer chromatography
C. High-performance liquid chromatography
D. Gas chromatography-mass spectrometry (GC-MS)
E. Enzyme-linked immunosorbent assay (ELISA)
Correct Answer: D
EXPERT RATIONALE: GC-MS is the gold standard confirmatory method required
by DOT/SAMHSA to confirm all positive initial screening results with definitive
identification and quantification.
8. A specimen with a creatinine concentration of less than 2 mg/dL and
specific gravity less than 1.0010 is reported as:
A. Dilute
B. Negative
C. Substituted
D. Invalid
2026/2027 | 300+ Complete Questions and
Correct Answers Updated Study Guide for
Certification Success and High Pass Score
Medical Review Officer (MRO) Exam A & B 2026/2027
300+ Complete Questions and Correct Answers | Updated Study Guide
• This study guide contains 300 expertly curated multiple-choice questions covering
all core MRO certification domains, each with a clearly highlighted correct answer
and detailed EXPERT RATIONALE to reinforce understanding.
• Use this material by attempting each question independently before checking the
answer, focusing extra review time on any EXPERT RATIONALE you find unfamiliar
— this method maximizes retention and exam readiness.
1. What is the primary role of a Medical Review Officer (MRO)?
A. To collect urine specimens from employees
B. To discipline employees who test positive for drugs
C. To report all positive results directly to law enforcement
D. To manage the drug testing laboratory
E. To receive and review laboratory results of drug tests and determine their
medical validity
Correct Answer: E
EXPERT RATIONALE: The MRO is a licensed physician responsible for receiving
and reviewing laboratory results from drug testing programs and evaluating those
results for medical validity, legal defensibility, and accuracy, including consideration
of legitimate medical explanations.
,2. Under DOT regulations, which federal agency oversees MRO certification
requirements?
A. DEA
B. FDA
C. DOT through SAMHSA guidelines
D. OSHA
E. CDC
Correct Answer: C
EXPERT RATIONALE: The Department of Transportation (DOT), in conjunction
with SAMHSA guidelines, governs MRO qualifications and workplace drug testing
standards under 49 CFR Part 40.
3. Which specimen type is the standard required by DOT regulations for
workplace drug testing?
A. Blood
B. Saliva
C. Hair
D. Urine
E. Sweat patch
Correct Answer: D
EXPERT RATIONALE: DOT regulations under 49 CFR Part 40 mandate urine as
the standard specimen for federal workplace drug testing programs.
4. Which of the following drugs is NOT included in the standard DOT 5-panel
drug test?
A. Marijuana (THC)
,B. Cocaine
C. Benzodiazepines
D. Amphetamines
E. Phencyclidine (PCP)
Correct Answer: C
EXPERT RATIONALE: The DOT 5-panel test covers marijuana, cocaine, opioids,
amphetamines, and PCP. Benzodiazepines are not included in the standard DOT
panel.
5. What is the MRO's responsibility when a donor provides a medical
explanation for a positive drug test result?
A. Automatically report the result as positive
B. Ignore the explanation and report as confirmed positive
C. Defer the case to law enforcement
D. Require a blood test to confirm
E. Evaluate the medical explanation and determine if it is a legitimate medical
use
Correct Answer: E
EXPERT RATIONALE: The MRO must conduct a medical interview and evaluate
any legitimate medical explanation offered by the donor before making a final
determination on the result.
6. What is the initial screening cutoff concentration for marijuana (THC)
metabolites in urine under DOT regulations?
A. 25 ng/mL
B. 100 ng/mL
, C. 50 ng/mL
D. 75 ng/mL
E. 10 ng/mL
Correct Answer: C
EXPERT RATIONALE: The DOT-mandated initial screening cutoff for marijuana
metabolites (THCA) in urine is 50 ng/mL, with a confirmation cutoff of 15 ng/mL by
GC-MS.
7. What confirmatory test method is required by DOT for positive drug test
results?
A. Immunoassay
B. Thin-layer chromatography
C. High-performance liquid chromatography
D. Gas chromatography-mass spectrometry (GC-MS)
E. Enzyme-linked immunosorbent assay (ELISA)
Correct Answer: D
EXPERT RATIONALE: GC-MS is the gold standard confirmatory method required
by DOT/SAMHSA to confirm all positive initial screening results with definitive
identification and quantification.
8. A specimen with a creatinine concentration of less than 2 mg/dL and
specific gravity less than 1.0010 is reported as:
A. Dilute
B. Negative
C. Substituted
D. Invalid
