NRCME case studies

NRCME · Put your knowledge to work in context.

National Registry of Certified Medical Examiners (NRCME) certification is the credential a physician, chiropractor, nurse practitioner, physician assistant, or doctor of osteopathy must hold to perform physical qualification examinations of interstate commercial motor vehicle drivers and to issue the Medical Examiner's Certificate. Certification is a federal program administered through the FMCSA; passing the certification test is one component of a process that also includes completing an approved training curriculum and holding an active, unrestricted license in your scope of practice. The NRCME case studies are 5 cases and about 3,745 words.

Type 1 Diabetes, a Recent Severe Hypoglycemic Episode, and a Driver Who Needs to Leave Monday

MR is a 44-year-old interstate tractor-trailer driver with type 1 diabetes of 19 years, managed with an insulin pump and CGM, A1c 7.6 percent, no retinopathy, nephropathy, or neuropathy, BMI 27. He checks glucose at least four times daily and relies on CGM alarms.

806 words, about 4 min 2

A Two-Year Card From a Provider Who Is Not on the National Registry

JC is a 57-year-old interstate driver applying for a new certificate. He hands you a Medical Examiner's Certificate issued 20 months ago for a two-year period by a chiropractor; it is the only document his carrier has on file.

714 words, about 4 min 3

Hearing: A Failed Whisper Test, a Functioning Hearing Aid, and an Audiogram That Says Something Else

TP is a 49-year-old driver presenting for recertification. With the door closed and the room quiet, you perform a forced whisper test at 5 feet: in the right ear he repeats all three letter-number combinations correctly; in the left ear he misses two of three.

768 words, about 4 min 4

172/106 at the Examination, Home Readings in the 150s, and a Driver Who Leaves Tomorrow

RB is a 54-year-old line-haul driver presenting for recertification. Seated BP in the right arm is 172/106; after five minutes of rest a repeat in the left arm is 168/104.

699 words, about 3 min 5

Stable Depression on an SSRI, a Driver's Request for Silence, and a Carrier's Phone Call

LS is a 39-year-old driver presenting for recertification. On the history he discloses three years of major depressive disorder treated with sertraline 100 mg daily.

758 words, about 4 min