Medical Review Officer Self-Assessment Examination

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Medical Review Officer

Self-Assessment Examination

Instructions: This examination has 50 questions. For each question, there is one correct answer. Click on what you feel is the best answer for each question. The examination program will respond to your answer with a comment and mark your answer sheet with ~~incorrect answer~~ or correct answer marks. On each question, keep trying until you get the correct answer.

1.	Urine drug test results are expressed as nanograms per mililiter. A nanogram is:

	A. One thousandth of a gram (10^-3 gram)
	B. One ten-thousandth of a gram (10^-4 gram)
	C. One millionth of a gram (10^-6 gram)
	D. One billionth of a gram (10^-9 gram)
	E. One trillionth of a gram (10^-12 gram)

2.	In the laboratory, confirmatory testing in regulated urine drug testing programs:

	A. Must be GC/MS.
	B. May be GC/MS
	C. Must be immunoassay
	D. May be immunoassay.
	E. May be either immunoassay or GC/MS

3.	In micrograms per deciliter, what is the highest acceptable level of nitrites in the urine for urine drug testing?

	A. 1000
	B. 45
	C. 1
	D. 250
	E. 500

4.	The specimen ID numbers on the Custody and Control Form (CCF) and the specimen do not match. Fatal or correctable flaw?

	A. Fatal
	B. Correctable

5.	A positive alcohol breath test must be performed on evidentiary breath alcohol equipment and reviewed by a MRO.

	A. True
	B. False

6.	The upper level cut-off for pH in urine drug testing is:

	A. 9
	B. 10
	C. 11
	D. 12
	E. 13

7.	Certifying scientist signature is missing for a non-negative result. Fatal or correctable flaw?

	A. Fatal
	B. Correctable

8.	If the 6-AM is negative, the MRO needs clinical signs of opiate abuse unless the morphine concentration greater than or equal to:

	A. 5 ng/ml
	B. 100 ng/ml
	C. 1000 ng/ml
	D. 15,000 ng/ml
	E. 25,000 ng/ml

9.	Under Federal Motor Carrier Safety Administration (FMCSA) regulations post-accident urine drug testing must be performed within:

	A. 2 hours
	B. 12 hours
	C. 18 hours
	D. 24 hours
	E. 32 hours

10.	A urine is considered adulterated if the pH is less than or equal to:

	A. 3
	B. 4
	C. 5
	D. 6
	E. 7

11.	How long does the donor have to request a split specimen analysis after being notified of a positive test?

	A. 24 hours
	B. 36 hours
	C. 48 hours
	D. 72 hours
	E. 1 week

12.	The confirmation test level for 6-acetylmorphine (ng/ml) is:

	A. 10
	B. 20
	C. 50
	D. 500
	E. 10,000

13.	Under Federal Motor Carrier Safety Administration (FMCSA) regulations, the employer must, with the employee's written authorization, inquire about positive alcohol and urine drug tests and refusals to test over the previous:

	A. 6 months
	B. 1 year
	C. 2 years
	D. 5 years
	E. 10 years

14.	Confirmation testing for cocaine is specific for:

	A. di-acetyl cocaine
	B. mono-acetyl cocaine
	C. ecgonine methyl ester
	D. benzoylecognine

15.	The major point of challenge for a positive drug test most likely arises from:

	A. specimen collection
	B. employee selection
	C. laboratory testing
	D. MRO analysis

16.	Which enantiomer of methamphetamine does not constitute a positive test for illegal drug use?

	A. d - (dextro)
	B. 1 - (levo)

17.	Ingestion of which one of the following substances is MOST LIKELY to cause a positive urine drug test for marijuana?

	A. 1 "Seedy Sweetie" snack bar
	B. 6 ounces of Heavenly Hemp flour in pancakes
	C. 8 ounces of Health Inca Tea
	D. 1 tablespoon of "Hemp Liquid Gold" hemp oil

18.	An employee is abusing Oxycontin ® (oxycodone HCL controlled-release), taking 200 mg/day, and no other substances, the most likely result for his urine drug test will be:

	A. positive for morphine (2,000 ng/ml), negative for 6-AM
	B. positive for morphine (5,000 ng/ml), positive for 6-AM
	C. positive for morphine (18,000 ng/ml), positive for 6-AM
	D. positive for morphine (18,000 ng/ml), negative for 6-AM
	E. negative

19.	The time period between screening and confirmatory breath alcohol tests must be AT LEAST:

	A. 5 minutes
	B. 15 minutes
	C. 30 minutes
	D. 45 minutes
	E. 60 minutes

20.	The Americans with Disabilities Act considers urine drug testing to be a medical examination. (TRUE/FALSE)

	A. True
	B. False

21.	A urine specimen with a creatinine less than or equal to 2 mg/dl and specific gravity of less than or equal to 1.001 is:

	A. dilute
	B. adulterated
	C. substituted

22.	A positive urine drug test indicates:

	A. use of the drug.
	B. impairment.
	C. route of administration.
	D. amount of drug consumed.

23.	Drinking vinegar will speed the urinary excretion of which two drugs?

	A. Opiates and marijuana
	B. Amphetamine and phencyclidine
	C. Phencyclidine and marijuana
	D. Cocaine and opiates

24.	In a conference with the Medical Review Officer, a donor with a positive drug test for amphetamine states that the test results from use of a Vick's Inhaler. A test for d- and l- differentiation must demonstrate AT LEAST what percentage of d- for the MRO to report the test as positive?

	A. 5%
	B. 10%
	C. 20%
	D. 80%
	E. 100%

25.	If an employee does not regularly use marijuana and smokes two joints, how long is his or her drug test likely to remain positive.

	A. 1 day
	B. 3 days
	C. 7 days
	D. 14 days
	E. 30 days

26.	Tolectin, Flagyl and Cipro are the three drugs most often causing:

	A. False positive tests for cocaine
	B. False negative tests for cocaine
	C. False positive tests for marijuana
	D. False positive tests for opiatess
	E. Invalid specimens

27.	In 1990, it was discovered that high doses of pseudoephedrine can produce a positive GC/MS for methamphetamine. As a result, confirmatory requirements for methamphetamine now must contain at least:

	A. 500 ng/ml of methamphetamine
	B. 500 ng/ml of amphetamine
	C. 1000 ng/ml of methamphetamine and 500 ng/ml of amphetamine
	D. 500 ng/ml of methamphetamine and 500 ng/ml of methamphetamine
	E. 500 ng/ml of methamphetamine and 200 ng/ml of amphetamine

28.	Which of the following sets of screening and confirmatory levels is INCORRECT:

	A. Marijuana: 50 ng/ml initial, 20 ng/ml confirmatory
	B. Opiates: 2000 ng/ml initial, 2000 ng/ml confirmatory
	C. Phencyclidine: 25 ng/ml initial, 25 ng/ml confirmatory
	D. Amphetamine: 1000 ng/ml initial, 500 ng/ml confirmatory
	E. Cocaine: 300 ng/ml initial, 150 ng/ml confirmatory

29.	An truck driver has a positive, random drug test for marijuana. Which of the following statements is TRUE about the response of the employer to this employee's job?

	A. Federal regulations do not prevent the employer from firing the employee.
	B. The employer may not fire the employee because of provisions in the Americans with Disabilities Act (ADA).
	C. The employer may not fire the employee because of Federal Motor Carrier Safety Administration (FMCSA) regulations.
	D. The employer must fire the employee because of Federal Motor Carrier Safety Administration (FMCSA) regulations.

30.	An employee has a confirmed positive test for cocaine. The employee insists that the urine is not his and requests the MRO to order DNA testing before confirming the result. Under DOT rules, the MRO should:

	A. Order DNA testing and delay reporting the results until the testing is completed.
	B. Report the test as "Provisionally Positive" and order the DNA testing.
	C. Report the test as "Negative" because the urine may not be the employee's.
	D. Seek a court ruling on the DNA testing before reporting the results.
	E. Report the test as "Positive" because the DOT does not authorize the reversal of test results based on DNA testing.

31.	"A need for markedly increased amounts of the substance to achieve intoxication or desired effect OR markedly diminished effect with continued use of the same amount of substance." This is a definition for:

	A. Substance dependence
	B. Tolerance
	C. Withdrawal
	D. Experimental substance use
	E. Recreational substance use.

32.	Saliva tests may be used in which of the following federally-regulated testing programs?

	A. Screening drug test
	B. Confirmatory alcohol test
	C. Screening alcohol test
	D. Confirmatory drug test
	E. Screening drug and alcohol tests

33.	Which statement regarding the epidemiology of drug testing and drug use is INCORRECT:

	A. Drug use is consistently higher in males than in females.
	B. The frequency of positive drug tests is higher in federally-mandated testing programs than in testing for the general population.
	C. The rate of drug test positivity has declined about 50% in the last decade.
	D. Marijuana is drug most frequently found in positive drug tests.
	E. "For cause" drug testing is the category of drug testing that has the highest rate of drug positivity.

34.	Each of the following pairs list a drug test and a drug which can make the initial and confirmatory drug test positive. All pairs are correct EXCEPT:

	A. Drug Test: Phencyclidine / Drug: Benadryl^®
	B. Drug Test: Opiates / Drug: Tylenol with Codeine^®
	C. Drug Test: Marijuana / Drug: Marinol^®
	D. Drug Test: Cocaine / Drug: TAC
	E. Drug Test: Amphetamine / Drug: Dexedrine^®

35.	The percentage of specimens required for internal laboratory quality control for GC/MS is:

	A. 1%
	B. 2%
	C. 5%
	D. 10%
	E. Not specified by regulation.

36.	Under Federal Motor Carrier Safety Administration (FMCSA) regulations, what is the minimum number of follow-up drug tests in the twelve months following a positive drug test and an SAP evaluation?

	A. 1
	B. 3
	C. 6
	D. To be determined by the MRO
	E. Not specified by regulation

37.	As a quality control function, the MRO must personally review and sign (or initial) what percentage of negative results?

	A. 1%
	B. 2%
	C. 5%
	D. 10%
	E. Not specified by regulation.

38.	An employee with a positive drug test may be able to provide evidence of a legitimate medical use for each of the following drugs, EXCEPT:

	A. Amphetamine
	B. Cocaine
	C. Marijuana
	D. Opiates
	E. Phencyclidine

39.	Regarding urine specimen collection -- The five following circumstances can result in direct observation. For which of them is direct observation OPTIONAL?

	A. Specimen temperature "out of range"
	B. Tampering attempt observed
	C. Previous test cancelled as "Invalid Result"
	D. Previous test cancelled because specimen was "Unavailable"
	E. Return to duty

40.	An air blank between an screening and confirmatory breath alcohol test which reads >.00 is a:

	A. Correctable flaw
	B. Fatal flaw

41.	All of the following statements about "Cancelled Tests" are correct, EXCEPT:

	A. Cancelled tests can be used to meet random test percentage requirements.
	B. Cancelled tests are neither positive nor negative.
	C. Cancelled tests cannot be used to trigger a non-DOT test.
	D. MROs cannot cancel tests for "minor" procedural errors.

42.	For non-negative results, the MRO attempts to contact the donor:

	A. 1 try in 24 hours
	B. 3 tries in 24 hours
	C. 3 tries in 48 hours
	D. 3 tries in 72 hours
	E. Not specified by regulation.

43.	The mean population rate of alcohol metabolism in g/dl/hr is:

	A. 0.001 - 0.003
	B. 0.008 - 0.012
	C. 0.015 - 0.018
	D. 0.025 - 0.027
	E. Varies too much to make a general statement.

44.	Under the regulations which take effect August 1, 2001, the MRO can receive drug testing results verbally, by phone. (TRUE/FALSE)

	A. True
	B. False

45.	Under Federal Aviation Administration rules, aviation employees who have two violations (drug or alcohol) or a single on-duty use violation,

	A. must undergo 6 follow-up drug tests in the next twelve months, before returning to work.
	B. must undergo inpatient rehabilitation.
	C. are barred for life from their aviation occupation.
	D. must undergo rehabilitation as directed by the SAP.
	E. must be returned to their previous job after rehabilitation.

46.	Under Federal Railway Administration rules, a refusal to test results in:

	A. 6 month suspension.
	B. 9 month suspension.
	C. 12 month suspension.
	D. Being permanently barred for life from a railway occupation.
	E. The consequences are not specified by regulation.

47.	As of January 31, 2003, all of the following statements accurately describe the requirements for a person to function as an MRO in a DOT drug testing program, EXCEPT:

	A. A physician (MD or DO) licensed to practice in any US, Mexico, or Canadian jurisdiction.
	B. Completion of qualification training.
	C. Satisfactory completion of a certifying examination conducted by the DOT.
	D. Completion of 12 hours of continuing medical education related to MRO functions every three years.
	E. Continuing medical education must include self-assessment tools.

48.	An employee has a positive drug test for marijuana in a state where a law has been passed making smoking medical marijuana legal. The employee provides documentation that he has been smoking medical marijuana consistent with the state law. The MRO should:

	A. Report the test as "Negative"
	B. Cancel the test
	C. Report the test as "Positive"
	D. The MRO should use his or her discretion in deciding whether the test is "Positive" or "Negative"

49.	All of the following statements about privacy in urine collection in DOT drug testing programs are correct, EXCEPT:

	A. No undressing or gowning
	B. The pockets may not be searched.
	C. No medication inquiries.
	D. There must be a private enclosure for urination.
	E. The donor may retain his or her wallet.

50.	Under Federal Motor Carrier Safety Administration (FMCSA) regulations, an employee must refrain from alcohol consumption after an accident for:

	A. 2 hours
	B. 8 hours
	C. 12 hours
	D. 24 hours
	E. Not specified in the regulations

About this examination: I wrote this examination to help physicians meet the new MRO continuing education requirements requiring self-evaluation tools. In addition to the federal regulations, these questions came primarily from my much-used copy of The Medical Review Officer's Manual, by Swotinsky and Smith. [This is an excellent book and available from OEM Press.] and from ACOEM's MRO course taught by Dr. Kent Peterson and others. [This is a wonderful course which I really enjoyed. Further information is at ACOEM.] I wrote the questions during the lectures of the June 23/24, 2001 course. My intent was to create a group of self-evaluation questions of a difficulty level similar to that of the MROCC examination so that physicians could realistically gauge their level of knowledge. If you have questions or comments about this exam, let me know. I hope you find it helpful.

William L. Newkirk, MD, FACPM

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