USCIS Risk Assessment & Management 3 — Questions and Answers
Question 1: A civil surgeon reviewing vaccination records finds an adult applicant received a single dose of MMR at age 12. What is the correct risk management action?
- Accept the single dose as sufficient for all three components
- Administer a second dose of MMR to ensure full immunity (Correct answer)
- Order serologic testing for all three MMR components before acting
- Waive the requirement since the applicant is over 18
Correct answer: Administer a second dose of MMR to ensure full immunity
USCIS requires two doses of MMR for adults; a single prior dose is insufficient and the second dose must be administered or documented before completing Form I-693.
Question 2: Which of the following best describes the civil surgeon's role in managing risk for applicants with Hansen's disease (leprosy)?
- Automatically classify as Class A inadmissible and suspend the exam
- Assess whether the disease is active or inactive and classify accordingly (Correct answer)
- Refer to USCIS for a waiver without completing the medical form
- Prescribe multi-drug therapy before completing Form I-693
Correct answer: Assess whether the disease is active or inactive and classify accordingly
Hansen's disease is only a Class A condition if active and infectious; the civil surgeon must assess clinical activity to classify correctly.
Question 3: An applicant presents with gonorrhea confirmed by NAAT testing. What is the appropriate risk management step before completing Form I-693?
- Complete Form I-693 and note as a Class B finding only
- Treat the infection, document cure, and then complete the form (Correct answer)
- Refer the applicant to a urologist before any documentation
- Classify as inadmissible and stop the exam process
Correct answer: Treat the infection, document cure, and then complete the form
Gonorrhea is a communicable disease of public health significance; the applicant must complete treatment and demonstrate cure before Form I-693 can be finalized.
Question 4: A civil surgeon is evaluating an applicant with well-controlled HIV on antiretroviral therapy with undetectable viral load. How should this be classified?
- Class A — HIV is always inadmissible
- Class B — managed condition with ongoing medication need (Correct answer)
- No notation — undetectable viral load means no concern
- Refer to CDC for case-by-case determination
Correct answer: Class B — managed condition with ongoing medication need
HIV was removed from the list of inadmissible communicable diseases in 2010; it is now documented as a Class B condition reflecting a physical abnormality requiring ongoing management.
Question 5: When assessing drug abuse risk during the USCIS medical exam, which of the following best distinguishes a Class A drug abuse finding from a Class B finding?
- Class A requires daily use; Class B requires weekly use
- Class A requires a current disorder meeting DSM criteria; Class B reflects a history in remission (Correct answer)
- Class A applies only to illegal drugs; Class B applies to alcohol
- Class A is determined by urine drug screen; Class B by clinical interview only
Correct answer: Class A requires a current disorder meeting DSM criteria; Class B reflects a history in remission
A current substance use disorder meeting DSM-5 criteria is Class A; a substance use disorder in sustained remission is Class B, reflecting reduced public health and social risk.
Question 6: A civil surgeon reviews chest X-ray findings from an overseas medical exam showing old fibrotic lesions. The applicant has no symptoms and a negative IGRA. What is the most appropriate classification?
- Class A — any pulmonary finding requires inadmissibility classification
- Class B — pulmonary TB, no current disease (Correct answer)
- No classification required since IGRA is negative
- Defer the exam and request repeat imaging in 6 months
Correct answer: Class B — pulmonary TB, no current disease
Old fibrotic lesions consistent with prior TB, combined with a negative IGRA and no active disease, are typically classified as Class B TB, requiring follow-up after admission.
Question 7: Which scenario represents an appropriate use of a vaccination waiver during the USCIS medical examination process?
- An applicant who dislikes needles and refuses all vaccines
- An applicant with a documented medical contraindication to a specific vaccine (Correct answer)
- An applicant whose home country does not recommend a particular vaccine
- An applicant who missed the appointment and cannot return within 30 days
Correct answer: An applicant with a documented medical contraindication to a specific vaccine
Medical contraindications are a recognized basis for vaccination waivers; religious and moral objections are also recognized grounds, but personal preference or logistical issues are not.
USCIS Risk Assessment & Management 3
A civil surgeon reviewing vaccination records finds an adult applicant received a single dose of MMR at age 12.
What is the correct risk management action?