What's on the TMC Exam? Content Areas, Format, and the RT Exam That Replaces It in 2027

What is on the TMC exam? Three content areas and 140 scored items

The TMC exam covers three content areas from the National Board for Respiratory Care (NBRC): Patient Data; Troubleshooting and Quality Control of Devices, and Infection Control; and Initiation and Modification of Interventions. It has 160 multiple-choice items, 140 scored and 20 pretest, in 3 hours, and two cut scores decide whether you earn the CRT and whether you may go on to the Clinical Simulation Examination (CSE). From January 4, 2027, NBRC gives the Respiratory Therapy (RT) Exam instead, so a 2027 candidate studies the RT outline, which keeps those three areas and adds a clinical judgment portion.

The three areas come from NBRC's Therapist Multiple-Choice Examination Detailed Content Outline, effective January 2020 through December 31, 2026. Each area is split into lettered tasks with their own item counts:

The outline also sets how hard the items are. Of the 140 scored items, 33 are recall, 66 application and 41 analysis, so about three in four ask you to use information rather than remember it. Pediatric patients (1 month to 17 years) have a target of 4 items per form, with a range of 3 to 8, and neonatal patients a target of 3, with a range of 2 to 5; the rest are adult or general.

How is the TMC exam formatted and scored?

• Length and time: 160 multiple-choice items in 3 hours at a PSI assessment center. NBRC's handbook says pretest items are embedded at random and not identified, so every item deserves the same effort.
• Scoring: each scored item is worth one point, and your raw score is compared with the cut score. The TMC has two: the low cut earns the CRT, and the high cut earns the CRT and makes you eligible for the CSE, provided you are eligible for the RRT. What each cut opens for you is in the guide to the TMC cut scores.
• Fees and retakes: $190 for new applicants and $150 for repeat applicants, as checked on November 1, 2026. You may attempt the TMC three times without waiting, and then must wait at least 120 days between attempts. Retaking does not affect a CRT you already hold.
• End date: NBRC's RT page gives December 15, 2026 as the last day to apply for the TMC and December 31, 2026 as the last day to take it.

What replaces the TMC exam in 2027?

NBRC is moving to a single exam for both the CRT and the RRT. Its RT page gives January 4, 2027 as the start of the Respiratory Therapy Examination, which replaces the TMC and the CSE. The CSE stays open through December 31, 2027, but only for candidates who passed the TMC at the high cut score before December 31, 2026; they can also choose the RT Exam and pass it at the high cut to earn the RRT.

To sit for the RT Exam, NBRC requires you to be at least 18 and a graduate, with at least an associate degree, of an entry-into-practice respiratory therapy program supported or accredited by CoARC, or to hold the Canadian Society of Respiratory Therapists (CSRT) RRT credential. The CRT-to-Registry admission route ends December 31, 2026, and TMC and CSE attempts do not count toward your RT Exam attempts.

How do the TMC content areas carry into the RT Exam?

NBRC's announcement of the 2027 changes says the Breadth of Knowledge portion is based on the TMC content domains and cognitive levels, and the Depth of Clinical Judgment portion on the CSE's patient types, settings, patient ages and clinical activities. The Respiratory Therapy Examination Detailed Content Outline, effective January 2027, gives the Breadth portion these three areas per form:

Interventions keep half of the knowledge items, as on the TMC. The devices area grows from about 14% of the TMC's scored items to a quarter of the Breadth portion, and its second task now reads "Ensure Infection Prevention or Control, Safety, and Performance of Quality Assurance Procedures." In the Breadth portion, 23 items are recall, 52 application and 25 analysis.

Several topics appear in the RT outline that the 2020 TMC outline does not name: vaping history, social determinants of health and barriers to care, biologics for asthma and CFTR modulators for cystic fibrosis, closed-loop communication, debriefing after adverse patient events, and trauma-informed, culturally aware interaction. Patient and family education now sits inside a new task, Interact with Team Members, Patients, and Families, with 5 items. The four areas are also how the 1,100 questions planned for full NBRC RT Exam prep are split.

What does the Depth of Clinical Judgment portion test?

The 60 Depth items are limited to the application and analysis levels. Each is linked to a patient condition, a clinical judgment type, a setting and one of the Breadth tasks, so the same ventilator or oxygen knowledge comes back inside a patient story.

Two other specifications shape every Depth form. Twenty items are information gathering (choose what to assess, or interpret information) and 40 are decision making (decide what to add, modify, continue or discontinue). Forty-six are set in a hospital and 14 outside one. Across the whole exam, each form carries 15 to 18 neonatal or pediatric items.

The outline adds that forms are built by a linear-on-the-fly system from item sampling groups, so two candidates can see different items written to the same specifications. The CSE's 22 simulation problems give way to these 60 multiple-choice items. When a decision item goes wrong, the useful review is the finding that should have changed your choice, and every answer in full RT Exam prep planned for launch is set to come with an explanation of that finding.

TMC exam questions candidates ask

Can I still take the TMC exam in 2027?

No. NBRC's last TMC test day is December 31, 2026. From January 4, 2027, a new candidate for the CRT or the RRT takes the RT Exam.

I passed the TMC at the high cut. Do I need the RT Exam?

Not necessarily. If you passed at the high cut before December 31, 2026, you can earn the RRT by passing the CSE through December 31, 2027, or by passing the RT Exam at its high cut.

Can I use a calculator on the TMC or the RT Exam?

NBRC's candidate handbook says calculators are not permitted. The RT outline lists cardiopulmonary calculations such as P(A–a)O2, VD/VT, the P/F ratio, the oxygenation index and the SpO2/FIO2 ratio, so practice them by hand.

Studying for the RT Exam with the TMC areas as a base

If you test in 2027, use the RT outline's item counts as your weights. Depth of Clinical Judgment and Initiation and Modification of Interventions together make up 110 of the 160 scored items, so they deserve most of your week, while Patient Data and devices stay in rotation. Material written for the TMC outline still covers much of the Breadth content, since NBRC built that portion on the TMC's domains, but check it against the new topics above, and add case practice across the adult and pediatric conditions in the Depth table.

For a baseline, try the 20 free NBRC RT Exam practice questions. They are original Passy items split 3, 3, 6 and 8 across the four areas, with an explanation for every option, and a set that short does not predict a result. Then enter your test date in the free RT Exam study planner. NBRC also links an RT practice examination on its RT page and sells official Self-Assessment Examinations through PSI. For pacing, 4 hours for 185 items averages about 78 seconds per item, and a timed 185-question mock exam is planned for full RT Exam prep to rehearse it.