Things are are not a pass on EU inspection will not necessarily get you off the road immediately, but you will have to have them fixed within a period of time. If you do not, cannot, past the inspection, the car can be taken off the road.
Rust is one issue that is seldom considered in the USA. Lack of integrity used to be considered on the MOT(such as rusted sills, rust around struts, etc) and I suppose still is.
Oil drips are considered, including grease seals at hubs, ball joints, CV joints, tranny, etc. These, if they catch the eye of the inspector, have to be fixed. And it goes on and on.
Cuhulin just gave you a clue as to what is really done here. They often scrape off the old sticker and put on a new one..Typically American way of doing things, I am afraid.
We Americans stirred up the shit about pollution, about alkylphenolethoxylates, and a number of other issues ,but we typically do not taste of our own medicine. As in the news stories lately, there is a new scandal almost every day, and our view of our moral highground is less and less credible.