Exam Flashcards
1
Q
Name 4 situations that require a driver to be physically qualified.
A
- Combined gross vehicular weight of 10,001 lbs. or more.
- When transporting 9-15 passengers, including the driver, for compensation.
- When transporting 16+ passengers w/ or w/o compensation.
- When transporting hazardous material that requires a placard under hazardous materials regulations.
2
Q
Drivers must be medically certified how often?
A
2 years without exception. Can be shorter. Must be re-qualified after injury or illness which could compromise driving ability. There is no grace period.
3
Q
Four non-discretionary qualifiers. Which 2 can receive exemption providing temporary regulatory relief?
A
Vision, hearing, epilepsy, diabetes. Vision and diabetes.
*The provider cannot grant these exemptions. We would qualify them as “otherwise qualified” if accompanied by an exemption.
4
Q
Minimum age to be a CMV driver
A
21
5
Q
What should be verified in terms of DOB?
A
That it matches the age.
6
Q
From which date does examiner’s certificate expiration date calculated, original certification, recertification or any required follow-up examination?
A
Certification or recertification.
7
Q
The driver is also asked to report any illness/injury he/she has sustained within the last __ years, whether or not currently under treatment.
A
5
8
Q
Two or more unprovoked seizures is considered ______.
A
Epilepsy
9
Q
Complaints of _____ or _______ are driver responses that may be the first warning signs of an eye disorder that interferes with safe driving.
A
Glare or near-crashes
10
Q
What must you do if the driver reports current CVD?
A
Consult with the driver health care provider and obtain documentation prior to certification.
11
Q
Due to risk of syncope and gradual or sudden incapacitation while driving FMCSA medical guidelines recommend not to certify the driver who has an ___.
A
And implanted cardiac defibrillator (ICD). This includes a dual pacemaker/ICD, even if the ICD has not been activated.
12
Q
Drivers on dialysis?
A
Cannot be certified.
13
Q
How long can a driver with insulin-treated diabetes mellitus who are otherwise qualified be certified with a medical exemption?
A
One year
14
Q
To pass the vision test drivers must have distant visual acuity and distant binocular visual acuity of at least _____ (Snellen) in each eye, with or without corrective lenses.
A
20/40
15
Q
What is the only portion of the driver physical examination that can be performed and certified by
a provider other than a medical examiner?
A
Vision
16
Q
Drivers must pass one of two hearing tests.
1, First perceive a forced, whispered voice in one ear at not less than ___ feet.
2. Not have an average hearing loss in one ear greater than __ decibels (dB) at ___ hertz (Hz),
____ Hz, and ____ Hz.
A
5 feet
40 decibels (dB) at 500 hertz (Hz), 1,000 Hz, and 2,000 Hz**
*500 is half of a 1000 which is half of 2000
17
Q
Under what circumstance would the driver usually have to go to an audiologist or hearing aid center for testing?
A
When they wear a hearing aid.
18
Q
BP greater than ___/__ must be confirmed with a second measurement taken later during the
examination.
A
139/89
19
Q
A one-time, three-month medical certificate is granted for which 2 hypertensive cases?
A
BP that is equivalent to stage 2 hypertension, or a driver that was certified with stage 1 hypertension has not achieved a BP less than or equal to 140/90 at recertification.
20
Q
What is stage 2 hypertension?
A
160-179/100-109
21
Q
What is stage 1 hypertension?
A
140-159/90-99
22
Q
What is stage 3 hypertension?
A
> =180/>=110
23
Q
When a BP reading is a value where the individual systolic and diastolic readings are in different stages,
you should classify the reading by the ______ stage.
A
Higher
For example, 168/94 and 148/104 are both examples
of Stage 2 hypertension.
24
Q
How long can your recertify for a 1-year expiration date due to hypertension?
A
1 year if BP is at or below 140/90
25
How long can your recertify for a 6-month expiration date due to hypertension?
Six months if BP is at or below 140/90
26
How long can your recertify for a one-time certification of 3-months due to hypertension?
1 year if BP is at or below 140/90
27
You must perform a urinalysis (dip stick) to test for which 4 things?
Specific gravity, protein, blood, glucose
28
Glucosuria should prompt you to check what?
Blood glucose
29
At a minimum, you must check for which 7 things on the eye exam?
Pupillary equality, reaction to light and accommodation, ocular motility, ocular muscle imbalance, extraocular movement, nystagmus, and exophthalmos.
30
At a minimum, you must check for these 3 things on the ear exam.
Scarring of the tympanic membrane, occlusion of the external canal, and perforated eardrums.
31
In the case of Meniere's disease it is recommended to certify or not certify the driver?
Not certify the driver.
32
The SPE certificate is issued for how many years?
2 years.
33
For how many years must you retain a copy of the driver medical records, including the certificate?
3
34
How long must a drive be symptom-free in order to be certified if they have benign positional vertigo or acute/chronic peripheral vestibulopathy?
2 months
35
True or false: Disorders of the labyrinth are disqualifying.
True
36
An individual diagnosed with Stage 1 hypertension may be certified for __ At recertification, an individual with a BP equal to or less than 140/90 may be
certified for __; however, if his or her BP is greater than 140/90 but less than 160/100, a one-time
certificate for ___ can be issued.
one year, one year, 3 months
37
An individual diagnosed with Stage 2 should be treated and a one-time certificate for ___ certification can be issued. Once the driver has reduced his or her BP to equal to or less than 140/90, he or she may be recertified every ___ thereafter.
3-month certification, yearly
38
An individual diagnosed with Stage 3 hypertension should not be certified until his or her BP is reduced to 140/90 or less, and may be recertified every ___.
6 months.
39
True or false: "One-time" certification means you cannot issue consecutive 3-month certificates for BP greater than 140/90. It does not mean once in a lifetime.
True
40
Certify or not? Driver presents with a one-time, 3-month certificate for elevated BP or hypertension and BP greater than 140/90.
Not certify
41
A history of stage 3 hypertension and BP greater than 140/90.
Not certify
42
BP greater than or equal to 180/110, regardless of any other considerations.
Not certify
43
How long can a driver who is disqualified for stage 3 hypertension be recertified if BP is equal to or less than 140/90?
6 months
44
How long can a driver who is disqualified for stage 1 hypertension may be recertified if BP is lowered to
less than 140/90?
One year
45
Which stage of hypertension is considered an absolute indication for antihypertensive medication?
Stage 2
46
Certify or not? Driver presents with a one-time, 3-month certificate for stage 2 hypertension and BP greater hypertension and BP greater than 140/90.
Not certify
47
Certify or not? Driver presents with a history of stage 3 hypertension and BP greater than 140/90
Not certify
48
Certify or not? Driver presents with a BP equivalent to stage 2 hypertension and the driver:
• Has no history of hypertension.
• Does not use antihypertensive medication to control BP
Certify
49
What is the maximum time a driver with stage 3 hypertension can be recertified?
6 months
50
Which cardiac condition is most common in sudden driver incapacitation?
Arrhythmia
51
What is the most common etiology for cardiac arrhythmias?
Coronary heart disease
52
What is the minimum waiting period for stabilization of anticoagulant therapy?
One month
53
What is the maximum certification period for a driver on coumadin therapy?
One year (with documentation of INR)
54
Disqualify driver on coumadin therapy under these 3 circumstances.
INR not being monitored, INR not demonstrating therapeutic levels, underlying disorder is disqualifying.
55
For drivers on coumadin how often should INR be checked?
Monthly
56
What is the minimum waiting period for post-surgical repair of an aneurysm (all types)? What is the maximum recertification period?
3 months, 1 year
57
Certify or not certify? AAA less than 4 cm and the driver is asymptomatic?
Certify
58
Certify or not certify? AAA greater than 4 cm but less than 5 cm and the driver is asymptomatic?
Certify but only with clearance from a cardiovascular specialist who understands the functions and demands of commercial driving.
59
Certify or not certify? AAA surgically repaired.
Certify if driver meets post-surgical repair of aneurysm guidelines.
60
Certify or not certify? AAA needing surgical repair.
Not certify.
61
Certify or not certify? AAA greater than 4 cm but less than 5 cm.
Not certify unless driver has medical clearance for commercial driving from a cardiovascular specialist.
62
Certify or not certify? AAA greater than 5 cm.
Not certify under any circumstance.
63
Certify or not certify? AAA having increased more than 0.5 cm during a 6 month period, regardless of size.
Not certify
64
What 2 things need to happen before you can certify a driver with a h/o DVT?
Etiology needs to be confirmed, and treatment has been shown to be adequate/effective, safe, and stable.
65
Maximum certification period for a driver with a h/o DVT
One year
66
Maximum certification period for a driver with chronic DVT disease?
2 years if driver has no symptoms
67
What is the waiting period for post-surgical repair for PVD (intermittent claudication)?
3 months (etiology must be confirmed)
68
Certify or not certify? Pain in legs, at rest, due to intermittent claudication.
Not certify
69
Certify or not certify? Thoracic aneurysm less than 3.5 cm.
Certify
70
What is the waiting period after implantation of a pacemaker when the underlying condition is sinus node dysfunction?
One month
71
What is the waiting period after implantation of a pacemaker when the underlying condition is AV node block?
One month
72
What is the waiting period after implantation of a pacemaker when the underlying condition is neurocardiogenic syncope?
3 months
73
What is the waiting period after implantation of a pacemaker when the underlying condition is hypersensitive carotid sinus with syncope?
3 months
74
Maximum certification period if driver has a pacemaker
1 year
75
What is the waiting period for a diagnosis of atrial fibrillation treated adequately with anticoagulants?
One month
76
What is the waiting period for a diagnosis of atrial flutter treated with post-isthmus ablation?
One month
77
Minimum waiting period after being diagnosed with coronary heart disease, right ventricular outflow VT, or idiopathic left ventricular VT.
One month
78
You cannot certify a driver if they have a diagnosis of NSVT with a LVEF less than ___.
0.40
79
Certify or not certify? Has a diagnosis of hypertrophic cardiomyopathy.
Not certify
80
Certify or not certify? Long QT interval syndrome.
Not certify
81
Certify or not certify? Brugada syndrome
Not certify
82
Name four things a driver must do successfully to pass an exercise tolerance test.
• Exercise to a workload capacity greater than 6 Metabolic Equivalents (METs) (through Bruce
protocol stage II or equivalent).
• Attain a heart rate greater than or equal to 85% of predicted maximum (unless on beta blockers).
• Have a rise in systolic blood pressure greater than or equal to 20 mm Hg without angina.
• Have no significant ST segment depression.
83
Minimum waiting period after acute myocardial infarction.
2 months
84
Name 4 CHD risk-equivalent conditions.
* Presence of diabetes mellitus.
* Presence of peripheral vascular disease.
* A Framingham risk score predicting a 20% CHD event risk over the next 10 years.
* Being over 45 years of age with multiple risk factors for CHD.
85
What is the minimum waiting period for a driver after CABG surgery?
3 months.
*Sternum must be completely healed.
86
What is the minimum waiting period after percutaneous coronary intervention (PCI)?
One week
87
Minimum waiting period after heart transplant.
One year
88
Maximum certification period for drivers who have had a heart transplant.
6 months
89
Maximum certification period for drivers who experience syncope.
One year
90
Four types of murmurs which warrant additional evaluation for certification.
* Systolic, grade I or II, and the driver has signs or symptoms of heart disease.
* Systolic and grade III or higher.
* Holosystolic or late systolic.
* Diastolic or continuous.
91
Certify or not certify? A driver with moderate aortic regurgitation with abnormal LV function or more than mild LV enlargement.
Not certify.
92
How often should echocardiography be repeated when driver is certified with mild or moderate aortic regurgitation.
Every 2-3 years.
93
Certify or not certify? A driver with aortic regurgitation with an LV end-diastolic dimension (LVEDD) less than or equal to 60 mm.
Certify
94
Certify or not certify? A driver with aortic regurgitation with an LV end-systolic dimension (LVESD) less than or equal to 50 mm.
Certify
95
What is the maximum time a driver with aortic regurgitation can be recertified?
One year w/ surgical repair, 6 months if not.
96
The certification interval for severe aortic stenosis that has not been surgically repaired should not exceed ___ even if the monitoring interval is greater than ____.
6 months, 6 months
97
What is the waiting period for surgical repair for aortic stenosis?
One year
98
Certify or not certify? Mild aortic stenosis that is asymptomatic.
Certify
99
Certify or not certify? Moderate aortic stenosis that is asymptomatic and the driver has no disqualifying findings and/or conditions.
Certify
100
Certify or not certify? Severe aortic stenosis that has been surgically repaired and meets all aortic valve repair surgical guidelines.
Certify
101
Certify or not certify? Aortic stenosis with reduced left ventricular ejection fraction less than 50%.
Not certify
102
Certify or not certify? Has LV dilatation LVEDD greater than 70 mm.
Not certify
103
Certify or not certify? Has LV dilatation LVESD greater than 55 mm.
Not certify
104
How often should echocardiography be repeated with aortic stenosis LVEDD less than 60mm or LVESD less than 50 mm?
6 to 12 months
105
How often should echocardiography be repeated with aortic stenosis LVEDD less than 60mm or LVESD less than 50 mm?
4-6 months
106
Five conditions that when comorbid with moderate aortic stenosis disqualify the driver.
Angina, heart failure, atrial fibrillation, LV dysfunction with EF <50%, thromboembolism.
107
How often should echocardiography be repeated for mild aortic stenosis?
5 years
108
How often should echocardiography be repeated for moderate aortic stenosis?
1-2 years
109
Minimum waiting period for surgical repair for aortic stenosis?
3 months
110
What is the maximum certification period for aortic stenosis?
One year
111
Minimum waiting period for post-surgical commissurotomy to repair mitral regurgitation?
3 months
112
Do not certify a driver with mild, moderate, or severe mitral regurgitation and has one or more of these 7 conditions.
* Symptoms.
* Less than 6 METs on Bruce protocol
* Ruptured chordae or flail leaflet
* Atrial fibrillation
* LV dysfunction
* Thromboembolism
* Pulmonary hypertension
113
Moderate mitral regurgitation should have an echocardiography how often?
Annually
114
Severe mitral regurgitation should have an exercise tolerance test and echocardiography how often?
Every 6-12 months
115
Recommendations for mitral stenosis are based on which two criteria?
Valve area size and the presence of signs or
| symptoms.
116
What is the minimum waiting period post-percutaneous balloon mitral valvotomy?
4 weeks
117
What is the minimum waiting period if post-surgical commissurotomy?
3 months
118
What is the maximum certification period for mitral stenosis?
One year
119
Certify or not certify: Asymptomatic mild to moderate mitral stenosis
Certify
120
Certify or not certify: Severe mitral stenosis
Certify if cleared by a cardiovascular specialist who understands the functions and demands of commercial driving.
121
Three procedures that should be performed with mitral stenosis. At at a minimum of what time interval?
* Chest X-ray
* Electrocardiogram.
* Two-dimensional echocardiography with Doppler or other mitral stenosis severity assessment.
Annually
122
Maximum certification period for mitral stenosis
One year
123
Two conditions that disqualify a driver with mitral stenosis.
Thromboembolic events and pulmonary hypertension (pulmonary pressure greater than 50% of systemic blood pressure).
124
Minimal waiting period for a diagnosis of mitral stenosis
3 months
125
Seven conditions that disqualify a driver if combined with mitral valve prolapse
* Symptoms or reduced effort tolerance due to mitral valve prolapse or mitral regurgitation
* Ruptured chordae or flail leaflet
* Systemic emboli
* Atrial fibrillation
* Syncope
* Documented ventricular tachycardia
* Severe mitral regurgitation or LV dysfunction
126
Mitral valve prolapse, even if mild, with markedly thickened leaflets should have echocardiography at a minimum of how often?
Annually (along with clearance from a cardiovascular specialist who understands the functions and demands of commercial driving)
127
Minimum waiting period for post-surgical repair of mitral valve prolapse.
3 months
128
Maximum certification period for mitral valve prolapse.
One year
129
Three conditions when comorbid with MVP are disqualifying.
* Thromboembolic complications.
* Atrial fibrillation.
* Pulmonary hypertension.
130
Minimum waiting period for prosthetic valve surgery.
3 months
131
Minimum waiting period for post-balloon valvuloplasty to repair pulmonary valve stenosis.
1 month
132
Minimum waiting period for post-surgical valvotomy to repair pulmonary valve stenosis.
3 months
133
Maximum certification time for allergic rhinitis
2 years
134
Maximum certification for asthma
2 years
135
Do not certify asthmatic drivers who have significant impairment of pulmonary function (FEV in the first second of expiration (FEV1) less than __%) and significant hypoxemia (partial pressure of arterial oxygen (PaO2) less than __ millimeters of mercury (mm Hg).
65%, 65mm Hg
136
The driver presents for examination with a recent history (five weeks ago) of pneumothorax. He has no prior history
of pneumothorax. In order to be considered medically qualified, his forced vital capacity (FVC) should be greater than __%
65%
137
Minimum waiting time for benign positional vertigo?
2 months
138
The recommended waiting period (WP) and certification period (CP) for a driver following surgical correction for intermittent claudication are?
3 months WP and one year CP
139
Five years post‐CABG, the driver must provide a copy of _________ in order to qualify for recertification
ETT
140
A driver who is otherwise qualified when accompanied by an SPE can be certified for how long?
2 years
141
Minimum waiting period for anticoagulation treatment?
1 month
142
What is the recommended certification period for a driver with diabetes mellitus who does not use insulin?
One year
143
The driver presents for recertification. He discloses a head injury sustained 4 months ago in a bike accident. His biking companion said that he “passed out” for about 15 minutes, but did not have any seizure activity. Which of the following waiting period (WP) and certification period (CP) are recommended?
WP 0, CP 2
144
The new driver has a history of bacterial meningitis with early seizures. However, he has been seizure free and
otherwise symptomatic since recovery six years ago. He has been off of anticonvulsants for approximately 5.5 years. With adequate documentation, you may certify this driver for how long?
2 years
145
Is autonomic neuropathy disqualifying?
No
146
The driver has a history of ADHD and submits clearance from his provider indicating he has been on treatment for six months, during which he has tolerated treatment well with good results. What is his maximum certification period?
One year
147
The driver presents for recertification following a “major breakdown” and had a failed suicide attempt following his wife’s death six months ago after she suffered a lengthy illness. He says that he was diagnosed with major depression, tried on a couple of antidepressants before he finally began to feel better but is now feeling well, has recovered, and realizes his wife would want him to continue life and find some happiness. He has taken on new activities on his free days and assures you that he no longer has any ideas of suicide. His mental health provider’s clearance supports this history. What certification decision is recommended?
Disqualify until he has been symptom free for at least a year.
148
A 28 year old otherwise healthy driver reports he had a sudden brief seizure two months ago, thought to be due to high fever during a recent serious lung infection. He is adamant he does not have epilepsy and takes no medications. The seizure was unwitnessed. According to medical guidance from FMSA, what should the examiner do?
Request medical records for neurological diagnosis and related information, temporarily disqualify until clearance
verified.
149
To convert International Organization for Standardization (ISO) test results to the ANSI standard, subtract from the ISO test results:
A. __ dB for 500 Hz, __ dB for 1,000 Hz, and ___ dB for 2,000 Hz
14 dB for 500 Hz, 10 dB for 1,000 Hz, and 8.5 dB for 2,000 Hz
150
Which recertification and exercise tolerance test (ETT) monitoring intervals does FMCSA recommend for a driver with a medical history of myocardial infarction?
Recertification every year; ETT every 2 years
151
What 3 criteria must be met for the ME to qualify a driver with history of CHF?
No ventricular arrhythmias, only mild symptoms, LVEF >50%.
152
Following electroconvulsive therapy (ECT) for depression, the FMCSA recommended waiting period is how long?
6 months symptom free
153
A CMV driver has indicated on the health history questions that he had coronary stent placement 9 months ago. Using cardiovascular medical guidance, what additional information does the ME need to determine certification status?
Results of his stress test obtained 6 months after PCI and clearance by his cardiologist.
154
A 22 y/o male driver with a long history of asthma has been prescribed montelukast (Singulair) and uses Albuterol (Ventolin) MDI as needed ‐ BMI is 23, Lungs clear, normal respirations and appears fit. What decision must the examiner make regarding his fitness to drive?
Certify for one year since he has a chronic, but stable, illness
155
To maintain certification, all CMEs must submit monthly with the following 6 pieces of information for all drivers examined within the month:
Name, DOB, drivers license # and state, date of exam, indication of exam outcome, whether intrastate driver only.
156
Recertification/refresher how often?
Refresher every 5 years, recertification every 10
157
Jake, a 46 year driver with chronic health issues has a BMI measured at 38. He has hypertension controlled on two medications and returns for yearly exam. Neck size is 18.25” and he responds “yes” to all sleep apnea screening questions. He was advised to get a Sleep Study but he has no insurance as an owner‐operator. Out of concern for driver and public safety, the medical examiner must do what?
Note determination pending until he seeks medical follow‐up
158
If the medical examiner questions the Whisper Test hearing acuity at the tested minimum distance, an audiogram is required. What form must the test be recorded in decibels following established by which group?
The American National Standard Institute
159
Any driver who presents with a chronic history of mild shortness of breath and abnormal respiratory examination findings suspect for chronic lung disease should have, according to FMCSA, which initial respiratory test?
PFT
160
If a driver post-CABG cannot achieve a satisfactory ETT what can he do?
Provide a radionucleotide stress test or a echocardiographic myocardial image.
161
How long must a patient be on first-time insulin before you can certify them?
2 months
162
A driver is found to have a blood pressure measured twice during the examination at 166/106 mm HG. According to FMCSA guidelines on blood pressure, the examiner should issue what?
A 3-month card
163
A driver with a history of stable angina would require the following for renewal?
Exercise stress test every 2 years
164
FMCSA considers what level of the Hemoglobin A1C to be indicator of poor blood glucose control?
>10%
165
Few commercial drivers are enrolled in the FMCSA diabetes waiver program. What year did that program end?
1996
166
If granted, a FMSA medical exemption is good for what period of time?
2 years
167
NRCME recognizes Attention Deficit Disorder/ Attention Deficit Hyperactivity Disorder in the Commercial Motor Vehicle Driver (CMV) as a treatable condition. Which is true regarding a driver prescribed a medication for stimulant medications?
Stimulate medications may be allowed with documentation of effectiveness, tolerability, absence of side effects.
168
Which of the following drivers should be certified?
A. If thoracic aortic aneurysm is 4.0 cm and symptomatic
B. If thoracic aortic aneurysm is 3.0 and asymptomatic
C. If thoracic aortic aneurysm is well documented as stable at 4.5 cm
D. Any driver with thoracic aortic aneurysm
B. If thoracic aortic aneurysm is 3.0 and asymptomatic
169
A driver presents for recertification and shares that he has recently been taking an “old prescription” of oxycodone for ongoing back pain, after a recent fall while unloading his truck. What is the best ME action?
Disqualify the driver
170
A 40 year old driver presents for his routine recertification exam. He continues to report smoking cigarettes and
admits to becoming short of breath while loading and unloading or walking distances. You should do what next?
Order spirometry
171
A new driver has history of a single unprovoked seizure 7 years ago. He has been seizure free and off all
medications for 6 years. He provides copies of records from and clearance from a neurologist. You should:
Qualify the driver for one year
172
A driver with a history of diabetes treated by oral agents presents for recertification.
He describes an episode of hypoglycemia two years ago that resulted in loss of consciousness. His medications were
adjusted and he has since “been fine” and has had no hypoglycemic events since the one noted. You should first:
Qualify the driver for one year
173
The driver’s blood pressure is 136/94. You should qualify the driver for:
One year
174
A harsh, medium pitch systolic murmur is detected at the third left intercostal space. This is consistent with:
Pulmonic stenosis
175
Indications of active thrombophlebitis includes:
Calf tenderness and swelling
176
A driver with diabetes presents for recertification. His treatment includes an incretin mimetic. He provides records from his endocrinology specialist providing clearance and reporting good tolerance of medications, driver’s careful self‐monitoring, and A1C 6.9%. Exam in your office is within normal limits. You should:
Qualify the driver for one year
177
Maximum timeframe by which 'determination pending' remains valid?
45 days
178
Vision exemption maximum certification period
One year
179
Waiting period for acute/chronic peripheral vestibulopathy
2 months (same as BPV)
180
Most important prognostic factor with CAD
Left ventricular function (LVEF >40%)
181
Minimum waiting period for an MI? Maximum certification period?
2 months, one year
182
Minimum waiting period after CABG? Maximum certification period?
6 months, one year
183
When should a driver get a ETT post-PCI?
6-9 months
184
How often should a driver get ETT post-PCI?
Every other year
185
CHF: do not certify if these 3 conditions are present
EF <40%, sustained ventricular tachycardia (30+ seconds or requires intervention), is symptomatic (NY Heart Association Class II or higher).
186
SVT certification
Minimum — 1 month post-isthmus ablation for atrial flutter
Minimum — 1 month asymptomatic/treated and the diagnosis is:
Atrioventricular nodal reentrant tachycardia
Atrioventricular reentrant tachycardia and Wolff-Parkinson-White syndrome
Atrial tachycardia
Maximum certification is 1 year
The driver should have an annual medical examination.
187
A-fib minimum waiting period
One month
188
A-fib:
Certify if these 4 conditions are met.
Maximum certification period?
1 year if:
- Anticoagulated adequately
- The heart rate is controlled
- There is no disqualifying underlying heart disease
- Cleared by cardiovascular specialist who understands the functions and demands of commercial driving
189
Is ETT a good indicator of SCD?
No
190
Ventricular arrhythmia-do not certify under these 4 conditions.
Recommend NOT certifying driver who:
- Is symptomatic
- Has sustained VT
- Occurs with an EF <40%
- Has hypertrophic cardiomyopathy, long QT interval syndrome or Brugada syndrome
Annual evaluation by cardiologist
191
Syncope: waiting period/certification
Waiting period is at least three months.
Certification is for 1 year if the cause can be prevented or the driver is not a risk while driving or the driver is syncope free for three months and no underlying heart or neurological disease is found after evaluation.
The examiner also needs to consider if the CMV driver has pre-syncope warning or if the driver's underlying condition places him/her at an increased risk for recurrent syncope.
192
Certify driver with neurocardiogenic syncope with a pacemaker under these 3 conditions.
How long?
* Documentation indicating the presence of a functioning pacemaker.
* Documentation indicating completion of routine pacemaker checks.
* No disqualifying underlying disease.
One year
193
Murmur: no evaluation needed if:
No evaluation is recommended if the murmur is: - Mid-systolic and grade 2 or less
- No symptoms
- No clinical findings
- Venous hum
194
Murmur: evaluation needed if:
Evaluation is recommended if the murmur is:
- Early Systolic
- Mid-systolic grade 3 or more
- Late systolic
- Holosystolic
- Mid-systolic murmur grade 2 or less with symptoms or other signs of cardiac disease
- Diastolic
- Continuous murmur
- Systolic Grade 1+ or 2 with S/S of heart disease
195
Mild Mitral Stenosis (MVA >1.6 cm2):
Certify under this condition.
For how long?
Echo how often?
Certification: Yes, if asymptomatic.
Re-certification: Annual.
Echo every 3 to 5 years and for reevaluation in drivers with known MS and changing symptoms or signs.
196
Moderate Mitral Stenosis (MVA 1.0 to 1.6 cm2): cert/recert?
Certification: yes if assymptomatic
Recertification: Annual.
Recommend annual exam by a cardiologist. If asymptomatic, echo every 2 years and in drivers with known MS and changing symptoms or signs
197
Severe mitral stenosis (MVA < 1.0 cm):
Certify if these 2 conditions are met.
Do not certify under these 5 conditions.
Certification: NO if:
- NYHA Class II or higher;
- Atrial fibrillation;
- History of systemic embolism
- Pulmonary artery pressure >50% of systemic pressure;
- Inability to exercise for >6 Mets on Bruce protocol (Stage II)
Recertification:
YES if:
Surgical repair
- At least 4 weeks post percutaneous balloon mitral valvotomy; or
- At least 3 months post-surgical commissurotomy;
- Annual; clearance by cardiologist annually
198
Mild mitral regurgitation: certify under these 3 conditions.
For how long?
Echo?
```
Certify if:
- Asymptomatic;
- Normal LV size and function;
- Normal PAP
Recert:
- Annual
- Annual echo not necessary.
```
199
Moderate mitral regurgitation:
Certify under these 3 conditions.
How long?
Echo frequency?
Certification: Yes if
- Asymptomatic;
- Normal LV size and function;
- Normal PAP.
Recertification:
- Annual
- Annual echo
200
Severe mitral regurgitation:
Certify under these 2 conditions.
Do not certify under these 6 conditions and/or with these 4 symptoms.
Certify:
YES, if asymptomatic.
YES, if postop: at least 3 months post-surgery, asymptomatic and cleared by cardiologist.
NO if:
- Symptomatic: dyspnea, orthopnea, fatigue, PND
- Inability to achieve > 6 METS on Bruce protocol;
- Ruptured chordae or flail leaflet;
- Atrial fibrillation
- LV dysfunction: LVEF < 60%; LVESD > 45mm LVEDD > 70MM
- Thromboembolism;
- PAP> 50% of systolic arterial pressure;
Recert
- Asymptomatic patient should see cardiologist every 6 to 12 months to assess for symptoms or development of asymptomatic LV dysfunction --- Echo every 6-12 months.
- ETT may be helpful to assess symptoms
201
Mild Aortic Stenosis (AVA > 1.5 cm2):
Certify under this condition.
How long?
Echo how frequently?
Certification:
- Yes if asymptomatic
Recertification:
- Annual
- Echocardiogram every 5 years.
202
Moderate Aortic Stenosis (AVA 1.0 - 1.5 cm2):
Certify under this condition?
No if these 4 symptoms and 2 other conditions.
```
Certification:
Yes, if asymptomatic
No, if:
- Symptoms are angina, heart failure, syncope; atrial fibrillation;.
- LV dysfunction with EF <50%;
- Thromboembolism.
```
203
Severe Aortic Stenosis (AVA <1.0 cm2):
| Certify only if? And what is the waiting period?
Certification:
No regardless of symptoms or LV function
Yes if at least 3 months after surgical repair (annual recert)
204
Mild Aortic Regurgitation:
Certify under this condition
For how long?
Echo how frequently?
Certification: Yes, if asymptomatic
Recert:
- Annual
- Echo every 2-3 years
205
Moderate Aortic Regurgitation:
| Yes under these 2 conditions
Certification:
YES, if:
- Normal LV function;
- No or mild LV enlargement.
Recertification:
- Annual
- Echo every 2 to 3 years.
- Repeat echocardiogram recommended at annual recert if
* onset of symptoms,
* equivocal history of changing symptoms,
* changing exercise tolerance, or
* findings suggest worsening
regurgitation or progressive LV dilatation
206
Severe Aortic Regurgitation:
Certify under these 3 conditions.
Do not certify under these 3 conditions.
Certification
YES, if:
- Asymptomatic;
- Normal LV function (EF > 50%);
- No LV dilatation (LVEDD < 60mm, LVESD < 50mm).
YES if at least 3 months post op for valve surgery, asymptomatic and cleared by cardiologist (annual recert)
NO if:
- Symptomatic
- Unable to complete Bruce protocol Stage II, - Reduced EF < 50%,
- LV dilatation(LVEDD > 70mm or LVESD > 55mm)
Recertification
- Every 6 months, echo every 6-12 mos
- IF LVEDD > 60mm or LVESD > 50mm: every 4-6 mos with echo every 4-6 mos if no surgery performed
207
Mechanical valves:
Certify under these 3 conditions.
Do not certify under these 5 conditions.
Certification:
YES, if at least 3 months postop, asymptomatic and cleared by cardiologist
Recert: Annual, cardiol eval, annual echo???
NO if:
- Symptomatic;
- LV dysfunction-EF < 40%;
- Thromboembolic complication post procedure;
- Pulmonary hypertension;
- Unable to maintain adequate anticoagulation (based on monthly INR checks).
208
Biological prosthesis: cert/recert?
NOTE: Anticoagulant therapy not necessary in patients in sinus rhythm (after initial 3 months), in absence of prior emboli or hypercoagulable state
Certification/Recertification:
- YES if: At least 3 months postop;
- Asymptomatic;
- None of above disqualifying criteria for mechanical valves;
- Cleared by cardiologist
209
Ebstein abnormality:
Certify under these 5 conditions.
Surgical correction WP?
If mild/asymptomatic certify with annual recert/evaluation by cardiologist with experience with adult congenital HD
If moderate/severe: certify only if:
- No intracardiac lesions;
- No shunt;
- No symptomatic arrhythmia or accessory conduction;
- No worse than mild cardiac enlargement;
- No worse than mild RV dysfunction.
MAY certify after surgical repair if:
- At least 3 months post-op; and
- None of above disqualifying features.
210
Restrictive cardiomyopathy: cert/recert?
Disqualified
211
Idiopathic Hypertrophic Subaortic Stenosis (IHSS): cert/recert?
Disqualified
212
Thoracic aortic aneurysm: cert/recert?
```
Disqualify if > 3.5 cm or
Rapidly growing (>.5 cm/6-12 mos)
```
Otherwise, annual with imaging to document size of aneurysm
Waiting period after surgical repair is 3 mos.
213
Peripheral vascular disease: cert/recert?
In a driver with PVD, the examiner should also consider the risks for other atherosclerotic disease.
On a case-by-case basis, the examiner may obtain additional tests and consultation to assess the driver's medical fitness for duty.
driver should have an annual medical examination
214
Intermittent claudication:
Disqualify if driver has ____.
Certify post-op under these 2 conditions.
Certify for one year; certification is annual with annual medical examination
DISQUALIFY if: driver has resting pain
Surgery: certify post op if:
Relief of symptoms
No other disqualifying cardiovascular disease
3 month waiting period post-op
215
Anticoagulation monitoring guidelines
Relief of symptoms
| No other disqualifying cardiovascular disease
216
Chronic thrombotic disease of LE: cert/recert?
Yes, if no symptoms
217
Superficial phlebitis: cert/recert?
- DVT often comorbid
- Waiting period: The examiner should not certify the driver until the etiology is confirmed and treatment has been shown to be adequate, effective, safe, and the driver is stable.
- Maximum certification period is two years
- Recommend certifying the driver who is otherwise medically qualified
- Recommend not certifying the driver with coexisting DVT who does not meet the DVT guidelines
218
Varicose veins: cert/recert?
If no complications.
Maximum certification period is two years
219
Measuring BP: technique
For 5 minutes, the individual sits in a chair with his/her back supported and with his/her legs uncrossed and both feet touching the floor.
The examiner supports the arm at the elbow (easier if the arm is flexed at the elbow) so the mid-point of the BP cuff is even with the right atrium (mid-point of sternum).
220
Surgical treatment for secondary hypertension: waiting period
3 months
221
Stage I hypertension (140-159/90-99): cert/recert?
Cert: one year (first time only)
| If remains stage I at 1 year re-eval, can give one-time 3 month certificate
222
Stage II HTN (160 - 179/100 - 109 ): cert/recert?
Cert: 1-time 3 month
Recert: one year from date of initial eval if ≤140/90
223
Stage III HTN (>180/>110): cert/recert?
Disqualified. Cannot drive until BP is reduced to 140/90 or better, then recert q. 6 mos
224
Allergy-related life-threatening condition
Individuals with a history of an allergy-related life-threatening condition must have undertaken successful preventive measures and/or treatment without adverse effects before the driver can be considered medically qualified.
225
Hypersensitivity pneumonitis
You should not certify the driver until etiology is confirmed and treatment has been shown to be
adequate/effective, safe, and stable.
Maximum certification — 2 years
Recommend to certify if:
As the medical examiner, you believe that the nature and severity of the medical condition of the driver does not endanger the health and safety of the driver and the public.
226
You should not certify a driver with COPD if they have these 3 conditions
* Hypoxemia at rest.
* Chronic respiratory failure.
* History of continuing cough with cough syncope.
227
What should be performed in all smokers over the age of 35?
Spirometry
228
With COPD what is are 2 indicators for additional PFTs?
* Obvious difficulty breathing in a resting position
* Forced expiratory volume in the first second of expiration (FEV1) is less than 65% of that predicted.
* In these cases arterial blood gas measurements should be evaluated.
229
Lung disease: when to get ABGs based on PFT
When the pulmonary function test shows airway obstruction;
(FEV1 is < 65% of predicted; FEV1/FVC ratio < 65%)
OR
When the pulmonary function test shows a restrictive impairment: (FVC is less than 60%)
THEN obtain pulse oximetry
IF pulse ox is less than 92% (P02 = 64)
THEN obtain arterial blood gas (ABG) -
230
ABGs: Don't certify if:
Partial pressure of arterial oxygen (PaO2) less than: - 65 millimeters of mercury (mmHg) at altitudes below 5,000 feet. - 60 mm Hg at altitudes above 5,000 feet
Partial pressure of arterial carbon dioxide (PaCO2) greater than 45 mmHg at any altitude
231
Cystic fibrosis: When can you certify?
You should not certify the driver until it has been documented that treatment has been shown to be
adequate/effective, safe, and stable and the driver complies with continuing medical surveillance by the
appropriate specialist.
232
Cystic fibrosis: do not certify under these 5 conditions.
* Hypoxemia at rest.
* Chronic respiratory failure.
* History of continuing cough with cough syncope.
* Not met spirometry parameters.
* Unstable condition and/or treatment regimen.
233
Cystic fibrosis: maximum certification period
2 years
234
Interstitial lung disease: do not certify under these 3 conditions
* Hypoxemia at rest.
* Chronic respiratory failure.
* History of continuing cough with cough syncope.
235
Waiting period after pneumothorax?
No recommended time frame
Ensure complete recovery using chest X-rays. If there is air in the pleural space and/or air in the mediastinum (pneumomediastinum) additional time away from work is indicated.
236
Recommend to certify pneumothorax if these 4 parameters are met.
* Is asymptomatic without chest pain or shortness of breath.
* Has no disqualifying underlying lung disease.
* Has confirmed resolution of the single spontaneous pneumothorax.
* Has successful pleurodesis and meets acceptable pulmonary parameters.
237
Do not certify pneumothorax under these 6 circumstances.
* Not met certification parameters.
* A history of two or more spontaneous pneumothoraces on one side if no successful surgical procedure has been done to prevent recurrence.
* Hypoxemia at rest.
* Chronic respiratory failure.
* A history of continuing cough with cough syncope.
238
Under which four conditions is it recommended to certify a driver with active TB?
* Is not contagious.
* Has completed streptomycin therapy without affecting hearing and/or balance.
* Is compliant with antitubercular therapy.
* Has no side effects that interfere with safe driving
239
Under which five conditions is it not recommended to certify a driver with active TB?
• Advanced TB with respiratory insufficiency not meeting pulmonary function test criteria.
• Chronic TB.
• Exhibited noncompliance with antitubercular therapy.
• Not completed streptomycin therapy.
• Residual eighth cranial nerve damage that affects balance and/or hearing to an extent that
interferes with safe driving.
240
Minimum waiting period after a PE
3 months
241
When to certify a driver with a h/o PE?
* Appropriate long-term treatment.
| * No other disqualifying cardiovascular disease.
242
When not to certify a driver with a h/o PE?
Symptomatic
243
Maximum certification period for a driver with cor pulmonale
2 years
244
Certify cor pulmonale under what condition?
As the medical examiner, you believe that the nature and severity of the medical condition does not
endanger the health and safety of the driver and the public.
245
Do not certify a driver with cor pulmonale if these 4 conditions are present.
```
• Dyspnea at rest.
• Dizziness.
• Hypotension.
• Partial pressure of arterial oxygen (PaO2) in arterial blood greater than 65 millimeters of mercury
(mm Hg).
```
246
Waiting time and maximum certification period for pulmonary hypertension.
No recommended waiting time. 1 year.
247
Six components on the neurological exam that should be performed.
* Compromised equilibrium, coordination, and/or speech pattern?
* Asymmetrical deep tendon reflexes?
* Abnormal patellar and Babinski reflexes?
* Sensory abnormalities?
* Positional abnormalities?
* Ataxia?
248
When sending driver to a specialist, include the following 3 items:
A copy of the medical examination report form
A description of the driver's role
A copy of the applicable medical standards and guidelines
249
CVA: Waiting period, minimum for certification
Minimum criteria for certification:
The driver should have an essentially normal physical examination, with no neurological residuals.
Any residuals present should not interfere with the ability to safely operate a commercial motor vehicle.
Waiting period:
NO seizure risk (cerebellum or brainstem lesion): 1 year
Seizure risk IS present: (cortical or subcortical deficits): 5 years
Maximum certification—one year
250
Congenital myopathies: certify or not certify
Do not certify
251
Peripheral neuropathy: certify or not certify
Do not certify
252
Guidelines for reconsideration of
| the decision not to certify due to peripheral neuropathy include:
• Evaluation by a neurologist or physiatrist who understands the functions and demands of
commercial driving. Specialist may recommend a simulated driving skills test or equivalent
functional test.
• Annual recertification that repeats specialist evaluation and driving test when indicated
253
Central nervous system tumors can be certified under which 2 conditions?
Seizure-free and not taking anticonvulsant medications
254
Removal of these 5 types of central nervous system tumors requires a one-year waiting period post-surgical removal.
* Infratentorial meningiomas.
* Acoustic neuromas.
* Pituitary adenomas.
* Spinal benign tumors.
* Benign extra-axial tumors.
255
Removal of these 2 types of central nervous system tumors requires a two-year waiting period post-surgical removal.
* Benign supratentorial tumors.
| * Spinal tumors.
256
Maximum certification period for central nervous system tumors.
One year
257
Recommend to certify a driver with a h/o central nervous system tumors under which 3 conditions?
* Completed the appropriate minimum waiting period.
* Stable non-progressive deficit or no neurological deficit.
* Imaging that shows no tumors.
258
Recommend not to certify a driver with a h/o central nervous system tumors under which 3 conditions?
* Not completed appropriate waiting period.
* Primary or metastatic malignant tumors of the nervous system.
* Benign nervous system tumors.
259
Which two areas of the brain when affected by stroke are not associated with an increased risk for seizures.
* Cerebellum and brainstem vascular lesions
* Cortical and subcortical deficits are associated with an increased risk for seizures.
* Evaluation by a neurologist is necessary to confirm the area of involvement.
260
Which two types of brain deficits affected by stroke are associated with an increased risk for seizures.
Cortical and subcortical deficits
*Evaluation by a neurologist is necessary to confirm the area of involvement.
261
Waiting period after a stroke when risk of seizure?
5 years
262
Waiting period after a stroke when no risk of seizure?
1 year
263
Recommend to certify after a stroke under which 4 conditions?
• Completed the appropriate waiting period.
• Normal physical examination, neurological examination including neuro-ophthalmological
evaluation, and neuropsychological testing.
• No neurological residuals or, if present, residuals of a severity that does not interfere with ability
to operate a commercial motor vehicle.
• Clearance from a neurologist who understands the functions and demands of commercial driving.
264
Recommend to not certify after a stroke under which 5 conditions?
• Has not completed the appropriate waiting period.
• Uses oral anticoagulant therapy because of the risks associated with excessive bleeding.
• Uses any other drug or combination of drugs that have potentially high rates of complications
(e.g., depressing effects on the nervous system).
• Has residual intellectual or physical impairments that interfere with commercial driving.
• Does not have clearance from a neurologist who understands the functions and demands of
commercial driving.
265
Recommended waiting time and maximum certification time for autonomic neuropathies.
No waiting period. 2 years.
266
Under what circumstances would you not certify a driver with autonomic neuropathy?
Cardiovascular autonomic neuropathy that causes:
• Resting tachycardia.
• Orthostatic blood pressure.
• Other organ autonomic neuropathy that interferes with driving ability.
267
Progressive neurological disorders: conditions where disqualification is permanent and could change only with a change in diagnosis:
```
Dementia
Motor neuron disease
Malignant CNS tumors
Huntington's disease
Wilson's disease
```
268
Acute Seizures/Structural Insult to the brain: 3 instances where a one-year waiting period is appropriate.
* 1 year seizure free and off anticonvulsant medication following:
* Mild insult without early seizures.
* Stroke without risk for seizures.
* Intracerebral or subarachnoid hemorrhage without risk for seizures.
269
Acute Seizures/Structural Insult to the brain: 3 instances where a two-year waiting period is appropriate.
2 years seizure free and off anticonvulsant medication following:
• Moderate insult without early seizures.
• Mild insult with early seizures.
270
Acute Seizures/Structural Insult to the brain: 3 instances where a five-year waiting period is appropriate.
5 years seizure free and off anticonvulsant medication following:
• Moderate insult with early seizures.
• Stroke with risk for seizures.
• Intracerebral or subarachnoid hemorrhage with risk for seizures.
271
Acute Seizures/Systemic Metabolic Illness: Waiting period
No recommended time frame
You should not certify the driver until etiology is confirmed and treatment has been shown to be
adequate/effective, safe, and stable.
272
Acute Seizures/Systemic Metabolic Illness: Maximum certification period and under which 2 conditions?
2 years
• The underlying systemic metabolic dysfunction has been corrected.
• The driver has no disqualifying risk of recurrence of the primary condition.
273
If seizure history is limited to febrile seizures is it ok to certify?
Yes
274
Minimum waiting period for epilepsy
10 years off anticonvulsant medication and seizure free
275
Certify drivers with h/o headache?
Up to ME's discretion
276
Single, unprovoked seizure.
Following an initial unprovoked seizure, the driver should be seizure free and off anticonvulsant medication for at least 5 years to distinguish between a medical history of a single unprovoked seizure and epilepsy (two or more unprovoked seizures). A second unprovoked seizure, regardless of the elapsed time between seizures, would constitute a medical history of epilepsy, and the driver would no longer meet the physical requirements for 49 CFR 391.41(b)(8).
277
Waiting period for mild (LOC <30 mins) with early seizures and moderate (LOC >30 min; <24 hours) TBI without early seizures.
Severe is disqualified.
2 years seizure free and off anticonvulsant medication following:
• Moderate TBI without early seizures.
• Mild TBI with early seizures.
278
Waiting period for moderate TBI with early seizures.
5 years seizure free and off anticonvulsant medication
279
Minimum waiting period for viral encephalitis with early seizures.
10 years
280
Waiting period for aseptic meningitis
None. Aseptic meningitis is not associated with any increase in risk for subsequent unprovoked seizures; therefore, no restrictions should be considered for such individuals, and they should be considered qualified to obtain a license to operate a commercial vehicle.
281
FMCSA defines a severe hypoglycemic reaction as one that results in:
* Seizure.
* Loss of consciousness.
* Need of assistance from another person.
* Period of impaired cognitive function that occurs without warning.
282
Recommend not to certify if the driver with diabetes mellitus if these conditions are present.
• Other than the use of insulin to treat diabetes mellitus, any other medical problem or condition
that prevents certification in accordance with the qualification requirements of 49 CFR 391.41(b).
• In the last 12 months, had a severe hypoglycemic reaction resulting in:
• Seizure.
• Loss of consciousness.
• Need of assistance from another person.
• Period of impaired cognitive function that occurred without warning.
• In the last 5 years, has had recurring (two or more) disqualifying severe hypoglycemic reactions
(as described above).
• Loss of position sensation.
• Loss of pedal sensation.
• Resting tachycardia.
• Orthostatic hypotension.
• Diagnosis of:
• Peripheral neuropathy that interferes with safe driving.
• Proliferative retinopathy (e.g., unstable proliferative or non-proliferative).
283
How often do the Federal Diabetes Exemption Program guidelines mandate blood glucose checks for drivers?
* Before driving.
* Every 2 to 4 hours while driving.
Blood glucose levels that remain within the 100 milligrams per deciliter (mg/dL) to 400 mg/dL range are generally considered safe for commercial driving.
284
Waiting period and certification period for hernia?
None, 2 year certification
285
It is recommended to certify a driver with a hernia under what condition?
When the etiology is confirmed, and treatment has been shown to be adequate/effective, safe, and stable.
286
What is the maximum certification period for a driver on antipsychotic therapy?
One year
287
Recommended waiting for a driver on lithium therapy?
None
288
Minimum waiting period for bipolar disorder when
| symptom free following a non-psychotic major depression unaccompanied by suicidal behavior
6 months
289
Minimum waiting period for bipolar disorder when symptom free following a severe depressive episode, a suicide attempt, or a manic episode
1 year
290
Not recommended to certify a driver with bipolar disorder under these circumstances.
• Active psychosis.
Prominent negative symptoms, including:
• Substantially compromised judgment.
• Attentional difficulties.
• Suicidal behavior or ideation.
• Personality disorder that is repeatedly manifested by overt inappropriate acts.
• Treatment side effects that interfere with safe driving.
291
Minimum waiting period for symptom free depression following a nonpsychotic major depression unaccompanied by suicidal behavior
6 months
292
Minimum waiting period for symptom free depression symptom free following a severe depressive episode, a suicide attempt, or a manic
episode
One year
293
Schizophrenia is ?
Disqualifying
294
Minimum waiting period for symptom free if a brief reactive psychosis or schizophreniform disorder
6 months
295
Minimum waiting period for symptom free if any other psychotic disorder
One year
296
Drug and alcohol disorders have a maximum certification of how long?
2 years
