NRCME Flashcards
DOT Exams
1
Q
Re-current training every x years
A
5 yrs
2
Q
Re-Certification every x years
A
10
3
Q
Retaking training cannot
occur before x yr
A
4 years
4
Q
Retaking the test cannot
occur before x years
A
9 years
5
Q
Driving Status must be
determined on x
A
the day of
the exam
6
Q
Report to website monthly, even if x
A
no exams were
completed.
7
Q
CMEs must report exams perform on all drivers of a
CMV that are medically certified to
A
drive across state lines.
8
Q
Drivers of a CMV that are medically certified to
drive across state lines Includes:
A
- Drivers w/, or pending CDL or Permit (CLP)
- School bus drivers who are not
exempted from the federal medical examiner regulation.
•Interstate Non CDL Drivers of vehicles that weigh/rated for over 10,000lbs but under 26,001lb.
9
Q
MEs must provide a copy of the examination form to
FMCSA within x hours when requested.
A
48 hours
10
Q
The Driver Medical Exam
requires urinalysis for:
A
Specific Gravity
Protein
Glucose
Blood
11
Q
CLIA=
A
Clinical Laboratory
Improvement Amendment
12
Q
A vehicle with twice the weight of the other vehicle
equals a x risk of death to person in other vehicle
A
six-fold
13
Q
What is the time interval for medical certification and the vision exemption issued for a driver who is required to have a vision exemption?
A
1 year, 2 years…The driver must have an annual medical examination with a vision specialist and an annual medical certificate, but the vision exemption is granted for two years.
14
Q
A driver has a blood pressure of 168/112 confirmed during the examination. The driver would be?
A
Disqualified …This is Stage 3 hypertension. The driver is disqualified until their blood pressure is less than or equal to 140/90 at which time they will have a maximum certification of 6 months from the date of this examination.
15
Q
A driver with COPD, hypertension and had a MI comes for re-certification. The results from the cardiologist were normal, however you notice that the driver achieved 4.5 METs on the ETT. What should the examiner do?
A
Disqualify the driver…Drivers must exceed 6 METs on an ETT to be qualified to drive.
16
Q
Drivers must exceed ______ METs on an ETT to be qualified to drive.
A
6 METs
17
Q
During the medical examination, the ME suspects undiagnosed OSA. There are no other exam findings that indicate disqualification. What is the next step?
A
Whenever the ME suspects undiagnosed OSA, the driver should be disqualified until evaluated by a sleep specialist.
18
Q
A driver is missing all of his index finger on his right hand, but has a thumb and all of his other digits. The next step is:
A
Assess ability to perform driver demands such as rotation of outstretched arms against resistance as if turning a steering wheel….If the driver can demonstrate sufficient power grasp and prehension, they can be certified to drive without a SPE.
19
Q
If the driver can demonstrate sufficient power grasp and prehension, they ___
A
can be certified to drive without a SPE.
20
Q
Which of the following describes the responsibilities of the medical examiner?
A
49 CFR 391.43
21
Q
A driver has a right diminished Achilles reflex and right leg pain. What is the next step?
A
Check for decreased plantar-flexion strength…this may result in functional inability to control a CMV safely and may be indicated by a loss of Achilles reflex.
22
Q
A driver has noticeable pain in his lower back during lumbar flexion. The driver indicates that he is under active treatment for a recent low back strain. He has been released to return to light duty work. He never has to load or unload his truck. The examiner should.
A
Disqualify the driver… There is no light duty option for driving.
23
Q
The driver lists a history of hypertension and diabetes on his history. His wife complains of his loud snoring. BP of 136/82. BMI is a 42.26 and his neck size is 17.5 inches. The examiner should:
A
Disqualify the driver pending a sleep apnea evaluation from a specialist..suspected undiagnosed OSA should be evaluated prior to certification.
24
Q
Is the stanford sleepiness test a required yearly test for drivers with OSA?
A
No…The Stanford sleepiness scale is a sleepiness survey and not considered an objective test as required yearly for certification.
25
What are the required yearly tests for drivers with OSA?
Polysomnography
Maintenance of wakefulness test
Multiple sleep latency test
26
The driver is unable to flex either hip more than 60 degrees due to right and left hip replacement performed 5 years ago and 7 years ago. He is adamant that he is able to drive a truck. This is his first driver medical exam since the surgery. What is the next step?
Require an orthopedic evaluation to determine if the driver requires and/or is a candidate for a SPE...A driver with physical limitations that may interfere with safe operation of a CMV should be evaluated to determine if he has a "fixed deficit". Hip flexion of 90 degrees may be required to enter the cab.
27
The driver is taking “Wellbutrin”, low dose, to help him stop smoking. He is provided a note from his PCP stating that he has no side effects and confirms that he is taking the medication for smoking cessation. The examiner would?
Certify the driver for 2 years....The driver is not being treated for a mental condition and has no side effect risk for safe driving.
28
A driver was prescribed Provigil two weeks ago to treat excessive sleepiness. The driver reports feeling better and denies any medication side effects. What is the next step?
Disqualify the driver for 4 weeks to complete a six week waiting period...
29
Drivers prescribed Provigil (sleepiness) may be considered for driving after a x.
minimum 6 weeks period
30
After completion of the 6 week waiting period for Provigil, the prescribing physician and ME must agree the treatment is effective and document no untoward side effects are present. Drivers are re-certified ________
annually.
31
The examiner notices that the driver is distant, lacks eye contact and shows no emotional response during the exam. The examiners best response should be.
Refer the driver to a mental health profession prior to certification...The driver appears to exhibit a Flat affect which is seen in schizophrenia and in severe depression. The driver should be evaluated by a mental health expert for evaluation prior to certification.
32
MMSE questionnaire is used for evaluation of x
cognitive status.
33
A driver with diabetes has 6 month follow-ups w/ his PCP, his last A1C of 9.5 was measured 2 months ago. He is taking metformin and Byetta. He has peripheral neuropathy involving loss of temperature sensation in both feet. What is the driving status?
Qualified to drive for 1 year...Diabetics are disqualified if they have peripheral neuropathy except when the loss only involves temperature sensation. Byetta is not insulin, but may require more frequent monitoring.
34
Diabetics are disqualified if they have peripheral neuropathy except when the loss only involves x.
temperature sensation
35
Byetta=
is an injectable incretin mimemic, not insulin, but taking this medication may require more frequent monitoring.
36
During the ear and hearing portion of the examination, the medical examiner must always:
Complete testing for both ears even if one passed.
37
A driver states that he was out of work following back surgery for over a year, but since has returned to driving and his last certification was good for 2 years. He lists as his only medication Oxycodone, which he takes only as needed. He reports seeing his “pain doctor” every few months for evaluation. The examiner should?
Request medical clearance prior to certification...The driver suffers a chronic pain condition that may inhibit his ability to perform all essential functions associated with driving a CMV and is taking a narcotic medication which requires clearance from the prescribing physician.
38
A driver with a history of diabetes is taking Byetta, provides a note from his PCP that lists his A1c level as 10. The medical examiner should?
Certify the driver for 1 year....An A1c level of 10 equates to a blood glucose level of about 300 mg/dl representing small risk for a hypoglycemic event. You may certify the driver for only a period of 1 year if he is a diabetic.
39
An A1c level of 10 equates to a blood glucose level of about 300 mg/dl representing small risk for a...
hypoglycemic event.
40
You may certify the driver for only a period of _____ if he is a diabetic.
1 year
41
What frequencies are used to determine average hearing loss?
500 Hz, 1000 Hz 2000 Hz...The driver may not have greater than 40db of hearing loss in the better ear using the ANSI standard measured at 500 Hz, 1000 Hz and 2000 Hz.
42
The driver may not have greater than ______ of hearing loss in the better ear using the ANSI standard measured at 500 Hz, 1000 Hz and 2000 Hz.
40db
43
ANSI standard is measured at _______
500 Hz, 1000 Hz and 2000 Hz.
44
A driver who utilizes contact lenses to drive should be counseled to?
Have a spare pair of glasses when driving
45
A driver has one ear canal completely plugged with wax but both ears pass the hearing standard. The medical exam is otherwise normal. What is the next step?
Disqualify the driver until wax is removed (correct)
46
T/F The ME must view the tympanic membrane and auditory canal prior to certification.
T
47
Which is not an appropriate Hours of Service regulation for CMV drivers?
Must carry driving logs for last 48 hours (correct)
48
Driver must have their driving log for the last X days.
7 days
49
All of the following meet the FMCSA definition of epilepsy except:
2 or more provoked seizures. (correct)
50
Provoked seizures due to a known cause are not part of the FMCSA definition of x.
epilepsy.
51
A driver cannot be considered for a SPE if:
The deficit affects the torso (correct)
52
Drivers with deficits that affect the X cannot be consider for a SPE
torso
53
A driver reports a history of using coumadin to treat Atrial Fibrillation. He presents with medical clearance from his cardiologist stating he may drive and his most recent INR is 2.5. The examiner would?
Certify the driver for 1 year.
54
A driver with A-Fib would require medical clearance. All drivers on anticoagulation therapy are required to comply with _______.
monthly INR readings. INR values between 2 and 3 are acceptable.
55
Drivers with a history of which of the following can be certified to drive?
Autonomic Neuropathy (correct)
56
Drivers with a history of myotonia and _______ CANNOT be certified to drive?
Isaac's Syndrome
| Stiff-man syndrome
57
Myotonia, Isaac's Syndrome and Stiff-man syndrome are X
congenital myopathies and disqualifying
58
A 67 year-old male driver lists Rx of lisinopril, HCT, pravastatin, metformin and aricept. The driver does not remember the reason he is taking Aricept. The driver’s wife answers many of the questions during the exam. The examiners best decision would be to:
Temporarily disqualify the driver to obtain medical information for the use of aricept (correct)
59
Aricept is a medication that is used in the treatment of x
Alzheimer's disease.
60
Any dementia, including that associated with Alzheimers, is x
disqualifying. Once confirmed, the driver would be permanently disqualified.
61
If a driver is disqualified by FMCSA standards, and the medical examiner believes the driver is qualified to drive, what can be done?
Override the guideline based on best practice. (correct)
62
A driver reports that he suffered a left orbital fracture. He presents a note from an ophthalmologist stating “may drive”. His exam shows limitation in horizontal vision in his left eye, which was inconclusive. His distance acuity was 20/20 right and 20/40 left. The medical examiner should?
Refer the driver to a vision specialist to determine horizontal vision.
63
The driver must have horizontal vision of x degrees bilaterally to drive a CMV.
70
64
In order for the driver to obtain an Insulin exemption, the medical examiner must give the driver which of the following?
A short and long form both marked certified for 1 year, accompanied by "with insulin" written in the blank and exemption? circled.
65
A driver with which of the following AAA’s cannot be certified to drive?
Greater than 5 cm with CV specialist recommendation not to be repaired. (correct)
66
Regardless of recommendation for no repair, AAAs over x cm are disqualifying.
5
67
A driver is taking a safe dose of methadone for pain management. His treating physician has cleared the driver as being safe to drive taking the medication as prescribed. What is the next step?
Disqualify the driver
68
T/F Methadone use is a non-discretionary standard and is always disqualifying.
T
69
What is the waiting period and re-certification interval for a driver that has had a heart transplant?
1 year 6 months (correct)
70
A driver with a heart transplant must wait one year and if asymptomatic, tolerates medication, CV clearance, no signs of rejections and if meets all other CV requirements he may be certified for x months.
6
71
What is the waiting period for Benign Positional Vertigo (BPV)?
2 months
72
The waiting period for BPV is ____months symptom free.
2
73
The urine test that is performed during the DOT physical examination is primarily to assess?
Kidney function and diabetes (correct)
74
T/F= Testing for Alcohol, prescription medication or illicit drug is not usually part of the CDL medical exam.
T
75
The urine test that is part of every medical exam is a urinalysis to detect x
diabetes or kidney pathology.
76
A driver with a history of diabetes is taking Byetta, provides a note from his PCP that lists his A1c level as 10. His exam is essentially WNL including laboratory analysis except he is notably overweight. The medical examiner should?
Certify the driver for 1 year. (correct)
77
An A1c level of x equates to a blood glucose level of about 300 mg/dl representing small risk for a hypoglycemic event.
10
78
You may certify the driver for only a period of x year if he is a diabetic.
1 year
79
_______is an injectable incretin mimemic, not insulin, but taking this medication may require more frequent monitoring.
Byetta
80
A driver weighs 500 lbs, eats only fast food and gets no exercise. His total cholesterol is 400 and his blood pressure is 138/88. Pulse is 99. The driver admits to not being faithful to using his statins and other medications as prescribed. What is the next step?
Caution the driver regarding non-compliance of medication and treatment plan
81
You notice that a driver is wheezing and out of breath during the exam. What is the next step?
Refer to pulmonologist (correct)
82
Drivers that exhibit wheezing and out of breath during the exam should have a x prior to certification.
pulmonary evaluation
83
Are Extended wear contacts disqualifying?
no
84
Are Monocular vision, Monovision, Telescopic lenses disqualifying?
yes
85
Monocular vision requires a x for qualification.
vision exemption
86
A driver is found to have red/green color deficiency using the Ishihara color blindness test. What is the next step?
Refer the driver to a vision specialist (correct)
87
To pass the color standard, a driver must differentiate between traffic signal red, green, and amber. Can Ishihara charts make that determination?
no
88
The ME should use ____ to test color deficiency or refer to a vision specialist.
traffic signal colors
89
The vision exemption is for ____only.
visual acuity and horizontal vision
90
The previous driver reports back for re-certification with the same findings except that his blood pressure is now 165/101. The next step is:
Certify the driver for 3 months and refer the driver for hypertension intervention (correct)
91
The returning driver has Stage 2 hypertension and should be given a ______ certificate and referred for treatment.
3 month
92
What is the time interval for medical certification and the vision exemption issued for a driver who is required to have a vision exemption?
1 year, 2 years (correct
93
For a driver who is required to have a vision exemption, the driver must have an _______medical examination with a vision specialist and an annual medical certificate,
annual
94
The vision exemption is granted for _____ years.
two
95
A driver complains of slow progressive diminished distance visual acuity and glare particularly at night from oncoming headlights and decreased contrast. The most likely cause is:
Cataracts (correct)
96
Cataract formation causes diminished visual acuity in ______, and night glare from headlights is one of the first changes to appear.
all fields
97
Near vision may be improved with what eye condition?
Cataract formation
98
night glare from headlights is one of the first changes to appear from what?
Cataract
99
The longest the medical examiner would certify a driver with a history of Stage 3 hypertension is?
6 months (correct)
100
Should a driver who is taking an anticonvulsant medication be qualified or disqualified and why?
Qualified. If taken for chronic pain, the dose is smaller and is less likely to have side effects that interfere with driving. (correct)
101
What is the lowest allowable PaO2 concentration if the driver has an ABG due to a chronic respiratory disorder.
60% (correct)
102
The lowest PAO2 concentration is x when obtained at altitudes at or above 5000 feet.
60%
103
A driver lists in his history that he has diabetes and is taking insulin. He provides a copy of his exemption that was granted just over one year ago, a recent visit to his treating physician and eye specialist, and a log indicating that he has monitored his sugar levels and demonstrates that he has a fast acting glucose source in his possession. The CME should:
Certify the driver for 1 year. (correct)
104
The driver has satisfied all requirements of the insulin exemption which is valid for 2 years, Maximum medical certification is ______
1 year.
105
A driver reports that she has Carpal Tunnel Syndrome in her left wrist. Additionally, she reports using a brace at night, taking and seeing a physical therapist for treatment. She has no current restrictions from work. Her grip strength in her right and left hand is 5/5. The best next step is:
Certify the driver but require more frequent monitoring
106
An SPE is not available for______ bc is not a Fixed Deficit. If the driver can meet the functions involving hand strength they should be certified to drive but may be required to have more frequent monitoring of this potentially progressive disease.
CTS
107
A driver reports a history of “Irritable Bowl Syndrome” or IBS. He is being treated with the use of diet and “Lomotil” and he reports he is well managed. He does not provide any release from his treating provider. The examiner best decision would be to:
Certify the driver for 2 years. (correct)
108
Heart rate in an athletic adult at or above x bpm is considered normal.
50 bpm
109
The driver reports of history of COPD and that he smokes a pack and a half of cigarettes daily. He has been treated by a pulmonologist for a few years now but insists he is able to drive safely. He lists that he is taking Spiriva daily and his “water pill” which he cannot remember the name of, for high blood pressure. His examination reveals notable wheezing in all lung fields upon auscultation, a BMI of 34.23, and the rest of his examination is unremarkable. The examiner should:
Request a Pulmonary Function Test.
110
T/F= Drivers with a history of COPD should be evaluated prior to certification to see if they meet pulmonary standards.
T
111
A driver has 35 degrees of cervical rotation to the right and left but can view both side mirrors. What is the next best step?
Qualify the driver for two years (correct)
112
FMCSA has not adopted a standard cervical range of motion guideline for drivers. Drivers must be able to view ______
both mirrors.
113
Which of the following commercial drivers involved in interstate commerce are not required to have a current medical certificate?
Driving a vehicle with compensation carrying or rated to carry 9 passengers within 75 air miles of the driver?s normal work-reporting location. (correct)
114
Usually driving a vehicle for compensation that carries between 9-15 passengers in interstate commerce requires a current medical certificate, except when the vehicle stays within _____ miles of the driver?s work-reporting location.
75 air miles
115
A driver has a right diminished Achilles reflex and right leg pain. He states that he can drive a truck without difficulty. What is the next step?
Check for decrease plantar-flexion strength (correct)
116
Decreased ________of the ankle may result in functional inability to control a CMV safely and may be indicated by a loss of Achilles reflex.
plantar-flexion
117
A driver reports that 2 months ago he had a benign supratentorial tumor successfully removed without residual neurological deficits. The exam is otherwise normal. He brings a surgical and evaluation report from the surgeon who recommends return to driving. What is the certification status of the driver?
Disqualified for 22 months to complete the two year waiting period (correct)
118
This category of tumor has a two year waiting period.
benign supratentorial tumor
119
The FMCSA definition of sleep apnea is:
30 or more apnea events per hour (correct)
120
The FMCSA definition of sleep apnea is 30 hypo/apnea events per hour. However, recent recommendation is that drivers with a diagnosis by a sleep specialist of mild to severe (15-30) sleep apnea should _______
receive sleep apnea treatment.
121
A driver reports having a pacemaker implanted 2 years ago. The cardiologist implanted a pacemaker/cardioverter defibrillator model although there was no current risk for defibrillation. The defibrillation portion of the device is deactivated. What is the driving status for this driver?
Disqualified (correct)
122
Implanted defibrillation devices with or without pacemakers are ________
always disqualifying.
123
A motor carrier has asked the ME to perform the medical certification exams for their drivers but they require that the driver be able to lift 100 lbs. What is the next step?
Perform the CDL medical exam on these drivers using FMCSA standards with the additional lifting requirement of the motor carrier. (correct) Motor Carriers have the right to adopt stricter medical standards.
124
Which of the following is a sign of stable angina?
Pain from exertion (correct)
125
Stable angina includes pain with exertion, emotion, extremes in weather and _______
sexual activity.
126
A CDP student reports he takes Zyprexa for the treatment of Schizophrenia. He presents a note from his psychologist stating that the condition is managed and he should be able to “drive”. The examiners best decision would be to:
Disqualify the driver. (correct)
127
________ is a permanent psychiatric disorder and is in nearly all cases a disqualifying condition.
Schizophrenia
128
During a history the driver admits that he has been treated in the last year for tuberculosis. He reports that he feels ok and was cleared to drive. Which of the following is not required for certification?
Yearly follow-up with treating healthcare provider (correct)
129
A driver with a history of TB is disqualified until they have medical clearance, and have provided results of a _______, and pulmonary function test that meet or exceed minimum requirements to drive.
chest X-ray
130
T/F: For Tuberculosis, It is not required to have yearly follow-up evaluation unless recommended by treating physician or due to the clinical course of the condition.
T
131
A driver with a history of Stage 3 hypertension comes in for recertification. His confirmed blood pressure during the examination is 166/92. What is the next step?
3 month certification (correct)
132
With a BP of 166/92, the driver has Stage ___ hypertension and gets a one time _____ certificate.
stage 2, 3 month certification
133
During an exam, a driver reports a history of pulmonary emboli from deep vein thrombosis that occurred 75 days ago. He reports being on anticoagulant medication. What is the certification status for this driver?
Temporarily disqualified to drive for another 15 days to complete the 3 month waiting period. (correct)
134
There is a ______ waiting period free of pulmonary embolism.
3 month
135
A driver has a MI followed by CABG. What is the mandatory waiting period for this driver?
3 months
136
The waiting period for a MI is _________
2 months
137
The waiting period for CABG is _______
3 months.
138
Dexedrine (Dextroamphetamine), Ritalin (methyphenidate), and Cylert (pemoline) can be used for drivers with:
ADHD
139
A driver may use a stimulant solely for the treatment of ______
ADD or ADHD.
140
What is the maximum certification period for Obstructive Sleep Apnea (OSA)?
12 months
141
Which of the following types of medical examination report form is used if further information is needed before you can make a decision on driver status?
Follow-up
142
Checking the box on Page 1 Section 1 "Follow-up" is used if further information is needed before you can make your determination. It is a continuation of your original, new or recertification exam. Do you need to perform the entire physical exam again?
no
143
The driver admits during the examination that he drinks 14 drinks on the weekends. The examiner provides a “CAGE” questionnaire and the driver scores a 1 on the questionnaire. The examiner should?
Certify the driver for 2 years.
144
14 drinks per week with less than a score of 2 on the CAGE questionnaire w/ no other clinical evidence to indicate a current active diagnosis of alcoholism, is certified for up to ______
2 years.
145
Drivers with a history of diabetes must provide the ME a ______ medical history before being certified to drive.
5 year
146
The minimum acceptable spirometry values required to certify a driver are?
FEV1 65%, FVC 60%, FEV1/FVC ratio 65% (correct)
147
A driver reports a traumatic pneumothorax, this time on the left side. A previous spontaneous pneumothorax was on the right side. The doctor has released the driver to return to driving. What is the next step?
Disqualify the driver until X-ray confirms complete recovery
148
The driver was recently prescribed humulin for the control of diabetes. What is the next step?
Discuss the need to apply for an insulin exemption
149
A driver recently started on insulin or a driver who has been taking insulin without an insulin exemption should be counseled regarding applying for an insulin exemption. The medical examiner completes the exam, gives the driver a ______ certificate and checks the box that an insulin exemption is required to drive.
one year
150
On examination a driver’s blood pressure is measured at least twice. The lowest value recorded was 156/101. This is:
Stage 2 Htn.
151
Stage 2 Htn is defined as ______
160-179 / 100-109.
152
What is the minimum time the Medical Examiner must keep a copy of the medical exam report and medical examiner’s certificate?
3 years
153
A driver has bilateral hand and arm tingling. There is a positive Tinel sign at the wrist. What should the ME order next?
Nerve conduction test
154
A driver must exhibit a minimum of what % compliance of CPAP usage?
70%
155
A driver marks that he has suffered a seizure that occurred 5 months ago as a result of a medication reaction. He only had one event, and did not require any medication. Medical records confirm the driver’s comments and indicate the underlying cause has been corrected and is unlikely to reoccur. The examiner should?
Certify the driver for 2 years.
156
The driver had a single acute provoked seizure from a known cause involving no medication use. There is a _____ recommended waiting period
NO waiting period. The examiner may certify him for 2 years.
157
What is the initial waiting period and re-certification repeat ETT requirements for a driver with a history of CABG?
3 months Annual after 5 years
158
Drivers with a history of CABG have an initial waiting period of _____ and after five years must have an annual ETT.
3 months
159
Drivers with a history of CABG have an initial waiting period of 3 months and after ______ must have an annual ETT.
five years
160
An elderly driver is late by 1 hour to his appointment and says he gets lost easily. He struggled during his exam to remember his doctor’s name and joked that it was due to his old age. His exam is otherwise normal. What is the next step?
Have the driver complete a MMSE exam
161
A driver reports for examination 7 years post CABG. He presents a release from his cardiologist two years ago that states that he has no restrictions from driving. The driver brings a copy of a normal ETT that was performed 2 years ago. Otherwise his examination is unremarkable. The next step is:
Disqualify the driver. Prior to certification, drivers with a history of CABG must have annual examination and clearance from a cardiovascular specialist.
162
Five years post CABG a driver must also have a ______
Normal annual ETT.
163
Is Height/weight a required test?
no
164
Name 4 required tests for certification:
Visual acuity
Urinalysis
Hearing
BP
165
What is the age requirement to operate a CMV in interstate commerce?
21 years old
166
Interstate CMV drivers must be _______, but some states allow intrastate commercial drivers to drive at 18 years old.
21 years old
167
A driver without a history of hypertension has the following blood pressure readings on examination. What is the next step?
1st reading; 140/85
2nd reading; 135/90
Take a third reading. If first and second measurement have either the systolic or diastolic values equal to 140/90 where the accompanying value is less than or equal to 140/90, the ME should take a third reading.
168
If either the systolic or diastolic values on the third measurement are equal to 140/90 and the corresponding value is equal to or less than 140/90, the medical examiner determines whether to give the driver a ___________.
one year or two year certificate.
169
Which of the follow must be present in determine functional capacity of a hand?
Prehension and power grasping
170
The FMCSA definition of a severe hypoglycemic reaction does NOT include:
Blood Glucose levels of 400. The definition includes having a period of impaired cognitive function that occurred without warning. Blood glucose levels as high as 400 indicate hyperglycemia but are not considered a high risk for a sudden event.
171
The FMCSA definition of a severe hypoglycemic reaction includes:
Seizure
Loss of consciousness
Assistance needed from another person
172
A driver is missing all of his index finger on his right hand, but has a thumb and all of his other digits. The next step is:
Assess ability to perform driver demands such as rotation of outstretched arms against resistance as if turning a steering wheel.
173
If the driver can demonstrate ______, they can be certified to drive without a SPE.
sufficient power grasp and prehension
174
Which of the following is NOT part of the urine test during an examination?
Creatinine
175
What is tested for as part of the urine test during an examination?
Blood
Specific Gravity
Protein
Glucose
176
A driver reports going in to the ER with chest pain 2 months ago. He states that he was advised to follow-up with his PCP, all tests were normal but he hasn’t followed up with his doctor. What is the next step?
Disqualify the driver and refer to his PCP
177
A satisfactory ETT must attain heart rate greater than ______ of predicted maximum (unless on beta blocker)
85%
178
What are components of a satisfactory ETT?
- Through Bruce Stage II or equivalent (incorrect)
- Increased diastolic blood pressure greater than 20mmHg without angina
- No significant ST segment depression or elevation
179
A driver is taking Streptomycin for the treatment of chronic tuberculosis. His history reveals that he has not been symptomatic within the past year. He reports no significant fatigue and is examination findings are unremarkable. He provides a note from his treating physician that indicates that he may drive a truck. Office notes including his most recent X-ray, and pulmonary function tests are also provided for the examiners review. The X-ray shows a few discrete nodules, without any other abnormal findings. The PFT has an FEV1 of 75, FVC of 70 and an FEV/FVC ration of 75. The examiner should:
Disqualify the driver until treatment is successfully completed due to possible streptomycin damage to the 8th cranial nerve that could affect hearing and balance.
180
A driver with chronic tuberculosis taking streptomycin is disqualified until treatment is successfully completed due to possible streptomycin damage to _________
the 8th cranial nerve that could affect hearing and balance.
181
A driver had an acute seizure 1 week ago due to an allergic reaction to a chemical he was transporting. The risk for recurrence is low, the driver has recovered and has been counseled to avoid this chemical in the future, and no treatment or medication has been recommended. The next step is?
Qualify the driver for 2 years. An acute seizure form a systemic metabolic illness does not have a recommended time frame and can be qualified for up to 2 years
182
MEs are required to ask these questions to a driver with a history of diabetes:
Diabetic symptoms
Blood glucose monitoring
History of hypoglycemic episodes
Insulin treatment
183
T/F: The ME it is not specifically required to ask whether a diabetic driver has been evaluated by a diabetic specialist.
T
184
A driver reports a history of Meniere’s disease during the driver medical exam for which he is under current treatment. He reports that his last episode was 2 months ago and since that time he has been symptom free. The exam is otherwise unremarkable. The next step is?
Disqualify the driver. Menieres disease is disqualifying.
185
When a driver is disqualified due to an incomplete waiting period, the ME should:
Mark "Does not meet Standards" and fill out the "Temporarily disqualified due to" section
186
A driver reports a history of being treated for alcoholism many years prior. He continues to attend AA meetings, and reports being in remission for over 5 years. He does not take any medication to control his alcoholism. His examination is free of any signs of alcoholism and is otherwise unremarkable. The examiner provides a CAGE questionnaire and the driver scores a 0 out of 4. The best certification decision would be to.
Certify the driver for 2 years. Had there been signs of alcoholism, an evaluation would have been required. Voluntary attendance at self-help meetings is not disqualifying.
187
A driver’s UA shows a specific gravity of 1.032, Protein is negative, Blood shows a trace amount, and Glucose is 2000. The driver reports that he does not have any known medical conditions. What is the suspected medical condition and the next step?
Deiabetes Mellitus, Disqualify the driver until evaluated by PCP
188
Increased ________ and sugar spilled into the urine are traits of Diabetes Mellitus.
specific gravity
189
Is Shortness of breath with exertion an indicator for pulmonary testing?
no
190
Indicators for pulmonary testing?
Hx of any specific lung disease
Chest tightness
Smoking in drivers over 35 years old
wheezing or coughing, and shortness of breath at rest
191
Is the Stanford sleepiness scale a required yearly test for drivers with OSA?
No. The Stanford sleepiness scale is a sleepiness survey and not considered an objective test as required yearly for certification.
192
Wat are the required yearly tests for drivers with OSA?
Polysomnography
Maintenance of wakefulness test
Multiple sleep latency test
(All required tests are objective)
193
T/F: If medication and dosages are listed in the driver’s history section in response to a “Yes” answer, recent test results do not need to be noted in the driver history.
T
194
T/F: Physicians contact information, date of onset, limitations, diagnosis and medications use including OTC and herbal supplements are required to be listed in the health history.
T
195
A driver had to use a hearing aid to pass the hearing standard. What should the ME council the driver about?
Carry extra batteries
196
Do drivers with hearing aids need hearing exemptions?
The driver should be counseled to carry an extra hearing aid battery and that they must wear a hearing aid while driving. The driver does not need a hearing exemption.
197
A driver has the following ANSI hearing results. What is the driver’s status?
Hz Right 500 1000 2000 4000
Hz Left 500 1000 2000 4000
30 40 50 80 40 50 50 20
Qualified: The right ear passes
198
The hearing standard using audiometry is that at least one ear must have hearing loss no greater than _____
40db.
199
A driver complains of painless gradual loss of night vision, peripheral vision, and decreased color discrimination. Distance visual acuity has not changed. The most likely cause is:
Glaucoma
200
Intraocular pressure causes progressive atrophy of nerve cells. Symptoms include redirection of visual attention, and decreased peripheral, night vision, and color discrimination for certain colors. What condition is described?
Glaucoma
201
- Visual Acuity: 20/30 left; 20/20 right; 20/20 both
- Able to distinguish signal red, amber, green
- Lateral Horizontal Vision: 80 left, 80 right.
- Whisper test: 5 ft. right; 4 ft. left
- BP 148/88; pulse: 86
- UA: Specific Gravity: 1.010; Protein: trace; Blood: Negative; Sugar: Negative.
- The rest of the examination is unremarkable.
The examiners best decision would be to:
Certify the driver for 1 year. The driver suffers from Stage 1 hypertension. There is no previous history of hypertension, the driver may be certified for 1 year.
202
BP 148/88= driver suffers from Stage 1 hypertension. If there is no previous history of hypertension, the driver may be certified for ______
1 year.
203
A driver with a current medical certificate that does not expire for another year had an injury that interfered with his ability to drive. What is the next step?
Driver must return to the ME for a medical examination
204
When a driver returns from an illness or injury that interferes with driving ability, the driver must ________
undergo a medical examination even if the medical examiners certificate has not expired
205
What is the waiting period for a Single unprovoked seizure?
5 years
206
What is the waiting period for Stroke with risk for seizures?
5 years
207
What is the waiting period for Bacterial meningitis with early seizures?
5 yr
208
Moderate TBI without early seizures has a waiting period of _____
2 years.
209
What waiting periods and event history is used to determine driver certification status according to the bipolar guidelines?
6 mth waiting period symptom free following a nonpsychotic major depression
210
A history of Bipolar mood disorder can have a _____ waiting period depending on the severity of the preceding episode.
6 month or 1 year
211
Name 3 symptoms of Congestive Heart Failure:
Shortness of breath with mild exertion or at rest.
Need to urinate at night
Swelling in the ankles and the abdomen.
212
What condition has symptoms include wheezing, enlargement or prominent neck and facial veins, raised jugular venous pulse, bluish discoloration of face, presence of abnormal heart sounds, fatigue, weight gain and more.
Congestive heart failure
213
T/F: Headache is not a typical symptom of congestive heart failure.
T
214
Does a ME need to ask the driver about what license class they have?
No. All CDL classifications must meet the same medical guidelines to be medically certified to drive, therefore there would be no reason to ask whether they have a Class A, B, or C license. Some drivers that do not have a CDL license must still have a medical certificate.
215
During the examination, the examiner notices that the driver’s horizontal vision is 60 degrees to the left and 90 degrees to the right. Visual acuity is 20/20 in each eye and together. What is the next step?
Counsel the driver regarding the need for a vision exemption
216
A driver has one eye meet the vision standard. Counsel the driver regarding the need for a _______.
vision exemption
217
What are the two types of exemptions?
vision and diabetes
218
What stages of hypertension call for a medical certificate that expires in a year?
Stage 1 or higher
219
Minimum distant visual acuity in each eye with or without correction?
20/40
220
Is a medical examiner required to inquire about glycosuria from a driver with diabetes mellitus?
yes
221
Vision standard: 20/20 and 20/10 are higher standards than necessary. ______ is not a high enough acuity standard.
20/60
222
Stage 3 corresponds to a medical certificate, good for 6 months from date of examination if the reading is less than or equal to _______.
140/90
223
Stage 1 hypertension certification expires after ______.
a year
224
Stage 2 hypertension results in a one-time, ______ medical certificate.
three-month
225
A driver has a BP of 160/100, but no prior knowledge of high BP. What's the next action for the medical examiner?
Take a second measurement later in the examination and then refer him or her to a PCP
226
If a driver has >______BP, take a second measurement later in the examination. If the driver had no prior knowledge high BP, refer them to a PCP for management.
> 139/89
227
Can Carcinoma, Chronic bronchitis, and Asthma all interfere with oxygen exchange and could result in gradual or sudden incapacitation?
Yes
228
Medical examiner is required to ask all but which of the following questions?
a. Do you have shortness of breath?
b. Do you have lung disease?
c. Do you smoke? If so, how much and for how long?
d. Do you have emphysema?
c. Do you smoke? If so, how much and for how long?
| suggested, but not required
229
An electronic device that treats cardiac arrest, ventricular fibrillation, and ventricular tachycardia through the delivery of rapid pacing stimuli or shock therapy:
An implantable cardioverter-defibrillator
230
A pacemaker is an implantable device designed to treat _______
bradycardia.
231
________ tachycardia is a type of arrhythmia that is usually not considered a risk for sudden death.
supraventricular tachycardia
232
__________ includes ventricular fibrillation and ventricular tachycardia and is responsible for the majority of instances of cardiac sudden death.
ventricular arrhythmia
233
T/F: long hours and rotating work schedules predispose a driver for increased risks of cardiovascular disease.
F
234
T/F: Drivers environmental stressors are detrimental to the cardiovascular system.
T
235
T/F: The medical examiner must document all abnormal findings on the Report Form, even if they are not disqualifying
T
236
1 refers to General Appearance, 3 refers to Ears, 5 refers to Heart, and 7 refers to __________.
Abdomen and viscera
237
Body section #_______ refers to General Appearance
1
238
Body section #______refers to Ears
3
239
_______ refers to Heart, and 7 refers to Abdomen and viscera.
5
240
________ do treat arrhythmias, but they do not prevent them. So, the driver remains at risk for syncope.
implantable cardioverter-defibrillator
241
T/F: Combination ICD/pacemaker devices are ineffective in preventing incapacitation cardiac and arrhythmia events.
T
242
_________ antidepressants, which include tricyclics such as amitriptyline and imipramine, have consistently been shown to interfere with safe driving.
First generation
243
________ antidepressants, including fluoxetine and venlafaxine, have fewer side effects and are generally safe.
second generation
244
T/F: Guidelines recommend a case-by-case assessment of drivers treated with antidepressant medication.
T
245
T/F: With long-term use of antidepressants, most drivers tend to develop a tolerance to the sedative effects.
T
246
Pulmonary Tuberculosis- Certify If:
- Certify If: Driver is not contagious. Etiology is confirmed and treatment is adequate/effective, safe and stable.
- Certification: 2 years.
- No Waiting Period
247
CMEs must report exams performed on Interstate Non CDL Drivers of vehicles that weigh/rated for over _________
10,000lbs but under 26,001lb.
248
T/F: CMEs must apply for a CLIA Certificate of Waiver, and, a State Laboratory license for performing CLIA waived urinalysis dipstick tests.
T
249
T/F: Hands, arms and legs required points of contacts to enter or exit a cab.
T
250
A second __________, regardless of the elapsed time between seizures, would constitute a medical history of epilepsy, and the driver would no longer meet the physical requirements.
unprovoked seizure
251
T/F: Lantus is a form of insulin which is non-certifiable
T
252
Use of contact lenses when one lens corrects distant visual acuity and the other lens corrects near visual acuity is ______
Disqualifying Vision
253
T/F Some drivers with monocular vision may be able to be certified if otherwise medically fit for
duty and are granted a Federal vision exemption certificate.
T
254
Hearing exam; Forced whispered voice in one ear at not less than _______
5ft
255
BP greater than _______ must be confirmed with a second measurement taken later during the examination
139/89
256
A one-time, 3-month medical certificate is granted in two cases: where the driver has a BP that is
equivalent to Stage ________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.
Stage ___2_____hypertension. This three-month certificate is a one-time issuance for the recertification period and is not intended to mean once in the driver’s lifetime.
257
140-159/90-99
Stage 1 hypertension
258
160-179/100-109
Stage 2 hypertension
259
greater than or equal to 180/110
Stage 3 hypertension
260
At a minimum, you must check for pupillary equality, reaction to light and accommodation, ocular motility, _______, extraocular movement, nystagmus, and exophthalmos.
ocular muscle imbalance
261
At a minimum, you must check for scarring of the tympanic membrane, occlusion of the external canal, and ___________.
perforated eardrums
262
ME requires distant visual acuity of at least ______
(Snellen) in each eye without corrective lenses or visual acuity separately corrected to 20/40 (Snellen) or better with corrective lenses
20/40
263
Distant binocular visual acuity of at least _______ (Snellen) in both eyes, with or without corrective lenses.
20/40
264
Examine the eyes for:
```
Pupillary equality.
Reaction to light and accommodation.
Ocular motility.
Ocular muscle imbalance.
Extraocular movements.
Nystagmus.
Exophthalmos.
```
265
To convert International Organization for Standardization
(ISO) test results to the ANSI standard, subtract from the ISO test results: 14 dB for 500 Hz, 10 dB for
1,000 Hz, and _______ for 2,000 Hz.
8.5 dB
266
Acute and chronic peripheral vestibulopathy is similar to BPV in that it has a _______ waiting period symptom free.
2 month
267
The Conference on Neurological Disorders and Commercial Drivers report recommends disqualification
when there is a diagnosis of ________fistula.
labyrinthine
268
BP equal to or less than 140/90 may be certified for 1yr; however, if his or her BP is greater than 140/90 but less than 160/100, a one-time certificate for _____ can be issued.
3 months
269
Stage 2 (BP is ________) should be treated and a one-time certificate for 3-month certification can be issued. Once the driver has reduced his BP to equal to or less than 140/90, he may be recertified annually thereafter.
160/100-179/109
270
Stage 3 hypertension (BP equal to or greater than ______) should not be certified until his or her BP is reduced to 140/90 or less, and may be recertified every 6 months.
180/110
271
"One-time" means you cannot issue consecutive 3
-month certificates for BP greater than _______.
It does not mean once in a lifetime.
140/90
272
Certify for 1 year if: It is the first examination at which the driver has BP equivalent to stage 1 hypertension and the driver:
Has no history of hypertension.
| Does not use antihypertensive medication to control BP.
273
Certify one time for 3 months for BP if a driver has:
A 1-year certificate for untreated stage 1 hypertension.
| Not been prescribed antihypertensive medication to control high BP.
274
Don't certify if the driver has a one-time, 3-month certificate for elevated BP, and BP greater than _______
140/90.
275
Don't certify a driver with history of ________ and BP greater than 140/90.
stage 3 hypertension
276
Don't certify if BP greater than or equal to ________, regardless of any other considerations.
180/110
277
The driver who is disqualified for stage 1 hypertension may be recertified for 1 year if BP is lowered
to less than ______
140/90.
278
Minimum 3 months post-surgical correction. Maximum certification period _______ post-surgical correction .
1 year
279
Minimum — 3 months post-pacemaker implantation if underlying disease is:
Neurocardiogenic syncope.
| Hypersensitive carotid sinus with syncope.
280
Minimum — 1 month post-pacemaker implantation if underlying disease is:
* Sinus node dysfunction.
| * AV block.
281
Minimum — 1 month post-isthmus ablation and diagnosis is ________
atrial flutter
282
Disqualifying Arterial Blood Gas values:
PaO2 45 mmHg
65 mmHg
283
Consider screening with Sleep Study all patients with BMI >_____to 33 mg/kg2
BMI >30
284
Heart Transplantation At least 1 year post-transplant; asymptomatic
no rejection
_______ Clearance by cardiologist required.
Biannual
285
Driver should be able to Exercise to a workload capacity greater than ______ Metabolic Equivalents (METs) (through Bruce protocol stage II or equivalent).
6 Metabolic Equivalents (METs)
286
ExerciseToleranceTest: attain a heart rate greater than or equal to ______ of predicted maximum (unless on beta blockers).
85% of predicted maximum
287
An ETT should have no Have no significant _______depression.
ST segment
288
Don't certify significant hypoxemia (partial pressure of arterial oxygen (PaO2) less than _______ of mercury (mm Hg)).
65 millimeters
289
Recommend not to certify the driver when ABG measurements that reveal:
Partial pressure of arterial oxygen (PaO2) less than:
___________ at altitudes below 5,000 feet.
o65 millimeters of mercury (mm Hg). o60 mm Hg at altitudes above 5,000 feet.
290
Epilepsy Minimum ______ off anticonvulsant medication and seizure free
—10 years
291
Don't certify significant impairment of pulmonary function = forced expiratory volume in the first second of expiration (FEV1) less ________
than 65%
292
Minimum 10 years seizure free and off anticonvulsant medication following: Viral encephalitis with ________
early seizures.
293
Minimum waiting period of 2 years post-surgical removal of these 2 tumors:
* Benign supratentorial tumors.
| * Spinal tumors.
294
What is the waiting period for History of epilepsy OR Viral encephalitis with early seizures?
10yr
295
What is the waiting period for Bacterial meningitis and early seizures?
5yr
296
What is the waiting period Acute seizure with acute structural central nervous system insult?
2yr
297
Events with no risk for future seizures generally have a waiting period of ______
1yr
298
RescueGlucoseMinimum — 1 month, if the driver with diabetes mellitus was previously diagnosed and on treatment that __________
did not include the use of insulin
299
Don't certifying the driver who uses a first generation _______
tricyclic antidepressant
300
Right ear
30 + 33 + 35 = 98/3 = 32.6 = PASS
Left ear
40 + 43 + 50 = 133/3 = 44.3 = FAIL
The hearing standard is met because the average hearing loss in the right ear is less than 40 dB when
measured with an audiometer.
