NRCME Exam Questions Flashcards
Which point of contact is NOT required when entering and exiting the cab? A. Elbows B. Hands C. Arms D. Legs
CORRECT ANSWER: A»Explanation: Hands, arms, and legs are required points of contacts to enter or exit a cab
A driver needs a minimum grip strength of \_\_\_ pounds (\_\_\_ kilograms) to be certified when a dynamometer is used. A. 58 pounds (26.3 kilograms) B. 80 pounds (36.3 kilograms) C. 42 pounds (19.1 kilograms) D. 36 pounds (16.4 kilograms)
CORRECT ANSWER: A»Explanation: A minimum grip strength of 58 pounds (26.3 kilograms) of force is recommended for both men and women if a dynamometer is used.
A driver comes in with a diagnosis of peripheral neuropathy. You should:
A. Certify for 6 months
B. Not certify the driver
C. Send the driver for evaluation by a neurologist and certify based on the neurologist’s recommendation
D. Certify for 3 months
CORRECT ANSWER: B»Explanation: A driver with peripheral neuropathy should not be certified, but may file for an appeal, which includes evaluation by a neurologist or physiatrist. However, if the driver chooses not to appeal he does not require a neurologist or physiatrist. You should disqualify the patient
A driver presents with autonomic neuropathy. Which of the following is NOT affected by this disorder? A. Control of lower extremities B. Blood pressure C. Bowel and bladder function D. Digestion
CORRECT ANSWER: A»Explanation: Autonomic neuropathy affects the autonomic system, which regulates vital functions such as blood pressure, heart rate, bowel and bladder control, and digestion. Control of the lower extremities would be affected by the peripheral neuropathies.
A driver presents with autonomic neuropathy with resting tachycardia. You should:
A. Certify the driver for 6 months
B. Certify the driver for any length of time you feel is safe
C. Not certify the driver
D. Certify the driver for 1 year
CORRECT ANSWER: C»Explanation: A driver with autonomic neuropathy can be certified for up to 2 years once etiology is confirmed and treatment has been shown to be safe and effective. A driver with autonomic neuropathy cannot be certified when the neuropathy is accompanied by resting tachycardia, orthostatic drop in blood pressure, or other organ autonomic neuropathy that interferes with driving ability.
A driver is prescribed nitroglycerin. In what situation can the driver be certified?
A. The driver may be certified if the nitroglycerin has not been used in the past month
B. A driver on nitroglycerin can be certified regardless of the type of angina being experienced
C. The driver may be certified if the angina is stable
D. Nitroglycerin is always disqualifying
CORRECT ANSWER: C»Explanation: Nitroglycerine use is not disqualifying. The medical examiner may require an evaluation by the treating cardiologist to make sure that the driver’s angina is stable.
A driver presents with severe and unpredictable bouts of dizziness (vertigo). As the medical examiner, you suspectMénière'sdisease. You should: A. Certify the driver for 2 years B. Certify the driver for 1 year C. Not certify the driver D. Certify the driver
CORRECT ANSWER: C»Explanation:Ménière’sdisease, a condition associated with severe and unpredictable bouts of dizziness (vertigo), is disqualifying. This recommendation can be found in the Conference on Neurological Disorders and Commercial Drivers.
Which of the following conditions is NOT automatically disqualifying for certification? A. Autonomic neuropathy B. Myotonia C. Isaac's syndrome D. Stiff person syndrome
CORRECT ANSWER: A»Explanation: Autonomic neuropathy is only disqualifying under certain conditions. Myotonia, Isaac’s syndrome, and stiff person syndrome are always disqualifying.
Which of the following is NOT a risk category addressed by the panel for the Conference on Psychiatric Disorders and Commercial Drivers? A. Psychopharmacology B. Counseling C. Mental disorders D. Residual symptoms
CORRECT ANSWER: B»Explanation: The 3 categories addressed by the panel for the Conference on Psychiatric Disorders and Commercial Drivers are mental disorders, residual symptoms, and psychopharmacology. They did not address treatment by counseling.
What blood alcohol level is used as a guideline when assessing the effect of psychotropic medications? A. 0.06 B. 0.08 C. 0.05 D. 0.04
CORRECT ANSWER: D»Explanation: When assessing the effects of psychotropic medications, the guidelines suggest comparing the effects to behavior and effects of having a blood alcohol level of 0.04.
Which mental disorder has the highest risk to public safety and is most likely to be disqualifying? A. Major depression B. Anxiety C. Personality disorder D. Schizophrenia
CORRECT ANSWER: D»Explanation: The more serious the diagnosis, the more likely there will be risk to public safety. Schizophrenia is the most serious mental disorder and, therefore, is more likely to be disqualifying.
Cyclothymia is a mild form of: A. Schizophrenia B. Depression C. Anxiety D. Bipolar mood disorder
CORRECT ANSWER: D»Explanation: Cyclothymia is a mild form of bipolar mood disorder and is rarely disqualifying.
Which of the following is NOT true of major depression?
A. Major depression may relapse within 5 years
B. The highest risk of suicide is in the first few years after onset
C. There is no relation between major depression and stressful events
D. Most cases of major depression will recover
CORRECT ANSWER: C»Explanation: Stressful events commonly occur in the 6 months previous to depression.
Which one is NOT a question associated with the CAGE assessment.
A. Have you ever felt bad or guilty about your drinking?
B. Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (eye-opener)?
C. Have people annoyed you by drinking in your presence?
D. Have you ever felt like you should cut down on your drinking?
CORRECT ANSWER: C»Explanation: The correct question for A-annoyance is, ““Have people annoyed you by criticizing your drinking?”“
A driver shows up for the medical exam disheveled with bloodshot eyes and alcohol on his breath. You should:
A. Directly contact FMCSA or the driver’s employer for information on controlled substances and alcohol testing under Part 382 of the Federal Motor Carrier Safety Regulations
B. Tell the driver to come back tomorrow when he is sober
C. Certify the driver if all other conditions are met since a blood alcohol test is not part of the certification
D. Do a blood alcohol test
CORRECT ANSWER: A»Explanation: A blood alcohol test is not part of the certification process, although one could be done in conjunction with the test if the driver is required by another regulation or the employer to have one. So you wouldn’t do one at this time unless specifically directed to do so. You should not certify a driver you suspect of being an alcoholic even if he meets other conditions. The guidelines suggest contacting the FMCSA or the employer.
A driver voluntarily attending a 12-step program for maintenance of recovery is:
A. Eligible for certification 1 month after completing the program
B. Not disqualified
C. Automatically disqualified
D. Eligible for certification 3 months after completing the program
CORRECT ANSWER: B»Explanation: Ongoing voluntary attendance at self-help groups (eg, 12-step programs) for maintenance of recovery is not disqualifying.
Drug testing:
A. Must be done at the beginning of the exam
B. Must be done at the end of the exam
C. Can be done anytime during the exam
D. Is not a required part of the certification exam
CORRECT ANSWER: D»Explanation: Drug testing is not part of the certification process, although, one could be done in conjunction with the test if the driver is required by another regulation or the employer to have one.
What is typically the first sign in the development of diabetic nephropathy? A. Persistent proteinuria B. Hematuria C. Glucosuria D. Increased specific gravity
CORRECT ANSWER: A»Explanation: The first sign of nephropathy commonly is the development of persistent proteinuria. End-stage renal disease follows some time later.
What is the maximum certification time frame for a driver with diabetic nephropathy?
A. Two years as long as hematuria is not present
B. Two years when etiology is confirmed and treatment has been shown to be adequate/effective, safe, and stable
C. One year when etiology is confirmed and treatment has been shown to be adequate/effective, safe, and stable
D. Six months when etiology is confirmed and treatment has been shown to be adequate/effective, safe, and stable
CORRECT ANSWER: B»Explanation: The guidelines state that a driver with diabetic nephropathy can be certified for up to 2 years when etiology is confirmed, and treatment has been shown to be adequate/effective, safe, and stable. The presence of hematuria is not considered in the diabetic nephropathy guidelines.
How often should a driver with a hernia have follow-up? A. Biennially B. Biannually C. Annually D. Every 5 years
CORRECT ANSWER: A»Explanation: The driver must have at least biennial medical examinations.
Which location is not specifically identified in the guidelines as a place to check for hernias? A. Viscera B. Genitourinary C. Lumbar region D. Abdomen
CORRECT ANSWER: C»Explanation: The guidelines specifically state to assess for hernias in ““hernia for both the abdomen and viscera body system and the genitourinary system.”” Lumbar hernias are not specifically mentioned.
A driver with a hernia that causes pain: A. Should receive a 1-year certification B. Needs further evaluation C. Is automatically disqualified D. Will see no effect on driving ability
CORRECT ANSWER: B»Explanation: A driver with a hernia that causes pain needs further evaluation to determine the effect on driving ability and certification status. If, after further evaluation, it is determined that there is no or minimal effect on driving ability, the driver may be certified for up to 2 years.
What should you do in the case of an abnormal urinalysis?
A. Refer the driver for evaluation and treatment when indicated
B. Certify the driver; getting a urinalysis is a mere formality
C. Treat the driver
D. Have the driver come back the next day to repeat the test
CORRECT ANSWER: A»Explanation: You should advise the driver of any abnormal findings, and when indicated, encourage the driver to seek primary care provider evaluation, particularly if an abnormal urinalysis could indicate the presence of a medical condition that if left untreated could result in a serious illness that might affect driving. When acting as a medical examiner, you should not prescribe treatment.
What do the guidelines say about the use of medical marijuana?
A. The use of medical marijuana is disqualifying
B. A driver using medical marijuana can be certified after 3 months of monitoring to assess the effects
C. A driver using medical marijuana can be certified for up to 2 years if the marijuana was prescribed by a clinician familiar with the driver’s medical history and assigned duties
D. The use of medical marijuana is never disqualifying
CORRECT ANSWER: A»Explanation: The use of medical marijuana is disqualifying.
Which of the following is NOT true when medical clearance to drive from the prescribing clinician is received?
A. You may certify for a time period of ≤2 years
B. Schedule I drugs are never certifiable, even with the prescribing clinician’s endorsement
C. You must approve certification
D. The decision to certify or not certify is always up to the medical examiner
CORRECT ANSWER: C»Explanation: Some medications on the disqualification list can still be qualified when approved by the prescribing provider. The decision is left to the medical examiner, and the prescribing clinician’s opinion does not have to be followed. You may choose to certify for any time period of ≤2 years based on perceived risk. Schedule 1 drugs, however, can never be qualified.
Which of the following is not true about Schedule III to V medications?
A. Use of Schedule III to V drugs can be certified for a time frame of <2 years based on the risk to public safety.
B. Use of Schedule III to V medications does not need to be evaluated because they pose little risk to safety.
C. Use of Schedule III to V medications may be disqualifying based on side effects.
D. Use of Schedule III to V medications is automatically disqualifying due to the possibility of habit formation or addiction.
CORRECT ANSWER: B»Explanation: Schedule III to V drugs have decreasing potential for abuse than preceding schedules. Abuse may lead to moderate or low physical dependence or high psychological dependence. Schedule III drugs include tranquilizers. Schedule IV drugs include drugs such as chlorhydrol and phenobarbital. Schedule V drugs have the lowest potential for abuse and include narcotic compounds or mixtures. Side effects are not part of the DEA schedule rating criteria. Therefore, a substance can have little risk for addiction and abuse but still have side effects that interfere with driving ability. Side effects and risk to public safety should always be considered in the certification process.
Which of the following conditions must a driver under anticoagulant treatment meet in order to be certified?
A. Monthly partial thromboplastin time (PTT)
B. Monthly international normalized ratios (INRs)
C. Quarterly international normalized ratios (INRs)
D. Weekly international normalized ratios (INRs)
CORRECT ANSWER: B»Explanation: A patient on anticoagulants must have monthly international normalized ratios to monitor risk of bleeding in order to maintain certification.
A driver is prescribed beta-blockers to treat migraine headaches. The proper action is to:
A. Qualify the driver for the time period indicated by the severity of the condition
B. Disqualify the driver as migraines are disqualifying
C. Disqualify the driver since the use of beta-blockers is disqualifying.
D. Qualify the driver for 1 year
CORRECT ANSWER: A»Explanation: The use of beta-blockers when used to treat migraines allows a driver to be qualified. Follow the recommendations for migraines. You may certify the driver for up to 2 years based on severity of symptoms, accompanying symptoms (such as visual disturbance), frequency of headaches, and side effects of treatment.
A driver taking antacids:
A. Should be certified as long as the medication is tolerated well and there are no acute incapacitating events caused by the underlying disease
B. Can always be certified without limitations
C. Should never be certified
D. Should be certified as long as the driver also drinks lots of milk
CORRECT ANSWER: A»Explanation: A patient taking antacids should be certified as long as the medication is tolerated well and there are no acute incapacitating events caused by the underlying disease such as those that accompany ulcerative colitis and Crohn disease.
A driver taking anticonvulsants for seizures:
A. Is disqualified
B. Can be certified for 2 years
C. Can be certified for 1 year
D. Can be certified accompanied by evidence that the seizures have stopped
CORRECT ANSWER: A»Explanation: A driver on anticonvulsants for the treatment of seizures is disqualified. A driver taking anticonvulsants to treat a condition other than seizures may be certified based on the underlying condition.
A driver taking Provigil can be certified for:
A. One year after a 6-week waiting period for monitoring
B. One year with no waiting period for monitoring
C. Two years after a 6-week waiting period for monitoring
D. Two years with no waiting period for monitoring
CORRECT ANSWER: A»Explanation: Drivers being prescribed Provigil should not be qualified until they have been monitored closely for at least 6 weeks while taking Provigil. The treating physician and the medical examiner should agree that the Provigil is effective in preventing daytime somnolence and document that no untoward side effects are present. Commercial motor vehicle drivers taking Provigil should be recertified annually.
The main goal of the cardiovascular exam is to:
A. Determine which stressors the driver is under that may affect his/her cardiovascular health
B. Determine whether the driver has a cardiovascular abnormality that increases the risk for sudden death or incapacitation
C. Prescribe treatment for cardiac abnormalities
D. Refer the driver with a cardiac abnormality to a cardiovascular specialist
CORRECT ANSWER: B»Explanation: The medical examiner should never prescribe treatment. The medical examiner may provide a referral to a specialist as part of the exam, but this is not the main purpose of the exam. The medical examiner should be knowledgeable about the stressors drivers experience and how those stressors affect the health of the driver. However, assessment of these stressors is not the main purpose of the exam. The main purpose of the exam is to determine whether the driver has a cardiovascular abnormality that increases the risk for sudden death or incapacitation and, therefore, risk to the driver and public safety.
Environmental factors affecting the health of drivers may include:
A. Whole-body vibration, temperature extremes, and excessive noise
B. Pollution, bad weather, and extreme loneliness
C. Whole-body vibration, bad smells, and bad weather
D. Excessive noise, too much pizza, and pollution
CORRECT ANSWER: A»Explanation: The following environmental stressors affect a driver’s health: excessive noise, temperature extremes, pollution, whole-body vibration, and bad weather.
What is one reason to use imaging studies instead of an exercise tolerance test?
A. An imaging study is less expensive than an exercise tolerance test.
B. There is no reason since the tests are equivalent.
C. Imaging studies have superior sensitivity and specificity compared to a standard stress test.
D. An exercise stress test has superior sensitivity and specificity compared to a standard stress test.
CORRECT ANSWER: C»Explanation: Imaging studies have superior sensitivity and specificity compared to a standard stress test.
Which result of an exercise tolerance test allows certification?
A. A workload capacity >6 METs, a heart rate >85% predicted maximum rate unless on beta-blockers, a systolic blood pressure rise ≥20 mm Hg without angina, and no significant ECG findings
B. A workload capacity >4 METs, a heart rate >85% predicted maximum rate unless on beta-blockers, a systolic blood pressure rise ≥20 mm Hg without angina, and no significant ECG findings
C. A workload capacity >6 METs, a heart rate >90% predicted maximum rate unless on beta-blockers, a systolic blood pressure rise ≥20 mm Hg without angina, and no significant ECG findings
D. A workload capacity >4 METs, a heart rate >85% predicted maximum rate unless on beta-blockers, a systolic blood pressure rise ≥10 mm Hg without angina, and no significant ECG findings
CORRECT ANSWER: A»Explanation: A workload capacity >6 METs, a heart rate >85% predicted maximum rate unless on beta-blockers, a systolic blood pressure rise ≥20 mm Hg without angina, and no significant ECG findings.
Pulmonary hypertension is defined as:
A. Pulmonary artery pressure <50% of systemic systolic blood as determined by echocardiography or cardiac catheterization
B. Pulmonary artery pressure >60% of systemic systolic blood as determined by echocardiography or cardiac catheterization
C. Pulmonary artery pressure <60% of systemic systolic blood as determined by echocardiography or cardiac catheterization
D. Pulmonary artery pressure >50% of systemic systolic blood as determined by echocardiography or cardiac catheterization
CORRECT ANSWER: D»Explanation: Pulmonary artery pressure >50% of systemic systolic blood as determined by echocardiography or cardiac catheterization.
Which is NOT a modifiable risk factor for coronary heart disease? A. Hypertension B. Sedentary lifestyle C. Age D. Smoking
CORRECT ANSWER: C»Explanation: Age cannot be changed.
Why should you educate a driver about the warning signs of an impending cardiovascular event?
A. Once symptoms are present, sudden death is imminent
B. There is no reason to educate a driver about cardiovascular symptoms
C. You only need to educate drivers with a current cardiovascular issue
D. The driver may only have a short time to safely stop the vehicle and call for medical assistance
CORRECT ANSWER: D»Explanation: All drivers should be educated about the warning signs of an impending cardiovascular event because the driver may only have a short time to safely stop the vehicle and call for medical assistance once symptoms present.
A driver describes chest pressure at rest accompanied by slight nausea and sweating. The best course of action is:
A. Refer the driver for evaluation by a specialist. Do not certify the driver at this time.
B. Refer the driver for evaluation by a specialist. Certify the driver for 3 months.
C. Certify the driver for 1 year
D. Prescribe nitroglycerin sublingual PRN for chest pain and certify the driver
CORRECT ANSWER: A»Explanation: The driver most likely has unstable angina. A driver with unstable angina cannot be certified and should be referred to a specialist for treatment. The driver may be certified after 3 months without unstable angina. If the driver has stable angina, he/she may be certified for 1 year if he/she is asymptomatic, tolerates medication, and has a satisfactory exercise tolerance test.
An examiner should inquire about risk factors of coronary heart disease, in addition to active coronary disease, because:
A. Having risk factors for coronary heart disease indicates an increased risk for a cardiovascular episode
B. Once risk factors are present, a cardiovascular event is imminent
C. The presence of cardiovascular risk factors does not indicate an increased risk for an event, so there is no reason to ask
D. If there are no risk factors, an event will not occur
CORRECT ANSWER: A»Explanation: Although risk factors play an important role in the risk of developing coronary heart disease (CHD), the presence of risk factors does not mean the driver will develop CHD, only that there is an increased risk. Conversely, the absence of risk factors does not mean that the driver will not have a CHD event.
Which is the major predictor for prognosis of coronary heart disease? A. Associated vascular disease B. Presence of angina C. Left ventricular function D. Presence of arrhythmias
CORRECT ANSWER: C»Explanation: The major predictor of coronary heart disease (CHD) is left ventricular function. Other indicators to be considered include general health, age, arrhythmias, angina pectoris, associated vascular disease, and severity of CHD.
The prognosis for a patient with an arrhythmia is generally determined by:
A. The length of an arrhythmic episode
B. The age at which the arrhythmia first presented
C. The underlying heart disease
D. The frequency with which the arrhythmia occurs
CORRECT ANSWER: C»Explanation: Risk determination is difficult because of the number of variables that must be considered. The prognosis is generally determined by the underlying heart disease. While defibrillation may restore a normal rhythm, there remains a high risk of recurrence.
Which condition does NOT disqualify a driver with arrhythmias?
A. When the underlying condition is disqualifying
B. When the arrhythmia puts the driver at risk for sudden death
C. When the dysrhythmia does not increase the risk for hypoperfusion and/or impaired consciousness
D. When the arrhythmia increases the risk for cerebral hypoperfusion and/or impaired consciousness
CORRECT ANSWER: C»Explanation: Per Cardiac Conference Guidelines. Since this is a discretionary issue, a dysrhythmia alone does not disqualify as long as hypoperfusion or altered or lack of consciousness is not involved.
The major risk factor associated with atrial fibrillation is:
A. Bleeding caused by anticoagulant therapy
B. There is no reason to be concerned about atrial fibrillation
C. Syncope
D. Formation of a blood clot, which could travel to the cerebral vascular system and cause a stroke
CORRECT ANSWER: D»Explanation: The major risk associated with atrial fibrillation is the presence of an embolus, which can cause a stroke. Anticoagulant therapy decreases the risk of peripheral embolization in individuals with risk factors for stroke.
When is the use of anticoagulant therapy disqualifying?
A. Use of anticoagulants is never disqualifying
B. Use of anticoagulants is always disqualifying
C. When used to treat a neurovascular condition
D. When used to treat a cardiovascular condition
CORRECT ANSWER: C»Explanation: Use of anticoagulants for neurovascular disorders is always disqualifying because of the high rate of complications associated with bleeding that can incapacitate the driver while operating a vehicle. Under certain conditions, a driver can be certified when the anticoagulants are used for cardiovascular disorders. If a driver is on anticoagulants for both neurovascular and cardiovascular disorders, use the stricter guideline for neurovascular and do not certify.
Supraventricular tachycardia is a(n):
A. Common arrhythmia that is usually not considered a risk for sudden death
B. Common arrhythmia that is considered a risk for sudden death
C. Uncommon arrhythmia that is usually not considered a risk for sudden death
D. Uncommon arrhythmia that is considered a risk for sudden death
CORRECT ANSWER: A»Explanation: Supraventricular tachycardia (SVT) is a common arrhythmia that is usually not considered a risk for sudden death. On occasion, SVT can cause loss of consciousness or compromise cerebral function. Treatment by catheter ablation is usually curative and allows drug therapy to be withdrawn.
Ebstein anomaly is frequently accompanied by a(n): A. Aortic stenosis B. Coarctation of the aorta C. Atrial septal defect D. Patent ductus arteriosus
CORRECT ANSWER: C»Explanation: Ebstein anomaly is frequently accompanied by an atrial septal defect.
A driver with an Ebstein anomaly should have a(n):
A. Annual cardiovascular re-evaluation
B. Annual exam by any provider
C. Annual cardiovascular re-evaluation that should include echocardiography and evaluation by a cardiologist knowledgeable in adult congenital heart disease and who understands the functions and demands of commercial driving
D. Cardiovascular re-evaluation every 2 years that should include echocardiography and evaluation by a cardiologist knowledgeable in adult congenital heart disease and who understands the functions and demands of commercial driving
CORRECT ANSWER: C»Explanation: An annual cardiovascular re-evaluation that should include echocardiography and evaluation by a cardiologist knowledgeable in adult congenital heart disease and who understands the functions and demands of commercial driving.
Which of the following should be used to decide certification status for a driver with a congenital heart disease?
A. Severity of the defect, age at diagnosis, and anatomic diagnosis
B. Severity of the defect, age at diagnosis, and risk of sudden death or incapacitation
C. Severity of the defect, results of treatment, and risk of sudden death or incapacitation
D. Severity of the defect, age at diagnosis, and risk of sudden death or incapacitation
CORRECT ANSWER: C»Explanation: The factors to be considered for a congenital heart defect are anatomic diagnosis, severity of the congenital defect, results of treatment, present fitness status, and risk of sudden death or incapacitation.
A medical examiner is most likely to see the following congenital heart diseases: A. Coarctation of the aorta B. Ebstein anomaly C. Tetralogy of Fallot D. Transposition of the great vessels
CORRECT ANSWER: B»Explanation: Ebstein anomaly is the most likely congenital heart disease to be encountered and is the only one addressed in the medical examiner’s handbook. The other congenital heart diseases listed are only addressed in the FMCSA medical reports.
You may certify a driver with pulmonary hypertension, accompanied by dyspnea at rest, for: A. Do not certify B. 2 years C. 6 months D. 1 year
CORRECT ANSWER: A»Explanation: A driver with pulmonary hypertension cannot be certified if the pulmonary hypertension is accompanied by dizziness, hypotension, dyspnea at rest, or partial pressure of arterial oxygen (PaO2) <65 mm Hg.
Which one of the following is not a type of valvular heart disease? A. Aortic stenosis B. Mitral regurgitation C. Aortic coarctation D. Aortic regurgitation
CORRECT ANSWER: C»Explanation: Aortic coarctation is a narrowing of the aorta.
What grade of murmur is described as, ""can hear the murmur with the stethoscope close to the skin; it does not have to be in contact with the skin to detect the murmur""? A. Grade II B. Grade VI C. Grade I D. Grade VII
CORRECT ANSWER: B»Explanation: There are 6 grades of murmur with being able to hear the murmur without a stethoscope in contact with the skin being the most severe at grade VI. A grade I murmur is described as ““must strain to hear a murmur.”
In which case do the guidelines for aortic regurgitation NOT apply? A. Congenital aortic regurgitation B. Severe aortic regurgitation C. Acute aortic regurgitation D. Chronic aortic regurgitation
CORRECT ANSWER: C»Explanation: The guidelines for aortic regurgitation do not apply when the cause is due to an acute condition such as infective endocarditis.
Under which condition should a driver with a history of aortic valve repair NOT be certified?
A. Thromboembolic complications
B. At least 3 month postoperative
C. Meets asymptomatic guidelines for underlying cause
D. Clearance from a cardiovascular specialist
CORRECT ANSWER: A»Explanation: Do not certify a driver who has had an aortic valve repaired with thromboembolic complications.
What is the recommended certification time for a driver with a heart transplant? A. 18 months B. 6 months C. 3 months D. 1 year
CORRECT ANSWER: B»Explanation: The recommended time for certification for heart transplant is 6 months.
A driver with a heart transplant has a fever and dyspnea. This driver may be certified for:
A. The driver cannot be certified
B. 6 months
C. 3 months
D. 6 months if cleared by a cardiac specialist
CORRECT ANSWER: A»Explanation: Fever and dyspnea are signs of transplant rejection, so the driver cannot be certified until rejection is ruled out.
Which of the following is NOT a sign of heart failure? A. Hair loss B. Edema of the abdomen C. Weight gain D. Palpitations
CORRECT ANSWER: A»Explanation: The signs of heart failure include edema of the abdomen, weight gain, palpitations, dyspnea, cough, edema of feet and ankles, irregular or rapid pulse, difficulty sleeping, fatigue, weakness, faintness, loss of appetite, and indigestion.
Which one does not indicate poor prognosis for a driver with mitral regurgitation? A. Fatigue B. Orthopnea C. Tachycardia D. Dyspnea
CORRECT ANSWER: C»Explanation: The following indicate a poor prognosis for a driver with mitral regurgitation: fatigue, dyspnea, orthopnea, paroxysmal nocturnal dyspnea.
A driver with mitral regurgitation can be certified if the driver also has: A. Atrial fibrillation B. Thromboembolism C. Ruptured chordae or flail leaflet D. Tachycardia
CORRECT ANSWER: D»Explanation: Do not certify a driver with mitral regurgitation who also as any of the following: symptoms,<6 METs on Bruce protocol, ruptured chordae or flail leaflet, atrial fibrillation, LV dysfunction, thromboembolism, or pulmonary hypertension.
Which is not always a congenital heart disease? A. Aortic regurgitation B. Ebstein anomaly C. Tetralogy of Fallot D. Transposition of the great vessels
CORRECT ANSWER: A»Explanation: Aortic regurgitation can be developed or acquired.
Drivers are at high risk for acute deep vein thrombosis because of: A. Long hours of sitting B. Long hours of driving C. Obesity D. Loud noises
CORRECT ANSWER: A»Explanation: Long hours of sitting is a risk factor for the formation of deep vein thrombosis.
Risk of recurrent thrombosis is decreased by \_\_\_% with adequate anticoagulant therapy. A. 0.8 B. 0.75 C. 0.78 D. 0.9
CORRECT ANSWER: A»Explanation: Risk of recurrent thrombosis is decreased by 80% with adequate anticoagulant therapy.
A driver with superficial phlebitis and deep vein thrombosis (DVT) can be certified:
A. Never
B. If the guidelines for DVT are met
C. When the DVT is resolved
D. As long as the driver is not using anticoagulants
CORRECT ANSWER: B»Explanation: A driver with superficial phlebitis and deep vein thrombosis can be certified if the guidelines for DVT are met. The guidelines for DVT are: do not certify the driver until etiology is confirmed, and treatment has been shown to be adequate/effective, safe, and stable.
The maximum certification for a driver with superficial phlebitis is: A. 3 years B. 18 months C. 2 years D. 1 year
CORRECT ANSWER: C»Explanation: The maximum certification for a driver with superficial phlebitis is 2 years.
A driver who has had surgical repair for peripheral vascular disease should have a waiting period of how long? A. 3 months B. 2 weeks C. 6 months D. 1 month
CORRECT ANSWER: A»Explanation: A driver who has had surgical repair for peripheral vascular disease should have a 3-month waiting period.
A driver who has had surgical repair of a thoracic aneurysm should have a waiting period of how long? A. 2 weeks B. 6 months C. 1 month D. 3 months
CORRECT ANSWER: D»Explanation: A driver who has had surgical repair of a thoracic aneurysm should have a 3-month waiting period.
A driver with a thoracic aneurysm cannot be certified if:
A. The size of the aneurysm is <=3.5 cm
B. The driver is at least 3 months post-surgery and has been cleared by a cardiovascular specialist
C. There is no reason not to certify a driver with a thoracic aneurysm
D. The size of the aneurysm is > 3.5 cm
CORRECT ANSWER: D»Explanation: Size is the major risk factor for dissection or rupture of a thoracic aneurysm. The larger the aneurysm, the greater the risk for rupture. Do not certify a driver with a thoracic aneurysm >3.5 cm.
A driver with dilated cardiomyopathy can be certified if the driver has:
A. Sustained V-tach with any left ventricular ejection fraction
B. Syncope/near syncope and any left ventricular ejection fraction
C. Non-sustained V-tach and left ventricular ejection fraction ≥40%
D. Non-sustained V-tach and left ventricular ejection fraction <40%
CORRECT ANSWER: C»Explanation: A driver with dilated cardiomyopathy can be certified if he/she has nonsustained V-tach and left ventricular ejection fraction ≥40%.
When can you certify a driver with restrictive cardiomyopathy?
A. When the restrictive cardiomyopathy is not accompanied by dyspnea
B. When a METS measurement is >6
C. If the oxygen saturation is >90%
D. Never
CORRECT ANSWER: D»Explanation: The Clinical Profile and Outcome of Idiopathic Restrictive Cardiomyopathy report done at the Mayo Clinic indicated a 5-year survival rate of only 64%, compared with an expected survival rate of 85%. Because of this, a driver with restrictive cardiomyopathy is disqualified.
What is the most serious complication of an aneurysm?
A. Pain
B. There is no reason to be concerned about an aneurysm
C. Rupture
D. Leakage
CORRECT ANSWER: C»Explanation: Rupture is the most serious complication of an aneurysm and is related to the size of the aneurysm.
Which drug is NOT commonly used to treat tuberculosis? A. Vancomycin B. Ethambutol C. Rifampin D. Pyrazinamide
CORRECT ANSWER: A»Explanation: The following medications are commonly used to treat tuberculosis: ethambutol, isoniazid, pyrazinamide, streptomycin, rifampin.
Treatment of tuberculosis may cause:
A. Eighth cranial nerve damage and subsequently vision abnormalities
B. Ninth cranial nerve damage and subsequently vision abnormalities
C. Eighth cranial nerve damage and subsequently hearing and balance deficiencies
D. Ninth cranial nerve damage and subsequently hearing and balance deficiencies
CORRECT ANSWER: C»Explanation: Treatment of tuberculosis may cause residual eighth cranial nerve damage that affects balance and/or hearing to an extent that interferes with safe driving.
Bronchiectasis is: A. Destruction and widening of the large airways B. Infection of the large airways C. Bleeding in the large airways D. Collapsed alveoli
CORRECT ANSWER: A»Explanation: Bronchiectasis is destruction and widening of the large airways.
The following are types of chronic obstructive pulmonary disease (COPD):
A. Chronic bronchitis, emphysema, and asthma
B. Chronic bronchitis and emphysema
C. Chronic bronchitis and asthma
D. Emphysema and asthma
CORRECT ANSWER: B»Explanation: Chronic bronchitis and emphysema are types of COPD. Asthma is an inflammatory disorder and not considered as COPD.
Which is NOT one of the cardinal symptoms of chronic obstructive pulmonary disease (COPD)? A. Dyspnea on exertion B. Circumoral cyanosis C. Chronic cough D. Large amounts of sputum production
CORRECT ANSWER: B»Explanation: Chronic cough, large amounts of sputum production, and dyspnea on exertion are cardinal symptoms of COPD. Circumoral cyanosis may be present in COPD, but is not considered one of the cardinal signs.
To improve highway safety by producing trained certified medical examiners who can effectively determine if a commercial motor vehicle driver’s health meets Federal Motor Carrier Safety Administration Standards is the mission statement of :
A. The American Medical Association
B. The National Registry of Certified Medical Examiners
C. The Federal Motor Carrier Safety Administration
D. The Office of Medical Programs
CORRECT ANSWER: B»Explanation: The primary mission of the National Registry of Certified Medical Examiners is to improve highway safety by producing trained, certified medical examiners who can effectively determine if a commercial motor vehicle driver’s health meets Federal Motor Carrier Safety Administration standards.
Which of the following serves as the lead federal agency for the regulation of commercial motor vehicle driver’s health and safety and conducts relevant research?
A. The American Medical Association
B. The Office of Medical Programs
C. The Federal Motor Carrier Safety Administration
D. The National Registry of Certified Medical Examiners
CORRECT ANSWER: B»Explanation: To promote safety, the Office of Medical Programs serves as the lead federal agency for the regulation of commercial motor vehicle driver’s health and safety and conducts relevant medical research.
The FMCSA identifies a person who can be a medical examiner by the following 2 criteria:
A. Professional licensure and scope of practice that include performing physical examinations
B. Current DEA registration and board certification in internal medicine
C. Medical Doctorate and current state licensure
D. Graduate of accredited school of medicine and board certification in a medical specialty
CORRECT ANSWER: A»Explanation: The Federal Motor Carrier Safety Regulations identify a person who can be a medical examiner by 2 criteria: professional licensure and scope of practice that includes performing physical examinations.
Medical certification in accordance with Federal Motor Carrier Safety Administration physical qualification standards is required when a driver is operating a commercial vehicle (in interstate commerce) for all of the following EXCEPT:
A. Has >4 wheels and a sleeping compartment
B. Transports hazardous materials in quantities that require placarding under the hazardous materials regulations
C. Is designed or used to transport 9 to 15 passengers (including the driver) for compensation
D. Has a combined gross vehicle weight or weight rating of ≥ 10,000 pounds
CORRECT ANSWER: A»Explanation: Medical certification in accordance with FMCSA physical qualification standards is required when the driver is operating a commercial motor vehicle in interstate commerce that: has a combined gross vehicle weight or weight rating of ≥10,000 lbs; is designed or used to transport 9 to 15 passengers (including the driver) for compensation; is designed or used to transport ≥16 passengers (including the driver) whether for compensation or not; or transports hazardous materials in quantities that require placarding under the hazardous materials regulations.
Which of the following statements is NOT true?
A. The medical examiner is responsible for certifying only drivers who meet the physical qualification standards.
B. The medical examiner’s certificate expires at midnight on the day, month, and year written on the certificate.
C. Certification of a Federal Motor Carrier Safety Administration qualified driver can be extended beyond 2 years only at the discretion of a certified medical examiner.
D. 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 examiner’s certificate has not expired.
CORRECT ANSWER: C»Explanation: The medical examiner is responsible for certifying only drivers who meet the physical qualification standards. Certification cannot exceed 2 years, and at the discretion of the FMCSA medical examiner, may be <2 years.
Interstate commerce means trade, traffic, or transportation in the United States for all of the following EXCEPT:
A. Between any 2 commercial properties separated by >100 nautical miles
B. Between a place in a state and a place outside of such state (including a place outside of the United States)
C. Between 2 places in a state through another state or a place outside of the United States
D. Between 2 places in a state as part of trade, traffic, or transportation originating or terminating outside the state or the United States
CORRECT ANSWER: A»Explanation: Interstate commerce means trade, traffic, or transportation in the United States between a place in a state and a place outside of such state (including a place outside of the United States), between 2 places in a state through another state or a place outside of the United States or between 2 places in a state as part of trade, traffic, or transportation originating or terminating outside the state or the United States.
Select the statement that is NOT true.
A. The Department of Transportation publishes rules on who must conduct drug and alcohol tests.
B. Safety-sensitive transportation employees in aviation, trucking, railroads, mass transit, pipelines, and other transportation industries are included in the Omnibus Transportation Employee Testing Act (1991).
C. Interaction between the medical examiner and the health-care professionals who perform services in the drug and alcohol testing program is prohibited by HIPAA regulations.
D. The Omnibus Transportation Employee Testing Act (1991) requires drug and alcohol testing of safety-sensitive transportation employees.
CORRECT ANSWER: C»Explanation: The Department of Transportation publishes rules on who must conduct drug and alcohol tests, how to conduct those tests, and what procedures to use when testing. There are times when a medical examiner may have interactions with health-care professionals who perform services in the drug and alcohol testing program.
Choose the correct statement.
A. The Drug Enforcement Administration formulates rules regarding procedure to be followed for drug and alcohol testing.
B. The Department of Transportation publishes rules on how to conduct drug and alcohol tests.
C. A medical review officer (MRO) is a licensed MD, DO, DC, PA, or APN who is responsible for receiving and reviewing laboratory results generated by an employer drug testing program and for evaluating medical explanations for certain drug test results.
D. A substance abuse professional is responsible for evaluating employees who have violated Department of Transportation drug and alcohol regulations, but may not make recommendations concerning treatment and follow up.
CORRECT ANSWER: B»Explanation: The Department of Transportation publishes rules on who must conduct drug and alcohol tests, how to conduct those tests, and what procedures to use when testing.
Choose the correct statement.
A. A release form signed by the driver is not recommended if the employer wishes to obtain a copy of the medical examination report form.
B. Employer compliance with applicable state laws regarding the privacy and maintenance of employee medical information is not required.
C. Regulatory requirements take precedence over the Health Insurance Portability and Accountability Act.
D. The Federal Motor Carrier Safety Regulations require the medical examiner to give a copy of the medical examination report form to the employer.
CORRECT ANSWER: C»Explanation: Regulatory requirements take precedence over the Health Insurance Portability and Accountability Act of 1996. There are potential subtle interpretations that can cause significant problems for the medical examiner. What information must or can be turned over to the carrier is a legal issue, and if in doubt, the examiner should obtain a legal opinion.
All of the following are true EXCEPT:
A. The motor carrier is required to keep a copy of the medical examiner’s certificate in the driver qualification file.
B. The medical examiner should keep a copy of the medical examiner’s certificate on file.
C. A release form is required to release the medical examiner’s certificate to the motor carrier that employs the driver.
D. A copy of the completed medical examiner’s certificate is provided to the driver and to the motor carrier (employer).
CORRECT ANSWER: C»Explanation: If the medical examiner finds that the driver is physically qualified to drive a commercial motor vehicle in accordance with 391.41 (b), the medical examiner shall complete a medical examiner’s certificate and furnish 1 copy to the driver and 1 copy to the motor carrier that employs the driver. A release form is not required.
Choose the incorrect statement.
A. The Code of Federal Regulations (CFR) is a compilation of the discretionary rules for medical examiners.
B. Regulations are laws and must be followed.
C. Standards or Federal Motor Carrier Safety Regulations (FMCSRs) are legal requirements for interstate commercial vehicles, drivers, and motor carriers.
D. The medical examiner may or may not choose to use the FMCSA-recommended medical guidelines.
CORRECT ANSWER: A»Explanation: The Code of Federal Regulations (CFR) is the codification of the general and permanent rules published in the Federal Register by the executive departments and agencies of the federal government.
Which of the following covers regulations for physical qualifications for drivers? A. FMCSA Medical Guidelines B. 49 CFR 391.43 C. 49 CFR 391.41 D. 49 CFR 391.45
CORRECT ANSWER: C»Explanation: 49 CFR 391.41 describes the physical qualification requirements for drivers.
The Skill Performance Evaluation (SPE) Certification Program:
A. Requires that the driver be otherwise qualified to drive a commercial motor vehicle and meet the provisions of the alternate (SPE) standard
B. Is available to drivers with a progressive musculoskeletal deficit of an extremity
C. Can be completed at a follow-up visit with the medical examiner
D. Requires renewal every 5 years
CORRECT ANSWER: A»Explanation: The Skill Performance Evaluation Certification Program is an alternative physical qualification standard for the driver with a fixed musculoskeletal deficit of an extremity who cannot physically qualify to drive under 49 CFR 391.41(b)(1)or (b)(2). The driver must be otherwise qualified to drive a commercial motor vehicle and meet the provisions of the alternate standard.
Currently, the FMCSA has the following 2 Medical Exemption Programs:
A. Federal Vision Exemption Program and Diabetes Exemption Program
B. Federal Vision Exemption Program and Auditory Assistance Exemption Program
C. Auditory Assistance Exemption Program and Automatic Internal Cardiac Defibrillator Exemption Program
D. Respiratory Disorders Requiring Oxygen Exemption Program and Auditory Assistance Exemption Program
CORRECT ANSWER: A»Explanation: Currently, the Federal Motor Carrier and Safety Administration has 2 medical driver exemption programs. These include the Federal Vision Exemption Program (1998) and the Diabetes Exemption Program (September 2003).
Which statement is incorrect?
A. Only the Diabetes Exemption Program requires the driver to have an annual medical examination for maintenance and renewal of the exemption.
B. The medical examiner cannot issue an exemption.
C. The role of the medical examiner is to determine if the driver is “otherwise qualified.”
D. There are currently no Federal Motor Carrier and Safety Administration medical waiver programs.
CORRECT ANSWER: A»Explanation: Both federal exemptions (vision and diabetes) require the driver to have an annual medical examination for maintenance and renewal of the exemption.
In addition to medical fitness for duty certification, other regulations affecting the commercial motor vehicle driver include all of the following EXCEPT: A. Use of safety restraints B. Drug and alcohol testing C. Record keeping D. Hours of service
CORRECT ANSWER: A»Explanation: In addition to medical fitness for duty certification other regulations affecting the commercial motor vehicle driver include drug and alcohol testing, record keeping, hours of service, and more.
Motor carriers are responsible for ensuring that a driver is able to speak and read English well enough for all of the following EXCEPT:
A. Making legible entries on reports
B. Successfully completing a high school equivalency exam
C. Conversing with the general public
D. Responding to official questions
CORRECT ANSWER: B»Explanation: Successful completion of a high school equivalency exam is not a requirement for a commercial motor vehicle driver.
Motor carriers are responsible for ensuring that the driver is compliant with all the following EXCEPT:
A. Be capable of safely operating a commercial motor vehicle
B. Have provided the motor carrier with required background and violations information
C. Be at least 25 years of age
D. Have a current medical examiner’s certificate on file
CORRECT ANSWER: C»Explanation: The age requirement for a commercial motor vehicle driver is 21 years of age.
State regulations:
A. May not have additional, different, or more stringent requirements to federal regulations
B. Are not the responsibility of the medical examiners performing the physical exam
C. Do not regulate commercial drivers NOT subject to federal regulations
D. Regulate intrastate commerce
CORRECT ANSWER: D»Explanation: States regulate intrastate commerce and commercial drivers who are not subject to federal regulations. They are required, at a minimum, to adopt federal physical qualification requirements and may even have additional, different, or more stringent requirements.
All of the following statements regarding a medical examiner are true EXCEPT:
A. Is responsible for ensuring that only the driver who meets the federal physical qualification requirements is issued a medical examiner’s certificate
B. May certify a driver for <2 years when the medical examination indicates
C. Certifies that the driver is fit for duty and can perform the driver role described in the medical examination form
D. May certify a driver for a minimum of 2 years
> > CORRECT ANSWER: D»Explanation: The medical examiner is responsible for ensuring that only the driver who meets the federal physical qualification requirements is issued a medical examiner certificate (certifying the driver is medically fit for duty and can perform the driver role described in the medical examination form). Maximum duration is 2 years; a driver may be certified for <2 years when the medical examination indicates.
The profile of the average truck or bus driver includes all the following EXCEPT: A. Sedentary, overweight B. Poor eating habits C. Age < 25 years D. Male, smoker
CORRECT ANSWER: C»Explanation: The profile of the average truck or bus driver includes the following: male; >40 years of age; sedentary; overweight; smoker; and poor eating habits.
The medical profile of the average truck or bus driver includes:
A. Equally as healthy as the average person
B. Less risk for gradual or sudden incapacitation
C. Prevalence of cardiovascular disease
D. Rarely >1 medical condition
CORRECT ANSWER: C»Explanation: The medical profile of the average truck or bus driver includes being less healthy than the average person, having >2 medical conditions, and a prevalence for cardiovascular disease.
All of the following factors contribute to making commercial driving a stressful occupation EXCEPT:
A. Short-relay routes
B. All of these factors contribute to making commercial driving a stressful occupation
C. Cross-country routes
D. Abrupt schedule changes
CORRECT ANSWER: B»Explanation: Factors that contribute to making commercial driving a stressful occupation include types of routes (turn-around or short-relay, long-relay, straight-through haul and cross-country routes), schedules, environment, and types of cargo
Safe driving includes all the following EXCEPT:
A. Appropriate behavior in both normal and emergency situations
B. 3 rest stops in a 12-hour period
C. Sustained mental alertness and physical endurance
D. Cognitive skills including problem-solving, communication, and judgment
CORRECT ANSWER: B»Explanation: Safe driving demands sustained mental alertness and physical endurance not compromised by fatigue or sudden incapacitating symptoms, problem-solving, communication, and judgment skills, appropriate behavior in normal and emergency situations, and the ability to judge the maximum speed at which vehicle control can be maintained under changing traffic, road, and weather conditions.
Manipulation of dashboard switches and controls requires:
A. Adequate reach, prehension, and touch sensation in hands and fingers
B. Familiarity with English and metric measurements
C. Appropriate, complete visual color perception
D. ≤3 gauges in operation at any given time
CORRECT ANSWER: A»Explanation: Manipulation of dashboard switches and controls requires adequate reach, prehension, and touch sensation in hands and fingers.
The job of commercial driving requires:
A. Smaller than ordinary steering wheel for ease of maneuvering
B. Entering and exiting the vehicle in a manner similar to that of private vehicles
C. The driver to repeatedly perform reciprocal movements of both legs coordinated with right arm and hand movements
D. Use of side mirrors to inspect cargo
CORRECT ANSWER: C»Explanation: Shifting gears requires the driver to repeatedly perform reciprocal movements of both legs coordinated with right arm and hand movements. Side mirrors are used to monitor traffic and in backing up to loading areas. Steering wheels of large trucks/buses are oversized, and entering/exiting a commercial motor vehicle is similar to climbing a ladder.
Physical demands involved in coupling and uncoupling trailers include all the following EXCEPT: A. Balance B. Flexibility C. Grip strength ≤35 pounds D. Upper body strength
CORRECT ANSWER: C»Explanation: Physical demands for coupling and uncoupling trailers include grip strength, upper body strength, range of motion, balance, and flexibility.
Loading, securing, and unloading cargo:
A. Is not a component of commercial driving
B. Is listed by the Centers for Disease Control and Prevention as an example of a vigorous activity
C. Federal Motor Carrier Safety Administration guidelines specify that a driver must be able to lift 75 pounds from the ground to waist level
D. Requires ≤4.8 metabolic equivalents (METs) to perform
CORRECT ANSWER: B»Explanation: FMCSA guidelines do not specify the number of pounds a driver must be able to lift. However, the Centers for Disease Control and Prevention’s table of General Physical Activities Defined by Level of Intensity lists ““loading and unloading a truck”” as an example of a vigorous activity that requires the individual to exert >6.0 metabolic equivalents in performance of the activity.
Results of the Federal Motor Carrier Safety Administration (FMCSA) Office of Analysis, Research, and Technology studies are used to:
A. Justify the need for highway safety patrol officers
B. Develop effective countermeasures that will reduce the occurrence and severity of crashes involving commercial vehicles
C. Provide the transportation industry and public with reports on trends in fuel consumption by commercial vehicles
D. Examine the public utilization of commercial transportation versus private transportation
CORRECT ANSWER: B»Explanation: The FMCSA Office of Analysis, Research, and Technology (ART) provides the transportation industry with reports of trends, costs, fatalities, and injuries in large truck and bus crashes, which helps to identify factors contributing to crashes. This facilitates development of effective countermeasures designed to reduce the occurrence and severity of crashes.
The purpose of an interstate commercial driver physical exam is to:
A. Identify, diagnose, and treat conditions that may result in a sudden incapacitating event
B. To establish an information base of driver demographics in the continental United States
C. (In part) Fund medical assistance programs for drivers disabled in crashes while on duty
D. Detect the presence of any physical, mental, or organic conditions of such character and extent as to affect a driver’s ability to operate a commercial motor vehicle safely
CORRECT ANSWER: D»Explanation: The purpose of interstate commercial driver physical examinations is to detect the presence of any physical, mental, or organic conditions of such character and extent as to affect the ability of the driver to operate a commercial motor vehicle safely.
As a medical examiner, a ““Yes”” answer to which question should be followed by a driver’s disqualification from driving?
A. Does a benign underlying prognosis have symptoms that interfere with the driver’s ability to drive?
B. Can the driver stop the vehicle safely before becoming incapacitated?
C. Can the driver process environmental cues rapidly, make appropriate responses, independently solve problems, and function in a dynamic environment?
D. Are the driver’s interactions appropriate, responsible, and nonviolent?
CORRECT ANSWER: A»Explanation: As you conduct the physical examination, you must consider whether a benign underlying condition with an excellent prognosis has symptoms that interfere with the ability to drive. If the answer is ““yes””, the driver must be disqualified. An example of this would be a benign supraventricular arrhythmia that causes syncope.
A medical examiner’s responsibilities include all of the following EXCEPT:
A. Promotion of public safety by education of drivers regarding medication use
B. Seeking further testing/evaluation for those medical conditions of which the medical examiner is unsure
C. Strict adherence to Federal Motor Carrier Safety Administration-recommended medical guidelines
D. Education and referral of drivers for further evaluation of an undiagnosed or worsening medical problem
CORRECT ANSWER: C»Explanation: The medical examiner must comply with FMCSA regulations, but may deviate from FMCSA-recommended medical guidelines. Reasons for a decision to deviate from guidelines should be appropriately documented.
Choose the incorrect statement. The medical examiner:
A. Is responsible for reviewing the driver information field of the medical examination report form for legibility
B. Is not responsible for ensuring that a driver meets the commercial driver’s license requirements before driving an interstate commercial motor vehicle
C. Is responsible for ensuring that a driver meets the 21 years of age requirement before driving an interstate commercial motor vehicle
D. May administer a driver physical to anyone who requests the exam
CORRECT ANSWER: C»Explanation: Theemployeris responsible for verifying age requirements for interstate drivers, as in some states a driver may qualify intrastate at the age of 18.
For any ""Yes"" response on his health history, a driver must include all of the following EXCEPT: A. Treating provider's name and address B. Family history C. Onset date D. Diagnosis
CORRECT ANSWER: B»Explanation: For each ““Yes”” answer, the examiner must: ask about history, diagnosis, treatment/response to treatment; explore underlying cause, precipitating events, and other pertinent facts; obtain additional tests/consults as necessary to assess fitness; review response to treatment and medications, including side effects and interactions, and document all.
By signing the medical examination report form, a driver affirms all of the following EXCEPT:
A. Acknowledges that providing inaccurate or false information or omitting information could result in the levy of a civil penalty against the driver under 49 U.S.C. 521 (b) (2) (B)
B. Forfeiture of right to sue examiner if job is denied him based on exam findings
C. Certification that information is complete and true
D. Acknowledges that providing inaccurate or false information or omitting information could invalidate the examination and any certificate issued based on it
CORRECT ANSWER: B»Explanation: By signing the medical examination report form, the driver certifies that information the is complete and true and acknowledges that providing inaccurate or false information or omitting information could invalidate the examination and any certificate issued based on it and/or result in the levy of a civil penalty against the driver under 49 U.S.C 521b(2)(B).
Federal Motor Carrier Safety Administration regulations dictate that a medical examiner must:
A. Review and discuss with the driver any “Yes” response in the health history section of the medical examination report form
B. Obtain a written statement from the driver’s treating provider for any condition listed
C. Issue a temporary disqualification if ≥2 conditions treated by medication are listed
D. Require the driver’s pharmacist to provide a list of current medications
CORRECT ANSWER: A»Explanation: Federal regulations require the medical examiner to review and discuss with the driver any ““Yes”” answers.
Which statement is incorrect?
A. A medical examiner should obtain documentation of heart surgery information and related testing as needed to adequately assess a driver’s medical fitness for duty.
B. If a driver reports current cardiovascular disease, consultation with and documentation from the driver’s health-care provider should be obtained prior to certification.
C. An automated implanted cardiac defibrillator (ICD) is disqualifying; however, dual pacemaker/ICD units may be qualified with supporting cardiologist’s clearance.
D. A driver reporting symptoms consistent with undiagnosed cardiovascular disease should be referred to a specialist for further evaluation prior to certification.
CORRECT ANSWER: C»Explanation: Federal Motor Carrier Safety Administration medical guidelines recommend not to certify the driver who has an ICD. This includes a dual pacemaker/ICD, even if the ICD has not been activated.
High blood pressure:
A. Is likely to cause a sudden incapacitating event
B. Accompanied by suspected target organ damage requires recommendation of specific therapy by the medical examiner
C. Is unlikely to target the cerebral vasculature
D. Treatment may produce side effects that impair job performance
CORRECT ANSWER: D»Explanation: Treatment of high blood pressure may produce side effects that impair job performance. Hypertension alone is unlikely to cause sudden collapse, but target organ damage increases the likelihood.
Which driver response to ““shortness of breath”” questioning should trigger a more detailed evaluation of the driver, possibly including a consult with an appropriate medical specialist?
A. I become short of breath while walking fast and carrying 50 pounds up a steep incline
B. My shortness of breath resolves after brief (<20 minutes) rest
C. I become short of breath while driving
D. Loading and unloading my cargo results in shortness of breath
CORRECT ANSWER: C»Explanation: According to guidelines, many drivers may experience shortness of breath (SOB) while performing the nondriving aspects of their work. However, most commercial drivers are not SOB while driving their vehicles. SOB while driving should trigger a more detailed evaluation of the driver.
A driver states he was hospitalized 6 months ago for 3 days following an exacerbation of his chronic lung disease. His medications were adjusted and continuous oxygen at 2 liters per minute was added to his treatment regimen. The driver has purchased an oxygen concentrator (portable) and brings a statement from his pulmonologist stating he may return to commercial driving. The examiner should
A. Speak directly to the pulmonologist, then issue certification at 6-month intervals based upon pulmonologist’s report from each 6-month follow-up visits
B. Attach copies of the pulmonologist’s documentation to the medical examination report form and issue a 1-year certification
C. Disqualify driver since the use of oxygen while driving is prohibited
D. Issue a 1-month certification and request documentation of pulmonary function tests with and without bronchodilators; if acceptable, a 1-year certification may be issued
CORRECT ANSWER: C»Explanation: Since a driver must be alert at all times, any change in mental state is in direct conflict with highway safety. Even the slightest impairment in respiratory function under emergency conditions (when greater oxygen supply is necessary for performance) may be detrimental to safe driving, and the driver should be disqualified.
A driver presents for recertification. Included in the driver’s health history is the fact that he/she is receiving dialysis 3 times a week. The driver is compliant with same and with monthly nephrologist follow-ups. The driver is accompanied by documentation from his/her nephrologist that he/she may return to commercial driving without restriction. The examiner should:
A. Issue 6-month certification intervals dependent upon acceptable (laboratory) renal function parameters
B. Attach a copy of the nephrologist’s documentation to medical examination report form and issue a 1-year certification
C. Disqualify the driver; if a driver is on dialysis, the driver cannot drive
D. Issue certification at 3-month intervals, to be based on written documentation from the nephrologist at each interval
CORRECT ANSWER: C»Explanation: If a driver is on dialysis, he/she cannot drive.
A driver presents for new certification. Included on the driver’s health history is the fact that he had 2 unprovoked seizures 7 years ago. He has been off medication and seizure-free for 3 years. The driver’s neurologist has provided him with a statement allowing him to return to commercial driving. The medical examiner should:
A. Temporarily disqualify the driver until laboratory results affirm that the driver is not on an anticonvulsant; if negative, certify for 1 year
B. Disqualify; a driver with epilepsy cannot be certified until/unless the driver has been off medications and seizure-free for at least 10 years
C. Complete the medical exam and provide forms to apply for Seizure Disorder Exemption
D. Attach the neurologist’s documentation to the medical examination report form and issue a 1-year certification
CORRECT ANSWER: B»Explanation: According to regulations, a driver with an established medical history or clinical diagnosis of epilepsy (2 or more unprovoked seizures) does not meet qualification standards and cannot be certified. Current advisory criteria allow that some ““drivers with a history of epilepsy/seizures off antiseizure medication and seizure-free for 10 years may be qualified to drive a commercial motor vehicle in interstate commerce.”
An Insulin Treated Diabetic driver may be certified for one year if ONLY an endocrinologist completes form MCSA-5870.
A. True
B. False
CORRECT ANSWER: B»Explanation: The treating clinician, which may include but is not limited to an endocrinologist, may fill out form MCSA-5870 and forward to the FMCSA medical examiner to be determined for certification.
Report of a missing or impaired hand, arm, foot, leg, finger, or toe:
A. May require a Skill Performance Evaluation (SPE) prior to certification
B. Is automatically disqualifying
C. Will not affect normal driving tasks
D. Does not require further history-taking or exam findings prior to certification
CORRECT ANSWER: A» Explanation: A missing or impaired hand, arm, foot, leg, finger, toe (fixed deficit) may require a Skilled Performance Evaluation (SPE) to determine whether the driver still maintains the ability to safely perform normal commercial driving tasks.
All of the following questions would appropriately be asked of a driver who reports chronic back pain EXCEPT:
A. Has the driver attempted relief from Dr. Jones, DC (ie, local chiropractor)?
B. How does the pain affect the driver’s ability to perform driving and non-driving tasks?
C. What does the driver do to alleviate the pain?
D. Does treatment for the pain interfere with safe driving?
CORRECT ANSWER: A»Explanation: Recommendation of treatments or treating providers is not included in the role of a medical examiner.
A driver has reported regular, frequent, alcohol use on the driver’s heath history. The examiner should NOT:
A. Administer the CAGE questionnaire to screen for potential dependency
B. Refer the driver who shows signs of a current alcoholic illness to a specialist
C. Disqualify since drinking and driving don’t mix
D. Inquire about quantity and frequency of alcoholic beverages
CORRECT ANSWER: C»Explanation: If a driver reports regular, frequent alcohol use, the medical examiner should ask about quantity and frequency, or use such tools as the CAGE questionnaire to screen for possible alcohol use problems. The medical examiner should refer the driver who shows signs of a current alcoholic illness to a specialist.
A driver states that she has occasional back pain for which she uses oxycodone prescribed to her by her primary care physician, whom the driver sees on an annual basis. The medical examiner should:
A. Disqualify the driver if the medical examiner believes the medication adversely impacts the driver’s ability to safely operate a commercial motor vehicle.
B. Issue certification based upon physical exam findings alone, since the medication is legally prescribed.
C. Stop the encounter, request a urine specimen for drug test, and resume examination at a later date if the results are negative.
D. Contact the company designated employee representative to obtain authorization for drug and alcohol testing.
CORRECT ANSWER: A»Explanation: The medical examiner has the authority to disqualify a driver if he believes that the medication the driver is taking adversely impacts the ability to safely operate a commercial motor vehicle.
The vision standard includes all of the following EXCEPT:
A. Depth perception of 40 arc seconds on standard DOT butterfly
B. Distant visual acuity of at least 20/40 (Snellen) in each eye and both eyes with or without corrective lenses
C. Field of vision of at least 70 degrees in the horizontal meridian in each eye
D. Ability to distinguish among the colors of traffic signals and devices showing the standard red, amber, and green
CORRECT ANSWER: A»Explanation: Vision regulation- Driver must have distant visual acuity of at least 20/40 (Snellen) in each eye, with or without corrective lenses, distant binocular visual acuity of at least 20/40 (Snellen) in both eyes, with or without corrective lenses, field of vision of at least 70 degrees in the horizontal meridian in each eye, and the ability to recognize and distinguish among the colors of traffic signals and devices showing the standard red, amber, and green.
Select the true statement:
A. Vision examination by a specialist (ophthalmologist or optometrist) is required for a driver whose peripheral vision is 85 degrees bilaterally
B. A driver may not test without glasses if the glasses are required for reading
C. Trained assistive personnel may perform vision screening tests and record results; however, the medical examiner must sign the medical examination report form, taking responsibility for and attesting to the validity of all documented test results
D. Drivers must remove contact lenses for vision testing during recertification exams only
CORRECT ANSWER: C»Explanation: Trained assistive personnel may perform vision screening tests and record results. However, the medical examiner must sign the Medical Examination Report form taking responsibility for and attesting to the validity of all documented test results.
Which of the following are not disqualifying?
A. Visual acuity of 20/40 in the left eye, 20/25 in the right eye, and 20/30 in both eyes with glasses
B. Use of 1 contact lens to correct distant vision - right eye and use of contact lens correcting near vision - left eye
C. Monocular vision
D. Use of telescopic lenses
CORRECT ANSWER: A»Explanation: Vision disqualifiers include: monocular vision; use of contact lenses when one lens corrects distant visual acuity and the other lens corrects near visual acuity; use of telescopic lenses; failure to meet any part of the vision testing criteria with one eye or both eyes.
Which of the following statements is not true?
A. Vision testing and certification may be completed by an optician
B. 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
C. If the vision test is performed by a specialist, that provider must complete name, date, telephone number, license number, and state of issue, and must sign the examination form in the appropriate areas
D. A specialist’s vision examination may be necessary to obtain adequate evaluation of vision with specialized diagnostic equipment
CORRECT ANSWER: A»Explanation: Vision testing and certification may be completed by an ophthamologist or optometrist. That provider must fill in the date, name, telephone number, license number with state of issue, and sign the examination form. Vision is the only portion of the driver physical examination that can be performed and certified by a provider other than a medical examiner.
A driver presents for new certification. The driver is able to hear a forced whisper at 6.0 feet in the left ear and at 4.5 feet in the right ear. The examiner should:
A. Determine that the driver has satisfactorily met the federal regulation for hearing
B. Proceed to an audiometric test to determine certification
C. Disqualify the driver until a hearing aid for the left ear can be obtained
D. Provide the driver with forms for hearing exemption
CORRECT ANSWER: A»Explanation: Hearing regulation-A driver must first perceive a forced, whispered voice IN ONE EAR at not less than five feet, OR not have an average hearing loss IN ONE EAR greater than 40 decibels at 500 hertz (Hz), 1,000 Hz and 2,000 Hz.
The results of an audiometric exam are as follows - right ear: 500 Hz=42, 1000 Hz=38, 2000 Hz=36, 4000 Hz=60; left ear: 500 Hz=40, 1000 Hz=50, 2000 Hz=48, 4000 Hz=20. The average decibel loss in the left ear for purposes of the Department of Transportation medical examination is: A. 46 B. 36.6 C. 39.5 D. 39.3
CORRECT ANSWER: A»Explanation: LEFT EAR: 500 Hz=40; 1,000 Hz=50; 2,000 Hz=48–40+50+48=138/3=46
Which statement is incorrect regarding a hearing aid?
A. Required use of a hearing aid must be documented on the medical examination report form
B. A driver may not use a hearing aid to meet the standard
C. A driver requiring a hearing aid usually must go to an audiologist or hearing aid center for (hearing) testing
D. A driver who must use a hearing aid to qualify is required to use a hearing aid while driving a commercial motor vehicle
CORRECT ANSWER: B»Explanation: A driver may use a hearing aid to meet the standard.
A driver states that he ““never (has) high blood pressure in (his) doctor’s office,”” and brings documentation from his medical provider of blood pressure readings at 3 different visits of 126/84, 128/78, and 130/80. The examiner should:
A. Explain that only blood pressure readings taken during the driver physical or follow-up examinations may be used for certification decisions, and obtain his own reading(s)
B. Accept the most recently-obtained blood pressure reading as valid, but issue only a 6-month certification
C. Average the 3 readings and document the result on the medical examination report form
D. Disqualify the driver since none of the readings are acceptable
CORRECT ANSWER: A»Explanation: Only blood pressure readings taken during the driver physical or follow-up examinations may be used for certification decisions.
Which statement is not true? A 1-time, 3-month certificate:
A. Is only issued once during a commercial driver’s driving career
B. Is granted to a driver whose blood pressure was previously normal, but is now at Stage 2
C. Is granted to a re-certifying driver who had previously received a 1-year certification for stage 1 hypertension who has not achieved a blood pressure ≤140/90
D. May be issued by an examiner using the examiner’s clinical expertise and the results of the individual driver’s examination
CORRECT ANSWER: A»Explanation: The issuance of a 1-time, 3-month certificate is a one-time issuance for the recertification period and is not intended to mean once in the driver’s lifetime.
When a blood pressure reading is a value where the individual systolic and diastolic readings are in different stages:
A. The examiner should classify the reading by the higher stage
B. A second blood pressure reading should be obtained and the average recorded
C. Stage classification should be based on the lowest systolic and lowest diastolic reading obtained in a series of 3 automatic device readings
D. The examiner should classify the reading by the lower stage
CORRECT ANSWER: A»Explanation: When a blood pressure reading is a value where the individual systolic and diastolic readings are in different stages, the medical examiner should classify the reading by the higher stage.
Which of the following is not a required parameter for a Department of Transportation dip urinalysis. A. Protein B. Specific gravity C. pH D. Blood
CORRECT ANSWER: C»Explanation: The medical examiner must perform a urinalysis (dipstick test) and test for specific gravity, protein (proteinuria), blood (hematuria), and glucose (glycosuria).
Which of the following is a true statement?
A. Trained assistive personnel who obtain urine specimens and record test results must sign the medical examination report form.
B. Urine testing for controlled substances is included in the physical qualifications for the driver examination process.
C. Checking for hematuria is not a required parameter for the driver examination process.
D. The medical examiner must perform a dipstick urinalysis during a Department of Transportation medical examination.
CORRECT ANSWER: D»Explanation: The medical examiner must perform a urinalysis (dipstick test) and test for specific gravity, protein (proteinuria), blood (hematuria), and glucose (glycosuria).
Regarding documentation of the physical exam, which statement is incorrect?
A. A body mass index (BMI) >32 requires testing for sleep apnea
B. Height must be recorded in inches and weight in pounds
C. “No” is checked if the body system is normal
D. “Yes” responses require documentation in detail, including the finding’s impact on driving
CORRECT ANSWER: A»Explanation: The medical examiner must measure and record driver height (inches) and weight (pounds). The physical qualification standards do not include any maximum or minimum height and weight requirements. Height and weight factors should be considered as part of the overall driver medical fitness for duty.
Which is the correct statement?
A. Documentation of abnormal findings that are not disqualifying is not required
B. Defer documentation of abnormal findings until additional evaluation results are available
C. Discussion with a driver, including advice to seek additional evaluation of a condition that is not disqualifying, is private and should not be included on the medical examination report form
D. A copy of any supplementary medical evaluation obtained to adequately assess a driver’s health should be included with the medical examination report form
CORRECT ANSWER: D»Explanation: Medical examiner comments should include a copy of any supplementary medical evaluation(s) obtained to adequately assess driver health.
At minimum, when examining the eyes, you must check for:
A. Aphakia, nystagmus, and glaucoma
B. Pupillary equality, reaction to light and accommodation, ocular motility, ocular muscle imbalance, extraocular movement, nystagmus, and exophthalmos
C. Retinopathy, extraocular movements, and pupillary response to light
D. Cataracts, macular degeneration, and exophthalmos
CORRECT ANSWER: B»Explanation: The eye exam must, at a minimum, include checking for pupillary equality, reaction to light and accommodation, ocular motility, ocular muscle imbalance, extraocular movement, nystagmus, and exophthalmos.
When examining the heart, evaluation for all of the following must be included EXCEPT:
A. Pitting edema of the lower extremities
B. 12-lead electrocardiogram
C. Murmurs, extra sounds, enlargement
D. Presence of pacemaker and/or automatic defibrillator
CORRECT ANSWER: B»Explanation: The medical examiner must examine the heart for murmurs, extra sounds, enlargement, and a pacemaker or implantable cardioverter defibrillator and check the lower extremities for pitting edema and other signs of cardiac disease.
Further considerations after finding an abnormality indicating that the driver may have a current cardiovascular disease include all of the following EXCEPT:
A. Will the driver be capable of driving if specifically prescribed work restrictions are in place?
B. Is the disease likely to cause symptoms of syncope, dyspnea, collapse, or congestive heart failure?
C. Is the disease progressive?
D. Can the condition be corrected surgically or managed by pharmacologic measures?
CORRECT ANSWER: A»Explanation: There are no work restrictions permitted. The commercial driver must be able to perform all job-related tasks, including lifting, to be certified.
When examining the lungs and chest, determination for the presence of all of the following must be considered EXCEPT:
A. Abnormal chest wall expansion or deformity
B. Presence of abnormal breath sounds
C. Accompanying cyanosis; clubbing of fingers
D. Presence of breast masses and/or nipple discharge
CORRECT ANSWER: D»Explanation: Breast examination is not part of the commercial driver fitness for duty medical examination
The medical examiner, when conducting an exam of the abdomen and viscera, should include all the following EXCEPT:
A. Determining the presence of bruits or masses
B. Determining the presence of enlarged liver and spleen
C. Bedside ultrasonography
D. Determining the presence of significant abdominal wall muscle weakness
CORRECT ANSWER: C»Explanation: Examination of the abdomen and viscera includes checking for enlarged liver and spleen, masses, bruits, hernia, and significant abdominal wall muscle weakness, as well as checking for tenderness and auscultation of bowel sounds.
Which of the following statements is not true?
A. The diagnosis of arterial disease should prompt the examiner to evaluate for the presence of other cardiovascular diseases
B. A driver who has not provided a urine specimen for dipstick urinalysis cannot be certified
C. The driver must be checked for hernias
D. Calf circumference must be documented when evaluating the vasculature of the lower extremities
CORRECT ANSWER: D»Explanation: Documentation of calf circumference is not a required component of completion of the medical examination report form.
Which of the following statements is not true?
A. Presence of sufficient mobility and strength to operate pedals properly must be determined
B. Presence of clubbing or edema must be noted and the presence of an underlying heart, lung, or vascular condition considered
C. Drivers with documented progressive disease of the upper or lower extremities must obtain a Skill Performance Evaluation (SPE) certificate before being certified to drive
D. Presence of sufficient prehension to maintain steering wheel grip must be determined
CORRECT ANSWER: C»Explanation: Skilled Performance Evaluation certificates are issued only for fixed deficits, not progressive disease deficits.
An exam finding that would direct the examiner to further evaluate a driver for decreased sensation, muscle weakness, and/or chronic pain would be:
A. Mid-line longitudinal well-healed surgical scar from L3-5 levels
B. Stretch marks present on anterior thighs
C. Varicosities of bilateral popliteal areas, without inflammation
D. Bounding posterior tibialis pulse on left with dependent rubor
CORRECT ANSWER: A»Explanation: Physical evidence of previous back surgery would require the examiner to further evaluate for changes in sensation, muscle strength, and/or history of chronic pain and treatment thereof.
All of the following should be included in the neurological exam EXCEPT:
A. Evaluation of equilibrium, coordination, and speech pattern
B. Babinski reflex
C. Evaluation for Grey-Turner sign
D. Deep tendon reflexes
CORRECT ANSWER: C»Explanation: The neurological exam requires examination of the driver for impaired equilibrium, coordination, speech pattern, reflexes, and sensory or positional abnormalities.
Discussion with a driver whom the examiner has chosen to certify may include all the following EXCEPT:
A. Expiration information - occurs at midnight on the expiration date listed on the driver’s medical examiner’s certificate
B. Requirements for 2-week grace period following the expiration date on the driver’s medical examiner’s certificate
C. Additional requirements associated with certification
D. Reason for periodic monitoring and shortened examination interval
CORRECT ANSWER: B»Explanation: Discussion with a driver who has been certified may include: reason for periodic monitoring and shortened examination interval; additional requirements associated with certification; and expiration information including its occurrence at midnight on the expiration date and that it has NO grace period.
Discussion with a driver whom the examiner has chosen to disqualify or temporarily disqualify may include all of the following EXCEPT:
A. Requirement of a driver to submit the driver’s license to the Department of Motor Vehicles as it is currently suspended
B. Steps that can be taken to meet certification standards
C. List of documentation driver must provide to examiner
D. Reason for disqualification
CORRECT ANSWER: A»Explanation: Discussion with a driver who has NOT been certified may include reason for disqualification and steps that can be taken to meet certification standards. Temporary disqualification reasons include length of waiting period, conditions that could restart the waiting period, and a list of any documentation the driver is to provide to the medical examiner.
A medical examiner’s recordkeeping requirements include all of the following EXCEPT:
A. Must retain a driver’s medical records for a minimum of 3 years
B. Provide a copy of the medical examination report form to the driver who is applying for or renewing a diabetes or vision exemption certificate
C. Provide a copy of the medical examination report form to the driver who is applying for or renewing a Skill Performance Evaluation certificate
D. Provide a copy of the medical examination report form to the Department of Motor Vehicles
CORRECT ANSWER: D»Explanation: Results of driver physical examination must be documented in accordance with the medical examination report form and the instructions cited in 49 CFR 391.43. Driver medical records must be retained for a minimum of 3 years, and a copy provided to the driver who is applying for, or renewing, a Skill Performance Evaluation certificate, a diabetes exemption certificate or a vision exemption certificate. A copy of the medical examiner’s certificate may be provided to a prospective or current employer upon request.
All of the following statements regarding the medical examiner’s certificate are true EXCEPT:
A. The original medical examiner’s certificate must be provided to the driver who the medical examiner examined and found medically fit for duty.
B. A copy of the medical examiner’s certificate must be retained by the medical examiner for a minimum of 3 years.
C. The driver must carry an original, copied, or reduced-size copy of the medical examiner’s certificate while operating a commercial motor vehicle.
D. A copy of the medical examiner’s certificate may be provided to a prospective or current employer upon request only after the driver signs a release.
CORRECT ANSWER: D»Explanation: Release from a driver is not required when providing a copy of the medical examiner’s certificate to a prospective or current employer.
The medical examination report form must document all of the following information related to certification status EXCEPT:
A. Length of (shortened) interval and reason for required periodic monitoring
B. Special requirements, eg, corrective lenses, hearing aid
C. Expiration date of Skill Performance Evaluation (SPE) certificate when the SPE certificate is required
D. Certification status maximum of 2 years
CORRECT ANSWER: C»Explanation: Indication of the required Skill Performance Evaluation (SPE) certificate is sufficient; date of its expiration is not required. The medical examiner’s evaluation should have included confirmation that SPE certificate is valid.
The treating clinician has a maximum of 45 days to fill out form MCSA-5870 and forward to the Medical Examiner.
A. True
B. False
CORRECT ANSWER: A»Explanation: Per FMSCA regulations
Which of the following statements is not true?
A. Driving within an exempt intracity zone guarantees the driver police protection while driving through areas noted for high crime rates.
B. A medical examiner starts the exemption program application process by first determining if a driver is otherwise qualified except for monocular vision or the use of insulin.
C. Operation of 49 CFR 391.64 applies to a small number of individuals who participated in the FMCSA studies conducted prior to implementation of the medical exemptions program.
D. A medical examiner must disqualify a driver who fails to meet a physical qualification requirement cited in the standards or whom the examiner believes has a medical condition that endangers the health and safety of the driver and the public.
CORRECT ANSWER: A»Explanation: By checking the ““Driving Within an Exempt Intracity Zone”” option, the examiner certifies that the driver is otherwise medically fit for duty except for the exempted condition, that the exempted condition remains stable, and that the driver remains in medical compliance with the requirements of section 391.62.
When a driver is temporarily disqualified due to a condition having a clinical course likely to restore the driver’s medical fitness for duty:
A. A medical examiner’s certificate reflecting the disqualification and follow-up date should be issued.
B. The follow-up date should be greater than or equal to the waiting period when a recommended waiting period is applicable.
C. The reason for temporary disqualification and treatment to be implemented should be documented.
D. The follow-up date documented should reflect the shortest waiting period if the driver has multiple medical conditions and a waiting period is applicable.
CORRECT ANSWER: B»Explanation: When the (temporarily) disqualifying condition or treatment has a clinical course likely to restore a driver’s medical fitness for duty and a recommended waiting period is applicable, the date should be greater than or equal to the waiting period, or if multiple medical conditions exist, greater than or equal to the longest waiting period-no medical examiner’s certificate should be issued.
A driver is taking a medication typically used for hypertension for the driver's anxiety. For what length of time can the driver's certificate be issued? A. 1 year B. No certificate can be issued C. 2 years D. 6 months
CORRECT ANSWER: C»Explanation: If the driver was taking these medications for hypertension, then only a 1-year certificate could be granted even if his blood pressure was ≤140/90. But, because he is taking them for anxiety, a 2-year certificate could be granted.
A driver is taking verapamil for anxiety and states that her condition is well controlled. All of the following are true EXCEPT:
A. The driver may be issued a 1-year certificate
B. The driver must pass all other components of the physical exam in order to be qualified for certification
C. The driver is automatically disqualified
D. The medical examiner must have a letter from the cardiologist stating that the driver is able to drive a commercial vehicle before issuing a certification
CORRECT ANSWER: C»Explanation: The key here is that you must have something signed from the cardiologist or primary care physician releasing the driver to drive a commercial vehicle.
When using Sudafed or other drugs for allergies, a driver may operate a commercial vehicle unless:
A. The medications contain codeine
B. The driver is driving alone without a companion
C. The driver has been taking the medications for < 3 months
D. The medication is in the form of a nasal spray
CORRECT ANSWER: A»Explanation: As long as the medication does not contain codeine, the driver may be qualified to operate a commercial vehicle.
Antibiotics as a class are not a reason to disqualify a driver unless:
A. The antibiotic is being taken for a respiratory infection
B. The driver is on the second round of antibiotic for the same infection
C. The driver experiences dizziness, nausea, or other side effects that may interfere with their driving ability
D. The driver has been on the antibiotic for >6 weeks
CORRECT ANSWER: C»Explanation: Antibiotics as a classification, have no restrictions. However, the patient may have an infection that causes dizziness, nausea and other side effects that may lead you to give a temporary limited license.
All of the following are true about a driver on Coumadin EXCEPT:
A. A driver may be taking Coumadin due to an increased risk of a stroke
B. A thorough history as to any limitations set by the driver’s primary care physician should be used as a guide in making your determination
C. A 2-year certificate can be issued
D. Coumadin can be prescribed for a driver who has an increased risk of blood clot in the legs
CORRECT ANSWER: C»Explanation: A patient on this medication must have at least a 1-month history of well regulated Coumadin. Many times it is prescribed for conditions that could lead to an incapacitating event. You should discuss the reasons for the medication with the primary care physician when making your decision.
In order to evaluate a driver’s risk of having an incapacitating event when taking medications for asthma or chronic obstructive pulmonary disease, a medical examiner must know all of the following EXCEPT:
A. The length of time the driver has been using an inhaler
B. How often the driver must use an inhaler
C. If it is an inhaled or ingested medication
D. If the driver is stable
CORRECT ANSWER: C»Explanation: Evaluation with the driver’s primary care physician is key. If you are not satisfied that the condition is under control (eg, seasonal asthma), then a limitation until the condition is stable may be necessary.
If a driver on medication for asthma/chronic obstructive pulmonary disease has a statement from a pulmonologist indicating that the driver is stable, what length of certification may the driver receive? A. 2 years B. 1 year C. 3 months D. 6 months
CORRECT ANSWER: B»Explanation: When evaluating these drivers, you must be careful to question them to confirm that the medications are being used correctly. If they are not used as prescribed, an incapacitating event could occur while driving.
During the physical exam, the medical examiner notes the driver's blood pressure (BP) to be 135/65. The examiner tests the BP 2 times. The driver is taking a beta-blocker to lower the blood pressure. The pressure has been stable for 2 years. What is the length of certificate the driver is qualified to receive? A. 3 months B. 6 months C. 2 years D. 1 year
CORRECT ANSWER: D»Explanation: If the blood pressure is ≤140/90, even if is stable at this pressure, they can only qualify for a 1-year certificate.
When a driver has been taking Prilosec for ulcers, the limitation on the license is: A. 1 year B. No limitation C. 3 months D. 6 months
CORRECT ANSWER: B»Explanation: Medications taken for ulcers have no limitations.
A driver comes to a medical examiner for recertification. The driver is in his early 40s and is taking an antiseizure medication for his migraines. All the rest of the physical exam is within the normal ranges. The driver qualifies for:
A. No restrictions
B. Is automatically disqualified until the examiner sees a letter from the driver’s primary care physician or neurologist stating that the antiseizure medication is only for migraines; antiseizure medications automatically disqualify
C. 6 months
D. 1 year
CORRECT ANSWER: B»Explanation: Antiseizure medications automatically disqualify until you see a letter from his primary care physician or neurologist stating that the antiseizure medication is only for migraines.
A driver that the medical examiner saw 1 year ago is here for recertification. Over the past year, the driver quit smoking and is taking ChantixTM. The medical examiner should: A. Certify the driver for 6 months B. Certify the driver for 1 year C. Certify the driver for 2 year D. Temporarily disqualify the driver
CORRECT ANSWER: D»Explanation: Understanding the side effects of all drugs is important as we make clinical decisions about certification of a driver. The side effects of some medications such as Chantix could be seizures, dizziness and heart arrhythmias. Until the primary care doctor who prescribed the Chantix provides written documentation that driver is no longer taking it, the driver should be temporarily disqualified.
A driver is coming for a first time certificate. The driver is middle-aged and has a pacemaker. He brings with him a letter from his cardiologist stating that all cardiac functions are within normal limits. For what length of time can the driver be qualified?
A. A 1-year certificate can be issued
B. Only a 3-month certificate can be issued
C. A 2-year certificate can be issued
D. The driver must be disqualified because of cardiac reasons
CORRECT ANSWER: A»Explanation: As long as a driver has a written letter from his cardiologist stating that all cardiac function test are within normal limits and that the pacemaker is functioning properly they may be qualified for a 1-year certificate.
If the above patient with a pacemaker is taking Coumadin, what would the limitations be?
A. The driver must be on Coumadin for a period of at least 1 month and it must be regulated in order to qualify for a certificate
B. No driver taking Coumadin can be qualified to drive
C. A driver on Coumadin must have at least a 6-month history of well-regulated Coumadin levels
D. Coumadin is not on the list of medications that are regulated
CORRECT ANSWER: A»Explanation: As long as a patient is regulated on Coumadin for at least 1 month, and has a letter from his primary care physician, it will not disqualify him from a driving certificate.
All of the following statements about blood pressure medications are true EXCEPT:
A. There are no limitations as long at the blood pressure is stable
B. The medications can be used to lower blood pressure
C. Some of the medications can be used for anxiety disorders
D. When used for hypertension, a 1-year certificate is the most that can be issued
CORRECT ANSWER: A»Explanation: Automatically, if a driver is taking any of these medications for hypertension or maintenance of hypertension, then only a 1-year certificate can be granted.
All of the following statements about Humulin, Lantus, Novolin, and Humalog are true except:
A. These medications are only limiting if the blood sugars are not controlled
B. These are insulin-containing preparations
C. Drivers admitting to taking these drugs are immediately disqualified
D. These medications are often used when other medications used to control blood sugars have failed
CORRECT ANSWER: A»Explanation: Some medications used to control blood sugars contain insulin and others do not. Medications that DO NOT contain insulin DO NOT disqualify a driver. Those that DO contain insulin are an automatic disqualifier.
A driver presenting for recertification tells the medical examiner that he has cancer and has been treated with chemotherapy and radiation. All of the following are true in this case except:
A. The examiner must consider the driver’s ability to function safely when making the examiner’s certification recommendations
B. The use of chemotherapy and radiation do not automatically disqualify a driver
C. A driver with cancer who is currently undergoing cancer treatment of any kind is automatically disqualified
D. Cancer is not a disqualifier
CORRECT ANSWER: C»Explanation: The key here is to qualify the driver based on their ability to function safely. You should look at the side effects of any treatment or drugs the driver is undergoing and possibly issue a shorter certification time.
A driver underwent coronary artery bypass graft surgery 4 months ago. All of the following conditions must be met for the driver to be certified except:
A. The driver must be off all medications
B. The CABG procedure must have been at least 3 months ago
C. The left ventricular ejection fraction must be ≥40%
D. The driver must have approval by the their cardiologist
CORRECT ANSWER: A»Explanation: The 3-month delay in returning to work is to allow the sternal incision to heal. The driver must also be asymptomatic and be tolerating all medications.
A medical examiner is temporarily disqualifying a driver due to multiple medical conditions. Which of the following statements are true about selecting the appropriate waiting period?
A. The examiner should select the most recent condition for which the driver has started treatment and use that as the examiner’s guide when selecting the waiting period.
B. Whenever the examiner is temporarily disqualifying a driver, the examiner must use the 3-month waiting period.
C. The examiner should select the waiting period that is equal to the longest waiting period when there are multiple conditions or medications involved.
D. Before issuing a certification, the examiner must have a letter from the cardiologist stating that the driver is able to drive a commercial vehicle.
CORRECT ANSWER: C»Explanation: Many times we will be evaluating drivers with multiple conditions or medications. For the safety of the driver and the public, we must choose the condition or medication that has the longest waiting period and use that as our guide.
When discussing the health history with the driver, the medical examiner must:
A. Give the examiner’s opinion about the profession of commercial vehicle drivers
B. Be careful to not ask questions about pregnancy if the driver is a woman
C. Document the examiner’s discussion
D. Limit the discussion to how the driver operates the truck or bus that they will be driving
CORRECT ANSWER: C»Explanation: Regulations state you must document your discussion with the driver about their medical fitness for driving, which would cover all of these questions.
Of the 4 things the examiner is testing for on the urinalysis, which of them will have actual numbers that the examiner must write in on the physical exam form? A. Glucose B. Specific gravity C. Protein D. Blood
CORRECT ANSWER: B»Explanation: When comparing the testing strip to the guide found on the container, specific gravity will have numbers to choose from, and you must write down the number that most correctly responds to the color of the test strip.
All of the following are complications associated with varicose veins except: A. Decrease in leg circumference B. Chronic venous insufficiency C. Leg ulcerations D. Recurrent deep vein thrombosis
CORRECT ANSWER: A»Explanation: Varicose veins are an indication that there may be a vascular problem. They tend to get worse over time, and can become swollen or inflamed (thrombophlebitis).
The vision test includes tests for all of the following except: A. Night vision acuity B. Central visual acuity C. Peripheral vision D. Color vision
CORRECT ANSWER: A»Explanation: The Snellen chart measures static central vision acuity. The peripheral vision requirement is 70 degrees in the horizontal meridian for each eye, and the color vision requires recognizing and distinguishing among red, amber and green.
All of the following are true statements about monocular vision except that it:
A. Occurs when the vision requirements are met in only 1 eye
B. Is not automatically disqualifying
C. Causes deficiencies in contrast recognition
D. Causes deficiencies in depth perception compared to binocular vision
CORRECT ANSWER: B»Explanation: Monocular vision is disqualifying. If the driver is otherwise qualified, they may want to apply for a federal vision exemption.
All of the following can alter how a medication may affect a driver except:
A. The size of the tablet or capsule
B. Sleep deprivation or poor quality of sleep
C. Long and irregular work hours
D. Long periods of time without food
CORRECT ANSWER: A»Explanation: Medications have instructions that must be followed. Some are to be taken with food, others without. Most require a constant steady dose to be in the patients system. If the patient misses a dose and then ““doubles”” up, they can have serious side effects. Sticking to a schedule can be difficult and you must question any driver on medications about this.
During the physical exam, a medical examiner finds that a driver has an undiagnosed medical condition that does not disqualify the driver from driving. The examiner should:
A. Refer the driver to a primary care physician for diagnosis and treatment
B. Make a diagnosis for that condition
C. Treat the driver for that condition before the examiner certifies the driver
D. Just ignore it as it is not part of the Department of Transportation physical exam requirements
CORRECT ANSWER: A»Explanation: The purpose of the Department of Transportation physical exam is to examine the drivers medical fitness for duty, not diagnosing and treating personal medical conditions.
Which of the following is not included in the medical profile of an average truck or bus driver? A. Less healthy than the average person B. More than 2 medical conditions C. Cardiovascular disease prevalence D. More active than the average person
CORRECT ANSWER: D»Explanation: The profile of the average driver is similar to the general population; however, the medical profile shows them to be less active, have >2 medical conditions, and be cardiovascular disease prevalent.
When a driver is on any medications, a medical examiner is responsible for educating the driver for all of the following EXCEPT:
A. How to read the medication warning labels
B. Monitoring and not neglecting conditions that could result in serious illnesses or a disqualification in the future
C. Whether the driver should continue to take their medications
D. The side effects of all drugs, including prescriptions and over-the-counter medications
CORRECT ANSWER: C»Explanation: As a medical examiner, you are obligated to determine if the driver can safely operate a commercial vehicle. You are responsible to help promote public safety by educating the driver in these areas.
Complications from hypoglycemia or hyperglycemia can include all the following EXCEPT: A. Drowsiness B. Hyperactivity C. Semi-consciousness D. Diabetic coma or insulin shock
CORRECT ANSWER: B»Explanation: Drivers using medications containing insulin have the risk of using too much or too little medication. This can lead to an incapacitating event such as those listed.
All of the following statements in relation to anti-inflammatory and/or arthritis medications are true EXCEPT:
A. A driver can only be issued a 1-year certificate if he/she is taking anti-inflammatory and/or arthritis medications due to potential side effects
B. These medications have the potential side effect of sleepiness/fatigue
C. There is no limitation on issuing a certification as long as the side effects do not interfere with safe driving
D. These medications are prescribed to alleviate inflammation
CORRECT ANSWER: A»Explanation: Some of these drugs include the corticosteroids, hyaluronic acid products (used in knee injections) and nonsteroidal anti-inflammatory drugs to name a few. As long as the side effects do not interfere with safe driving, there are no limitations.
All of the following conditions may interfere with oxygen exchange and result in some type of incapacitating event EXCEPT: A. Hypertension B. Emphysema C. Chronic asthma D. Carcinoma
CORRECT ANSWER: A»Explanation: If during the history and physical exam you detect a medical condition such as these and feel it may interfere with the driver’s ability to safely drive, you should refer the driver to a specialist for further evaluation.
To confirm that a driver has an elevated blood pressure, the medical examiner should:
A. Test the driver sitting down and then re-test the driver standing up
B. Test the driver at the beginning and then again at the end of the physical exam
C. Test the driver on at least 2 subsequent measurements and on different days
D. Test the driver during the physical exam, 2 times on each arm
CORRECT ANSWER: C»Explanation: To confirm that a driver has an elevated blood pressure you should take the blood pressure more than once during a visit, then ask them to come back for additional testing on a different day. A 1-time reading of an elevated blood pressure does qualify for a diagnosis of hypertenstion.
All of the following statements on performing the hearing test are true EXCEPT:
A. The driver must be able to hear a forced whisper at a distance of ≥7 feet
B. The medical examiner should not use only sibilants (“s” sounds)
C. The ear NOT being tested should be covered
D. If the driver fails the whispered voice test, the driver should be tested using the audiometric test
CORRECT ANSWER: A»Explanation: A driver must be able to hear a forced whisper in the testing ear at not <5 feet in order to qualify for certification. If they do not, you should refer them for testing using the audiometric device.
Medical guidelines are established for use in clinical settings. All of the following about these guidelines are accurate EXCEPT:
A. They are laws and must be followed
B. The guidelines have recommendations for examiners to follow in order to help make “best practice” decisions
C. They use advisory criteria and medical conference reports to help make recommendations
D. Guidelines are not laws that must be followed like the “medical standards” are
CORRECT ANSWER: A»Explanation: It is important to distinguish between ““medical standards,”” which are laws that must be followed and ““Guidelines,”” which are NOT law, but are intended as best practice for the examining doctor.
If a medical examiner disqualifies a driver, the examiner should do all of the following except:
A. Discuss the reason the driver is being disqualified, including what steps the driver can take to meet the federal qualification requirements
B. Recertify only when the examiner determines that the driver can now meet the federal requirement for certification
C. Issue the driver a certificate with multiple limitations
D. Do not issue a medical examiner’s certificate
CORRECT ANSWER: C»Explanation: There are only 2 options: either the driver is issued a medical certificate or the driver is disqualified. If they are disqualified, they are not to be issued a certificate. It is important for them to understand why you made that decision and then make referrals to the appropriate physician for evaluation and treatment.
Of the 13 medical standards for commercial vehicle drivers, how many are nondiscretionary? A. 9 B. 11 C. 4 D. 6
CORRECT ANSWER: C»Explanation: The 4 nondiscretionary medical standards are diabetes mellitus, epilepsy, vision, and hearing.
If a driver wearing a hearing aid fails the forced whisper test, the driver can be certified for:
A. The driver must be sent for an audiometry test to determine certification
B. Cannot be certified
C. 1 year
D. 2 years
CORRECT ANSWER: A»Explanation: A driver is certified until they fail the audiometry test, and then, they would be disqualified.
A driver's hearing was tested using International Organization for Standardization (ISO) with the following results: 31 at 500 Hz, 32 at 1000 Hz, and 27 at 2000 Hz. What would the driver's readings be using the American National Standards Institute (ANSI) standard? A. 22.5, 22.0, 13.0 B. 17.0, 22.0, 18.5 C. 21.0, 18.0, 18.5 D. 17.0, 23.5, 17.0
CORRECT ANSWER: B»Explanation: When switching from ISO to ANSI, at 500 Hz, subtract 14, at 1000 Hz, subtract 10, and at 2000 Hz, subtract 8.5.
Which of the following is not used to treat benign positional vertigo? A. Anticholinergics B. Steroids C. Benzodiazepines D. Sympathomimetics
CORRECT ANSWER: B»Explanation: Steroids are used to treat infections/inflammation.
The most common cause of retinopathy is which of the following? A. Sickle cell disease B. Systemic lupus C. Diabetes mellitus D. Carcinoma
CORRECT ANSWER: C»Explanation: All are causes of retinopathy, but diabetes mellitus is the most common cause.
A driver has a vision exemption due to monocular vision. How often must the driver renew the exemption?
A. It is always good as long as the driver passes the vision requirements with the good eye
B. Every 2 years
C. Every year
D. Every 3 years
CORRECT ANSWER: B»Explanation: The exemption is good for a maximum of 2 years.
Which of the following is a classification for type 2 diabetes?
A. Glucose control counter regulatory mechanisms are often severely compromised
B. May preserve glucose control counter mechanism for many years with lifestyle changes and oral hypoglycemic medications
C. No insulin produced
D. Insulin replacement therapy required
CORRECT ANSWER: B»Explanation: The other options are classifications of type 1 diabetes.
Which of the following is not a condition caused by hypoglycemia as defined by the FMCSA?
A. Loss of consciousness
B. Period of impaired cognitive function that appears without warning
C. Rapid heart rate
D. Seizure
CORRECT ANSWER: C»Explanation: Rapid heart rate is a condition caused by mild hypoglycemia.
A driver comes in for a Department of Transportation physical exam and is taking Byetta to control her diabetes. The driver can be certified for how long?
A. Cannot be certified
B. Certified for a year after the driver shows a diabetes exemption form
C. 1 year
D. 2 years
CORRECT ANSWER: C»Explanation: It is not considered insulin and approved by the FMCSA.
A driver presents for a physical and has a blood pressure reading of 143/88. The driver is classified as: A. Stage 1 hypertension B. Borderline hypertension C. Stage 2 hypertension D. Normal
CORRECT ANSWER: A»Explanation: Always use the guideline for the higher number.
A driver with stage 2 hypertension has a 1-time 3-month certificate that is expiring. Currently the driver’s blood pressure is 140/90. For how long can the driver now be certified?
A. Cannot be certified
B. 1-year certificate from original physical
C. 1 year from date of recheck
D. 2 years
CORRECT ANSWER: A»Explanation: One year based on ≤140/90 blood pressure, from date of original exam when the 1-time 3-month certification was given.
For which of the following is hypertension not a risk factor? A. Diabetes mellitus B. Cardiovascular disease C. Peripheral vascular disease D. Chronic renal insufficiency
CORRECT ANSWER: A»Explanation: The other options are risk factors, while diabetes is not.
A driver is taking heparin for treatment after experiencing a stroke. For how long can the driver be certified? A. 2 years B. 6 months C. Cannot be certified D. 1 year
CORRECT ANSWER: C»Explanation: Cardiac Conference Guidelines. If an anticoagulant is being taken to prevent cerebrovascular accident or post CVA, driver cannot be certified. However if driver is taking this medication to prevent cardiovascular issues, with specialists note of approval and monthly INR results, the driver may be certified.
Which of the following locations are at the greatest risk for post-stroke seizures?
A. Cortical
B. Cerebellum
C. Brainstem
D. All strokes are at great risk of seizures
CORRECT ANSWER: A»Explanation: Cortical deficits are at the highest risk for seizure while cerebellum and brainstem deficits are the least likely to cause seizure.
A driver with dementia can be certified for how long? A. 1 year with an appeal B. Cannot be certified C. 1 year D. 2 years
CORRECT ANSWER: B»Explanation: Due to the variation in progression.
For which of the following may a driver with multiple sclerosis (MS) appeal disqualification?
A. Course of MS is benign with minimum dysfunction at least 3 years post-diagnosis
B. There has been a new lesion on 2 studies within 1 year
C. Neurological signs are functionally insignificant
D. There has been a small amount of progression of disease
CORRECT ANSWER: C»Explanation: If signs are small or are nonexistent, they can apply for appeal.
Which congenital myopathy can be treated? A. Nemaline myopathy B. Centronuclear myopathy C. Myotubular myopathy D. Central core disease
CORRECT ANSWER: B»Explanation: Centronuclear myopathy is the only one that has effective treatment.
Which of the following medications is not immediately disqualifying when it comes to treating headaches? A. Antihistamines B. Propoxyphene C. Benzodiazepine D. Analgesics that combine sedatives
CORRECT ANSWER: A»Explanation: Antihistamines use a case-by-case disqualification and are not automatically disqualified.
When can a driver be certified after having seizures?
A. Seizure free and on anticonvulsants for 5 years
B. Seizure free and off anticonvulsants for 2 years
C. Seizure free and on anticonvulsants for 2 years
D. Seizure free and off anticonvulsants for 5 years
CORRECT ANSWER: D»Explanation: The recommendation is to be seizure free and off anticonvulsants for 5 years to be qualified.
A driver presenting into the office for a physical recently had surgery done that penetrated the dura, so for how long can the driver be certified? A. 6 months B. Cannot be certified C. 1 year D. 2 years
CORRECT ANSWER: B»Explanation: The risk of seizure following surgery that penetrates the dura is the same as that of severe head trauma. Therefore, the driver is disqualified.
How many different exemption programs are there for drivers? A. 1 B. 3 C. 2 D. None
CORRECT ANSWER: C»Explanation: There are 2 exemption programs, the diabetes exemption and the vision exemption.
As a medical examiner, how many of 49 CFR 391.41 qualification standards can a driver not meet before the driver is disqualified? A. Does not meet ≥1 B. Does not meet ≥2 C. Does not meet ≥3 D. Does not meet ≥4
CORRECT ANSWER: A»Explanation: The driver is disqualified if they do not meet one or more.
When a driver is disqualified and does not meet standards, what should the medical examiner do with the medical examiner’s certificate?
A. The examiner never issues a certificate to the driver.
B. The examiner does not issue the certificate
C. The examiner gives the driver the certificate marking that the driver is disqualified
D. The examiner issues a certificate for the employer to keep for their records.
CORRECT ANSWER: B»Explanation: Because the driver is disqualified and therefore does not need a certificate, the examiner would not issue one.
Which of the following would not be passing the vision standard?
A. Distant binocular visual acuity of at least 20/40 in both eyes with or without corrective lenses
B. Field of vision of at least 60 degrees in horizontal meridian in each eye
C. Ability to recognize the colors of the traffic signals
D. Distant visual acuity of at least 20/40 in each eye with or without corrective lenses
CORRECT ANSWER: B»Explanation: Fields of vision must be at least 70 degrees in each eye.
Which of the following agents is used to treat glaucoma?
A. Topical cyclosporine
B. Mast cell stabilizers
C. Vascular endothelial growth factor inhibitors
D. Carbonic anhydrase
CORRECT ANSWER: D»Explanation: The only one to treat glaucoma is carbonic anhydrase. The others are used to treat either dry eyes, allergic conjunctivitis, or macular degeneration.
The Snellen chart should be how many feet away from the driver? A. 20 feet B. 15 feet C. 25 feet D. 30 feet
CORRECT ANSWER: A»Explanation: The Snellen chart should be 20 feet away, as represented by the numerator.
If a driver is tested with an audiometric device, what does the driver need to pass?
A. Have an average hearing loss in 1 ear ≤40 decibels
B. Have an average hearing loss in 1 ear ≥40 decibels
C. Have an average hearing loss in 1 ear ≤30 decibels
D. Have an average hearing loss in 1 ear ≥30 decibels
CORRECT ANSWER: A»Explanation: To pass the test, a driver needs to have an average hearing loss ≤40 decibels. The test is done at 500, 1000, and 2000 Hz.
A driver fails the forced whisper test during his physical. What is the next step that the medical examiner should take?
A. An audiometry test should be the next test performed
B. The driver fails the physical exam and it should be marked on the form
C. The driver should be referred out for hearing aids
D. The driver would pass the physical exam
CORRECT ANSWER: A»Explanation: If the driver fails one of the two tests, the medical examiner would administer the next to determine if the driver passes the exam.
Which of the following medications is not used to treat anti-acute benign positional vertigo? A. Benzodiazepines B. Anticholinergics C. Sympathomimetics D. Steroids
CORRECT ANSWER: D»Explanation: Steroids are used to treat infection and inflammation.
Which of the following is a symptom of cataracts?
A. Deficits in peripheral vision
B. Atrophy of the optic nerve
C. Interference with detailed central vision
D. Diminished visual acuity
CORRECT ANSWER: D»Explanation: The slow, progressive opacification of the crystalline lens of the eye distorts the optical passage of light to the retina resulting in diminished visual acuity.
How long does a driver need to be symptom free when the driver has a diagnosis of chronic peripheral vestibulopathy? A. Symptom free for 6 months B. Symptom free for 2 months C. Symptom free for 3 months D. Automatic disqualification
CORRECT ANSWER: B»Explanation: The Conference on Neurological Disorders and Commercial Drivers report recommends that the driver may be certified after being symptom free for 2 months.
A driver has been diagnosed with Ménière's disease. For how long can the driver be certified? A. Cannot be certified B. 1 year C. 2 years D. 6 months
CORRECT ANSWER: A»Explanation: The Conference on Neurological Disorders and Commercial Drivers report recommends disqualification when there is a diagnosis of Ménière’s disease.
A driver presents to the clinic for a physical. The driver's blood pressure is 181/110. For how long can the driver be certified? A. 6 months B. 1 year with an appeal C. Cannot be certified D. 3 months
CORRECT ANSWER: C»Explanation: An individual diagnosed with stage 3 hypertension (blood pressure [BP] ≥180/110) should not be certified until his/her BP is reduced to ≤140/90, and may be recertified every 6 months.
