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DOT Exam :DOT Certification Exam: DOT EXAM:NRCME (DOT) Exam Test Bank: NRCME (DOT) Exam: NRCME Study Guide: DOT certification Exam: questions & Answers: Updated A Plus Solutions
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NRCME Exam: (Prep for the examination for National Registry of Certified Medical Examiners
vision requirements (Ans- 20/40 each eye and 20/40 both eyes peripheral vision (Ans- 70 degrees Federal exemption for monocular vision: can certi... [Show More] fy for how long? (Ans- 1 year hearing requirements (Ans- whisper at not less than 5 feet better ear, or average hearing loss no greater than 40 dB at 500Hz, 1000Hz, 2000 Hz. name 4 otic conditions that are automatic DQs (Ans- Meniere's, uncontrolled vertigo, labyrinthine fistula, nonfunctioning labyrinth Max cert period for Syncope (Ans- 1 year (needs neurologist clearance) Post MI drivers can be certified for 1 year with all 5 of these criteria: (almost the same criteria for post CABG) (first 4 also apply for CHF drivers) (Ans- 1. Asymptomatic 2. Tolerating meds 3. Satisfactory ETT with workload capacity of 6 METs (has to have this biennially) 4. LVEF >=40% 5. No ST depression on ECG - for post CABG this one is replaced by completely healed sternal incision Stable angina: max cert period (Ans- 1 year minimum waiting period post CABG (Ans- 3 months Min waiting period for post heart transplant (Ans- 1 year Max cert period for post heart transplant (Ans- 6 months Min waiting period post PCI (percutaneous coronary intervention) (Ans- 1 week Min waiting period for pacemaker implantation for sinus node dysfunction (Ans- 1 month Min waiting period for pacemaker implantation for neurocardiogenic syncope or hypersensitive carotid sinus with syncope (Ans- 3 months Min waiting period post AAA repair (Ans- 3 months Max cert period for being on anticoagulation for a CV condition (Ans- 1 year 3 criteria for certification if patient on anticoagulation for a CV condition (Ans- 1. Stable on meds for 1 month 2. Provide copy of INR at exam 3. Have INR checked and monitored at least monthly True or false: driver on anticoagulation for CVA can be certified for max 1 year (Ans- False. Should not be certified due to high risk of bleeding 5 reasons to DQ a driver with AAA (Ans- 1. Symptomatic 2. AAA >5cm 3. AAA 4-5 cm and does not have clearance from a cardiologist 4. AAA increased in size 0.5cm in 6 months 5. Surgical repair was recommended but not done [Show Less]
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DOT Exam: Questions & Answers: Latest Updated A+ Guide Solution
a 30 year old driver presents for a biennial recertification. the driver notes in his hx he's had 3 episodes of BPV 6 months ago but has been asymptomatic ... [Show More] since. he provides a letter from his neurologist stating he is cleared to work w/o restrictions. exam is negative with no abnormalities. how long may he be qualified a.disqualified due to not waiting the recommended period b.qualified up to 2 years c.refer to tilt table test d.refer for CT of brain (Ans- B use of muscle relaxants such as skelaxin, soma, or flexeril is disqualifying (Ans- false drivers diagnosed with the following motor neuron disease are disqualified per FMSCA a. ALS b. peripheral neuropathy c. fibromyalgia d. myofascial pain syndrome (Ans- A according to the FMCSA, the driver requiring insulin may be certified for a max of a. 12 months b. 6 months c. disqualified d. two years (Ans- A a driver who has an ICD can be certified for what period of time when he or she has clearance from a cardiologist a.6 months b.1 year c. 2 years d. disqualified (Ans- D to pass the vision exam, a visual acuity of .... corrected or uncorrected is required in each and both eyes a. 20/50 b 20/40 c 20/60 d 20/100 (Ans- B what eye conditions must you ask the driver about and if indicated request a specialist? a. retinopathy b. cataracts c.aphakia d. glaucoma e. all of the above (Ans- E a driver with monocular vision may apply for a federal vision exemption if they are otherwise medically qualified (Ans- true examiner can only certify a driver with corrective lenses for up to 1 year per FMSCA (Ans- false driver is required to have a peripheral vision of at least ... in the horizontal meridian of each eye a. 50 b.60 c.90 d.70 (Ans- D which of the following providers may not certify vision results a. medical examiner b. ophthalmologist c.optometrist d.neurologist e. all may certify (Ans- D when corrective lenses are used to meet qualifications, the corrective lenses must be used while driving (Ans- true the driver must be able to identify which colors in order to be medically fit? a. red b.purple c.orange d.blue e.brown (Ans- A medical examiners have discretion when applying the vision standard to determine if a driver can be physically qualified a. true b.false c. depends on factors (Ans- C which of the following otic disease are automatically disqualifying? a. otitis media b. otitis externa c. meniere's d. BPPV (Ans- C in order to pass the forced whisper test a driver must first perceive a forced whispered voice, in one ear at not less than .... a. two feet b.three feet c.four feet d.five feet (Ans- D to pass the audiometric test, hearing loss in one ear must be less than or equal to... a. 50 decibels b.40 decibels c.60 decibels d.80 decibels (Ans- B while conducting the audiometric test, record the results at a. 500 Hz, 1000 Hz, 2000 Hz b. 600 Hz, 1200 Hz, 2000 Hz c. 100 Hz, 500 Hz, 1000 Hz d. 200 Hz, 400 Hz, 600 Hz (Ans- A a hearing aide may be worn to qualify (Ans- true with a prior diagnosis of BPV a driver must be symptom free for a minimum of ... months to qualify a. 3 b.6 c.2 d.12 (Ans- C the examiner must conduct and record results for both the forced whisper test and audiometric test regardless of results of the first test (Ans- false does the driver meet the standards for certification? audiometric results = Rt ear 30,45,40 Lt ear 45,45,35 (Ans- Yes what neurological condition is not medically disqualifying a. headache b.epilepsy c.vertigo d.narcolepsy (Ans- A for which of the following diagnosed neurological conditions is the driver considered unqualified? a. TIA greater than 1 year b.febrile seizure c.dementia d. headache (Ans- C a driver taking levodopa/carbidopa which may cause the driver to be disqualified because it treats? a. CHF b. diabetes c. parkinsons d.hypertension (Ans- C the SPE certificate may be used to qualify an individual with MS (Ans- false a driver has surgery for removal of an acoustic neuroma, what is the minimum waiting period a. 6 months b.1 year c.2 years d.5 years (Ans- C [Show Less]
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DOT practice Questions & Answers: Updated A+ Guide Solution
Fatigue is a major concern. What do current FMCSA regulations allow from drivers? (Ans- 60 hours on the road over a 7 day period, or 70 hours over 8 days... [Show More] (also 14 hours on the road at a stretch if given 8 hours off to rest between) driver presents with a heart attack 1 month previous. He is following up with his MD again in 1 week. He is unsure of his prescriptions, but is asymptomatic. Should he be certified today? (Ans- No. There is a minimum waiting period of 2 months and specific criteria that must be met thereafter before certification Driver has been trying to stop smoking for 10 years without success. 1 month ago, she began taking Chantix. She reports no blackout, suicidal thoughts, or change in mood. The rest of the exam is normal. Can she be qualified? (Ans- No. Chantix is diqualifying Which of the following diagnoses is NOT always disqualifying? (narcolepsy, type 1 diabetes, meniere's disease, current alcoholism, bipolar disorder) (Ans- bipolar disorder when asked about seizures, a driver reports several febrile seizures as a young child. Is this disqualifying? (Ans- No. What does the acronym FMCSA stand for? (Ans- Federal motor carrier safety administration What is NOT a mission of the FMCSA? -develop and enforce data-driven regulations that balance motor carrier (truck and bus companies) safety with industry efficiency -target educational messages to carriers, commercial drivers, and the public -partner with stakeholders including federal, state, and local enforcement agencies, the motor carrier industry, safety groups, and organized labor on efforts to reduce bus and truck-related crashes -oversee the prosecution of criminally negligent cases of motor carrier safety breaches (Ans- oversee the prosecution of criminally negligent cases of motor carrier safety breaches who is NOT eligible to be a medical examiner? (APNs, DC, MD, PharmD, DO, PA, PT) (Ans- pharmacists and PTs cannot be medical examiners as they do not have the training, scope of practice, or licensure that allows them to diagnose what is the role of the medical examiner? -assess the driver for medical fitness to safely perform all driver duties -ensure the driver is properly following up on any potentially dangerous conditions -treat the driver for health conditions -council the driver on health conditions and consequences -diagnose new health concerns of the driver (Ans- -assess the driver for medical fitness to safely perform all driver duties -ensure the driver is properly following up on any potentially dangerous conditions -council the driver on health conditions and consequences what is ensured as a part of the NRCME's medical oversight mission? -individuals performing medical examinations are qualified to do so and are educated about occupational issues for drivers -a tracking mechanism that ensures that every prior application by an individual for medical certification is recorded and reviewed -medical certification regulations are updated periodically -a review process that prevents or identifies and corrects the inappropriate issuance of medical certification -all of the above (Ans- all of the above according to the DOT, the AVERAGE driver falls into all of these categories, EXCEPT: (male, between 25 and 39 years of age, sedentary, overweight, smoker, poor eating habits, less healthy than the average person, more than 2 medical conditions, cardiovascular disease prevalent) (Ans- between 25 and 39 years of age- the average driver is more than 40 years of age what of these abilities is NOT required of a driver to safely perform his/her duties? -perceptual skills to monitor sometimes complex driving situations -judgment skills to make quick decisions when necessary -manipulative/manual skills to control his vehicle -social sills to act kindly to interpersonal activities on the road (Ans- social sills to act kindly to interpersonal activities on the road- mental and physical abilities are required (social skills are not unless their absence indicates mental illness) fatigue is a major concern. what do current FMCSA regulations allow from drivers? (Ans- 60 hours on the road over a 7 day period, or 70 hours over 8 days [Show Less]
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DOT Certification Exam (FMCSA): Questions & Answers: Updated
A driver comes in for recertification. He has been diagnosed with a cataract in his left eye and will be having surgery in a few months. He has a new eyegl... [Show More] ass prescription and his vision is found to be: L - cannot read the chart uncorrected, 20/70 corrected. R - 20/40. You would: (Ans - Disqualify the driver. A driver is returning to work from an alcohol rehab program. Who should evaluate the driver and make recommendations on education, treatment, follow up testing, and aftercare? (Ans - Substance abuse professional Factors affecting the severity of chronic diseases leading to possible disqualification include all but: (Ans - Well tolerated medications may be needed to stabilize the condition. Factors contributing to commercial driving stressors include: (Ans - Long relay routes, abrupt schedule changes, responsibility for passenger safety. Four of the 13 Federal Motor Carrier Regulations or Standards are non-discretionary, with objective criteria not requiring decision making by the examiner. Which are the 4 standards? (Ans - Vision, Hearing, Diabetes Mellitus and Epilepsy [Show Less]
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DOT EXAM: Questions & Answers: Updated A+ Score Solution
Upon examination of a 46 y/o male smoker, you detect an irregularly irregular heart rhythm. The rate is 140 bpm. This is unknown to the driver and he denie... [Show More] s any symptoms of lightheadedness, shortness of breath, dizziness, palpitations, nor any cardiac history. You would: (Ans- Disqualify and refer to his PMD or cardiologist for further evaluation. Concerning the medical certificate, which is false? (Ans- Provide the original to the driver being examined. Retain a copy for at least 3 years. You may not provide a copy to the current or prospective employer, they must get it from the driver. The driver must carry the original certificate during operation of a CMV. How soon may a driver be certified after coronary artery bypass grafting (CABG) surgery? (Ans- 3 months with clearance by cardiologist, resting echocardiogram with an LVEF >40% after CABG, and asymptomatic status with no angina. FMCSA defines a severe hypoglycemic reaction as one that results in: (Ans- Need of assistance from another person, loss of consciousness, any period of impaired cognitive function that occurs without warning, or seizure Medical fitness for duty includes the ability to perform strenuous labor and to have good judgment, impulse control, and _____________________. (Ans- Problem solving skills All of the following may perform and certify vision test results except: (Ans- A chiropractor Ophthalmologist Optometrist or Registered Nurse The grace period for the expiration of a Medical Examiner's Certification is (Ans- There is no grace period, the certification expires at midnight on the date listed A 28 year old female presents for her CDL physical exam. She indicates she has been enrolled in a Methadone program for three months secondary to a previous substance abuse issue in the recent past. She presents a letter from the administrator of the program documenting her compliance with the program and absence of any history of prior violations of their agreement. According to medical guidance, can a driver be certified while taking methadone. (Ans- No, since Methadone is a habit-forming narcotic that can produce drug dependence. Methadone is not an allowable drug for CMV operators. Arriving for a recertification exam, a 48 y/o male non-smoker is 5'4", 275lbs. His supervisor calls you ahead of time stating he recently went off the side of the road crashing into a guard rail. There were no injuries and the truck sustained only minor damage. When the medical assistant goes to bring him back, he is found asleep, snoring in the waiting room and she needs to wake him by gently shaking him by the shoulder. She reports this to you. When you arrive in the exam room the patient appears to be nodding off while sitting on the exam table. Upon further questioning, he admits that his wife frequently elbows him because of his snoring and that he gasps and snorts in his sleep. When asked, he denies nodding off while driving. His exam is notable for obesity, Mallampati 4 oropharynx, HTN controlled with 2 medications, otherwise normal. Appropriate next steps: (Ans- Disqualify and refer to PMD for sleep study. You examine a 37 male driver with missing fingers on his left hand, you must evaluate and do all of the following, (Ans- Document the effect that the deficit has on the ability of the driver to safely operate a CMV Provide a copy of the Medical Examination Report form and medical examiner's certificate for an SPE initial or renewal application Ensure that the driver with an existing SPE certificate is complying with medical requirements You examine a 37 male driver with missing fingers on his left hand, you must evaluate and obtained Obtain approval from the primary care doctor (Ans- no When you perform a urinalysis (dip stick) test, you are to test for what? (Ans- Specific gravity, protein (proteinuria), blood (hematuria) and glucose (glycosuria) Commercial drivers have a greater propensity to develop hypertension than their peers in other professions. (Ans- true The percentage of drivers with hypertension increases with years of driving, from 29% in drivers with fewer than 10 years driving experience to 39% in drivers with over 20 years of experience. (Ans- true Effective hypertension management reduces overall cardiac morbidity and mortality. (Ans- true [Show Less]
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DOT certification Exam: Questions & Answers: A+ Guide Solution
1 cause of fatalities with big trucks? (Ans- driver fatigue DOT organization (Ans- all subcategories are separate entities and require different thi... [Show More] ngs What is covered in NRCME training? (Ans- federal motor carrier safety administration (FMCSA) How long does NRCME certification last? (Ans- 10 years with a 5 year update class once a driver is certified, what is the longest it lasts? (Ans- 2 years SPE (Ans- skill performance evaluation Three copies of driver's certificate: who gets them and who has original for how long? (Ans- driver, employer get copies examiner keeps original for 3 years Non discretionary standards (Ans- immediately DQ the driver, examiner MUST follow standards discretionary guides/recommendations (Ans- limits steered by recommendations and examiners judgement list the non discretionary DQers (Ans- Hx of epilepsy, failed hearing exam, failed Vx exam, active insulin dependent DM who oversees medical certification process? (Ans- office of medical programs how many X more is mortality rate for passenger vehicle vs large truck, in a crash between the two? (Ans- passenger vehicle 5X more likely to die where are physical standards for drivers listed? (Ans- 49 CFR 391.41 define CMV (Ans- commercial motor vehicle: any self propelled or towed MV used on a highway in interstate commerce to transport passengers or property...10k lbs or more, 8+ passengers for $$, 15+ passengers not for $$, hazardous materials where is CMV defined? (Ans- 40 CFR 390.5 where are medical examiner qualifications found? (Ans- 49 CFR 391.43 Where are general qualifications for CMV drivers found? (Ans- 49 CFR 391.11 list non-discretionary standards (Ans- loss of limb, limb impairment, CV condition, respiratory dysfunction, HTN, RA/OA/orthopedic/muscular, mental disorder, drug use, alcoholism "average" driver demographics (Ans- male, 40+, sedentary, obese, smoker, poor eating habits "average" driver medical health (Ans- less healthy than average citizen, 2+ medical conditions, CV disease list 9 occupational stressors for CMV drivers (Ans- type of route, schedule, finances, vehicle, road conditions, environmental, type of cargo when can a driver on insulin be certified? (Ans- if he/she has FMCSA waiver - 49 CFR 391.64 OR federal exemption program FMCSA definition of "severe hypoglycemia" (Ans- seizure, LOC, need assistance from others, impaired cog fxn if severe hypoglycemia, ask if driver has had reactions how frequently? (Ans- 1+ in last 12 months 2+ in last 5 years what happens if driver has loss of proprioception? what about peripheral neuropathy? (Ans- DQ and DQ what if DM patient has resting tachycardia or orthostatic HOTN? (Ans- DQ what if driver has silver wire, cotton patches? (Ans- qualify but recommend ophthalmologist yearly what if driver has unstable retinopathy where neovascularization extends into vitreous? (Ans- DQ driver uses telescopic lenses? (Ans- DQ what if driver on incretin mimetics? what about other oral hypoglycemics? (Ans- certify for one year DM exemption requires a driver to: (Ans- annual endocrinology visit, annual optho visit, DM education, glucose monitoring forced whisper test (Ans- hear a forced whisper at no less than 5ft audiometric testing limits (Ans- average hearing loss no greater than 40 decibels can driver wear hearing aids during forced whisper test? (Ans- yes audiometer should be calibrated to what standard? (Ans- American National Standards Institute (ANSI) Z24.5-1951 driver wears a hearing aid. can you do in office whisper test? what about audiometry test? (Ans- yes for whisper, no for audiometry how to calculate hearing loss? (Ans- determine what decibels heard at 500Hz, 1000Hz, 2000Hz in one ear. Add the results and divide by three. Result = average hearing loss. Audiometric testing - results? (Ans- qualify driver if less than 40dB hearing loss in good ear. both ears more than 40=DQ how to convert from International Organization for Standardization to ANSI? (Ans- minus 14 from 500 minus 10 from 1000 minus 8.5 from 2000 which test to do first, whisper or audiometric? (Ans- doesn't matter as long as one is passed, driver is qualified which otic diseases disqualify driver? (Ans- BPPV w/ Sx in last 2 months menieres labyrinthine fistula nonfunctioning labyrinths Required vision tests? (Ans- visual acuity (snellen/titmus), peripheral horizontal visual fields, color vision Snellen visual acuity - ft away from chart and standards? (Ans- 20 ft from chart, both eyes together and each eye must be 20/40 peripheral field of vision test? (Ans- 70 degrees what colors does driver need to distinguish between? (Ans- green amber red driver has retinopathy - what to do? (Ans- you can certify but driver must have annual medical exam, annual optho exam driver has unstable proliferative retinopathy (Ans- DQ driver can only meet requirements for Vx in one eye (Ans- DQ driver has contacts - one corrects for distance, one corrects for near acuity (Ans- DQ Federal vision exempt program (Ans- 2 years monocular vision study (Ans- 49 CFR 391.64, grandfathered in, driver can be certified for 1 year you note HTN for first time in driver. what to do? (Ans- certify for one year, after one year, certify for 3 months driver had stage 1 HTN, certified for 1 yr + 3 months, now what? (Ans- DQ BP = 180/110 (Ans- DQ, if driver gets BP down, can certify for 6 months at a time pending 3 month interval checkups first time stage 2 HTN, what to do? (Ans- certify for 3 months...after this DQ if not lowered BP driver had stage 2 HTN, got a 3 month certification and got BP down. now what? (Ans- certify for 1 year after the INITIAL check (3 months ago) name three neurologic standards, and choose the one that is nondiscretionary (Ans- rheumatic/arthritic/ortho/muscular, epilepsy, mental...epilepsy is nondiscretionary driver is on anticoagulant therapy for cerebrovascular disorder (Ans- DQ driver has cerebrovascular disorder - when to qualify? (Ans- normalized INR, recert q1yr, monthly INR monitoring TIA recurrence risk (Ans- greatest in first few weeks following stroke, by one year post TIA, risk is 5% driver had TIA (Ans- wait 1 year then recert if not on anticoagulants driver had stroke affecting cerebellum or brainstem (Ans- 1 year wait, then recertify if not on anticoagulants and able to obtain clearance from neurologist driver had stroke affecting cortical or subcortical region (Ans- 5 year wait period then recertify if not on anticoagulants and you're able to obtain clearance from neurologist intracerebral/subarachnoid bleed (Ans- wait 1 year if in brainstem/cerebellum, wait 5 years if cortical/subcortical [Show Less]
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DOT Exam :DOT Certification Exam: Questions & Answers: Guaranteed A+ Score
An unrestricted Commercial Motor Vehicle Driver Medical Certificate must be renewed (Ans - Every Two Years A driver presents with history of an isolate... [Show More] d TIA 6 months ago. He has a return to work letter from his primary care provider (PCP) and neurologist. He is taking and tolerating well hydrochlorothiazide and simvastatin. All other aspects of the exam and history were normal. What should the medical examiner do next? (Ans - Disqualify driver for now FMCSA regulates interstate commercial operation including the (Ans - Driver, Vehicle, and Motor Carrier During the CMV exam a driver perceived a whispered voice at 5 feet in his left year and 4 feet in his right year. Exam was otherwise normal. What do you do as the medical examiner? (Ans - Certify driver for 2 years Which of the following is an assessment of L4 nerve root pathology? A. Plantar flexion B. Patellar reflex C. Hip extension D. Babinski reflex (Ans - Patellar reflex A driver presents for medical exam and reports being a smoker and having frequent shortness of breath. What do you do next? (Ans - Order a spirometer test According to regulation, which of the following must be evaluated as part of the eye exam? A. Pupil reaction B. Iris symmetry C. Conjunctiva injection D. Tonometry pressure (Ans - Pupil reaction Continued certification of NRCE Medical Examiners requires which of the following? A. Periodic training at least every five years B. Completion of recertification test every five years C. Completion of certification test every 10 years D. Electronic transmission to FMCSA CMV Medical Examination Results at least monthly (Ans - Periodic training at least every five years, Completion of certification test every 10 years, Electronic transmission to FMCSA CMV Medical Examination Results at least monthly A driver presents for recertification. The only condition he lists is GERD, for which he takes OTC omeprazole. He says that when he is driving and eating fast foods, he is more likely to have heartburn than when off‐duty. You should (Ans - Correlate history with abdominal exam Which of the following findings is disqualifying? A. Oxygen saturation 90% B. LVEF 40% C. FEV 68% predicted D. All of the above (Ans - Oxygen saturation 90% The driver presents for recertification and submits an ultrasound report indicating an abdominal aortic aneurysm from two months ago, shortly before he had surgical correction. He has surgical clearance and says he is doing well, has no symptoms. You should (Ans - Inform the driver of the 3 month waiting period before he can be certified The driver takes diphenhydramine twice a day to treat nasal congestion. What must you document in order to certify? (Ans - Cannot drive within 12 hours of taking diphenhydramine The driver has a history of carpal tunnel repair of her right hand 2 months ago. Her grip strengths are symmetrical and strong. What is necessary in order to qualify this driver? (Ans - Document her findings for 2‐year certification Which of the following abdominal complaints is most likely to be incapacitating? A. IBS B. GERD C. Urinary tract infection D. Nephrolithiasis (Ans - Nephrolithiasis The waiting period for benign positional vertigo is (Ans - 2 months The driver's BP is 148/96. You verify her history, which indicates she has no prior history of hypertension. If otherwise qualified, you may certify her for (Ans - 1 year The driver's current BP is 135/76. Your records indicate at history of Stage III hypertension 4 years ago. The maximum certification for this driver is (Ans - 6 months The driver presents for examination with a recent history (five weeks ago) of pneumothorax. He has no prior history of pneumothorax. In order to be considered medically qualified, his forced vital capacity (FVC) should be greater than (Ans - 65% The recommended waiting period (WP) and certification period (CP) for a driver following surgical correction for intermittent claudication are (Ans - WP 3 months, CP 1 year [Show Less]
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NRCME (DOT) Exam Test Bank: Questions & Answers: Well Elaborated With Explanations
An unrestricted Commercial Motor Vehicle Driver Medical Certificate must be renewed: A. Annually B. Every Two Years C. Every Four Years D. Whenever t... [Show More] he State Issued Driver's License is renewed (Ans- B. Every two years 2 years is the max for a healthy person 2. A driver presents with history of an isolated TIA 6 months ago. He has a return to work letter from his primary care provider (PCP) and neurologist. He is taking and tolerating well hydrochlorothiazide and simvastatin. All other aspects of the exam and history were normal. What should the medical examiner do next? A. Certify driver for 1 year B. Disqualify driver for now C. Certify driver for 3 months D. Certify driver for 2 years (Ans- B. Disqualify the driver for now The waiting period is 1 year for Transient ischemic attack, stroke, or intracerebral or subarachnoid hemorrhages with no risk for seizures. 3. FMCSA regulates interstate commercial operation including the: A. Driver B. Vehicle C. Motor Carrier D. All of above (Ans- D. All of the above Self-explanatory 4. During the CMV exam, a driver perceived a whispered voice at 5 feet in his left year and 4 feet in his right year. Exam was otherwise normal. What do you do as the medical examiner? A. Required audiometric test to determine the extent of hearing loss in left ear B. Certify driver for 2 years C. Certify driver for 1 year D. Disqualify driver (Ans- B. Certify the driver for 2 years. Passing the forced whisper test at 5 ft in at least 1 ear is good enough. 5. Which of the following is an assessment of L4 nerve root pathology? A. Plantar flexion B. Patellar reflex C. Hip extension D. Babinski reflex (Ans- B. Patellar Reflex ("Knee-Jerk Reflex") Patellar Reflex = L3-L4 (Primarily the L4) Plantar Flexion = S1-S2 (Tibial nerve) Hip Extension = L4-L5 (via the gluteal nerve) Babinski Reflex (Plantar Flexion) = upper motor neuron lesion 6. A driver presents for medical exam and reports being a smoker and having frequent shortness of breath. What do you do next? A. Order an ECG B. Refer to a pulmonologist C. Order a spirometer test D. Provide 1 year certification (Ans- C. Order a spirometry test Obvious difficulty breathing in a resting position is an indicator for additional pulmonary function tests. If the forced expiratory volume in the first second of expiration (FEV1) is less than 65% of that predicted, arterial blood gas measurements should be evaluated. NOTE: Smokers have a high incidence of COPD, yet individuals may have a significant reduction in lung function without symptoms. Spirometry should be performed in all smokers over the age of 35 years. You should obtain forced expiratory volume in the first second of expiration (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio when any of the following indicators are present: • History of any specific lung disease. • Symptoms of shortness of breath, cough, chest tightness, or wheezing. • Cigarette smoking in drivers 35 years of age or older. No further testing is necessary if the lung function is normal and no other abnormality is suspected. Abnormal lung function should be further evaluated. 7. According to regulation, which of the following must be evaluated as part of the eye exam? A. Pupil reaction B. Iris symmetry C. Conjunctiva injection D. Tonometry pressure (Ans- A. Pupil reaction Pupil reaction is neurological. Iris symmetry is cosmetic Conjunctiva injection is usually for infections Tonometry pressure is for intraocular pressure, usually measured by optometrists/ophthalmologists. 8. Continued certification of NRCE Medical Examiners requires all EXCEPT which of the following? A. Periodic training at least every five years B. Completion of recertification test every five years C. Completion of certification test every 10 years D. Electronic transmission to FMCSA CMV Medical Examination Results at least monthly (Ans- B. Completion of recertification test every 5 years - Online training every 5 years. - You need to re-certify every 10 years. - You need to submit your CMV medical exam results each month to the FMCSA. In December 2016, FMCSA issued a statement that it will be the sole provider of the required 5-year refresher training, and it will provide the training online at no cost to Certified Medical Examiners. Certified Medical Examiners who are eligible for the 5-year periodic online training will be notified by FMCSA when the training is available and the examiner is able to access the training site. Training providers associated with the initial 10-year certification process are not involved with the refresher training and will not contact Certified Medical Examiners regarding the required 5-year refresher training. Certified medical examiners agree to keep their National Registry accounts up to date (licenses, training, records etc.) and to transmit at least monthly results of all CMV driver exams performed to FMCSA via the National Registry System. 9. A driver presents for recertification. The only condition he lists is GERD, for which he takes OTC omeprazole. He says that when he is driving and eating fast foods, he is more likely to have heartburn than when off‐duty. You should: A. Request recent UGI results B. Correlate history with abdominal exam C. Certify for one year with restricted diet D. Discuss alternative employment (Ans- B. Correlate history with abdominal exam. GERD and PPIs are not reasons to disqualify or certify someone for less than the max 2 years. Make sure there's not an AAA or some other etiology. 10. Which of the following findings is disqualifying? A. Oxygen saturation 90% B. LVEF 40% C. FEV 68% predicted D. All of the above (Ans- A. Oxygen saturation 90% [Show Less]
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NRCME Test Bank Questions & Answers: Guaranteed A+ Guide Solution
Which of the following is a requirement for drivers with a diabetes exemption? A) Possess a rapidly absorbable form of glucose while driving B) Self—mo... [Show More] nitor blood glucose one hour before driving and at least once every 2 hours while driving C) Plan to submit blood glucose monitoring logs every 6 months D) Maintain a Hemoglobin A1C value less than 7 (Ans- A. Drivers with diabetes should self monitor blood glucose before driving and every 4 hours while driving. Blood glucose monitoring logs should be submitted annually. There is no specific requirement for HgA1C level. Drivers with insulin dependent diabetes: A) May be certified for a maximum of 6 months B) Must maintain a hemoglobin A1C level of less than 7 to qualify for certification C) Cannot be certified if they have a history of myocardial infarction D) May be eligible for a diabetes exemption (Ans- D) Drivers with insulin dependent diabetes cannot be certified but may be eligible for a diabetes exemption Which of the following is true? A) A driver with diabetes who uses insulin does not meet the minimum requirements of 49 CFR Part 391.41 B) The most important concert related to medication use for treating diabetes is hyperglycemia C) Peripheral neuropathy is not a disqualifying condition D) Diabetes is not a coronary heart disease (CHD) equivalent condition (Ans- A) The greatest risk for medication use for drivers with diabetes in hypoglycemia, not hyperglycemia. Peripheral neuropathy is disqualifying condition. Diabetes is a CHD equivalent condition. What is the recommended certification interval for a driver with diabetes mellituse who does not use insulin? A) Three months B) Six months C) One year D) Two years (Ans- C) Drivers with non-insulin dependent diabetes should be certified for a maximum of one year A diabetes exemption may be issued by: A) An endocrinologist B) The Medical Examiner C) The driver's personal physician D) The FMCSA (Ans- D) Only the FMCSA can grant exemptions A driver with diabetes mellliktus who uses insulin is determined to be otherwise medically qualified. The medical examiner must indicate that a diabetes exemption is required on the : A) Medical Examination Report status section and Medical Examiners Certificate B) Letter to the FMCSA C) Employer authorization form D) Endocrinology consultation form (Ans- A) Exemption requirements must be noted on the Medical Examination Report status section and the Medical Examiners Certificate If glucose is detected on urinalysis in a driver with no history of diabetes, an appropriate next step is: A) Endocrinology consultation B) One year clearance and recommendation to see personal physician C) Fingerstick or blood glucose determination D) Temporary disqualification (Ans- C) The medical examiner should first determine blood glucose and then make an appropriate certification determination and referral Drivers with a history of _____________ severe hypoglycemic reactions in the past year or _____________ severe hypoglycemic reactions in the past five years should not be certifed. A) one, three B) one, two C) two, three D) two, five (Ans- B) A driver should not be certified if the driver has had one hypoglycemic reaction in the past year or two in the past five years. Which of the following is not a criteria that the FMCSA uses to define a severe hypoglycemic reaction? A) Seizure B) Dizziness C) Need of assistance from another person D) Period of impaired cognitive function that occurred without warning (Ans- B) FMCSA defines severe hypoglycemia as reactions that result in seizure, loss of consciousness, need of assistance from another person, and a period of impaired congitive function that occurred without warning Which diabetes mellitus risk poses the greatest threat to public safety A) Hyperglycemia B) Peripheral neuropathy C) Hypoglycemia D) Metabolic encephalopathy (Ans- C) Although hyperglycemia, peripheral neuropathy, and metabolic encephalopathy all pose significant risks for safe driving, hypoglycemia poses the greatest risk. The risk is particularly pronounced in drivers who use insulin. FMCSA defines a hypoglycemia episode as one that results in seizure, loss of consciousness, need of assistance from another person, or a period of impaired cognitive function that occurs without warning. A driver with a diabetes exemption should check glucose levels when? A) One hour before driving and at least once every four hours while driving B) One hour before driving and at least every eight hours while driving C) Once after four hours of driving D) Once a day after driving period has ended (Ans- A) Driver's with diabetes exemption should check glucose values one hour before driving and once every four hours while driving Which of the following is true for diagnosis of a hernia? A) The driver should be referred to a surgeon to determine whether repair of a hernia is necessary B) The waiting period following hernia surgery is two weeks C) Inguinal hernias have been associated with an increased risk for CMV accidents D) The maximum certification interval for a driver with a hernia is two years (Ans- D) The medical examiner can use his/her judgment as to whether a driver should be referred to a surgeon or other specialist. There is no specified waiting period following hernia surgery - the driver should not be certified until the medical examiner determines that treatment is safe and effective, and that the condition is stable. No evidence has linked hernias of any type to increased CMV accident risk. Which of the following is true of nephropathy? A) Nephropathy is a disqualifying condition B) The maximum certification interval for nephropathy is two years C) A driver with 3+ proteinuria should not be certified D) A renal specialist should make the certification determination for a driver with nephropathy (Ans- B) Nephropathy is considered on a case-by-case basis. The medical examiner determines what evaluation or monitoring is necessary for a driver with 3+ proteinuria and may disqualify the driver. The certification is always made by the medical examiner and cannot be deferred to a specialist. Drivers with which of the following conditions should be disqualified? A) Cancer requiring chemotherapy treatment B) Umbilical hernia not surgically repaired C) Renal failure on peritoneal dialysis D) Hemochromatosis (Ans- C) Dialysis of any type is disqualifying If a significant abnormal finding for urinalysis specific gravity, protein, or blood is found, the medical examiner should: A) Disqualify the driver B) Request that a renal specialist determine if the driver is medically qualified C) Use clinical expertise to determine a certification decision and to determine if additional evaluation is required or recommended D) Obtain blood chemistries for renal function (Ans- C) The medical examiner must determine whether additional evaluation is needed and whether the certification decision should be postponed or limited [Show Less]
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NRCME Study Guide: Questions & Answers: Latest Updated A+ Guide Solution
vision requirements (Ans- Distant vision 20/40 each eye and 20/40 both eyes, Peripheral vision at least 70 degrees, Ability to recognize and distinguish ... [Show More] between the colors of traffic signals and devices. If the driver presents a valid vision exemption, how long can he be certified? (Ans- 1 year The driver with a vision exemption must present what 2 things before receiving the medical examiner's certificate. (Ans- Valid vision exemption and copy of the specialist eye examination report. When applying for a vision exemption, the driver should include a copy of the Medical Examination Report form and the medical examiner's certification with what marked? (Ans- The "accompanied by" exemption checkbox and write "vision" to identify the type of exemption. If the driver is qualified by operation of 49 CFR 391.64 due to participation in the vision study program, what must the driver present to qualify for certification? (Ans- Letter identifying the driver as a participant and copy of the specialist eye examination. How long can a driver who is qualified by operation of 49 CFR 391.64 be certified. (Ans- 1 year hearing requirements (Ans- Whisper at not less than 5 feet in 1 ear, or average hearing loss no greater than 40 dB at 500Hz, 1000Hz, 2000 Hz in 1 ear. What is the waiting period for vertigo caused by benign positional vertigo or acute/chronic peripheral vestibulopathy? (Ans- 3 months Name 4 otic conditions that are automatic disqualification (Ans- Meniere's, uncontrolled vertigo, labyrinthine fistula, nonfunctioning labyrinth Apnea-hypopnea index of [blank] or more episodes per hour is diagnostic of OSA (Ans- 30 3 requirements for a passing ETT (Ans- 1. increased SBP of at least 20 without angina 2. workload capacity >6 METs 3. no significant ST depression Examiners must retain records for how many years? (Ans- 3 Regulation that describes the physical qualifications of drivers. (Ans- 49 CFR 391.41 Regulation that describes the responsibilities of the medical examiner. (Ans- 49 CFR 391.43 Regulation that describes the process for conflict resolution when there is a disagreement between the primary care provider for the driver and the medical examiner for the motor carrier concerning driving qualifications. (Ans- 49 CFR 391.47 Regulation that describes the Skill Performance Evaluation (SPE) Certification Program. (Ans- 49 CFR 391.49 Regulation that describes limited exemptions for intra-city zone drivers. (Ans- 49 CFR 391.62 Regulation that describes grandfathering for certain drivers who participated in vision and diabetes waiver study programs. (Ans- 49 CFR 391.64 Regulation that includes regulations for medical review officers and substance abuse professionals, including drug and alcohol testing procedures. (Ans- 49 CFR 40 Define Stage I Hypertension (Ans- BP greater than or equal to 140/90 What is the maximum certification period for stage I hypertension if this is the 1st examination at which the driver has BP equivalent to stage I hypertension and has no history of hypertension? (Ans- 1 year What is the maximum certification period for untreated known or inadequately controlled stage I hypertension? (Ans- 3 months What is the maximum certification period for blood pressure >140/90 and the following: follow-up 3 months certificate or history of stage III hypertension (Ans- None, driver is disqualified Define Stage II hypertension. (Ans- BP is ≥ 160 to <180 SYSTOLIC, and is ≥100 to < 110 Diastolic What is the maximum certification period for Stage II hypertension with blood pressure >140/90? (Ans- 3 months What is the maximum certification period for Stage II hypertension with blood pressure 180 Systolic and > 110 Diastolic What is the maximum certification period for Stage III hypertension with blood pressure >140/90? (Ans- 1 time certificate for 3 months in accordance with stage 1 or 2 HTN guidelines, as determined by a case by case basis. What is the maximum certification period for a driver with a history of Stage III hypertension but t exam his BP is at or less 140/90 and treatment is well tolerated? (Ans- 6 months What is the maximum certification period for Stage III hypertension with blood pressure >180/110? (Ans- None, driver is disqualified. What is the waiting period and maximum certification period for surgical correction of secondary hypertension? (Ans- 3 months and 1 year post surgical correction What is the waiting period and maximum certification period for driver on anticoagulants for cardiovascular cause? (Ans- 1 month stabilized and 1 year with monthly INRs What is the waiting period and maximum certification period for driver on anticoagulants for neurlogical condition? (Ans- None, driver is disqualified. 5 reasons to disqualify a driver with AAA (Ans- 1. Symptomatic 2. AAA >5cm 3. AAA 4-5 cm and does not have clearance from a cardiologist 4. AAA increased in size 0.5cm in 6 months 5. Surgical repair was recommended but not done Maximum certification period for driver with AAA that is asymptomatic or <4cm, >4cm and <5cm but has clearance from cardiologist (Ans- 1 year Maximum certification period for Acute DVT (Ans- 1 year Maximum certification period for Chronic DVT (Ans- 2 years Waiting period and maximum certification period for intermittent claudication if driver has no resting pain. (Ans- 3 months for post-surgical repair and 1 year Waiting period and maximum certification for aneurysms of visceral, peripheral arteries or venous vessels (Ans- 3 months post-surgical repair and 1 year with clearance from cardiologist Waiting period and maximum certification for peripheral vascular disease (Ans- 3 months post-surgical repair and 1 year without resting pain Waiting period and maximum certification for pulmonary emboli (Ans- 3 months with no pulmonary embolism and 1 year if asymptomatic Maximum certification period for superficial phlebitis (Ans- 2 years Waiting period and maximum certification for thoracic aneurysm <3.5cm (Ans- 3 months post surgical repair and 1 year True or false: having an ICD is automatic disqualification (Ans- true Min waiting period for pacemaker implantation for sinus node dysfunction or AV block (Ans- 1 month Min waiting period for pacemaker implantation for neurocardiogenic syncope or hypersensitive carotid sinus with syncope (Ans- 3 months In order for a driver to receive maximum certification period of 1 year for pacemaker the driver must: (Ans- Comply with pacemaker center scheduled function checks and provide documentation of pacemaker function checks at examination. Minimum waiting period for atrial fibrillation (Ans- 1 month with adequate anticoagulation Minimum waiting period for atrial flutter (Ans- 1 month post-isthmus ablation Minimum waiting period for AV nodal reentrant tachycardia, AV reentrant tachycardia and Wolff-Parkinson-White syndrome, Atrial tachycardia, Junctional tachycardia (Ans- 1 month without symptoms Maximum certification period for SVT with adequate rate control, anticoagulation if indicated, and clearance from a cardiologist. (Ans- 1 year Minimum waiting period for VT caused by coronary heart disease, right ventricular outflow VT, Idiopathic LV VT. (Ans- 1 month after drug or other therapy Maximum certification for VT if patient is asymptomatic, NSVT with LVEF >40% and has clearance from a cardiologist (Ans- 1 year Driver is to be disqualified if VT and the following: (Ans- symptomatic, sustained VT, NSVT with LVEF <40% or diagnosis of hypertrophic cardiomyopathy, long QT interval syndrome or Brugada syndrome Waiting period and maximum certification for Acute MI is (Ans- Waiting period 2 months post MI and maximum certification is 1 year What is required for initial certification following MI? (Ans- In-patient post-MI echocardiogram showing LVEF 40% What are the requirements for certifying driver with history of MI? (Ans- Asymptomatic, satisfactory ETT every 2 years, LVEF >/40%, no electrocardiogram ischemic changes and clearance by cardiologist Waiting period and maximum certification for angina in a driver without resting angina or change in angina pattern and 1 year with satisfactory ETT every 2 years and clearance by cardiologist (Ans- 3 months CHD risk-equivalent conditions include: (Ans- DM, PVD, Framingham risk score predicting 20% CHD event risk over the next 10 years or being over 45 years of age with multiple risk factors for CHF Maximum certification of multiple CHD risk-equivalent is (Ans- 1 year Waiting period and maximum certification for CABG if the driver is asymptomatic, LVEF >/40%, healed sternum and cleared by cardiology (Ans- 3 months after CABG and 1 year 5 years post-CABG, what routine tests need to be completed (Ans- Annual ETT and imaging stress test if indicated What is the maximum certification period for driver with heart failure who is asymptomatic, has ETT >6 METS and LVEF >/40% (Ans- 1 year Heart failure disqualifications are: (Ans- Symptomatic, asymptomatic with LVEF [Show Less]
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NRCME Test Questions & Answers: Updated Guide Solution
What minimum PaO2 level is necessary if the driver has an ABG due to a chronic respiratory disorder? a.70mmHg b.55mmHg c.60mmHg d.65mmHg (- Correct a... [Show More] nswer is "D". To be qualified, the driver should meet a minimum arterial blood gas (PaO2) greater than 65. A driver first perceives a whispered voice at 5 feet in his right ear and 4 feet in his left ear. All other aspects of his physical examination are unremarkable. The examiner should: a.Permanently disqualify the driver because he "failed" the whispered voice test. b.Certify the driver for 2 years. c.Certify the driver for 1 year. d.Require an audiometric test to determine the extent of hearing loss in his left ear. (- Correct answer is "B". The driver is qualified to drive without restriction as long as he is able to perceive a whispered voice at 5 feet in 1 ear. A driver reports for an examination 6 weeks after suffering a mild heart attack and presents a note from his cardiologist stating that he is able to return to work immediately without restriction. Included within the note, the cardiologist provides recent testing information showing that the driver had an ETT that showed he was able to reach 12 METS during the test. His echocardiogram showed an ejection fraction of 65%. The examination of the driver is unremarkable. The examiner should: a. Temporarily disqualify the driver. b. Qualify the driver for 1 year. c. Qualify the driver for 2 years. d. Consult with the cardiologist to determine if the driver suffers from angina. (- Correct answer is "A". The driver has not completed the required 2-monthwaiting period, but all other requirements for medical clearance and required testing have been met. The driver would be certified for 1 year at the completion of the waiting period. The date of the certification would be from the date of the original examination. A driver provides an audiometric test documenting the following: 1. 500 Hz: 2. 1000 HZ: 3. 2000 HZ: 4. 4000 Hz: 35 Right ear; 40 Left ear 40 Right ear; 45 Left ear 40 Right ear; 45 Left ear 50 Right ear; 50 Left ear 5. The medical examiner should: a. Disqualify the driver because he does not meet minimum hearing requirementsto drive. b. Certify the driver for 2years. c. Certify the driver for 1 year. d. Require the driver to obtain a hearing exemption. (- Correct answer is "B". The examiner would average the results from 500 Hz, 1000 Hz and 2000 Hz. This average is 38.33 in the Right and 43.33 in the Left ear. A driver must have an average hearing loss of less than or equal to 40 in the better ear. This does not have to be met in both ears. During the examination of a commercial driver, the examiner notices that the driver's peripheral vision is 70 degrees to the left and 80 degrees to the right. The examiner should: a. Qualify the driver for 2 years. b. Require the driver to obtain a vision exemption because of the limitation in the driver's left peripheral field. c. Disqualify the driver. d. Have the driver consult with an Ophthalmologist to determine if the driver's peripheral vision meets minimum standards. (- Correct answer is "A". A driver must exhibit a minimum peripheral vision of 70 degrees bilaterally. A driver admits to the use of marijuana for the treatment of his glaucoma, which is legal in the State in which he lives. He provides medical documentation for the glaucoma indicating he is able to drive a truck. He began using the marijuana about three months ago. His current medical card has no limitations listed and is for 2 years. His certification examination is within normal limits. The medical examiner should: a. Disqualify the driver. b. Perform a urine drug collection and provide the release from the testing provider. c. Certify the driver for 1 year. d. Certify the driver for 2 years. (- Correct answer is "A". Use of marijuana is prohibited by Federal law while driving a CMV and trumps State law in this matter. A driver has a blood pressure of 136/92 mm Hg. This is: a. Within normal limits and would not affect the driver's certification. b. Stage 1 Hypertension. c. Stage 2 Hypertension. d. Stage 3 Hypertension. (- Correct answer is "B". This is Stage 1 Hypertension, which is defined as 140-159/90 - 99. A driver is taking Celexa for the treatment of what he calls a "mild depression." He reports he has not considered or attempted suicide. The examiner should? a. Temporarily disqualify the driver until he obtains written clearance for the depression and the medication from the treating provi b. Certify the driver for a period of 1 year. c. Certify the driver for a period of 2 years. d. Disqualify the driver until he is no longer requiring medication for the treatment of depression. (- Correct answer is "A". Medical clearance is required for all mental health disorders. Celexa is an SSRI or 2nd Generation anti-depressant and is acceptable. A driver reports that he had a hunting accident wherein he suffered a left orbital fracture. He presents a note at the time of the examination from an ophthalmologist stating "may drive". His exam is unremarkable except for a limitation in peripheral vision in his left eye, which was inconclusive. His distance vision was 20/20 right and 20/40 left. The medical examiner should? a. Council the driver on the need for a vision exemption. b. Disqualify the driver pending vision exam to determine if it meets peripheral vision requirements. c. Certify the driver for 1 year. d. Certify the driver for 2 years. (- Correct answer is "B". The driver must have a peripheral vision of 70 degrees bilaterally to certify to drive a CMV. What minimum PaO2 level on an ABG performed for a chronic respiratory disorder is necessary to certify a commercial driver? a. 55 mm Hg. b. 60 mm Hg. c. 65 mm Hg. d. 70 mm Hg. (- Correct answer is "C". Blood oxygen saturation must be a minimum of 65 mm Hg for the driver to certify. A driver is taking Topamax for the treatment of migraine headaches. He reports good management of his headaches and they never seem to interfere with his driving ability with the medication. The medical examiner should? a. Obtain medical clearance for the condition and the medication. b. Disqualify the driver because he is taking an anti-seizure medication. c. Certify the driver for 1 year. d. Certify the driver for 2 years. (- Correct answer is "A". Topamax is a medication that is used for seizure control. The examiner should confirm with the prescribing provider that the driver does not take it to control seizures, and he is capable of driving a CMV. A 26 year-old driver presents for a first-time certification. He has a long-standing history of ADHD and is taking methylphenidate. You have verified his diagnosis and obtained clearance from his treating psychiatrist. As the certified examiner, you: a. Should disqualify the driver, explaining that use of such stimulants is cause for disqualification. b. May certify for a maximum of 6 months. c. May certify for a maximum of 12 months. d. May certify for a maximum of 2 years. (- c. May certify for a maximum of 12 months. A driver has a blood pressure of 168/112 mm Hg confirmed during the examination. The driver should be: a. Disqualified. b. Certified for 6 months. c. Certified for 1 year. d. Certified for 2 years. (- Correct answer is "A". This is Stage 3 hypertension. The driver is disqualified until his blood pressure is less than 140/90 mm Hg at which time he will have a maximum certification of 6 months. For how long would a driver be certified if he is taking Micardis HCT for hypertension, and has a confirmed blood pressure of 148/96 mm Hg at the time of the examination? a. 3 months b. 6 months c. 1 year d. 2 years (- Correct answer is "A". Because the driver has a history of hypertension (he is taking medication), and he had Stage 1 hypertension during his exam, he would be provided a 1- time, 3-month certificate in order to lower his blood pressure to an acceptable level during that time. During the examination, a driver is found to have a positive "Babinski" reflex. The examiner should: a. Certify the driver for 1 year. b. Certify the driver for 2 years. c. Council the driver to obtain an SPE. d. Disqualify the driver until s/he has a neurological consultation. (- Correct answer is "D". A positive Babinski reflex is indicative of abnormalities in the motor control pathways leading from the cerebral cortex and is widely used as a diagnostic aide in disorders of the central nervous system. The examiner should obtain clearance from a neurologist prior to reconsidering the driver for certification. All of the following are required components of all DOT medical examinations EXCEPT? a. Vision b. Hearing c. Blood Pressure d. Ophthalmoscopic examination (- Correct answer is "D". There are four required components of every examination: vision, hearing, blood pressure and urinalysis. Ophthalmoscopic examination is not required but may be done if deemed necessary. A driver reports in his history that he was treated for epilepsy 14 years ago but stopped taking anti-epileptic medication on his own since his move to your area 11 years ago. He has not seen a neurologist nor a health care provider in over 10 years and reports no seizures during this period. The examiner should: a. Request medical clearance, and if obtained the driver may be certified for 1 year. b. Request medical clearance, and if obtained the driver may be certified for 2 years. c. Refer the driver to the epilepsy/seizure exemption program. d. Disqualify the driver. (- D. Disqualify Comment: Even though the driver reports exceeding the 10-year waiting period, it was not under medical supervision and the driver discontinued medication use and treatment outside of medical oversight. Since the driver cannot a documented medical history this driver does not meet the non- discretionary epilepsy standard until it is established that the driver is 10 years seizure-free while off anti-convulsants. [Show Less]
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NRCME Prep Exam: NRCME Certification Exam Review: Questions & Answers
The minimum waiting period following PCI is: (Ans- 1 week The minimum waiting period after pacemaker implantation is: (Ans- 1 month The maximum t... [Show More] horacic aneurysm size allowable for certification is: (Ans- 3.5 cm After heart replacement surgery the minimum waiting period is: (Ans- 1 year After heart transplant surgery the maximum certification period is: (Ans- 6 months For mild aortic stenosis, how often should an echocardiogram be repeated? (Ans- 5 years For moderate aortic stenosis, how often should an echocardiogram be repeated? (Ans- 1-2 years What is the waiting period for pacemaker implantation related to syncope? (Ans- 3 months The waiting period following CABG is: (Ans- 3 months Anticoagulation for a cardiac condition may be certified up to: (Ans- 1 year Anticoagulation for a neurologic condition may be certified up to: (Ans- DO NOT CERTIFY What is the minimum LVEF for certification with respect to any cardiovascular condition? (Ans- >40% The minimum waiting period after surgical repair of an AAA is: (Ans- 3 months The maximum certification after surgical repair of an AAA is: (Ans- 1 year The maximum certification of a patient with CHF is: (Ans- 1 year Drivers should exercise to a minimum of ___ MET on stress test. (Ans- 6 MET For drivers on coumadin, how often should they have their INR rechecked? (Ans- monthly What is the waiting period for an implanted cardiac defibrillator? (Ans- NONE. DO NOT CERTIFY What is the waiting period for WPW with a fib? (Ans- NONE. DO NOT CERTIFY What is the waiting period for stable angina? (Ans- 3 months What is the waiting period following MI? (Ans- 2 months What is the waiting period for hypertrophic cardiomyopathy? (Ans- NONE. DO NOT CERTIFY How often should a patient go for ETT following an MI? (Ans- 2 years How often should a patient go for ETT following PCI? (Ans- 3-6 months following procedure and 2 years thereafter How often should a patient go for ETT following CABG? (Ans- 5 years after procedure, and annually thereafter Abdominal aneurysms greater than ___ cm are disqualifying (Ans- 5 cm The maximum period any driver with a cardiovascular condition should be certified is: (Ans- 1 year How long can a driver with stable angina be certified for? (Ans- 1 year An increase in what aneurysm size over a 6 month period is disqualifying? (Ans- 0.5 cm What is the waiting period following a pulmonary embolism? (Ans- 3 months What is the maximum certification for a driver following AV valve surgery? (Ans- 1 year Drivers with IDDM must present glucose monitoring for how long to their treating clinician? (Ans- 3 months What is the maximum certification for a driver with peripheral neuropathy? (Ans- NONE. DO NOT CERTIFY What is the maximum certification for a driver with non-insulin dependent diabetes? (Ans- 1 year If glucose is detected on UA, what is the appropriate next step? (Ans- Blood glucose level How does the FMCA define severe hypoglycemia? (Ans- episode involving coma, seizure, loss of consciousness, or requiring assistance from another person. What is the maximum certification interval for a driver with nephropathy? (Ans- 2 years What must be included on a driver urinalysis? (Ans- specific gravity, protein, blood, and glucose What is the maximum certification for drivers with a history of marijuana use, or a drug test positive for marijuana? (Ans- Marijuana use is disqualifying. Drivers must undergo a substance abuse medical assessment and any associated rehab. Marijuana is a schedule ___ drug. (Ans- Schedule 1 How may a driver with a history of alcoholism be certified? (Ans- Completion of counseling/treatment and not with any alcohol related disorders A breath alcohol level of ___ renders a driver disqualified. (Ans- 0.02% [Show Less]
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NRCME DOT Examiner Test Practice Questions & Answers: NRCME DOT Examiner Test
According to FMCSA regulations, which of the following must the medical examiner evaluate when examining a driver's eyes? A. Pupil reactivity B. Iris sym... [Show More] metry C. Conjunctival injection D. Corneal thickness (- Correct Response: A. Pupil reactivity Incorrect Responses: B. Iris symmetry This is incorrect because determining iris symmetry is not required by FMCSA. C. Conjunctival injection This is incorrect because most causes of conjunctival injection would not be disqualifying. Causes that are suspicious for a disqualifying condition need additional evaluation. While this abnormal finding should be explained, with determination of possible effects on safe driving before making a certification decision, it is not a condition that is specified in FMCSA regulations. D. Corneal thickness This is incorrect because it is not measured in an office examination except by an eye specialist. According to FMCSA regulations, medical qualification for two years can be given to a driver who has... ? A. An SPE certificate for a left below the knee amputation (BKA). B. Hypertension. C. A recent diagnosis of Lewy body dementia. D. Documented medical marijuana use for pain control. (- Correct Response: A. An SPE certificate for a left below the knee amputation. This is the correct response because in order to obtain the SPE certificate, the driver had to demonstrate the ability to perform all tasks for the commercial driver job description. Incorrect Responses: B. Hypertension. This is not the correct response because drivers with hypertension are only given a medical certificate that is good for one year. C. A recent diagnosis of Lewy body dementia. This is not the correct response because this is a progressive, degenerative condition with no known treatment. The effects of Lewy body dementia impact the ability to operate a CMV safely. D. Documented medical marijuana use for pain control. This is not the correct response because marijuana remains a drug listed in Schedule I of the Controlled Substances Act. It remains unacceptable for any safety-sensitive employee subject to drug testing under the drug testing regulations of DOT to use marijuana. Also, FMCSA medical guidelines state that "driving impairment due to marijuana use is well substantiated." During his visit to the medical examiner, a driver complains of severe pain in his finger for the last two weeks after it was punctured. The examination reveals an infected, swollen finger. After the medical examiner inquiries, the driver states that the pain is made worse when he grips the steering wheel. Which of the following should the medical examiner do next? A. Obtain a hand X-ray. B. Assess capillary refill in the hand. C. Obtain a culture and sensitivity. D. Assess the driver's grip strength. (- Correct Response: D. Assess the driver's grip strength. This is the correct response because the condition does not present a safety risk unless it interferes with the ability of the driver to hold and control the steering wheel. Incorrect Responses: A. Obtain a hand X-ray. This is not the correct response because this is a diagnostic test that a healthcare provider or specialist would perform or order. Your role as a medical examiner is to determine if the condition interferes with the ability of the driver to safely operate a CMV. B. Assess capillary refill in the hand. This is not the correct response because given the information in the question it is not the primary consideration for determining if the driver can safely operate a CMV. C. Obtain a culture and sensitivity. This is not the correct response because this is an action that a treating healthcare provider or specialist would do in the course workup and treatment- Your role as a medical examiner is to determine if the condition interferes with the ability of the driver to safely operate a CMV. A new driver who had a myocardial infarction six months ago is certified after completing an acceptable exercise tolerance test and is cleared by a cardiologist. According to FMCSA guidelines, which of the following is recommended regarding recertification and exercise tolerance test monitoring intervals? Recertification / Exercise tolerance A. Every year / Every year B. Every two years / Every year C. Every year / Every two years D. Every two years / Every two years (- Correct Response: C. Every year / Every two years This is the correct response because according to FMCSA medical guidelines, when a myocardial infarction is part of the medical history, there is a significant increased risk for another myocardial infarction to occur within six months to a year; therefore, a maximum of one-year certification is the guideline. Myocardial infarction guidelines also recommend exercise tolerance testing at least every two years to demonstrate continued ability to safely operate a CMV. [Show Less]
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Comprehensive Review for NRCME Exam: NRCME DOT Comprehensive Review Exam
Corrective lenses that are prohibited by the FMCSA, including: (Ans- lenses that correct distance vision in one eye and near vision in the other. teles... [Show More] copic lenses Medical guidelines for the driver with diabetes mellitus include: (Ans- Annual medical examination. Annual ophthalmologist or optometrist eye evaluation. Disqualification for a diagnosis of unstable proliferative retinopathy. Monocular Vision (Ans- Monocular vision is disqualifying. However, the driver who has monocular vision that with the better eye meets all vision qualification requirements may be considered for a Federal Vision Exemption if the Medical Examiner finds the driver otherwise medically fit for duty. Monocular vision is defined as vision that is at least 20/40 for distance in one eye with or without correction and vision that is less than 20/40 for distance in one eye with or without correction. The driver must meet other vision requirements in each eye, including visual fields (horizontal field of vision). Federal Vision Exemption: the driver with monocular vision who is applying for or has a federal exemption or is qualified by operation of 49 CFR 391.64 must have an annual physical examination. Drivers with vision loss who meet standards may be certified for up to two years. A driver who wears contact lenses which correct farsightedness in one eye and nearsightedness in the other, but has no other visual impairments can be certified under what additional conditions? Only if the driver wears prescription glasses which provide the same correction as the contact lenses. FMCSA guidance indicates that a driver should not be certified under these circumstances. Only by federal exemption. The driver is always certifiable under these conditions. (Ans- FMCSA guidance indicates that a driver should not be certified under these circumstances. Explanation: FMCSA guidance indicates that contact lenses that correct one eye for distance and one eye for near vision are not acceptable. Guidance recommends not to certify with ear problem diagnoses of: (Ans- a) Uncontrolled vertigo. b) Ménière's disease. c) Nonfunctioning labyrinth. d) Nonfunctioning fistula. The medical examiner's role in the exemption process includes _________. Issuing the exemption. Issuing the prescription for the driver's contact lenses and/or glasses. Providing the driver with contact information for the Federal Vision Exemption Program. Assuring that the driver has peripheral vision of at least 110 degrees in each eye. (Ans- Providing the driver with contact information for the Federal Vision Exemption Program. Explanation: The medical examiner's role in the exemption process is limited to performing the driver examination and providing the driver with contact information for the FMCSA related to the exemption process. An audiometric test produces the following results: Left ear: 500 Hz, 35dB Loss; 1,000 Hz, 35 dB loss; 2,000 Hz 45 dB loss. Right ear: 500 Hz, 40 dB loss; 1,000 Hz, 45 dB loss; 2,000 40 dB loss. What is the certification? Certify for one year. Certify for two years. Do not certify. Certify only when accompanied by hearing aid. (Ans- Certify for two years. Explanation: Drivers with an average hearing loss of < 40 decibels averaged across 500, 1000, and 2000 Hz in the better ear may be certified for two years. What eye conditions must the medical examiner ask the driver about? Cataracts, color deficiencies, retinitis pigmentosa, aphakia, glaucoma. Lazy eye, cataracts, aphakia, floaters, retinopathy. Glaucoma, macular degeneration, retinitis pigmentosa, color deficiencies. Retinopathy, cataracts, aphakia, glaucoma, macular degeneration. (Ans- Retinopathy, cataracts, aphakia, glaucoma, macular degeneration. Explanation: These are the "ask about" vision conditions. The medical examiner may ask the driver about any eye conditions, but should ask the driver about these specified conditions. Which of the following drivers' tests meet hearing certification standards? Whisper test 4 feet right ear, 3 feet left ear. Whisper test 5 feet right ear with hearing aid, 3 feet left ear without hearing aid. Audiogram left 30/500 Hz, 40/1000 Hz, 60/2000 Hz; right 25/500 Hz, 35/1000 Hz, 80/2000 Hz. Audiogram left 35/500 Hz, 50/1000 Hz, 40/3000 Hz; right 35/500 Hz, 35/1000 Hz, 60/3000 Hz. (Ans- Whisper test 5 feet right ear with hearing aid, 3 feet left ear without hearing aid. Explanation: Whisper test results require 5 feet in at least one ear for passing, with or without a hearing aid. Audiometric testing results require an average of 40 dB loss in the better ear for results averaged across 500, 1000, and 2000 Hz. Although testing may be performed at 3000 Hz, results obtained are not used to determine whether the driver meets hearing requirements. A driver has loss of hearing in the better ear of 25 dB loss at 500 Hz, 40 dB loss at 1000 Hz, and 60 dB loss at 2000 Hz. With respect to the hearing requirement for medical certification, the driver __________. May be certified for one year. May be certified for two years. May not be certified. May be certified if examined by an otolaryngologist who is familiar with the CMV driving duties who certifies the driver as medically qualified to drive a CMV. (Ans- May not be certified. Explanation: An average hearing loss of 41.7 decibels averaged across 500, 1000, and 2000 Hz in the better ear is disqualifying. The driver should be referred to obtain a hearing aid and may be certified if the driver passes while wearing a hearing aid. A specialist cannot determine certification, and a specialist cannot override medical qualification standards such as the minimum hearing requirement. Which of the following is acceptable for a driver who wears a hearing aid? Testing of the driver's hearing is waived if the driver presents a letter from a qualified specialist. Testing of the driver's hearing may be performed by the medical examiner using audiometric testing equipment. Testing of the driver's hearing may be performed by an audiologist or otolaryngologist using specialized audiometric testing equipment. Testing of the driver's hearing may be performed at 1,000 Hz only. (Ans- Testing of the driver's hearing is waived if the driver presents a letter from a qualified specialist. Testing the hearing of a driver who wears a hearing aid may be accomplished in three ways: 1) whisper test, 2) audiometric testing by an otolaryngologist using specialized audiometric testing equipment, or 3) audiometric testing by an audiologist using specialized audiometric testing equipment. Audiometric testing is required to be conducted at 500 Hz, 1000 Hz, and 2000 Hz. Passing Requirements for Vision Tests (Ans- Corrective lenses, eye glasses and/or contact lenses may be used. Distance binocular acuity of at least 20/40 (Snellen) in each eye with or without corrective lenses. Field of vision of at least 70º in the horizontal meridian in each eye. Monocular vision - vision meeting requirements in only one eye - is disqualifying by regulation. The ability to recognize the colors of traffic signals and devices showing standard red, green, and amber. Contact lenses that correct vision in one eye for distance and the other eye for near are not acceptable. Results must be converted to Snellen values if another test is used. Measured in each eye individually and both eyes. Drivers who wear corrective lenses should be advised to carry spare glasses. In general, any vision condition, such as lazy eye, glaucoma, cataract, and others, is not disqualifying as long as the driver meets minimum vision testing parameters. FMCSA is (Ans- Federal Motor Carrier Safety Administration. Is overseen by the DOT. The FMCSA creates standards for driver examinations. Regulates Interstate commercial operations, including the driver. Many states use federal FMCSA standards to govern intrastate commercial operations, including the driver, but the FMCSA does not directly regulate any intrastate functions. a division of the US Department of Transportation (DOT). Conditions which are usually disqualifying, but for which qualification can be considered on a case-by-case basis include __________. Autonomic neuropathy. Methadone use. Monocular vision. Carpal tunnel syndrome. (Ans- Correct Answer: Autonomic neuropathy. Explanation: Methadone use and monocular vision are always disqualifying. Carpal tunnel syndrome is not usually disqualifying. A driver experienced a pneumothorax four weeks ago. The medical examiner tests the driver's respiratory function and the forced vital capacity (FVC) is 58% of predicted. What should the certification decision be? Do not certify pending additional testing. Certify for three months, pending driver follow up with personal physician and/or specialist. Certify one year. Certify two years. (Ans- Correct Answer: Do not certify pending additional testing. Explanation: The driver may not be certified until FVC is > 60% predicted or additional testing reveals acceptable respiratory parameters - e.g., pulse oximetry with O2 > 92%. Stage 1 Hypertension Two certification options: (Ans- One Year: recommend to certify for one year if it is the first examination at which the driver has blood pressure equivalent to Stage 1 hypertension, and the driver has no history of hypertension and does not use medication for blood pressure control. Three Months: recommend to certify for a three month certification if the driver has been given a one-year certificate for untreated Stage 1 hypertension in the past, whether or not the driver is taking medication to lower blood pressure. If the driver is on blood pressure medication, the medication should be well-tolerated with no side effects that could affect safe driving. Do not certify the driver with Stage 1 hypertension if the driver has been given a three-month certificate related to blood pressure within the past three months. Do not certify a driver with Stage 1 hypertension who has a history of Stage 3 hypertension (> 180/110). The driver with Stage 1 hypertension is at low risk for hypertension-related acute incapacitation. Recertification: Recertification examinations should be done annually thereafter, and driver BP should be at or below 140/90. If at recertification examination the driver with a history of Stage 1 hypertension has a BP greater than 140/90 but less than 180/110, certification may be extended for three months. The Medical Examiner should advise the driver: That the driver should follow-up with her/his primary care physician for consideration of hypertension treatment, About the nature of hypertension and the importance of hypertension as a risk factor for cardiovascular disease (CVD), and That failure to lower BP to 140/90 or less will render the driver medically unqualified for continued certification. That if blood pressure is uncontrolled at future examinations the driver may be temporarily disqualified. Which of the following is a requirement for a driver with a history of alcoholism to be certified? Complete driver certification examination. Successful treatment with naltrexone. Successfully completed counseling and/or treatment. Passed a drug test. (Ans- Correct Answer: Successfully completed counseling and/or treatment. Explanation: A driver certification examination is not a requirement for return to driving. Treatment with naltrexone is not required for driver certification for a driver with a history of alcoholism. Passing a drug test is not a requirement, although passing an alcohol test is a requirement. [Show Less]
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NRCME DOT Exam Review - NRCME Training Institute Material: Questions & Answers
What is the mission of FMCSA? (Ans- FMCSA is focused on reducing crashes, injuries, and fatalities involving large trucks and buses. Who and what does... [Show More] the FMCSA regulate? (Ans- Interstate commercial operation, including the driver, vehicle, motor carrier, and the transport of hazardous materials. Examples of CMV driver stress factors (Ans- Interruption of normal sleep, exercising, eating pattern, and access to social support networks resulting in fatigue, obesity, and or/alienation of affection. Environment that may have excessive vibration, noise, and extremes in temperature and or/adverse road or traffic conditions that can interfere with driver ability to recognize a driving hazard, cause temporary or permanent physical damage to sensory perception or affect driver behavior. Increased potential for injury and fatalities should there be a crash when driver is responsible for passenger safety or hazardous cargo. What are the differences between the medical standards and medical guidelines? (Ans- Regulations are law and are mandatory. The ME must use standards to determine interstate CMV driver medical fitness for duty. Medical guidelines are not regulatory and the ME may choose not to follow the medical guidance. In which regulations are the driver physical qualification standards and Medical Examiners cited? (Ans- Driver physical qualification standards are found in 49 CFR 391.41. ME responsibilities are found in 49 CFR 391.43 What objective tests and measurements are required as part of the driver physical examination? (Ans- Height & weight Vision Hearing BP & pulse Urinalysis (spec gravity, protein, blood, glucose) What are the possible outcomes of the driver physical examination? (Ans- Certification Disqualification Determination pending What date is used to determine medical examiners certificate expiration? (Ans- The date of the exam is used as the basis for certificate expiration, except when determination pending is chosen. When determination pending is chosen, if the driver returns with the necessary information prior to the expiration of the driver's current certificate and the driver is qualified based on that information provided, the date used for the basis of the certification timeframe is the date the driver returned with the necessary information. What is the ME certificate expiration date for the following drivers? A - Exam 4/16/2011, meets standards in 49 CFR 391.41, qualifies for 2 year certificate. B - Exam 4/16/2011, meets standards, but periodic monitoring required due to HTN, qualifies for 1 year certificate. C - Exam 4/16/2011, determination pending due to not having results of post-CABG stress test, pt returns and provides that info on 4/25/2011, driver is qualified for 1 year. D - Exam 4/16/2011, disqualified due to benign position vertigo on 3/15/2011, returned to ME for certification examination on 5/20/11. He has been asymptomatic since 3/11/2011. Qualified for two years. (Ans- A: 4/16/2013 B: 4/16/2012 C: 4/25/2012 D: 5/20/2013 Patient example: Karen, recertification exam 42 y/o female No health history, no medications. Vision acuity: right 20/20, left 20/30. Both 20/20. Horizontal field of vision Rt 80 degrees, Lt 80 degrees. Not corrected vision. No monocular vision. No hearing aids, Whisper test 5' bilaterally. N/A audiometric testing UA: spec grav 1.020, protein 1+, blood 4+, glucose neg. Hgb 12.4 BP 134/88, P 80, regular. PE: on 4th day of menses with heavy bleeding. Advised to consult PCP or GYN for eval of excessive bleeding that could lead to anemia, leading to fatigue that would affect her driving. (Ans- Two year certification - no disqualifying health history or PE abnormalities. Ask about medication use, including OTC medications. ME obtained hemoglobin testing based on PE findings. (not required) The ME should correctly note the body system in which there was an abnormal finding. The note reflects inquiry as to the affect on driving ability and is also supported by Hgb test results. ME also documented medical follow up advice. Who can perform the vision portion of the interstate CMV driver physical examination? (Ans- The certified ME, optometrist, or an opthalmologist. If the specialist provider performs the exam, they should complete and sign the provider's information on the report form and provide the results. To pass the interstate CMV driver vision exam, a visual acuity of ___/___corrected or uncorrected is required. (Ans- 20/40 on Snellen chart in each eye individually AND in both eyes combined. What eye conditions must the ME ask the driver about and if indicated, request specialist evaluation? (Ans- Retinopathy, cataracts, aphakia, glaucoma, and macular degeneration. Pt example: Mr. Brown, 48 y/o male. No current meds, injury 5 years ago. Hunting accident 2 years ago with facial trauma and left orbital fracture. Presented a "may drive" note from eye surgeon (dated 3 months prior to examination). Uncorrected vision, right eye 20/20. left eye 20/40. Both 20/20. Horizontal field of vision Right 80 degrees, left eye is inconclusive. No monocular vision. No hearing aids. Whisper test 5' bilaterally. N/A audiometric test. UA normal. BP 122/74, p 80, regular. (Ans- Exam findings: Left eye muscles do not move eye to the left, discussed disqualification pending eye exam by specialist. Explained the specialist will get precise visual field measurements. Provided driver with appropriate medical release and copy of medical exam report with vision section highlighted. Driver does not meet requirements. He is pending specialist vision exam. Diminished vision in left eye noted. Pt could be functionally monocular. [Show Less]
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