5 Feet - ANSWER-A CMV driver must perceive a forced whispered voice in the better eat at not less than ___ with or w/o a hearing aid
Audiogram -
... [Show More] ANSWER-This test is performed only when the Forced Whisper Test is failed in both ears
40 decibels - ANSWER-If tested by the use of an audiometric device, they must not have an AVERAGE hearing loss in the better ear greater than ____ at 500Hz, 1000Hz, and 2000Hz
One - ANSWER-___ ear and two eyes certifies!
Audiologist - ANSWER-A driver with a hearing aid usually must go to an ____ or a hearing aid center for audiometry testing
2 Years - ANSWER-How long can a driver who meets the hearing requirements in one ear be certified?
Acute and Peripheral Vesitbulopathy - ANSWER-Inflammation of the inner ear that causes a sudden onset of vertigo. This requires a 2 month waiting period.
Benign Positional Vertigo - ANSWER-This occurs when a small piece of bone-like calcium breaks free and floats inside the Eustachian tube sending confusing messages to your brain about your body's position. This requires a 2-month waiting period.
False - ANSWER-T/F It is OK to certify someone with Uncontrolled Vertigo, Meniere's Disease, Labrythine Fistula, or Non-Functioning Labryinthes
Meniere's Disease - ANSWER-An inner ear disorder that affects balance and hearing.
Labrythine Fistula - ANSWER-An abnormal opening in the bony capsule of the inner ear resulting in the leakage of the peri lymph from the semicircular canals of the middle ear.
Non-Functioning Labryinths - ANSWER-Loss of vestibular function in both Labryinths leading to characteristic dysfunction in vision and balance. These symptoms reflect how crucial our Labryinth sense is for generating proper reflexes so that we can see clearly when we are moving and not lose our balance when we are standing or walking.
Inner Ear - ANSWER-Another name for the Labryinth
Elevated Blood Pressure - ANSWER-1 or 2 readings greater than or equal to 140/90 on the same day
Hypertension - ANSWER-Two readings greater than or equal to 140/90 on consecutive exams on two different days
The examiner - ANSWER-Who should remeasure abnormal BP and or pulse rate or rhythm, especially if they are significant factors in determining certification?
Even with the Sternum or right atrium of the driver - ANSWER-When measuring a driver's BP they should sit in the chair for at least 5 min, back is supported, legs are uncrossed, and feet are touching the ground. Support the drivers arm at the elbow so the midpoint of the BP cuff is...
140-159/90-99 - ANSWER-Stage 1 HTN
1 year - ANSWER-How long can you certify someone who comes in for certification for the first time and has Stage 1 HTN?
1 year on BP meds - ANSWER-If someone with Stage 1 HTN comes into the clinic for recertification how long can you certify them for if they are on BP meds and their BP is less than 140/90?
1-2 years if not on any BP meds - ANSWER-If someone with Stage 1 HTN comes into the clinic for recertification how long can you certify them for if they are not on any BP meds?
1 time, 3 month certification card - ANSWER-If a patient with Stage 1 HTN comes in for recertification and their BP is 140-159/90-99 what type of certification would they receive?
1 year from the date of the of the complete exam - ANSWER-If a patient with Stage one HTN who comes back in for a 3-month recheck and their BP is <140/90 how long can they be certified for?
160-179/100-109 - ANSWER-What is Stage 2 HTN?
3 months - ANSWER-When does a person need to come back to be seen with Stage 2 HTN after their first exam for recertification?
1 year from the date of the complete exam - ANSWER-A person with Stage 2 HTN returns for their recheck exam after 3 months. How long can they be certified if their BP is <140/90 and they are on BP meds?
1-2 years from the date of the complete exam - ANSWER-A person with Stage 2 HTN returns for their recheck exam after 3 months. How long can they be certified if their BP is <140/90 and they are not on BP meds?
Providers discretion - ANSWER-A person with Stage 2 HTN returns for their recheck exam after 3 months. How long can they be certified if their BP is >140/90?
> 180/11 - ANSWER-Stage 3 HTN
Disqualified - ANSWER-If a person comes in for an exam and their BP is 180/110 then they should be ...?
Certify for 6 months with recertification every six months - ANSWER-Stage 3 HTN patient returns for a recheck. How long can they be certified and how often should they be recertified?
The patient should be disqualified. - ANSWER-What should happen if a Stage 3 HTN patient comes in for a recheck and their BP is greater than 140/90??
One Time 3 month card - ANSWER-This certificate is included in the annual certification interval and is not an extension of the certification period. It can not be used in consecutive increments.
Drivers who must be tested for drugs and alcohol - ANSWER-Drivers who operate CMVs of 26,001 pounds or more, transport 16 or more passengers, or who carry placarded hazardous material on the public roadway -- All drivers operating CMVs in interstate commerce --- All drivers required to have a CDL
If they were in a testing program within the last 30 days and was tested within the last 6 months or a was a program for the previous 12 months - ANSWER-When is a driver exempt from Pre-Employment testing?
8 hours for ETOH and 32 hours for drugs - ANSWER-What is the time frames for ETOH and drug testing after a crash?
Post-Accident Testing - ANSWER-Testing that has to occur when the crash involves the loss of human life, the driver receives a citation within 8 hours of the accident, there is bodily injury to a person who immediately received medical treatment away from the scene, or if 1 or more MVs must be transported away by tow truck
6 drug tests within the first year - ANSWER-When a driver returns to duty after violating drug and ETOH standards, how many f/u drug and ETOH tests would they need in the first year of returning to driving?
Directly Observed Testing - ANSWER-Employee must raise shirt and lower underpants to mid-thigh to show no device is being worn during what kind of urine testing?
>2 drinks/day for men
>1 drink/day for women - ANSWER-Heavy drinking average for men and women?
Binge Drinking - ANSWER-A pattern of ETOH consumption that brings the Blood Alcohol Concentration (BAC) level to 0.08% or more in a 2-hour period - Men 5 or more drinks and Women 4 or more drinks
Alcohol Abuse - ANSWER-A pattern of drinking that results in harm to one's health, interpersonal relationships, or ability to work. Long term use can turn into dependence.
Alcohol Dependence - ANSWER-A chronic disease that includes a strong craving for ETOH despite repeated physical, psychological, or intepersonal problems; An inability to limit drinking
SAP (Substance Abuse Professional) - ANSWER-Evaluates employees who have violated DOT drug and ETOH regulations and makes recommendations concerning education, treatment, F/U testing, and aftercare
MRO (Medical Review Officer) - ANSWER-Licensed MD responsible for receiving and reviewing labs generated by a drug testing program, contacts the user when there is a positive result for an interview to determine if there is an alternate explanation for drug findings in the urine specimen
DER (Designated Employee Representative) - ANSWER-Individual who receives communications and test results from service agents, authorized to take immediate action to remove employees from safety sensitive duties, and to make required decisions in the testing and evaluation process-- Must be an employee of the company
Alcoholism - ANSWER-When in remission, _____ is not disabling unless transient or permanent neurological changes have occurred
- ANSWER-REVIEW MEDICATIONS AND IF THEY ARE SAFE FOR CMV DRIVERS
Normal Labs - ANSWER-A1C: 5%
Fasting Glucose: 99 or below
Oral GTT: 139 or Below
Prediabetes - ANSWER-A1C: 5.7-6.4%
Fasting Glucose: 100-125
Oral GTT: 140-199
Diabetes - ANSWER-A1C: 6.5% or greater
Fasting Glucose: 126 or above
Oral GTT: 200 or above
Type 1 DM - ANSWER-Lack of insulin production, must receive insulin, severely compromised counter-regulatory mechanisms
Type 2 DM - ANSWER-Adult Onset or Non-Insulin Taking, patient can produce insulin, treatment is diet and oral medication which preserves blood glucose mechanisms for years
If the driver takes insulin - ANSWER-Certification of a CMV driver with diabetes is based on what?
Macrovascular Disease - ANSWER-Accelerated atherosclerosis of coronary, cerebral, and peripheral vessels, higher risk for cardiovascular disease, can cause TIA or stroke, leading cause of death among diabetics
Microvascular Disease - ANSWER-Neuropathy, Nephropathy, Retinopathy, Macular Degeneration
Neuropathy - ANSWER-Disturbance in sensation and touch, loss of position sense, loss of vibratory sense, autonomic neuropathy
Symptoms of Acute Hyperglycemia - ANSWER-Fatigue, lethargy, sluggishness, transient cognitive disruption; Sudden onset unlikely; May begin around 280-300% but is more likely with a sustained plasma glucose of greater than 400%
>10% - ANSWER-The FMCSA Medical Examiner Handbook states that a Hgb A1C of ____ (275%) indicates poor glucose control
Mild Hypoglycemia - ANSWER-Rapid heart rate, sweating, weakness, and hunger
Severe Hypoglycemia - ANSWER-Seizure, loss of consciousness, need of assistance from another person, period of impaired cognitive function without warning
Blood Glucose - ANSWER-When performing a UA... A MA detects glycosuria. What should be the test that she performs?
Glomerular Damage - ANSWER-Diabetics with excessive proteinuria may be indicative of what?
Annualy - ANSWER-How often should diabetics be recertified because of the progressive nature of DM and the potential for complications?
Transportation Equity Act of 1998 - ANSWER-The act revised the authority of the Secretary of Transportation to grant waivers or exemptions and established procedures for pilot exemption programs
SAFETEA-LU - ANSWER-This 2005 act eliminated the 3-year driving requirement of driving a CMV while on insulin, adopted new waiting periods
New Diabetic Waiting Periods because of the 2005 SAFETEA-LU - ANSWER-Minimum 1-month if the driver was previously diagnosed and treated with oral mess but now requires insulin
Minimum 2-months of the driver is newly diagnosed with no prior treatment and is now starting insulin
True - ANSWER-There are no specific FMCSA guidelines regarding meeting musculoskeletal tasks of lifting, pushing, pulling, and bending
Skill Performance Evaluation - ANSWER-If a driver has limitations in extremity movement the medical examiner can send the driver for an on-road performance eval or a...?
L3-L4 (Nerve Root L4) - ANSWER-Motor Weakness: Extension of Quadriceps
Screening Exam: Squat and Rise
Reflexes: Knee Jerk Diminished
L4-L5 (Nerve Root 5) - ANSWER-Motor Weakness: Dorsiflexion of the Great Toe and Foot
Screening Exam: Heel Walking
Reflexes: None Reliable
L5-S1 (Nerve Root S1) - ANSWER-Motor Weakness: Plantar flexion of the great toe and foot
Screening Exam: Walking on toes
Reflexes: Ankle
jerk diminished
- ANSWER-This is a one-time driving examination by the FMCSA so it is not appropriate for a progressive or fluctuating limb disorder; Formerly called the Limb Waiver; Allows a person with the loss of an extremity (wrist up or ankle up) or with a fixed musculoskeletal impairment to be certified to drive a CMV; This loss can be more anatomically distal if the examiner determines that it impairs the ability to drive safely
Vision Standard - ANSWER-Physically qualified to drive a CMV if a distant visual acuity of 20/40 in each eye w/ or w/0 corrective lenses or visual acuity separately corrected to 20/40 or better with corrective lenses AND distant binocular acuity of 20/40 in both eye w/ or w/o corrective lenses AND a field of vision at least 70 degrees AND the ability to recognize the colors of traffic control signals and devices showing standard red, green, and amber
Retinopathy - ANSWER-Due to persistent or acute damage to the retina of the eye; Ongoing inflammation and vascular remodeling may occur over periods of time where someone is not aware of the extent of the disease; Usually any ocular manifestation of systemic disease
Cataracts - ANSWER-The most common cause of blindness. It is a clouding of the lens inside the eye which leads to a decrease in vision. Can be corrected with surgery.
Aphakia - ANSWER-The absence of the lens of the eye due to surgical removal. Without the focusing power of the lens the eye becomes very far sighted. This can be corrected by wearing glasses, contact lenses, or implanting an artificial lens.
Glaucoma - ANSWER-A term describing a group of ocular eye disorders that damage the optic nerve often associated with increased fluid pressure in the eye. It affects vision by decreasing the visual field by first affecting the peripheral vision and then potentially leading to blindness.
Macular Degeneration - ANSWER-This usually affects older adults and causes a loss of vision in the center of the visual field due to damage of the retina. It can make it difficult or impossible to read or recognize faces, although enough peripheral vision remains to allow other ADL
Distant Visual Acuity
Peripheral Vision along the horizontal meridian in each eye
Color vision - ANSWER-Required vision tests
An eye specialist - ANSWER-If a driver has an inconclusive vision test, the next step should be to refer them to...?
Glaucoma - ANSWER-Causes a progressive decrease in peripheral vision
Cataracts - ANSWER-Diminished visual acuity, contrast, and color resolution; also causes increased glare
Macular Degeneration - ANSWER-Leading cause of untreatable blindness in the US, Affects the central vision
Retinopathy - ANSWER-DM is the most common cause; Can affect central vision, contrast sensitivity, and color discrimination.
2 eyes - ANSWER-1 ear, _____ certifies! Max certification is one year.
No - ANSWER-Can someone be certified if they have contact lenses that correct distant acuity in one eye and near acuity in another eye?
Monocular Vision - ANSWER-Vision in one eye; In low illumination or glare it can cause deficiencies in contrast, recognition, and depth perception compared to binocular vision
Vision Exemption - ANSWER-Allows drivers with monocular vision to operate a CMV - Should be recertified annually
Transient Ischemic Attack - ANSWER-Focal neurological dysfunction, lasts > than a few seconds but less than 30-40 min
1 year - ANSWER-Waiting period after TIA
1 year - ANSWER-Max certification for someone with TIA
Thrombotic Stroke - ANSWER-Most common cause of stroke ages 45-65, caused by large artery atherosclerosis, often preceded by TIA; Treatment: Medical: Antiplatelet agents Surgical: Carotid Endardectomy
Embolism Stroke - ANSWER-The heart is usually the source of the embolus, prognosis often worse than thrombotic stroke because of larger stroke area and an increased incidence of blood at the stroke site; Treatment: Medical- Coumadin, Requires INR monitoring, Increased Bleeding Risks
1 year if the driver is not at risk for seizures - ANSWER-Waiting period after a stroke
Intracerebral Hemorrhage - ANSWER-Bleeding into the substance of the brain, Caused by ruptured arteriovenous malformation, there are also other causes as well
Subarachnoid Hemorrhage - ANSWER-Bleeding primarily in the space around the brain; often from a ruptured aneurysm
1 year; No additional time if no increased seizure risk and not on any anti-seizure meds - ANSWER-Waiting period for cerebellum or brain stem stroke
Cortical or Subcortical Stroke waiting period - ANSWER-1 year for stroke plus an additional 4 years if there is a seizure risk; Must be seizure free and off meds for 5 years but this waiting period may be shortened after consultation
Requires an individual assessment - ANSWER-Loss of position sense with peripheral neuropathies is disqualifying but loss of sensation...
Peripheral Neuropathies - ANSWER-Hereditary or aquired conditions that affect nerves, including the axon, myelin, or the myelin outside the spinal cord; common complication of DM
Seizure free and off anticonvulsants for 10 years - ANSWER-If a clinician chooses to certify a driver with an established medical history of epilepsy the driver must be...
Epilepsy - ANSWER-Two or more unprovoked seizures
- ANSWER-Minimum 5 years seizure free and off anti-convulsants meds; Requires annual recertification and biennial medical examination
Severe Head Injury - ANSWER-Dural penetration, loss of consciousness for >24 hours, with or without a prior history of seizures the risk of unprovoked seizures does not decrease over time, driver should not be considered for certification.
Moderate Head Injury - ANSWER-No Dural penetration, loss of consciousness >30 min but <24 hours, 5 years waiting period off of anticonvulsants and seizure free if there were early seizures, 2 year waiting period if there was no early seizure, Max certification = 1 year
Mild Head Injury - ANSWER-No Dural penetration, loss of consciousness <30 minutes, waiting period 2 years if there was an early seizure, max 1 year certification, No seizure = No waiting period; Max certification = 2 years
10 years - ANSWER-Waiting period for History of Epilepsy and Viral Encephalitis with an Early Seizure
5 Years - ANSWER-Waiting period for Single, unprovoked seizure, Bacterial meningitis with early seizures, Moderate TBI with early seizures, Stroke with risks of seizures, intracerebral or subarachnoid hemorrhage with risk for seizure
2 year waiting period - ANSWER-Waiting period for Seizure with acute structural insult to the brain, Moderate TBI without early seizure, Surgically removed supratentorial or spinal tumor
1 year waiting period - ANSWER-Waiting period for TIA, stroke, intracerebral or subarachnoid hemorrhage with no risk for seizure, Surgically repaired arteriovenous malformation/aneurysm with no risk for seizure, Surgically removed infratentorial meningioma, acoustic neuromas, pituitary adenomas, benign spinal tumors, or other benign extra-ataxial tumor with no risk for seizures
Excessive daytime sleepiness - ANSWER-Sleepiness when an individual is supposed to be awake and alert, Daily or almost daily for 3 months or greater
Mallampati Score of 3 or 4 - ANSWER-A risk factor for OSA... Upper airway narrowing; This standardizes the assessment of the oropharynx
Annually - ANSWER-Any driver with a neurological defecit that requires special evaluation and screening should have a medical certification how often?
Transient Ischemic Attack (TIA) - ANSWER-Focal Neurological Dysfunction in which there is inadequate blood supply to a portion of the brain; Usually last a few sections but usually less than 30-40 minutes
1 Year - ANSWER-How long is the waiting period for someone who has had a TIA?
Annual Certification - ANSWER-How often should someone be recertified if they have a history of TIA?
Thrombotic Stroke - ANSWER-Caused by large artery atherlosclerosis, often preceded by TIA; Treatment: Antiplatelet agents (Aspirin, Plavix) and Surgical: Carotid Endarterectomy
Embolic Stroke - ANSWER-The heart is usually the source; This prognosis is usually worse than the thrombotic stroke because the emboli is larger, a larger stroke area, and there in increased incidence of blood at the stroke site; Treatment: Medical - Coumadin, Requires INR Monitoring, Increases bleeding risks
Intracerebral Hemorrhage - ANSWER-Bleeding into the substance of the brain, caused by ruptered arteriovenous malformation (AVM)
Subarachnoid Hemorrhage - ANSWER-Bleeding primarily into the space around the brain, often from a ruptured aneurysm
- ANSWER-WHAT IS THE WAITING PERIOD FOR THROMBOTIC AND EMBOLIC STROKE
Cortical or Subcortical Stroke - ANSWER-1 year for the stroke plus an additional 4 years if there is a seizure risk; Must be seizure-free and off anticonvulsant meds for 5 years; may shorten waiting periods after consultation with an expert in epilepsy
Epilepsy - ANSWER-Two or more unprovoked seizures
Off all seizure meds, Seizure free for 1o years, has a neuro clearance - ANSWER-A clinician can only certify drivers with an established hx of epilepsy if:
5 years seizure free and off of anticonvulsants - ANSWER-Minimum waiting period after a single, unprovoked seizure
Excessive Daytime Sleepiness - ANSWER-Sleepiness when the individual is expected to be awake and alert; Daily or almost daily for nearly 3 months or greater
OSA, Narcolepsy, Restless Leg Syndrome - ANSWER-3 Primary Sleep Disorders
OSA (Obstructive Sleep Apnea) - ANSWER-The most common sleep disorder that causes Excessive Daytime Sleepiness
Apnea Hypopnea Index (AHI) - ANSWER-This index and the blood oxygen saturation determines the severity of the Obstructive Sleep Apnea
Mallampati Score - ANSWER-This score standardizes the assessment of the oropharynx
A score of 3 or 4 - ANSWER-A Mallampati Score of what standardizes the assessment of the oropharynx
Chronic Snoring - ANSWER-A hallmark of OSA but a poor predictor because of the prevelance in the general population
Witnessed apneas or breathing pauses during a sleep study - ANSWER-A good predictor of OSA but not its severity; 6% of the population without OSA experience this during sleep
Men >17" and Women >16" - ANSWER-Measurement of neck size in men or women that is a predictor of OSA
Neck circumference - ANSWER-In men with the a BMI >40 what is the greatest predictor of OSA severity?
20" - ANSWER-A neck circumference of ___ indicates high risk of OSA
Disqualified - ANSWER-Epworth Sleepiness Scale of 16 or higher
Grant a limited-time certification (Typically around 30 days) - ANSWER-A driver presents with suspected OSA. What can the provider give them while awaiting a sleep study?
Full, Attended Polysomnography - ANSWER-> or = to 7 channels in a lab setting, gold standard, diagnoses all sleep disorders, this is required when the examiner suspects another sleep disorder in addition to sleep apnea
Full, Unattended Polysomnography - ANSWER-> or = to 7 channels
Type 3 or 4 - ANSWER-Home sleep tests use what type of tests? Limited channel devices and usually uses oximetry as a parameter
Maintenance of Wakefullness Test - ANSWER-A test based on staying awake as an indicator of a sleep disorder or of treatment effectiveness
Multiple Sleep Latency Tests - ANSWER-A test based on going to sleep as an indicator of a sleep disorder or of treatment effectiveness
Apnea - ANSWER-Airflow ceases for 10 or more seconds
Hypopnea - ANSWER-Airflow decreases for 10 or more seconds
Apnea/Hypopnea Index - ANSWER-Mild: 5+ Episodes/Hour
Moderate: 15+ Episodes/Hour
Severe: 30+ Episodes/Hour
Airflow ceases while effort to breathe continues followed by arousal after airflow resumes - ANSWER-Polysomonogram shows what happens when
20 - ANSWER-An AHI >___/hour needs treatment
Disqualifying - ANSWER-A sleep study diagnostic for OSA that requires treatment is ____ until treatment is documented
At least 4 hours/night for 70% of nights - ANSWER-PAP compliance is
1 month - ANSWER-According to the FMCSA how long should you wait to certify after patient starts PAP?
Dental Appliances - ANSWER-The use of ___ ___ cannot be considered an acceptable alternative in treating OSA
3 month certification - ANSWER-If a driver is PAP compliant at one month, how long of a certification can they be issued?
1 year certification - ANSWER-If a driver is PAP compliant at 3 months, how long of a certification can they be issued?
35 - ANSWER-A BMI of ____ requires a sleep study according to the FMCSA
Bariatric Surgery - ANSWER-Usually requires 6 months or more to lose weight, may use CPAP until there is adequate weight loss to treat OSA, requires annual certification, reevaluate if there is a 5% weight gain or symptoms recur
Oropharyngeal UPPP - ANSWER-This surgery removes tissue in the throat, 1 month waiting period, annual recertification is required, 50% failure rate
Tracheostomy - ANSWER-Driver sees examiner 1-month post-op, no excessive sleepiness, annual recertification is required
Limited Certification - ANSWER-A ___ ___ can be granted to someone who had an OSA dx, claims compliance, but does not have a co p,iance report [Show Less]