1. Fatigue is a major concern. What do current FMCSA regulations allow from drivers?
2. driver presents with a heart attack 1 month previous. He is
... [Show More] following up with his MD again in 1 week. He is unsure of his pre- scriptions, but is asymptomatic. Should he be certified today?
3. Driver has been trying to stop smoking for 10 years without success. 1 month ago, she began taking Chantix. She reports no black- out, suicidal thoughts, or change in mood. The rest of the exam is normal. Can she be qualified?
4. Which of the following diagnoses is NOT always disqualifying? (narcolepsy, type 1 diabetes, meniere's disease, current alco- holism, bipolar disorder)
5. when asked about seizures, a driver reports several febrile seizures as a young child. Is this disqualifying?
60 hours on the road over a 7 day period, or 70 hours over 8 days (also 14 hours on the road at a stretch if given 8 hours off to rest between)
No. There is a minimum wait- ing period of 2 months and specific criteria that must be met thereafter before certifi- cation
No. Chantix is diqualifying
bipolar disorder
No.
6. What does the acronym FMCSA stand for? Federal motor carrier safety
administration
7. What is NOT a mission of the FMCSA?
-develop and enforce data-driven regula- tions that balance motor carrier (truck and bus companies) safety with industry effi- ciency
-target educational messages to carriers, commercial drivers, and the public
-partner with stakeholders including feder-
oversee the prosecution of criminally negligent cases of motor carrier safety breach- es
al, 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 negli- gent cases of motor carrier safety breaches
8. who is NOT eligible to be a medical examin- er? (APNs, DC, MD, PharmD, DO, PA, PT)
9. 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
10. what is ensured as a part of the NRCME's medical oversight mission?
-individuals performing medical examina- tions 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 re- viewed
-medical certification regulations are updat- ed periodically
-a review process that prevents or identifies and corrects the inappropriate issuance of medical certification
-all of the above
pharmacists and PTs can- not be medical examiners as they do not have the train- ing, scope of practice, or li- censure that allows them to diagnose
-assess the driver for med- ical fitness to safely perform all driver duties
-ensure the driver is properly following up on any poten- tially dangerous conditions
-council the driver on
health conditions and conse- quences
all of the above
11. 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 per- son, more than 2 medical conditions, cardio- vascular disease prevalent)
12. 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
13. fatigue is a major concern. what do current FMCSA regulations allow from drivers?
14. the motor carrier is required to make sure
between 25 and 39 years of age- the average driver is more than 40 years of age
social sills to act kindly to in- terpersonal activities on the road- mental and physical abilities are required (social skills are not unless their ab- sence indicates mental ill- ness)
60 hours on the road over a 7 day period, or 70 hours over 8 days
provide their full medical ex-
drivers meet certain requirements. EXCEPT aminer's report (long form)
which of the following, the driver must:
-be at least 21 years old
-speak and read English well enough to un- derstand highway/traffic signals and con- verse
-have a current medical examiner's certifi- cate on file
-provide their full medical examiner's report (long form) to the motor carrier
-have provided the motor carrier with re- quired background and violations informa- tion
-have successfully completed a driver's road test or equivalent
to the motor carrier
15. what should be done if the driver presents for his/her exam without a government is- sued ID?
16. for any affirmative response on the health history section, what are reasonable follow ups?
-ask about history, diagnosis, treatment, and response to treatment
-explore underlying cause, precipitating events, and other pertinent facts
-obtain additional tests or consultations, as necessary, to adequately assess medical fit- ness
-review and discuss driver response to treatment and medications currently or re- cently used
-all of the above
17. in addition to asking the driver about any affirmatives in the health history section, which of the following should be asked about every time?
-any past hospitalizations or surgeries
-any recent changes in health status
-any medical conditions or current com- plaints
-incidents of disability/physical limitations
-whether they smoke
-all of the above
18. the driver presents with a previous diagno- sis of type 2 diabetes. it is controlled by metformin, but not insulin. what is the max-
reschedule the appointment and have them return with their ID (you are responsi- ble to make sure (via govern- ment issued photo ID) that this is the real driver- not a stand in)
all of the above
all of the above
1 year
imum time period he should be given for certification?
19. driver presents with a type 2 diabetes diag- nosis. he has controlled it for 10 years with oral medication. he brings his most recent lab work from 2 months previous. A1c is at 7.3%. what is normal HbA1c?
20. driver presents with a type 2 diabetes diag- nosis. he has controlled it for 10 years with oral medication. he brings his most recent lab work from 2 months previous. A1c is at 7.3%. what is the level of HbA1c for diabetes diagnosis?
21. driver presents with a type 2 diabetes diag- nosis. he has controlled it for 10 years with oral medication. he brings his most recent lab work from 2 months previous. A1c is at 7.3%. what is the target range of HbA1c for those with a diabetes diagnosis?
22. driver presents with a type 2 diabetes diag- nosis. he has controlled it for 10 years with oral medication. he brings his most recent lab work from 2 months previous. A1c is at 7.3%. In this case, what would be an appro- priate action?
-certify for 2 years
-certify for 1 year and discuss glucose con- trol, diet, prognosis, etc.
-temporarily defer decision or give a 1-month certification. contact treating
physician regarding insulin control before deciding on further action
-disqualify
23. a driver presents with an 8 year history of type 2 diabetes mellitus. he reports that he
4 to 6.0%
>6.5%
<7%
-certify for 1 year and dis- cuss glucose control, diet, prognosis, etc.
-temporarily defer decision or give a 1-month certifica- tion. contact treating physi- cian regarding insulin con- trol before deciding on fur- ther action
disqualify for 6 month waiting period. call employer. refer
has not changed his diet nor activity level. he moved 9 months ago and has not found a new treating physician since. weight is 325 lbs and height is 72 inches. BMI = 44.1. there is a significant amount of glucose in his urine. A1c is ordered and found to be
15.4. Driver doesn't seem concerned. What do you do?
24. once a diabetic driver has to take insulin to control his blood sugar, how long should his re-certification period be to make sure he is stable and controlling the disease?
25. a driver presents for her first DOT med- ical exam. she is 48 years old and starting truck-driving school as a second career. she has no previous diagnosis of HTN, but BP today is 176/124. she is obese. what time period is appropriate for certification?
26. a driver presents with a BP of 118/72. pulse
directly to an endocrinologist for a new treatment plan. dis- cuss the seriousness of the situation
this is an absolute disqualifi- er. he can no longer be cer- tified without a waiver
disqualify. refer for treatment. re-check after 6 month wait
yes. he is stable and off his
is 66. he previously was on HTN medication, Rx. this is at the discretion of
but stopped taking it 6 months ago. in the last year, he lost 55 pounds, stopped smok- ing, and began exercising regularly. can he be given a 2 year card?
27. driver has no previous diagnosis of HTN. today his BP is 146/88. all else is clear. what certificate time should be given?
28. driver has been on HTN Rx for 3 years. he is inconsistent about taking his Rx. today BP is read at 146/96. what should be done?
the medical examiner
1 year
give 1 time certificate for 3 months. refer him back to his treating physician for imme- diate consultation on treat- ment options. discuss the consequences and council on diet, exercise, prognosis, etc.
29. which of the following should be considered for a sleep study (but given a certificate of up to 2 months to get the study done)?
-driver admits loud snoring and score of 13 on ESS
-BMI of 38 and neck circumference of 18 inches
-BMI of 40 and new diagnosis of HTN
-driver falls asleep during the exam
-previous diagnosis and CPAP, but non-compliant
-all of the above
-A and C
30. driver has been blind in 1 eye since a child- hood accident. he previously got his certifi- cate from his family doctor and always was certified for 2 years. what is the proper time period for certification?
31. 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 pre- scriptions, but is asymptomatic. should he be certified today?
32. driver had heart surgery 6 months ago. he reports recovering well and is asympto- matic. documentation from his MD shows he is indeed recovering well and tolerating his medication. surgery included installa- tion of an implantable cardioverter defibril- lator (ICD). can he be qualified today?
33. driver claims to be on no illegal drugs,
but he looks haggard and has fresh needle sticks on his forearm. can you order lab testing for drugs?
-driver admits loud snoring and score of 13 on ESS
-BMI of 38 and neck circum- ference of 18 inches
-BMI of 40 and new diagno- sis of HTN
D and E should be DIS- QUALIFIED and referred for evaluation. the others should be further evaluated
monocular vision is disquali- fying. driver may apply for an exemption (it is common that drivers have been improper- ly certified in the past)
no. there is a minimum wait- ing period of 2 months and specific criteria that must be met thereafter before certifi- cation.
no. an ICD is disqualifying
yes. this is outside of stan- dard DOT drug testing, but a non-DOT drug test can be ordered. refusal to test is a failure.
34. driver hears a forced whisper at 8 feet out of his right ear with no aid. he is deaf in his left ear. is this adequate?
35. driver is missing the distal half of his left 4th and 5th fingers. dynamometer shows grip strength to be a comparable to the right at 77 lbs. is this disqualifying?
36. driver tells you that he is red/green color- blind. he is unable to pick out the numbers
yes. hearing out of one ear at
>5 feet is adequate
it is up to your clinical judg- ment on the nature of his specific injury. this case is likely fine as grip strength is WNL.
yes. red, green, and amber are the only colors of con-
in an Ishihara color blindness test. however, cern. he may be fully quali-
he is able to identify red, green, and amber stoplights. does he meet vision standards?
37. which of the following is NOT a non-discre- tionary disqualifier? (epilepsy, insulin de- pendent diabetes, use of medical marijuana, hypertension)
38. driver has no glasses. her visual acuity is 20/20 with her left eye alone, 20/50 in her
fied. hypertension
temporarily disqualify. refer for vision correction. retest
right eye, and 20/30 with both eyes together. afterward.
what is the proper course of action?
39. driver is evasive when asked about alcohol use, but upon further pressing admits to drinking every day of the week, but not on the job. he has never been diagnosed as an alcoholic. what is a proper course of action?
-check for signs of alcoholism in exam. in- quire further using alcohol abuse question- naire.
-refer to a substance abuse professional or
-check for signs of alco- holism in exam. inquire fur- ther using alcohol abuse questionnaire.
-refer to a substance abuse professional or chemical de- pendency center for eval- uation. temporarily disquali- fy- possibly longer depend-
chemical dependency center for evaluation. ing on outcomes
temporarily disqualify- possibly longer de- pending on outcomes
-disqualify
-qualify. drinking is not affecting his job/safety
40. driver has been trying to stop smoking for 10 years without success. 1 month ago, she began taking Chantix. she reports no black- out, suicidal thoughts, or change in mood. the rest of the exam is normal. can she be qualified?
41. a morbidly obese driver comes for a DOT physical. he weighs 385 pounds and stands 5'10" (70 inches) tall. his BMI is 55.2. what BMI is considered "overweight"? "obese"?
42. a morbidly obese driver comes for a DOT physical. he weighs 385 pounds and stands 5'10" (70 inches) tall. his BMI is 55.2. what is the maximum allowable BMI to qualify?
43. BMI is a simple calculation for determining a person's thinness or thickness. it can be useful in discussing weight with patients. the DOT uses it as a screening tool for sleep apnea. in which case is the measurement most likely to be INaccurate.
-driver is generally sedentary. BMI is 29
-driver is also a body-builder. BMI is 36
44. driver has a long history of major depres- sion. his only current Rx is Paxil, and he reports no side effects. 3 months ago, he at- tempted to commit suicide by hanging, but was unsuccessful. physicially, all is within standards. can be be qualified?
-no. paxil is disqualifying
-not until consultation with his mental health professional.
-yes. this is not disqualifying
no. chantix is disqualifying
25-29.9 is overweight. 30+ is obese
there is no standard
driver is also a body-builder. BMI is 36. (although BMI is written as a measurement to be clinically used in the FM- CSA guidelines, but can be inaccurate- especially in ath- letes. it should not be the sole reason for a sleep study for OSA.
-not until consultation with his mental health profession- al
-no. the waiting period fol- lowing a suicide attempt is 1 year minimum
-yes. the waiting period following a suicide attempt is 2 months minimum
-no. the waiting period following a suicide attempt is 1 year minimum
45. driver's exam is unremarkable except for a history of panic attacks. these are under control with Xanax, and she reports no side effects. what certification is appropriate?
46. what is NOT a standard part of the thoracic exam portion? (heart and lung auscultation, inspection for asymmetry and scars, breast exam, palpation of spine for tenderness)
47. a 70 year old with emphysema presents for his exam. he reports shortness of breath, but controls it with an oxygen tank. mild cyanosis is noted in his lips. SpO2 reads 85% while resting and using his oxygen therapy. given this, should the gentleman be qualified?
-yes. this is not a concern to safely driving
-no. the tank is an explosion risk and may malfunction while on the road
-no. low oxygen levels will impair function in an emergency
-it may be considered if he can pass a pul- monary function test (PFT), but likely not
48. what is the minimum gross vehicle weight that will require a DOT medical exam for the driver?
xanax is now considered a disqualifier by the FMCSA. do not certify
breast exam
-no. the tank is an explo- sion risk and may malfunc- tion while on the road
-no. low oxygen levels will impair function in an emer- gency
10,001 pounds
49. drugs with no known medical use and a high schedule I
potential for abuse fall into what category?
50. what class of drugs is recommended to dis- qualify the driver due to increased risk of motor vehicle crash?
benzodiazepines
51. which of these prescribed drugs is NOT typ- ically disqualifying? (xanax (alprazolam), methadone, tagamet, fentanyl)
52. driver's onlly Rx is atenolol (tenormin). it is tolerated without side effects. how often should she be recertified?
53. driver is 35 years of age. he has a diagnosis of ankylosing spondylitis since he was 19. he has fusion throughout his spine- exclud- ing the upper cervical sine. neck rotation is limited to 15 bilaterally. his neck is perma- nently flexed 25 degrees forward and he can only extend it 10 degrees. agility is greatly diminished and he cannot climb well. based on this, what is the proper course of action?
54. TIAs (transient ischemic attacks) are a ma- jor concern. they can be one of the earli- est signs of cerebrovascular disease. symp- toms usually only last 10-20 minutes. all of the following are symptoms that may pre- sent in the history, except: (sudden tem- porary tingling, numbness, or weakness; confusion; sudden visual changes; severe headache- described as different than any past headache; sciatica)
55. TIAs (transient ischemic attacks) are a ma- jor concern. they can be one of the earli- est signs of cerebrovascular disease. symp- toms usually only last 10-20 minutes. a dri- ver with a history of TIAs should be removed
tagamet
-xanax is a benzodiazepine, methadone and fentanyl are both schedule II drugs, taga- met is used to treat GI ulcers
every year
-atenolol is a beta-blocker for HTN. all HTN medications should be monitored annual- ly
disqualify
-in this situation, he cannot safely fulfill the duties of a driver- including using his mirrors
sciatica
1 year
from the road for what minimum waiting pe- riod?
56. During his history, driver reports that he had a severe infection 2 months ago that re- quired hospitalization. While there, his fever
2 year certificate. no waiting period.
-this seizure was not caused
spiked and he experienced a seizure. He had by a structural insult to the
never had a seizure before or since. He has recovered well and the infection is gone. His MD told him the seizure was a result of the illness and fever. He is on no Rx. What is an appropriate course of action if all else is clear in the exam?
-2 year certificate, no waiting period
-disqualify, 6 month waiting period
-seizures disqualify for 5 years
57. epilepsy is a major concern due to risk
of seizures or loss of consciousness. how many unprovoked seizures are required for a diagnosis of epilepsy?
58. epilepsy is a major concern due to risk of seizures or loss of consciousness. once there is a diagnosis of epilepsy, how long must an individual be off antiseizure med- ication and seizure-free before they may po- tentially be qualified to drive a commercial vehicle again?
59. a 35 year old man was in an MVA 7 years
brain, but rather by a sys- temic illness. once the cause (in this case the illness) is past, the driver may be certi- fied with no waiting period.
2
10 years- with extensive documentation and consul- tation with treating doctor
yes. he has been seizure
ago with trauma to his brain. in the first week and Rx free for over 5 years.
therafter, he had a single seizure. for 1 year, there was a seizure, but not
he took anticonvulsive medication. he has been off all prescriptions and seizure free for 6 years. can he be certified?
60. after a diagnosis of meniere's disease, what is the recommendation for certification of a driver?
epilepsy
meniere's disease is pro- gressive and considered
61. which of these is intrastate (as opposed to interstate) commerce?
-a landscaper drives his pickup and trailer for jobs with 5 counties in central MN. All his sod and supplies are bought locally
-a UPS driver delivers packages from far and wide within a single city
-a semi driver drives a long haul route from FL to TX
-a commercial driver makes a run from New Orleans, LA to Monroe, LA, but passes through MS on the route
62. which of the following diagnoses is NOT always disqualifying?
narcolepsy, type 1 diabetes, meniere's dis- ease, current alcoholism, bipolar disorder
63. proteinuria can be caused by any of the fol- lowing except:
kidney disease or damage, dehydration, fever, emotional stress, gastritis, diabetes mellitus, HTN
64. in case of high proteinuria, what is a reason- able first step for follow-up?
completely disabling. dis- qualify.
a landscaper drives his pick- up and trailer for jobs with
5 counties in central MN. All his sod and supplies are bought locally
bipolar disorder
gastritis
-second dipstick 1 week lat- er. if still present, urine pro-
-second dipstick 1 week later. if still present, tein-to-creatinine ratio
urine protein-to-creatinine ratio
-second dipstick in 1 week. if still present, referral for further evaluation
-kidney blood panel
65. an obese driver's urinalysis shows 500 mg/dL of glucose. he claims he is not dia- betic, but it is simply because of the 20 oz. bottle of pop he drank in the hour before the test. what should be done?
-second dipstick in 1 week. if still present, referral for fur- ther evaluation
order follow-up test: fasting blood glucose or A1c
-kidneys will not secrete glu- cose into the urine if there is healthy blood-sugar control.
66. a driver's blood pressure is found to be 164/90 during his DOT exam in January. he is given a 3-month certificate. he returns in March, having lost 10 pounds and started a HTN Rx. blood pressure is found to be 136/84. a full exam is not performed. what length certification should be written and from what date?
alimentary glycosuria is pos- sible, but should not cause glucose to appear in the urine unless >100 g of sug- ar is consumed at once, and even then it should not be this much. he is likely diabet- ic. given the serious nature of diabetes, follow up testing is necessary
1 year from January
-although he now qualifies for a 1 year card, it can only be issued from the date of the full exam
67. who can grant a waiver or exemption? the FMCSA
68. i've already passed by FAA pilot physical. do i still need a DOT medical exam to drive a CMV?
69. which of the following questions is UNim- portant when considering any disease re- garding certification, time limitation, or dis- qualifications?
-is there likelihood of sudden incapacita- tion?
-is the disease stable?
-will the driver be financially stable if not certified?
-what is the likelihood of progression?
-does the nature of the disease affect safe- ty?
-will the driver be able to seek adequate care on the road?
yes, the exams are different and separate
will the driver be financially stable if not certified?
70. in what time period must you give the med- there is no standard
ical examiner's certificate to the driver after -the medical examiner can
the exam?
71. which is NOT a major risk of cor pulmonale? dizziness, drowsiness, hypotension, syn- cope, shortness of breath
72. you refer a driver for a sleep study. it is de- termined there that he should have a CPAP machine. how long must he wait, at mini- mum, to check for tolerance of the treatment before you may certify him?
73. if a driver has had a cortical stroke, what is the minimum waiting period before he/she may possibly be certified to drive?
74. diabetes mellitus is a major concern. which of the following is a long-term outcome of uncontrolled blood sugar?
cardiovascular disease, retinopathy, neu- ropathy, alzheimer's disease, nephropathy, death, all of the above
75. both schizoid and bipolar disorders can be disqualifying. which of the following condi- tions is NOT a major reason to disqualify?
-substantially compromised judgment
-swings in energy levels and mood
-attention difficulties
-suicidal behavior or ideation
-personality disorder that is repeatedly manifested by overt inappropriate acts
give the card to the driver im- mediately or at a later time of his/her choosing. follow-up labs, tests, and communica- tion with treating doctors can reasonably cause delays
drowsiness
1 month
5 years- as potential for seizure is a concern
all of the above
swings in energy levels and mood
76. what are the FMCSA guidelines for certifica- tion of a driver on Coumadin?
77. if a driver is only taking OTC medications, what are the possible ramifications?
78. insulin use is a major concern. which of these is NOT a possible outcome of a hypo- glycemic reaction?
seizure, loss of consciousness, shooting extremity pain, palpitations and tachycar- dia, period of impaired cognitive function that occurs without warning
79. exercise tolerance tests (cardiac stress tests) are needed to assess the driver after a cardiovascular incident or to assess for cardiac abnormalities. if ordered this test, there are specific measures that need to be met/ordered. which of these is NOT one of them?
-exercise to a workload capacity greater than 6 metabolic equivalents (METs) (through Bruce protocol stage II or equiva- lent)
-attain a heart rate greater than or equal to 85% of predicted maximum (unless on beta blockers)
-have a rise in systolic blood pressure greater than or equal to 20 mmHg without angina
-have no increase in diastolic pressure
-have no significant ST segment depression
use clinical judgment- not on the coumadin, but on the un- derlying disease
OTC medications can affect the decision to certify, time limit, or disqualify as deter- mined by the clinical judg- ment of the medical examin- er
shooting extremity pain
have no increase in diastolic pressure
80. which 2 of the following are not required for the urinalysis portion of the DOT medical exam?
specific gravity, drug test, blood, glucose, ketones, protein
81. once registered with the NRCME as a CME how often will you have to report all per- formed exams?
82. if the urinalysis shows findings that are ab- normal, but do not immediately threaten the driver or the public (such as slight protein- uria), which is the most reasonable course of action?
drug test, ketones
monthly
encourage the driver to seek further care from his primary care doctor and type a note of the findings for him/her to take
83. what is the epworth sleepiness scale? a simple, self-assessment
questionnaire to help guide the decision to seek further sleep studies
84. what is the common, concerning side effect of Lotab, Vicodin, and Neurotin?
85. which of the following is NOT a potential sign of drug abuse?
-bloodshot eyes, pupils larger or smaller than usual
-deterioration of physical appearance, per- sonal grooming habits
-progressive unilateral myopia
-tremors, slurred speech, or impaired coor- dination
-sudden mood swings or irritability
-lack of motivation; appears lethargic or "spaced out"
86. how do you properly mark the medical form if the driver wants to apply for a diabetes waiver?
dizziness
progressive unilateral my- opia
check "meets standards, but periodic monitoring in required to due INSULIN
87. pulse rate must be recorded. what is a nor- mal resting pulse rate for an adult?
88. a driver admits to not following his endocri- nologist's treatment plan to manage his dia- betes. he is obese, and has not lost weight. he rarely checks his own blood sugar levels as he does not like "sticking" himself. he often forgets to take his oral medication, and he missed his last appointment with his treating physician. glucose in the urinalysis is moderate to high. what is an acceptable course of action within the regulation?
-discuss seriousness of the situation. tem-
porarily disqualify the driver. contact his treating physician, and send the driver for an appointment with that doctor.
-defer a decision until you contact the treat- ing physician and order A1c lab test
-give him a 1-year card as he is diabetic, but not yet on insulin
-disqualify him
-give him a 1 month card, order lab work, and set up a return visit in 3 weeks
89. after you have registered with the NRCME, if you perform zero DOT medical exams in a month, do you have to still file a monthly report?
90. what is the advised minimum waiting period following coronary artery bypass surgery?
91. severe traumatic brain injuries are disquali- fying. how is a "severe TBI" defined?
TREATMENT. check 1 year, and check accompanied by a DIABETES EXEMPTION
60-100 beats per minute
all of the above
-one of the most frustrating issues that medical examin- ers deal with is the lack of absolute rules in the adviso- ry criteria. this is by design- to allow flexibility for the sit- uation. in this case, any of these is a legitimate course of action within the regula- tions- as determined by the individual details of the sit- uation and the clinical judg- ment of the medical examin- er. I would consider C to be the least appropriate (give him a 1-year card as he is di- abetic, but not yet on insulin)
yes
3 months
injury penetrates the dura and/or causes loss of con- sciousness >24 hours
92. benzodiazepines are a major concern. which of the following is NOT a benzodi- azepine?
xanax (alprazolam), valium (diazepam), ati- van (lorazepam), diovan (valsartan)
93. in a shy-bladder situation where a driver is unable to provide a urine sample, which 2 courses of action are INappropriate?
-allow the driver to return the next day to provide a sample
-give the driver water and time to relax until he/she is ready
-disqualify the driver
-send the driver home with a collection cup and have him/her return with a sample
94. varicose veins have the potential for com- plications including chronic venous insuffi- ciency, leg ulcerations, and recurrent deep vein thrombosis. what is the maximum cer- tification period for a driver with varicose veins?
95. gross vehicle weight is one measure of
diovan (valsartan)
-disqualify the driver
-send the driver home with a collection cup and have him/her return with a sample
a shy bladder is a relative- ly common occurrence. it is generally no reason for dis- qualification. drivers cannot bring in a sample
2 years
9 for compensation, 16 not
whether a driver needs a DOT medical exam. for compensation
another is the number of passengers the ve- hicle is DESIGNED to transport. what is the minimum number of passengers (including driver)?
96. a driver reports that he had arthroscopic surgery to repair a torn meniscus in his right knee 15 years previous. should this be recorded on the form?
97. a bipolar driver has been stable for 5 years without any manic or major depressive episodes. paperwork from his mental health
yes
-all conditions and past surg- eries should be noted- even if not a reason for denial
1 year
-lithium therapy is not shown to interfere with safe driving.
provider confirms this. he is treated with lithium. what is the best certification peri- od?
98. once a driver has a diagnosis of type 2 di- abetes mellitus, regular monitoring by his treating physician is needed, what other fol- low-up is needed to qualify for DOT certifi- cation?
99. there are a number of conditions for which the medical examiner should automatically disqualify the driver, but an appeal can be made to a neurologist familiar with the de- mands of CMV driving. which is NOT one of these?
narcolepsy, benign tumor of the CNS, multi- ple sclerosis, parkinson's disease
100. the medical examiner should know where to look up relevant regulations. what code of federal regulations describes the quali- fications of drivers, the responsibilities of medical examiners, and the DOT medical examination process?
42 CFR 221, 45 CFR 224, 39 CFR 158.8, 49
CFR 391
101. syncope is a major concern. what is syn- cope?
102. if a driver fails the whisper test, audiometry is required. what is the minimum level to pass?
103. when asked about seizures, a driver reports several febrile seizures as a young child. is this disqualifying?
for stable bipolar disorder, 1 year is appropriate
annual evaluation by op- tometrist or ophthalmologist
narcolepsy
-narcolepsy is always dis- qualifying. the others may be stable or mild enough to al- low the driver to safely stay on the road
49 CFR 391
loss of consciousness
average hearing loss in the better ear <(or equal to) 60 dB in the worse ear
no
-childhood febrile seizures are generally not a con- cern and fall outside the
recommendations for other seizures
104. when a driver fails the whisper hearing test, 3 frequencies- 500 Hz, 1000
he must be sent for audiometric testing. the measurement is the average loss across how many frequencies and which ones?
105. a driver marks "yes" to the box chronic low back pain. which of these is the LEAST rel- evant question to ask?
-how frequent and how intense is the pain?
-is there radiating pain, numbness, or weak- ness into either leg?
-does this affect your ability to drive, load, climb into the cab, or do other job func- tions?
-would you be more comfortable in a smaller CMV or with less hours driving?
-how has it been treated, and are you taking any pain medication?
106. the medical examination report (long form) asks about several specific conditions when evaluating extremities. which is NOT one of those?
-perceptible limb
-loss of or impairment of leg, foot, toe, arm, hand, or finger
-normal range of motion
-atrophy
-insufficient grasp and prehension in the upper limb to maintain steering wheel grip
Hz, 2000 Hz
would you be more comfort- able in a smaller CMV or with less hours driving?
-the medical examiner's role does not include giving work restrictions. the certification is all or nothing
normal range of motion [Show Less]