Interstate commerce definition? - ANSWER-Any material transported from 1 state to another state, even if the individual driver never leaves 1 state, that:
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a) weighs >10,001 lbs (if >26,001 lbs, they also need a drug test)
b) 9-15 passengers for compensation
c) 16+ passengers regardless of compensation
d) that requires placarding for hazardous materials
Does interstate commerce refer to the cargo or to the driver? - ANSWER-It refers to the cargo, tools, vehicle, NOT to the driver.
When is a 12 month (or shorter) certification required? - ANSWER-a) intracity zone exempt drivers
b) waiver program drivers
c) insulin
d) any driver whose job duties have been impaired by mental/physical injury
Does the driver need a new exam after sustaining an injury? - ANSWER-That is up to the employer.
Can an examiner write schedule/MSK restrictions? - ANSWER-No.
Document every abnormality? - ANSWER-Yes, and then just write in comments, "not likely to interfere."
Whisper test okay for hearing? - ANSWER-Yes
Need to fill out both state and federal? - ANSWER-No, one or the other
Is determination pending okay on both state and federal? - ANSWER-No, only permissible on federal
When to fill out state form? - ANSWER-If truly intrastate. Need to know the state variances for the state in which the driver operates.
How short a period can you put on the card? - ANSWER-As short as you want. Eg. 30 days, 45 days, 3 months, etc.
2 reasons for not medically qualified? - ANSWER-1) Disease/condition that temporarily or permanently DQs them OR 2) Haven't fulfilled appropriate waiting period, eg. 1 year
What do you document if driver stops exam? - ANSWER-"Incomplete exam"
If you do determination pending, what do you put as the expiration date? - ANSWER-The date they come back with whatever documentation you needed.
Is the medical certification limited to their current employer? - ANSWER-No. They are allowed to switch employers that might require more strenuous tasks/different schedule, etc.
What is "acceptable risk?" - ANSWER-1% annual risk of sudden incapacitation. If the driver is at increased risk compared to the general population, than they shouldn't be operating a CMV.
When to certify for less than 2 years? - ANSWER-If their condition requires more frequent monitoring by specialist/PCP, etc.
What do you put in the "medical record" box? - ANSWER-Can be blank, employee ID, etc. Up to you.
Okay to examine drivers from Canada and Mexico? - ANSWER-Yes
Driver ID requirements? - ANSWER-You must see some sort of government issued ID to make sure they're not having a friend/family member take the medical exam for them.
If they leave blank, check yes, or not sure under "medical certificate issued for less than 2 years," then what? - ANSWER-Ask why and address. Review old exams done in your clinic!!!
If driver wrote "not sure" to any answer... - ANSWER-Ask about and address. Never cross out what driver wrote but you can put additional comments below.
Does determination pending require a new exam? - ANSWER-No. A short medical certificate does, but a DP does not.
What to do if current med certificate expires tomorrow, but you need their HgbA1C, etc? - ANSWER-1) You can issue a short term certificate AND do determination pending but will need to repeat exam
2) DQ and do determination pending if you do not think driver is safe to be on the road in the meantime before you get the info
How long do you have to submit driver determination online after doing exam? - ANSWER-Close of next calendar business day.
Whose responsibility is it to address driver's age and language? - ANSWER-Employer
What do you do after you make your determination? - ANSWER-Required to discuss with the driver and what they need to do. Must be clear that you are making your decision based on best practice/guidelines and NOT on regulation.
What if a driver from another country has a variance/waiver? - ANSWER-They are not qualified in the US.
What are the 13 physical qualifications for drivers? - ANSWER-1 + 2. No loss/impairment of foot/leg/hand/arm.
3. No IDDM (new waiver)
4. No dx of heart dz that might cause syncope, SOB, collapse, or CHF
5. No respiratory dysfunction likely to interfere
6. No HTN likely to interfere
7. No hx or dx of MSK dz likely to interfere
8. No hx of epilepsy or dz causing LOC
9. No mental/psych dz likely to interfere
10. Distance vision of 20/40 in each eye and together, 70 degrees horizontal field, and ability to recognize red/green/yellow
11. Whisper at 5 feet in BETTER ear or no average HL in better ear>40 DBs at 500,1000,and 2000 hz
12. No schedule 1, amphetamine, narcotic, habit forming drugs except when prescribed by someone who says it will not affect ability to operate CMV
13. No dx of alcoholism
Can a medical examiner grant a waiver? - ANSWER-No. They have to go through the online FMCSA processes.
Don't certify until etiology is _______, and _____ is shown to be _____, ______, and _____. - ANSWER-Confirmed, treatment, safe, effective, stable.
What if multiple waiting periods for multiple comorbidities? - ANSWER-Wait until longest one is done.
When to get additional tests/consults? - ANSWER-Case by case basis to adequately address fitness for duty. No required to accept the consult/testing.
What are the only required regulations? - ANSWER-Vision, hearing, epilepsy, IDDM.
What to do if choose not to follow a guideline? - ANSWER-Document extensively why you did not.
What testing MUST be done for the exam? - ANSWER-Height, weight, vision, hearing, BP, pulse, urinalysis.
What optional testing may be done? - ANSWER-BMI, audiometry, PFTs, ECHO, EKG, sleep study, CT scan, etc, based on H&P and your determination. CAUTION: If you require these, you CANNOT be the one ordering or paying. Must be employer or driver's private health insurance or private pay.
4 possible options for determinations for medical exam? - ANSWER-1) Qualified
2) Not qualified
3) Determination pending
4) Incomplete
What is the date for the certificate expiration? - ANSWER-The date of determination, NOT necessarily of the exam.
Is dialysis disqualifying? - ANSWER-Yes
Is monocular vision okay? - ANSWER-No. Need to have 20/40 in BOTH eyes. No corrective contacts that make one eye see far/one near. No telescopic lenses.
Meniere's disease - DQ? - ANSWER-Yes, if active dx due to risk of incapacitation from vertigo spells. If in remission, no episodes for 10 years, probably fine.
What to do if proteinuria? - ANSWER-Nephrologist consult
Nitroglycerine use - DQ? - ANSWER-No, but need cardiologist letter certifying angina is stable.
Sustained V-tach > 15 seconds? - ANSWER-Disqualifying
Narcolepsy? - ANSWER-DQ
Provigil (modafinil)? - ANSWER-Not DQ but be cautious.
Uncontrolled vertigo? Waiting period? - ANSWER-DQ. WP is 2 months sx free.
Labyrinthine fistula or nonfunctioning labyrinth? - ANSWER-DQ
Vision acuity requirements? - ANSWER-20/40 in each eye and together.
If can't determine colors? - ANSWER-Need further testing.
Exemption for contact monovision? - ANSWER-No.
Exemption for natural monovision? - ANSWER-Yes, if one is is >20/40, can apply.
Vision exam includes? - ANSWER-PERRLA, EOMs, confrontation, nystagmus, eval for exopthalmos
Vision history includes? - ANSWER-Retinopathy, cataracts, aphakia, glaucoma, macular degeneration.
"Yes" answer on vision questions? - ANSWER-May require shorter certification and f/u with specialist.
When to get an eye consult? - ANSWER-Any yes answers, history, symptoms, or underlying disease: atherosclerosis, DM
Special state rules for vision exemption? - ANSWER-Florida or Indiana licenses require a special addendum for applying for the exemption
Do you need a medical certificate to apply for the vision exemption? - ANSWER-No.
What is required for the vision exemption? - ANSWER-Must have operated CMV with the vision deficiency for 3 year period immediately preceding the application. Must submit driving records, report within last 3 months by opth/opt. Direct drivers to the website and give them a special phone number (703-448-3094).
What is the vision waiver program? - ANSWER-From the 90s. Still need to present original letter and copy of recent eye exam. Grandfathered in.
Hearing standards? - ANSWER-Only need to meet in 1 ear. Whisper at <5 feet or audiometry standards better in one ear than 40 DB at 500/1000/2000 hz
Audiometry standards: - ANSWER-Audiometry: Better than 40 DB at 500/1000/2000 Hz add together and divide by 3 to get the average.
How to perform forced whisper test? - ANSWER-After exhaling completely, whisper a sequence of words/numbers, can also ask a question, eg. "Who is the president." Stand 5 feet away from pt. Have them cover opposite ear and turn ear being tested towards you. They must be able to hear at or great than 5 feet.
Is there a hearing exemption? - ANSWER-Not officially, but you can still apply for one.
Are hearing aids allowed for the whisper test? - ANSWER-Yes.
BPPV or peripheral vesibulopathy -- period sx free? - ANSWER-
How long a certification is given for vision/diabetes exemption programs? - ANSWER-1 year
Expiration date of card, when does it officially expire? - ANSWER-At midnight on the day specified. No grace period.
What is the role of the examiner with medical exemptions? - ANSWER-To determine if the driver is "otherwise qualified" besides the one issue that they will need an exemption for.
Are there any current FMCSA waiver programs? - ANSWER-No, only exemption programs.
What exemption programs are there currently? - ANSWER-Hearing, vision, and seizure.
CDC defines loading & unloading a truck as how many METS? - ANSWER-6
As an examiner, anytime ____ is higher than public safety, you should not certify the examiner. - ANSWER-Right to work
What is the purpose of the exam? - ANSWER-To determine if the driver is medically fit for duty.
If you have audio-metric testing in the office, can you test them if they use a hearing aid? - ANSWER-No
How many months sx free if have BPPV or peripheral vestibulopathy? - ANSWER-2
What do you ask the specialist if a driver has a dx of vertiginous dz? - ANSWER-What is the risk of recurrence? How long will you need to determine risk of recurrence? Use that to guide how long you set as your determination.
Labyrinthine fistula and non-functioning labyrinth? - ANSWER-DQ
When was the revised DM standard effective? - ANSWER-11/19/18
If have DM, not on insulin, but not controlled, qualified? - ANSWER-No.
What happened to the Diabetes exemption? - ANSWER-No longer needed. They can be qualified like everyone else.
What should a driver who is on 2 DM meds make you concerned about? - ANSWER-Hypoglycemia
What is THE primary concern for drivers with DM? - ANSWER-Hypoglycemia
History questions to ask diabetic drivers? - ANSWER-Do you routinely measure your blood glucose? Use OTC meds/supplements/incretin mimetics? Hx of fainting/dizziness/LOC? Hx of hypoglycemic reaction with seizure, LOC, needing someone else to give you sugary food, or "impaired cognitive function that occured without warning"? If yes to last qustion, 1 or more than 1 episode in last 12 months? 2 or more than 2 in last 5 years?
Questions to ask treating physician of driver who had a hypoglycemic episode - ANSWER-Was the episode unique and unlikely to recur OR is the driver non-compliant/has the doctor needed to make frequent/recent medication changes, etc?
Glucosuria? - ANSWER-Either uncontrolled diabetic OR on a medication that causes sugar to spill into urine (SGLT2 meds: jardiance/invokana/farxiga--the "flozins")
What DM complications to evaluate? - ANSWER-Retinopathy, macular degeneration, peripheral neuropathy, CAD, CVD/TIA/Stroke, PVD, autonomic neuropathy, syncope, nephropathy?
Presence of what DM complications should you probably DQ? - ANSWER-Neuropathy, retinopathy, nephropathy, CVD.
What to evaluate with peripheral neuropathy in diabetics? - ANSWER-Position sense in toes and feeling in feet.
Get nephrologist eval for diabetics? - ANSWER-There is a suggestion to do that.
Is hyperglycemia (>400) likely to cause impairment? - ANSWER-No.
Recommended time for card for diabetics? - ANSWER-1 year, but more frequently if more frequent exams are required to monitor progression of condition
If they can't feel their feet at all... - ANSWER-Think carefully about if you want to certify or not.
Resting tachycardia... - ANSWER-What happens with exertion?
Orthostatic hypotension? - ANSWER-Common complication with diabetics with autonomic dysfunction
What type of retinopathy gets DQs? - ANSWER-Severe: Unstable proliferative OR non-proliferative.
What form for the new Diabetes Insulin Standards and who fills it out? - ANSWER-The Insulin-Treated DM Form, filled out by treating clinician.
What does the new insulin form require? - ANSWER--Annual med exams
-The form must be filled out by TC within 45 days of med exam
-TC must determine if medically qualified and free of complications
Are you required to accept the medical insulin form? What are you supposed to decide - ANSWER-No. Must decide:
-Maintaining stable insulin regimen?
-Properly controlled DM? ("Non-compliant" or "No show" on medical records from TC demonstrates not following advice of TC)
-Permanent DQ if severe prolif or non-profil retinopathy.
If the TC does not have 3 months prior of BG monitoring, what do you do? - ANSWER-Can give them a 3 month card. Once the TC reviews these records, the TC then fills out a new 5870 and then the ME may issue a 12 month card.
What is required for the insulin self monitoring? - ANSWER-It must be electronically downloaded with recorded date and times. Can't be handwritten. A printout must be provided to the TC at the time of the eval.
What is required if the driver on insulin has a severe hypoglycemic episode? - ANSWER-They must contact the TC asap and be re-evaluated with a new 5870. They do not have to go to the medical examiner until next exam. They do not have to tell their employer. BUT you can encourage your clients to come back for re-evaluation.
Who is required to prescribe and manage the insulin? - ANSWER-The TC who fills out the form.
If questions #2 and 3 on the form are "No"? (no 3 months of self monitoring records) - ANSWER-If you feel comfortable, you can issue a 3 month card for them to get these records. (it allows this directly on the 5870)
If #4 and #5 are a "no?" (is the individual compliant with blood glucose self monitoring) - ANSWER-Call TC and get more info about why.
HgbA1C? - ANSWER-Don't look at it in isolation. Maybe it's a 10 now, but maybe it used to be a 14. Great! Or maybe it's a 10 now, but a year ago it was a 7! Warning sign.
What is the only end-organ damage complication due to DM that is DQ? - ANSWER-Severe proliferative retinopathy or nonproliferative retinopathy.
If a diabetic with an amputation, then what? - ANSWER-They can fill out a SPE.
Is there a requirement for annual eye exams? - ANSWER-No. If exam was within 18 months and no prior problems, probably fine. If 5 years since last one, should probably have them get one before certifying.
Why do we worry about nephropathy? - ANSWER-Can cause cognitive impairment when in hot environments and dehydrated.
Stable or unstable - same dose of insulin for 6 months? - ANSWER-Stable.
Stable or unstable - sliding scale insulin? - ANSWER-Stable as long as 3 month records show that BG has been stable.
Guidance on HgbA1c? - ANSWER-None.
Guidance on monitoring glucose while driving? - ANSWER-None.
What does 4 things can "severe hypoglycemic episode" include? - ANSWER-Any of the following:
1) Seizure
2) LOC
3) Needs assistance from another person
4) Period of impaired cognitive function that occurred without warning
Is there a requirement for ME to review beyond the 5870? - ANSWER-No
Are DM exemptions/waivers still valid? - ANSWER-No. They must use the new form.
Sulfonylurea with what other oral med increases risk of hypoglycemia? What is required if a driver is on both? - ANSWER-Incretin mimetics (GLP-1s). Guidance is for 1 year cert. Recommendation is for a written statement from TC on how individual is followed and if there are any complications. This is true for incretin mimetics or any potentially impairing drug.
Is an HgbA1c of 5 or 9 better? - ANSWER-9. A lower HgbA1c indicates tighter control therefore greater risk for hypoglycemia.
Required WP after Lasik procedure? - ANSWER-None. But do recheck visual acuity.
Does corrective glasses include cataract implant? - ANSWER-No.
What if spilling 3+ glucose but no dx of DM? - ANSWER-Get a fingerstick BG. If shows DM, then what? Several options. Can DQ and have them f/u with PCP. Can give a 3 month and have them f/u with PCP. If have 6 weeks left on card, can do determination pending and f/u with PCP. That way, don't have to do a new exam when they return.
Need medical records for IDDM along with 5870? - ANSWER-Not required, but definitely a good idea.
Pre-diabetic cert timeframe? - ANSWER-If concerned may progress to DM, 6 mos or 1 year. [Show Less]