Term
| What minimum PaO2 level is necessary if the driver has an ABG due to chronic respiratory disorder? |
|
Definition
65mmHg
To be qualified, the driver should meet a minimum arterial blood gas
(PaO2) greater than 65. |
|
|
Term
| A driver first perceives a whispered voice at 5 feet in his right ear an 4 feet in his left ear. All other aspects of his physical examination are unremarkable. The examiner should: |
|
Definition
Certify the driver for 2 years.
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. |
|
|
Term
| A driver reports for an examination 6 weeks after suffering a mild heart attack and presents a note from his cardiologist starting 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 and EF of 65%. The examination of the driver is unremarkable. The examiner should: |
|
Definition
Temporarily disqualify the driver.
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. |
|
|
Term
A driver provides an audiometric test documenting the following:
1. 500 Hz: 35 Right ear; 40 Left ear
2. 1000 HZ: 40 Right ear; 45 Leftear
3. 2000 HZ: 40 Right ear; 45 Leftear
4. 4000 Hz: 50 Right ear; 50 Left ear |
|
Definition
Certify the driver for 2years.
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. |
|
|
Term
| 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: |
|
Definition
Qualify the driver for 2 years.
A driver must exhibit a minimum peripheral vision of 70 degrees
bilaterally. |
|
|
Term
| During examination, the medical examiner notices that the driver is distant, lacks eye contact, and shows absolutely no emotional response during the exam. The examiner's best response should be: |
|
Definition
Disqualify the driver and refer him to a mental health professional prior to consideration for certification.
The driver exhibits what may be considered a “flat affect” which is seen in
schizophrenia and in severe depression. The driver should be evaluated by a mental health expert
to make a diagnosis prior to certification. |
|
|
Term
| 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. |
|
Definition
Disqualify the driver.
Use of marijuana is prohibited by Federal law while driving a CMV and
trumps State law in this matter |
|
|
Term
| A driver has a blood pressure of 136/92 mm Hg. This is: |
|
Definition
Stage 1Hypertension.
This is Stage 1 Hypertension, which is defined as 140-159/90 - 99. |
|
|
Term
| 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? |
|
Definition
Temporarily disqualify the driver until he obtains written clearance for
the depression and the medication from the treating provider.
Medical clearance is required for all mental health disorders. Celexa is an
SSRI or 2nd Generation anti-depressant and is acceptable. |
|
|
Term
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 examinershould? |
|
Definition
Disqualify the driver pending vision exam to determine ifit meets peripheral
vision requirements.
The driver must have a peripheral vision of 70 degrees bilaterally to certify to drive a
CMV. |
|
|
Term
What minimum PaO2 level on an ABG performed for a chronic respiratory disorder is
necessary to certify a commercial driver? |
|
Definition
65 mm Hg
Blood oxygen saturation must be a minimum of 65 mm Hg for the driver to
certify |
|
|
Term
A driver is taking Topamax for the treatment of migraine headaches. He reports good management of
his headaches and they neverseemto interfere with his driving ability with the medication. The medical
examinershould? |
|
Definition
Obtain medical clearance for the condition and the medication.
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. |
|
|
Term
| 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 treating psychiatrist. As the certified examiner, you: |
|
Definition
| May certify for a maximum of 12 months. |
|
|
Term
| A driver has a blood pressure of 168/112 mm/hg confirmed during the examination. The driver should be: |
|
Definition
Disqualified
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. |
|
|
Term
| For how long would a driver be certified if he is taking micardis HCT for hypertension, and has a confirmed blood pressure of 148/96mm/hg at the time of the examination? |
|
Definition
3 months
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. |
|
|
Term
| During the examination, a driver is found to have a postive "babinski" reflex. The examiner should: |
|
Definition
Disqualify the patient until he has a neurological consultation.
. 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. |
|
|
Term
| All of the following are required components of all DOT medical examinations except? |
|
Definition
Opthalmoscopic examination.
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. |
|
|
Term
| A driver reports in his history that he was treated ofr epilepsy 14 years ago but stopped taking anti seizure medication on his own since moving to the area 11 years ago. He has not seen a neuro nor a health care provider in over 10 years and reports no seizures during this period. The examiner should: |
|
Definition
Disqualify the driver.
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 nondiscretionary epileppsy standard until it is established that the driver is 10 years seizure-free while off
anti-convulsants. |
|
|
Term
A driver reports for a re-certification examination 8 weeks after having triple coronary artery bypass surgery.
He presents a note from his treating provider stating that he is able to return to driving without restriction.
Additionally, the note mentions that the driver’s results of his ETT were normal, and his echo showed a left
ventricular ejection fraction of 75%. The examinershould? |
|
Definition
Temporarily disqualify the driver until he has completed the required waiting period.
Following CABG, there is a 3-month waiting period. Since the driver is only at 8 weeks
post-op, he would have to wait 4 more weeks until he can certify. Once he completes his waiting period, he
would be certified for 1 year from the date of the original examination |
|
|
Term
| What is the maximum number of hours a CMV driver can drive in 7 consecutive days? |
|
Definition
60.
60-70 Hour Limit: A driver may not drive after 60/70 hours of duty in
7/8 consecutive days. Many versions of the NRCME exam will have one question about
the 60/70 rule. |
|
|
Term
| A blood pressure of 166/92 mm Hg would be? |
|
Definition
Stage 2 hypertension
Correct answer is “C”. The driver has Stage 2 hypertension (160 - 179/100 - 109). |
|
|
Term
The driver is taking “Sinemet” for the treatment of Parkinson’s disease. The
medical examiner should |
|
Definition
Disqualify the driver
A driver who is diagnosed with Parkinson’s is
permanently disqualified. |
|
|
Term
The driver uses hearing aids during the whisper test. He is able to hear at 5 feet on the right and
4 feet on the left |
|
Definition
Certify the driver for 2years.
The driver is able to use hearing aids during the whisper test (and this should be
marked on the form). A driver must only qualify in 1 ear to certify and there is no limitation of certification
time. |
|
|
Term
| The minimum acceptable spirometry values required to certify a driver are: |
|
Definition
FEV1 65%, FVC 60%, FEV1/FVC ratio65%
The minimum acceptable values are 65%, 60%, and 65% (FEV1, FVC, FEV1/FVC
ratio). |
|
|
Term
A driver presenting to your office marks down that he is taking “nitroglycerin” for angina and he has
been doing so for a few years. Upon questioning he indicates that he has needed morenitroglycerin
recently because his episodes have become more frequent. Your best course of action is to: |
|
Definition
Disqualify the driver and refer him to his cardiologist for further evaluation.
Disqualify the driver because his angina is not stable. |
|
|
Term
The longest the medical examiner would certify a driver with a history of Stage
3 hypertension is: |
|
Definition
6 months
The driver may only be certified for a maximum of 6 months for the rest of
his/her driving career. |
|
|
Term
A driver is taking Wellbutrin to help him stop smoking. He has provided a note from his PCP stating
that he has no side effects and confirms that he is taking the medication for smoking cessation.The
examiner would? |
|
Definition
Certify the driver for 2years
The driver is not being treated for a psychiatric condition such as anxiety
or depression, and he has clearance. He would be able to be certified for 2 years. |
|
|
Term
During the history, the driver admits to taking Benadryl for seasonal allergies. The
examiner should? |
|
Definition
Counsel the driver to not take the medication for 12 hours priorto driving
Counsel the driver concerning use of over-the-counter anti- histamines, and
anti-tussives (both cause drowsiness and should not be taken while driving) and about the 12-
hour rule. |
|
|
Term
A driver has a history of a moderate Traumatic Brain Injury that occurred 3 years ago as a result of a
car accident. He reports he has fully recovered and provides a note from his neurologist stating that he
suffered no seizures and that he is able to return to driving. He does not list any medications in his
history. The examinershould: |
|
Definition
Certify the driver for one year.
. The driver suffered no seizures from the TBI, has completed the required
waiting period (2 years), and has medical clearance. If the rest of the examination is unremarkable,
the driver could be certified for 1 year. |
|
|
Term
A driver reports a suicide attempt 10 months earlier, following the break-up of his marriage. Henoted
seeing a psychiatrist and he takes Citalopram daily and he reports he feels fine now and is moving on
with his life. He provides a release from his doctor that he may return to work without restrictions.
The medical examiner should: |
|
Definition
Disqualify the driver
The driver is temporarily disqualified because he has not completed the mandatory
waiting period for suicide attempt of 1 year. Once he has completed this, he may be certified for 1 year
due to the continued treatment of depression (taking an SSRI). The certification is from the date of the
original examination. |
|
|
Term
| The driver lists synthroid for the treatment of hypothyroidism. he has been taking it for about 6 months and feels fine now. His examination is essentially normal. The examiner should: |
|
Definition
Certify the driver for 2 years.
The driver’s hypothyroidism is well managed and he is
asymptomatic. The driver may be certified for 2 years. |
|
|
Term
A 48-year-old male driver presents for a certification examination. He reports in his history a back injury
that had occurred 4 years earlier. He states that he was out of work following back surgery for over a
year, but since has returned to driving and his last certification was good for 2 years. He lists as his only
medication Oxycodone, which he takes only as needed. He reports seeing his “pain doctor” every few
months for evaluation. He also reports he has had a steroid injection (series of 3) about a year ago,
which “helped a lot.” The examiner should: |
|
Definition
Request medical clearance
. The driver suffers a chronic pain condition which may inhibit his ability to perform all
essential functions associated with driving a CMV. He is also taking a narcotic medication. Both of these will
need clearance from a treating provider prior to making a decision regarding certification. |
|
|
Term
| A driver should not be certified when an ABG reveals a PaO2 of less than 65 at altitudes below: |
|
Definition
5,000 feet
The threshold changes to 60 mm Hg at altitudes above 5,000 feet |
|
|
Term
A driver presents for certification after a myocardial infarction. What is theminimum waiting
period status post myocardial infarction? |
|
Definition
2 months
There is a 2-month waiting period from the date of the MI |
|
|
Term
A driver presents for certification 6 weeks after suffering a myocardial infarction. She presents a note
from her cardiologist, clearing her to drive a CMV without restrictions. Her post MI echocardiogram shows
an EF of 50%. Her EKG shows no ischemia. Her ETT exceeds FMCSA standards. The medical examiner
should: |
|
Definition
Disqualify the driver
The driver should be disqualified because she has not met the minimum wait
time of 2 months (8 weeks) after suffering a myocardial infarction. The driver can return for
certification in two more weeks. |
|
|
Term
| A driver presents for certification. He checks "yes" for "Anxiety, depression, nervousness, and other mental health problems." For the driver health history portion of the medical examiner report form. He clarifieshe has depression which is controlled with medications and electroconvulsive therapy (ECT). Following ECT, the driver should be symptoms free for how long before being certified. |
|
Definition
6 mo
Following ECT, the waiting period is 6 months. Maintenance or ongoing ECT for
depression is not certifiable. |
|
|
Term
| According to FMCSA regulations, which of the following must the medical examiner evaluate when examining a driver's eyes? |
|
Definition
Pupil reactivity
Pupil reactivity (the only option that is included on the Medical Exam Report Form for
physical examination of the eyes). This is a cranial nerve test. A positive finding indicates a significant
neurological problem that must be worked up or have an explanation that clarifies whether or not the driver
has a condition that may interfere with the ability to safely operate a CMV. |
|
|
Term
| According to FMCSA regulations, medical qualification for two years can be given to a driver who has: |
|
Definition
A SPE Certificate for below the knee amputation.
”. In order to obtain the SPE certificate, the driver had to demonstrate the ability to
perform all tasks for the CMV job description. |
|
|
Term
| During his visit to the medical examiner, a driver complains of severe pain in his finger for the past 2 weeks after it was puctured. The exam reveals an infected, swollen finger. After ME inquiries, the driver states that the pain is made worse when he grips the steering wheel. Which of the following should the ME do next? |
|
Definition
Assess the driver’s grip strength
The condition does not present a safety risk unless it interferes with the ability of the
driver to hold and control the steering wheel. The purpose of this question is to remind you to think like a
medical examiner while taking the NRCME exam, not a primary care provider. Your focus is on DOT
certification, not treatment of the infected finger. There will be questions like this on the exam. |
|
|
Term
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 monitoringintervals? |
|
Definition
Recertification: Every year
Exercise tolerance test: Every two years
According to FMCSA medical guidelines, when an MI is part of the medical history,
there is a significant increased risk of another MI to occur within six months to 1 year; therefore, a
maximum of one-year certification is the guideline. MI guidelines also recommend exercise tolerance testing
at least every two years to demonstrate continued ability to safely operate a CMV |
|
|
Term
A 25-year-old driver denies a history of any medical problems. She is a nonsmoker who exercises regularly
without symptoms. The medical examiner auscultates bilateral wheezes during the examination. The
driver's SpO2 is 90 percent in the medical examiner's office. The rest of the examination is normal. The
driver should be: |
|
Definition
c. Temporarily disqualified until further evaluation.
This is the correct response because the driver has a non-diagnosed respiratory or
thoracic illness that might interfere with the ability to safely operate a CMV. The driver should not be
certified until the etiology is confirmed and treatment has been shown to be effective, safe, and stable.
Also, according to FMCSA medical guidelines, a SpO2 of less than 92 percent warrants obtaining an
arterial blood gas analysis. |
|
|
Term
| Which of the following stages of hypertension calls for a medical certificate that expires in oneyear? |
|
Definition
Stage 1
Medical certificates for drivers with Stage 1 hypertension expire after a year. Stage 2
hypertension results in a one-time, three-month medical certificate. Stage 3 corresponds to a medical
certificate, good for 6 months from date of examination if the reading is less than or equal to 140/90 mm
Hg. Lastly, Stage 4 hypertension doesn’t exist. |
|
|
Term
| Which of the following is true of psychological disorders in drivers? |
|
Definition
Drivers with a mood disorder may, during a manic episode, exhibit grandiosity, impulsiveness,
irritability, and aggressiveness
Drivers with an active psychotic disorder will exhibit unpredictable behavior,
accompanied with poor judgment. Drivers with a mood disorder will exhibit slower reaction times during a
depressive episode and grandiosity, impulsiveness, irritability, and aggressiveness during a manic episode.
Lastly, drivers with personality disorders may exhibit inflexibility and maladaptive behaviors, along with an
increased rash rate. |
|
|
Term
A medical examiner observes that a driver has a blood pressure of 160/100 mm Hg and the driver had
no prior knowledge of high blood pressure. Which of the following is the appropriate subsequent action
for the medical examiner? |
|
Definition
Obtain a second blood pressure reading later during the examination.
If the initial blood pressure reading of a driver is equal to or above 140/90 mm Hg, a
second reading should be taken later during the exam. |
|
|
Term
When deciding if a commercial driver should be medically certified, what is the fundamental question a
medical examiner should examine regarding cardiovascular health? |
|
Definition
Does the driver have a cardiovascular disease that increases the risk of sudden death or
incapacitation?
When looking at the cardiovascular health of a driver, the fundamental question is
whether the driver has a cardiovascular disease that increases the risk of sudden death or incapacitation,
creating a danger to the safety and health of the driver, as well as the public sharing the road. While history
and family history of such diseases are important, they are not the fundamental questions necessary about
which to ask. |
|
|
Term
If a medical examiner uses the number 1 during the physical examination, the medical examiner is
indicating which of the following parts of the bodysystem? |
|
Definition
General Appearance
. 1 refers to General Appearance, 4 refers to Ears, 6 refers to Heart, and 8 refers
to Abdomen |
|
|
Term
When conducting a vision examination, a driver must have at least what distant visual acuity in each
eye with or without correction? |
|
Definition
|
|
Term
| Which of the following is NOT true regarding the physical examination? |
|
Definition
There is a maximum height requirement.
There is not in fact a maximum (or minimum) height (or weight) requirement for drivers.
For each body system, mark “Yes” on the Report Form if abnormalities are detected or “No” if the body
system is normal. The medical examiner must document all abnormal findings on the Report Form, even if
they are not disqualifying. Lastly, the individual parts of the body system are categorized numerically. |
|
|
Term
Which of the following colors is not necessary to be able to distinguish and recognize in traffic signals and
devices? |
|
Definition
Blue
Due to specifically the colors of a stoplight and most road signs, it is necessary for a
driver to be able to recognize the colors amber, red, and green. Blue is not a necessary color to recognize in
traffic signals and devices. |
|
|
Term
. A DOT driver presents for his medical exam. On his history he states that he regularly takes
Dextromethorphan. This should prompt the medical examinerto: |
|
Definition
Counsel the driver about consuming the medication within 12 hours of driving
This is a cough suppressant and has sedative effects. Counsel the driver about not
consuming the medication within 12 hours of driving. |
|
|
Term
| Which of the following is an assessment of L4 nerve root pathology? |
|
Definition
|
|
Term
A driver presents for his DOT physical. A lateral pulsation is palpated approximately 2 inches superior of the
umbilicus. Auscultation in this area reveals an obvious bruit. What is the most important nextstep? |
|
Definition
Refer for diagnostic imaging and probable emergency care.
Possible Abdominal Aortic Aneurysm which is a medical emergency |
|
|
Term
A driver has a limitation of 35 degrees of cervical rotation to the right and left but can view both side mirrors.
What is the next best step?: |
|
Definition
Certify the driver for 2 years
The FMCSA has not adopted a standard cervical range of motion guideline for
drivers. However, drivers must be able to view both mirrors. If the driver can rotate the spine as
needed to see both mirrors s/he can be certified for up to 2 years. |
|
|
Term
| A driver presents with a history of isolated TIA 6 months previously. He presents with a return to work letter from his primary care physician and his neurologist. The driver is taking HCTZ and simvastatin. All other aspects of the exam and history were normal. What should the examiner do next? |
|
Definition
Temporarily disqualify the driver.
There is a waiting period of one year following a TIA. If there is any presence of
seizure, the driver must wait 5 years before being certified. |
|
|
Term
| Which of the following is a criterion for certification after a myocardialinfarction? |
|
Definition
a. EKG showing no signs of ischemia.
b. Echocardiogram showing an EF >= 40%.
c. ETT showing 85% of maximum predicted HR
All of the above.
All the listed choices are criteria for certification post myocardial infarction
after meeting the 2-month wait time. Certification is granted for one 1 year. |
|
|
Term
A driver presents for initial certification. His blood pressure is 180/102 mm Treated with amlodipine 5 mg
daily. Which of the following best represents the medical examiner's BP staging and certification
decision? |
|
Definition
Stage III hypertension Certify: Disqualify
. 180/102 is consistent with stage III hypertension (SBP of 180 is stage III, and DBP of 102
is stage II; the greater stage is obtained). Stage III hypertension is disqualified, according to FMCSA guidelines.
In order to be recertified after disqualification for stage III hypertension, a driver must present evidence of
good blood pressure control, i.e. <140/90. If upon returning, the BP is controlled (<140/90), the driver gets a 6-
month card. |
|
|
Term
| A driver reports that he was hospitalized recently for palpitations. He states he was diagnosed with atrial fibrillation, and was put on warfarin therapy. Which of the following is the correct certification criteria for atrial fibrillation? |
|
Definition
Waiting time: 1 month INR: monthly Certify: 1 year.
The waiting period for atrial fibrillation is 1 month with at least monthly INR. If stable
and tolerating medications without side effects, certification is granted for 1 year |
|
|
Term
A driver presents for certification. She reports that she was hospitalized recently for chest pain. She states she
was diagnosed with a myocardial infarction, and subsequently underwent left coronary artery balloon
angioplasty. She was put on Xarelto. Which of the following best represents certification decision for this driver? |
|
Definition
Waiting time: 2 months INR: none Certify: 1 year
Since the angioplasty was the result of a myocardial infarction, the waiting time is 2
months. Without an MI, the waiting time post angioplasty is 1 week. No INR monitoring is required for the
newer anticoagulants (Xarelto, Eliquis, Pradaxa, etc.). A patient on warfarin requires at least monthly INRs.
The maximum certification for a myocardial infarction is 1 year. |
|
|
Term
| The driver presents for re-certification. He admits a cerebellar stroke 2 years ago that has resolved without any residual deficits. He presents clearance from his neurologist, and he is on no anti-seizure or stroke medication. He is otherwise medically fit. What is the certification decision? |
|
Definition
Certify for 1 year.
. The waiting period for cerebellar or brain stem strokes is 1 year. The driver has met
the waiting period, obtained clearance from his neurologist and is on no medications for stroke. He can be
certified for 1 year. |
|
|
Term
A driver presents for examination following a spontaneous pneumothorax one month earlier. The records
provided by the driver indicate that the pneumothorax reduced the driver’s forced vital capacity (FVC) to
58% of predicted forced vital capacity. As the medical examiner, you should: |
|
Definition
Do not certify the driver.
Do not certify. According to recommendations, this driver should not be certified until
the medical examiner has verified that the recovery is complete, with X- rays, and the driver has an
adequate FVC. |
|
|
Term
Who can perform the vision portion of the interstate CMV driver physical examination other than the
medical examiner? |
|
Definition
a. Medical assistant.
b. Ophthalmologist.
c. Optometrist.
d. Any of the above
. A Medical Examiner, Medical assistant, or Ophthalmologist/Optometrist may perform
the vision testing. |
|
|
Term
A driver has an abdominal aortic aneurysm. The medical examiner obtains a copy of a recent abdominal
sonogram indicating that the aneurysm is 5.3 cm in diameter. According to current recommendations, can
the medical examiner certify this driver? |
|
Definition
| No. An aneurysm must be less than 5 cm for certification. |
|
|
Term
| According to regulations, which of the following can grant drivers an SPE certificate? |
|
Definition
The FMCSA.
Only the FMCSA can grant an SPE certificate at one of the FMCSA centers |
|
|
Term
As a certified medical examiner, for how long must you retain a copy of the Medical
Examination Report Form for each driver? |
|
Definition
3 years.
You are to retain the driver medical records for a minimum of 3 years. |
|
|
Term
As a medical examiner, you will need to provide a copy of the Medical Examination Report Form to a driver
who is applying for, or renewing, a: |
|
Definition
a. Skill Performance Evaluation (SPE) certificate.
b. Hearing exemption certificate.
c. Seizure exemption certificate.
******d. Any of the above.******
Since the medical examiner does not complete any of the three certificates listed –
they are approved by the FMCSA – the driver must have a copy of the Medical Examination Report Form
to apply for each exemption certificate. |
|
|
Term
| Which of the following is true of the vision requirements for commercialdrivers? |
|
Definition
The requirement for central distant visual acuity is at least 20/40 in eacheye.
The Snellen chart or the Titmus Vision Tester measures static central vision acuity.
The requirement for central distant visual acuity is at least 20/40 in each eye and distant binocular
visual acuity of at least 20/40. Test results must be recorded in Snellen-comparable values. Eyeglasses
or contact lenses may be worn to meet distant visual acuity requirements. When corrective lenses are
worn to meet vision qualification requirements, corrective lenses must be worn while driving. |
|
|
Term
| Which is accurate regarding the hearing test required of commercial motor vehicledrivers? |
|
Definition
If the driver perceives a forced whisper in one ear at 6 feet, he hasmet the
hearing requirement.
The required tests screen for hearing loss in the range of normal conversational
tones. Two tests are used to screen hearing: a forced whisper test AND/OR an audiometric test. Either
test may be administered first. Administration of the second test may be omitted when the test results
of the initial test meet the hearing requirement for that test. Hearing requirements are (1) First perceive
a forced whispered voice, in one ear, at not less than five feet OR (2) Have an average hearing loss, in
one ear, less than or equal to 40 decibels (dB). |
|
|
Term
When a driver who wears a hearing aid is unable to pass a forced whisper test, referral to which of the
following is required? |
|
Definition
a. An audiologist.
b. An otolaryngologist.
c. A hearing aid center.
d. Any of the above is acceptable.
Correct answer “D”. A hearing aid may be used during forced whisper testing. When a driver who
wears a hearing aid is unable to pass a forced whisper test, referral to an audiologist,
otolaryngologist, or hearing aid center is required. |
|
|
Term
Which of the following frequencies is NOT included as part of the audiometric hearing test for
commercial motor vehicle drivers? |
|
Definition
4,000Hz.
The hearing requirement for an audiometric test is based on hearing loss only at
the 500 Hz, 1,000 Hz, and 2,000 Hz frequencies that are typical of normal conversation. |
|
|
Term
A commercial driver is taking Coumadin for a diagnosis of atrial fibrillation. As the medical
examiner you explain to the driver that: |
|
Definition
He must undergo monthly INR monitoring
For a patient taking Coumadin, the maximum certification period is 1 year.
Recommend to certify the driver if the driver is stabilized on medication for at least 1 month, provides a
copy of the INR results at the examination, and has at least monthly INR monitoring. |
|
|
Term
Which of the following scenarios regarding a driver with a known abdominalaortic
aneurysm would warrant disqualification from commercialdriving? |
|
Definition
a. The AAA is 4.5 cm and it is asymptomatic; the driver has not seen a cardiovascular specialist –
he is only followed by his PCP.
b. The AAA increased from 3.4 cm to 4.0 cm during the last 6-month period.
c. The AAA has 5.1 cm in size, and has been stable for over 1 year.
****d. ALL of the above are disqualifying.***
Do not certify the driver if the AAA Is greater than 4 cm but less than 5 cm and driver does
not have medical clearance for commercial driving from a cardiovascular specialist; Is greater than or equal to
5 cm; has increased more than 0.5 cm during a 6-month period, regardless of size. |
|
|
Term
A driver presents for initial certification to drive 3 months following a myocardial infarction.
An in-hospital post-MI echocardiogram showing at least what left ventricular ejection fraction is sufficient for
certification to drive? |
|
Definition
40%
For an initial certification following an MI, an in-hospital post-MI
echocardiogram showing an LVEF greater than or equal to 40% is sufficient. |
|
|
Term
| What is the minimum waiting period following Coronary Artery Bypass Graftingsurgery? |
|
Definition
Three months
A significant risk associated with CABG surgery is the high long-term reocclusion rate
of the bypass graft. The Waiting Period is a Minimum of 3 months regardless of type of CABG surgery
performed. |
|
|
Term
Following an uncomplicated, elective percutaneous coronary intervention procedure to treat stable
angina, the post-procedure waiting period is: |
|
Definition
1 week.
Following an uncomplicated, elective percutaneous coronary intervention procedure
to treat stable angina, the post-procedure waiting period is 1 week. The waiting period allows for a small
threat caused by acute complications at the vascular access site. Drivers undergoing PCI in the setting of
an acute myocardial infarction or unstable angina should be restricted from driving duties for the longer
waiting period recommended for these conditions. |
|
|
Term
| Which cardiac condition is disqualifying? |
|
Definition
Hypertrophic cardiomyopathy
A driver with a diagnosis of Hypertrophic Cardiomyopathy may not be certified to drive.
Similarly, a driver with a diagnosis of Restrictive Cardiomyopathy may not be certified to drive. |
|
|
Term
A driver who exhibits difficulty breathing and has a history of COPD should undergo additional pulmonary
testing. A forced expiratory volume in the first second of expiration (FEV1) less than what level of
predicted should prompt arterial blood gas measurements? |
|
Definition
65%.
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. |
|
|
Term
A driver has a fixed deficit that is less than the whole hand. Which of the following is true regarding
certification of this driver? |
|
Definition
As a medical examiner, you determine if the severity of a fixed deficit that is less than the
whole hand is medically disqualifying unless the driver has an SPE certificate.
When the loss of (hand, foot, leg, or arm) or a fixed impairment to an extremity may
interfere with the ability of the driver to operate a commercial motor vehicle safely, you are responsible
for determining if the driver is otherwise medically fit to drive. A driver may be allowed to drive if the
qualification requirements for a Skill Performance Evaluation (SPE) certificate under 49 CFR 391.49 are
met. As a medical examiner, you determine if the severity of a fixed deficit that is less than the whole
hand is medically disqualifying unless the driver has an SPE certificate pursuant to 49 CFR 391.49. The SPE
is applicable only for fixed deficits of the extremities. |
|
|
Term
A urinalysis is a required part of the driver evaluations. If the UA indicates glycosuria, the medical
examiner: |
|
Definition
May elect to perform a finger stick to obtain a random blood glucose.
Glycosuria may indicate poor blood glucose control. When urinalysis shows
glycosuria, you may elect to perform a finger stick test to obtain a random blood glucose. |
|
|
Term
You are required to perform a urinalysis (dip stick) as a part of every driver certification and recertification
medical examination. An abnormal result for which of the following mandates temporarydisqualification? |
|
Definition
a. Protein.
b. Blood.
c. Glucose.
d. NONE of the above
. Proteinuria, hematuria, or glycosuria may be an indication for further testing to rule
out any underlying medical problem. You should advise the driver of any abnormal findings and when
indicated, encourage the driver to seek primary care provider evaluation, particularly if an abnormal
urinalysis could indicate the presence of a medical condition that if left untreated could result in a serious
illness that might affect driving. |
|
|
Term
| Each of the following mandates disqualification in a driver with a history of alcoholismEXCEPT: |
|
Definition
a. He voluntarily attends a 12-step program to maintain hisrecovery.
Ongoing voluntary attendance at self-help groups (e.g., 12-step programs) for
maintenance of recovery is not disqualifying. |
|
|
Term
A female driver presents for re-certification who is in her fourth day of menses with heavy bleeding. Her
US shows a Specific gravity of 1.020; Protein is +1; Blood is +4; Glucose is negative. All other aspects of
her medical examination are within normal. The examiner should: |
|
Definition
Certify the driver for 2 years.
The abnormality in the UA is the level of blood in the urine, which is likely a result of
the driver’s menstrual cycle. Without any other identified abnormality, the driver would be certified for 2
years. |
|
|
Term
At initial certification, a driver is found to have a blood pressure of 165/105 mm Hg. You give him a
certification for three months. Upon recheck, his blood pressure is 135/85. As medical examineryou: |
|
Definition
Give him a one-year certification from date of initial exam.
This driver has stage 2 hypertension on initial exam. He qualifies for certification has
his blood pressure at recheck is below 140/90. |
|
|
Term
A diagnosis of which of the following mandates disqualification from commercial motor vehicle
driving? |
|
Definition
a. Schizophrenia.
b. Hypertrophic cardiomyopathy.
c. Parkinson’s disease.
d. All of the above.
Each condition listed entail risks too great for commercial motor vehicle
driving. |
|
|
Term
Which of the following accurately describes the FMCSA’s requirement regarding grip strength
for certifying commercial drivers? |
|
Definition
The Federal Motor Carrier Safety Administration does not require any specific test for assessing
grip power.
The Federal Motor Carrier Safety Administration does not require any specific test for
assessing grip power. The driver must have sufficient grasp and prehension to control an oversize steering
wheel, shift gears using a manual transmission, and maneuver a vehicle in crowded areas. |
|
|
Term
| FMCSA guidance recommends drivers NOT be certified with the following conditions EXCEPT: |
|
Definition
Otitis Media.
Otitis media is not disqualifying |
|
|
Term
A driver with a history of congestive heart failure is asymptomatic at time of presentation
for certification. What minimum left ventricular ejection fraction is required for
certification? |
|
Definition
40%
The minimum LVEF for certification is 40% in a patient with known
Congestive Heart Failure. |
|
|
Term
A driver presents for certification and notes that he is recently had a surgical repair of an
aneurysm in his left leg. What is the minimum waiting period following surgical repair of an
aneurysm? |
|
Definition
3 months
Aneurysms can develop in visceral and peripheral arteries and venous vessels.
Rupture of any of these aneurysms can lead to gradual or sudden incapacitation and death. Much of
the information on aortic aneurysms is applicable to aneurysms in other arteries. The waiting period is
a minimum 3 months post-surgical repair of an aneurysm. |
|
|
Term
Which of the following is true regarding the FMCSA Blood Pressure regulations for commercial motor
vehicle drivers? |
|
Definition
a. Only BP readings taken during the driver physical or follow-up examinations may
be used for certification decisions.
b. A BP greater than 145/89 mm Hg should be confirmed with a second
measurement taken later during the examination.
c. Trained assistive personnel may take and record theBP.
d. All of the above are correct.
Trained assistive personnel may take and record the BP and pulse. When BP,
pulse rate, or both are significant factors in your decision not to certify a driver, it is prudent for you
to measure the readings yourself. However, the Medical Examiner must sign the Medical Examination
Report form. By signing the Medical Examination Report form, you are taking responsibility for and
attesting to the validity of all documented test results. |
|
|
Term
As part of the evaluation of a driver presenting for initial certification, as the medical examiner, you
must perform testing for: |
|
Definition
a. Alcohol.
b. Marijuana.
c. Opiates.
d. NONE of the above.
. Testing for controlled substances is not a part of the physical qualifications for the
driver examination process. Testing for controlled substances falls under a different regulation.
However, if you suspect a need for drug/alcohol testing, contact the Federal Motor Carrier Safety
Administration, or the motor carrier directly, for information on controlled substances and alcohol
testing under Part 382 of the Federal Motor Carrier Safety |
|
|
Term
Select the correct statement regarding evaluation and certification of acommercial
motor vehicle driver: |
|
Definition
a. There are no work restrictions permitted. The commercial driver must be able to perform
all job-related tasks, including lifting, to be certified.
b. The SPE program is intended only for individuals with fixed deficits of the extremities (not
for individuals with progressive diseases).
c. A driver is certified from the date of examination. If only the disqualifying condition, e.g.,
blood pressure, is evaluated at the next examination following temporary disqualification,the
date of the initial examination is used to calculate the certification period. If the examiner
performs a complete physical examination, then the certification period is calculated from
the date of this examination.
***d. ALL of the above are correct.*** |
|
|
Term
| Which of the following is NOT a mission of the FMCSA? |
|
Definition
| Oversee the prosecution of criminally negligent cases of motor carrier safety breaches |
|
|
Term
In which of the following cases should you mark an exam as "incomplete
examination"? |
|
Definition
| When the driver leaves before you have completed the exam and made a decision. |
|
|
Term
It is the responsibility of the Motor Carrier to make sure that commercial motor vehicle drivers meet
each of the following requirements EXCEPT: |
|
Definition
| Provide their full Medical Examination Report Form to the motor carrier. |
|
|
Term
| What HgbA1C level is indicative of a diagnosis of diabetes? |
|
Definition
|
|
Term
A driver presents for her first DOT medical exam. She is 48 years old and starting truck-driving school
as a second career. She has no previous diagnosis of HTN, but her blood pressure today is 176/124
mm Hg. What time period is appropriate for certification? |
|
Definition
Disqualify. Refer for treatment.
This driver exhibits stage 3 hypertension (the diastolic BP is over 110 mm Hg),
which mandates disqualification. |
|
|
Term
A Driver has no previous diagnosis of hypertension. Today his blood pressure is 146/88 mm Hg.
What certificate time should be given? |
|
Definition
|
|
Term
A Driver has been taking medication for hypertension for 3 years. He is inconsistent about taking the
medication. Today his blood pressure is 146/96 mm Hg. What should be done? |
|
Definition
Give a 1-time certificate for 3 months.
The one-time 3-month certificate offers the driver a chance to obtain appropriate
treatment to bring his blood pressure below 140/90 mm Hg at the next appointment. |
|
|
Term
| What is the maximum certification period for Obstructive Sleep Apnea? |
|
Definition
|
|
Term
A Driver sustained a myocardial infarction one month ago. He is following up with his primary care
physician again in 1 week. He is unsure of his prescriptions, but is asymptomatic. Should he be
certified today? |
|
Definition
No. There is a minimum wait period of 2 months and specific criteria that must be met
thereafter before certification. |
|
|
Term
A driver had heart surgery 6 months ago. He reports recovering well and is asymptomatic.
Documentation from his physician shows he is indeed recovering well and tolerating his
medication. Surgery included installation of an implantable cardioverter defibrillator. Can he be
qualified today? |
|
Definition
| No. An lCD is disqualifying. |
|
|
Term
A driver denies using illegal drugs, but he looks haggard and has fresh needle sticks on his forearm.
Can you order lab testing for drugs? |
|
Definition
Yes. This is outside of standard DOT drug testing, but a non-DOT drug test can be ordered.
Refusal to test is a failure. |
|
|
Term
| What is the maximum allowable BMI to qualify driver? |
|
Definition
There is no standard.
The FMCSA provides no definitive guidance regarding criteria that mandate screening for obstructive
sleep apnea nor any OSA risk factor thresholds that mandate disqualification. |
|
|
Term
A driver has a long history of major depression. His only current medication is Paxil, and he reports no
side effects. Three months ago, he attempted to commit suicide by hanging, but was unsuccessful.
Physically, all is within standards. Can he be qualified? |
|
Definition
| No. The waiting period following a suicide attempt is 1 yearminimum |
|
|
Term
A driver's exam is unremarkable except for a recent history of panic attacks. These are under
control with Xanax. She reports no side effects. What certification is appropriate? |
|
Definition
Xanax is generally considered to increase crash risk. Use your clinical judgment, but use
of benzodiazepines is typically disqualifying. Additional consultation with treating
physician may be needed. |
|
|
Term
| What is the minimum gross vehicle weight that will require a DOT medical exam for the driver? |
|
Definition
|
|
Term
| Drugs with no known medical use and a high potential for abuse fall into what category? |
|
Definition
|
|
Term
| Marijuana is what listed as which of the following? |
|
Definition
|
|
Term
A driver is 35 years of age. He has a diagnosis of Ankylosing Spondylitis since he was 19. He has fusion
throughout his spine, excluding the upper cervical spine. Neck rotation is limited to 15 degrees
bilaterally. His neck is permanently flexed 25 degrees forward and he can only extend it 10 degrees.
Agility is greatly diminished and he cannot climb well. He now presents for recertification, but notes
he primarily does an administrative desk job. Based on this, what is the proper course of action? |
|
Definition
Disqualify
This driver is unable to safely fulfill the duties of a commercial motor vehicle
driver, such as using the side mirrors. Remember, certification is for all duties of a driver. There are not
work restrictions offered. |
|
|
Term
Transient Ischemic Attacks are a major concern. They can be one of the earliest signs of
cerebrovascular disease. Symptoms usually only last 10-20 minutes. All of the following
are symptoms that may present in the history as a result of a TIA, EXCEPT: |
|
Definition
|
|
Term
A driver with a history of a TIA should be removed from the road for what minimum waiting
period? |
|
Definition
|
|
Term
Epilepsy is a major concern due to risk of seizure or loss of consciousness. How many
unprovoked seizures are required for a diagnosis ofepilepsy? |
|
Definition
|
|
Term
| After a diagnosis of Meniere’s disease, what is the recommendation for certification of a driver? |
|
Definition
| Meniere’s disease is progressive and considered completely disabling.Disqualify. |
|
|
Term
| Which of these is intrastate (as opposed to interstate) commerce? |
|
Definition
a. A UPS driver delivers packages from far and wide within a single city.
b. A semi driver drives a long-haul route from Florida to Texas.
c. A commercial driver makes a run from New Orleans, LA to Monroe, LA, but passes through
Mississippi on the route.
d. ALL of the above are examples of interstate commerce, notintrastate.
The U.S. Department of Transportation regulates interstate commerce, which is
defined as trade, traffic or transportation involving the crossing of a state or national boundary. The
vehicle and its contents must cross or there must be the intent to cross a boundary:
(1) Between a place in a state and a place outside that state (including a place outside of the United
States); (2) Between two places in a state, through another state, or a place outside of the United
States; (3) Between two places in the state as part of trade, traffic or transportation originating or
terminating outside the state or the United States. In the case of answer A, the contents are traveling
across state lines. |
|
|
Term
| Which of the following diagnoses is NOT always disqualifying? |
|
Definition
|
|
Term
An obese driver's urinalysis shows 500mg/dL of glucose. He claims he is not diabetic, but it is simply because of the
20-ounce bottle of soda he drank in the hour before the test. What should be done? |
|
Definition
| Obtain a finger stick glucose |
|
|
Term
| A driver's urinalysis shows 500mg/dl of glucose. He claims he is not diabetic, but it is simply because of drinking a 20 oz bottle of soda in the hour before the test. What should you do? |
|
Definition
| Obtain a finger stick glucose. |
|
|
Term
| A driver's blood pressure is found to be 164 /90mm/hg during his DOT exam in January. He is given a 3 mo ceritificate. He returns in march, having lost 10 lbs and starting an anti-HTN medication. His BP is now found to be 136/84mmhg. How should you proceed? |
|
Definition
| Certify for 9 mo from today's date. |
|
|
Term
| Who can grant a waiver or exemption? |
|
Definition
|
|
Term
| If a driver has had a cortical stroke, what is the minimum waiting period before he or she may possibly be certified to drive? |
|
Definition
| 5 years, as potential for seizure is a concern. |
|
|
Term
| Both schizophreniform and bipolar disorders can be disqualifying. Which of the following conditions is NOT a reason in and of itself to disqualify? |
|
Definition
| Swings in energy levels and mood. |
|
|
Term
What are the FMCSA guidelines for certification of a driver on Coumadin and compliant with
INR monitoring? |
|
Definition
| Use clinical judgment, based upon the underlying disease. |
|
|
Term
| If a driver is only taking over-the-counter medications, what are the possibleramifications? |
|
Definition
OTC medications can affect the decision to certify, time limit, or disqualify as determined by
the clinical judgment of the medical examiner |
|
|
Term
Exercise tolerance 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.
Which of these is NOT one of them? |
|
Definition
| Have no increase in diastolic pressure. |
|
|
Term
| Which of the following are not required for the urinalysis portion of the DOT medical exam? |
|
Definition
|
|
Term
If a dipstick urinalysis shows findings that are abnormal, but do not immediately threaten the
driver or the public, such as mild proteinuria, which is the most reasonable course ofaction? |
|
Definition
Encourage the driver to seek further care from his primary care provider and document the
findings for him/her to take to the PCP. |
|
|
Term
| What is the advised minimum waiting period following coronary artery bypasssurgery? |
|
Definition
|
|
Term
| Severe traumatic brain injuries are disqualifying. How is a "severe TBI"defined? |
|
Definition
| Injury penetrates the dura and/or causes loss of consciousness > 24hours. |
|
|
Term
A vehicle that is used to transport a minimum of which of the following number of persons
(including the driver) would be defined as a commercial motor vehicle for interstate commerce? |
|
Definition
9 for compensation, 16 not for compensation.
. A Commercial motor vehicle is defined as any self-propelled or towed motor
vehicle used on a highway in interstate commerce to transport passengers or property when the
vehicle: (1) Has a combined gross vehicle weight or weight rating of 10,001 pounds or more; (2) Is
designed or used to transport more than eight passengers (including the driver)for compensation; or Is
designed or used to transport more than 15 passengers, including the driver, and is not used to
transport passengers for compensation; or Transports hazardous materials in quantities that require
placards under the hazardous materials regulations. |
|
|
Term
A bipolar driver has been stable for 5 years without any manic or major depressive episodes.
Paperwork from his mental health provider confirms this. He is treated with lithium. What is the best
certification period? |
|
Definition
1 yr.
. Lithium therapy has not been shown to interfere with safe driving. For
stable bipolar disorder, guidance recommends a one-year certification. |
|
|
Term
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 demands of CMV driving. Which is
NOT one of these? |
|
Definition
Narcolepsy.
The Medical Examiner can diagnose and treat if within his/her scope of practice,
but it is a separate role. These roles can be referred. |
|
|
Term
| It is generally accepted that a HgbA1C above what level indicates poor control ofdiabetes? |
|
Definition
|
|
Term
| Central vision loss is a finding suggestive of: |
|
Definition
Macular degeneration
Central vision loss results from degeneration of the fovea – the central pit of the
retina, where visual acuity is sharpest. The most common cause is age-related macular degeneration,
which is also the leading cause of blindness in older adults. |
|
|
Term
On examination, the medical examiner palpates an enlarged liver on a driver and find signs
suggestive of early hepatic failure. The medical examiner should: |
|
Definition
Refer the driver to his Primary Care Provider.
The medical examiner’s responsibility is to determine a driver’s fitness to operate
a commercial vehicle. It is not to diagnose or prescribe medication. This is an important concept in the
context of the NRCME exam as it will likely be asked several different ways. Questions are often asked
about a disease which may be complex or unfamiliar to the examinee, causing confusion regarding
diagnostic steps. In fact, the answer is simply to refer the patient to the PCP or specialist and not initiate
a diagnostic work-up. |
|
|
Term
A 20-year-old person approaches you and asks you to perform a medical examination for him as he is
planning to apply for an interstate CMV driver job advertised by a local transportation company.
According to the FMCSA standards, a person under 21 is not eligible to work as an interstate CMV
driver; however, you can still perform the examination because: |
|
Definition
It is not your responsibility to ensure that the person meets the age requirements.
- It is not your responsibility to ensure that the person meets the age
requirements. Per the FMCSA, it is the responsibility of the motor carrier to ensure that their interstate
CMV drivers meet the age requirements. As a certified medical examiner, you can perform the driver
physical examination for any person who requests it. |
|
|
Term
A number of requirements must be met in order for a driver to pass a vision exam and be certified.
Which of the following would prevent a driver from being certified by a medicalexaminer? |
|
Definition
Inability to distinguish among traffic devices showing red, amber, and green colors
Inability to distinguish among traffic devices showing red, amber, and green
colors. The color vision requirement is met by the ability to recognize and distinguish among red,
amber, and green, the standard colors of traffic control signals and devices. True color perception is not
required. A driver who lacks the ability to distinguish between red, amber, and green cannot be
certified. |
|
|
Term
If a medical examiner has a reasonable suspicion that a driver has violatedfederal
guidelines regarding alcohol consumption, the driver: |
|
Definition
Must submit to alcohol testing
Must submit to alcohol testing. If a medical examiner has a
reasonable suspicion that a driver has violated federal guidelines regarding alcohol
consumption, the driver must submit to alcohol testing. |
|
|
Term
When a medical examiner performs a forced whisper test, he/she should avoid using only words
that begin with only what letter? |
|
Definition
"S"
When a medical examiner performs a forced whisper test, he/she should
stand at a distance of no less than five feet and whisper a sequence of letters and numbers. The
medical examiner should avoid repeatedly using words that begin with an “S” sound. |
|
|
Term
| Drug testing is the responsibility of which of the following? |
|
Definition
The employer.
Employer responsibilities include: implementing and conducting drug and
alcohol testing programs, providing a list of substance abuse professionals (SAPs), ensuring that
the driver who is returning to a safety-sensitive position has complied with SAP recommendations,
and conducting follow-up testing to monitor that the driver is compliant with DOT alcohol conduct
guidelines and abstaining from unauthorized drug use. |
|
|
Term
A driver presents who has suffered a stroke. The driver has brainstem vascular lesions. Can the
driver be certified? |
|
Definition
The driver can be certified after a one-year waiting period.
A driver who has suffered a stroke may or may not be at increased risk for
seizures, depending on the location of the lesions. A driver with brainstem vascular lesions is not
at an increased risk for seizures, and may be certified following a one-year waiting period. |
|
|
Term
A driver who has been diagnosed with depression and is prescribed lithium may be
certified if: |
|
Definition
a. The driver is asymptomatic.
b. Has no impairment that interferes with safe driving.
c. Has lithium levels that are maintained in the therapeutic range
****d. All of the above.*****
Studies show there is little evidence to link lithium to driving accidents. A
driver who currently takes lithium should be certified provided that: the driver is asymptomatic,
the driver has no impairment that interferes with safe driving, and the driver has lithium levels
that are maintained in the therapeutic range. |
|
|
Term
A 44-year-old male presents for examination. He has undergone a surgery for repair ofa 5.0 cm abdominal
aortic aneurysm 1 year ago. He provides a clearance report by a cardiovascular specialist indicating he is
asymptomatic. Is this person qualified? If yes, for how long? |
|
Definition
Yes, for one year.
”. Per FMCSA’s guidelines, persons with an abdominal aortic aneurysm of ≥
5.0 cm may be certified annually if more than three months have passed since surgery, they’re
asymptomatic, and are cleared by a cardiovascular specialist. |
|
|
Term
A 41-year-old male presents for examination. He has a history of thoracic aortic aneurysm which is
reported by his treating cardiovascular specialist to be 2.9 cm. How would you handle this case
and what is the medical certification period for this medicalhistory? |
|
Definition
Query and evaluate other associated cardiovascular diseases; annual certification
Per FMCSA’s guidelines, persons with a thoracic aortic aneurysm of less
than 3.5 cm may be certified annually after thorough evaluation and ruling out of any associated
cardiovascular diseases. |
|
|
Term
A driver with a prosthetic valve who also has LV dysfunction may not be certified if he/she has
ejection fraction of less than what? |
|
Definition
40%
A driver with a prosthetic valve and LV dysfunction of less than 40% may
not be certified. |
|
|
Term
| A driver presents with atrial fibrillation. The major risk associated with this condition is which of the following? |
|
Definition
Stroke
The major risk associated with atrial fibrillation is an embolus, which
can lead to stroke. The most effective means to treating the condition is anticoagulant
therapy. |
|
|
Term
A driver who admits to using controlled substances also attends a self-help program, such as
Alcoholics Anonymous. How should this driver’s case be handled? |
|
Definition
The self-help group cannot substitute for completion of an SAP-required drug
rehabilitation program.
For drivers who use narcotics or habit-forming drugs, certification may
require successful completion of a substance abuse professional (SAP)-required drug
rehabilitation program. Participation in a self-help program cannot be substituted for completion
of an SAP-required drug rehabilitation program. Voluntary, ongoing participation in a self-help
program to support recovery is not disqualifying. |
|
|
Term
. If a driver tests positive for the use of a controlled substance, he/she must do all of the
following EXCEPT before the driver can be a candidate forrecertification? |
|
Definition
Write a personal statement regarding his/her history of drug use.
A driver who tests positive for the use of a controlled substance can be
considered for recertification. The driver must meet certain conditions. In order to be a
candidate for recertification, the driver must be evaluated by a substance abuse professional,
have a negative result on a return-to-duty drug test, and comply with recommended
rehabilitation. |
|
|
Term
What responsibility does a medical examiner have to a driver who requires contact lenses to pass
the vision exam? |
|
Definition
To inform the driver to keep a pair of glasses while driving.
One of the responsibilities of the medical examiner is to provide health
education counseling. In the case of drivers who wear contact lenses, this includes advising the
driver to keep a pair of glasses in the vehicle while driving. |
|
|
Term
A driver with a heart transplant must be reexamined and recertified by a cardiovascular
specialist how often? |
|
Definition
Every six months
A driver who has had a heart transplant may be certified by a medical
examiner if certain requirements are met. Upon certification, a driver with a heart transplant must
be reexamined and recertified every six months by a cardiovascular specialist. |
|
|
Term
When examining a driver’s hearing, a forced whisper test must be performed from a
distance of: |
|
Definition
Five feet
When a medical examiner performs a forced whisper test, the test must
be conducted from a distance of no less than five feet. The distance must be measured and
marked before the exam. |
|
|
Term
If a driver is tested and has high blood pressure during the medical exam, but had blood pressure
within the normal range at prior recent visits with his primary care provider, may the prior blood
pressure be used? |
|
Definition
No, only the information from the driving exam may be use
Only blood pressures obtained during the medical examiner visit for the
driver’s qualification may be used. Results from prior exams, even if they are recent, are not
allowed to be used. |
|
|
Term
| Can a driver who has a history of childhood febrile seizures be certified? |
|
Definition
| Yes, provided the seizures were limited to childhood |
|
|
Term
A driver with a history of migraines whose condition does not interfere with the health and safety
of the driver and public may be certified for a maximum of howlong? |
|
Definition
2 yeARS
If there are no extenuating circumstances, such as impaired vision or
cognitive function, a driver with a history of migraines may be certified for a maximum of two
years |
|
|
Term
What ancillary information documentation must you obtain, and include in your medical
examiner report, for a CMV driver who is diagnosed with Meniere’s disease and who is currently
on medication treatment? |
|
Definition
a. Audiometric test
b. Clearance from a neurologist
***c. None of the above***
This is the correct answer because according to the recommendations of the
Conference of Neurological Disorders and Commercial Drivers, persons with Meniere’s disease
must be disqualified from being CMV drivers. Meniere’s disease is characterized by sensory-neural
hearing loss, tinnitus, pressure sensations within the ear, and severe attacks of vertigo. The
conference concludes that the condition is of sufficient severity and unpredictability that would
render a person unqualified to drive. |
|
|
Term
A potential driver is examined and is shown to have a blood pressure of 165/90 mm Hg. What is
the next step for the medical examiner in this instance? |
|
Definition
Perform a second measurement of the driver’s blood pressure later in the exam.
In the event that a driver is shown to have a BP over 140/90 mm Hg, a
second measurement should be taken later in the exam. An initially high BP can be due to
multiple factors. It could be due to problems with the technique of the examiner, “white coat
syndrome,” or numerous other factors |
|
|
Term
| A driver presents with a hernia. Can the driver be certified? |
|
Definition
Yes, if the hernia does not cause discomfort or interfere with driving.
In general, a hernia should not interfere with a driver’s ability to operate a
commercial vehicle. In some cases, additional tests may be required, but generally speaking, a
driver with a hernia can be certified as long as the hernia does not cause discomfort or interfere
with the driver’s ability to operate a motor vehicle. |
|
|
Term
What ancillary information documentation is/are required to be included in themedical
examination of a driver who has an implantable cardiac defibrillator(ICD)? |
|
Definition
a. Echocardiogram and ETT.
b. A cardiologist clearance report.
c. Cardiovascular specialist report.
***d. None of the above.***
This is the correct answer because according to FMCSA guidelines,
persons with ICDs are not to be qualified as interstate CMV drivers. These persons are at high
risk of sudden death or incapacitation and thus, they pose a risk to public safety. |
|
|
Term
A 37-year-male CMV driver presents for examination. He has the fourth finger missing from his
right hand. He provides a medical report confirming a strong right-hand grasp. Does this person
require a Skill Performance Evaluation (SPE) Certificate by FMCSA to complete the qualifying
procedure under CFR 391.41, and why? |
|
Definition
No, as long as there is a medical report confirming no interference with hand grasp power
a SPE certificate is not required for impairment / loss of a finger.
This is the correct answer because according to CFR 391.41, persons with
an impairment of a hand or finger that does not interfere with prehension and grasping power
may be qualified. In this case, the presence of a medical report confirming the prehension power
is valid evidence for the medical examiner and does not prompt for a SPE certificate. |
|
|
Term
A driver presents who takes Coumadin and has a cerebrovascular disorder. How should a medical
examiner handle the certification of the driver? |
|
Definition
The driver cannot be certified.
A driver who takes Coumadin and has a cerebrovascular disorder cannot
be certified. The high rate of complications associated with bleeding-many of which can
incapacitate a driver-necessitate this decision by a medical examiner. |
|
|
Term
In the event that a driver is disqualified, it is the responsibility of the medical examiner to do
which of the following? |
|
Definition
a. Provide the driver with a rationale for disqualification.
b. Provide instructions on how the driver may be qualified.
***c. Both A and B.***
There are multiple reasons that a driver can be disqualified. In the event
that a driver is disqualified, a medical examiner is required to provide both a rationale for
disqualification and instructions on how the driver may become qualified. |
|
|
Term
A driver who is being treated for ADHD with a central nervous system stimulant may be
certified following: |
|
Definition
There is no waiting period.
Provided the medication has been proven to be safe and effective with no
side-effects for the driver, a driver who takes a central nervous system stimulant may be certified
without a waiting period. |
|
|
Term
In the event that a dipstick urinalysis of a driver has positive results, which of the following should
happen? |
|
Definition
There should be additional evaluation.
Dipstick urinalysis tests for specific gravity and measures blood, protein,
and glucose in the urine. Should any of the tests have positive results, additional evaluation may
be required. |
|
|
Term
A 60-year-old male presents for examination. He admits to taking Sinemet tablets 3 times per day.
What is the health condition of this person and what is the decision regarding hiscertification? |
|
Definition
Parkinson’s disease/syndrome;Disqualified
Sinemet (Levodopa-Carbidopa) is used in the treatment of Parkinson’s
disease, which is a disqualifying health condition according to FMCSA guidelines. Parkinson’s
disease impairs the ability to drive as it results in motor function disorders such as prolonged
motor and premotor reaction times, slowness of execution of movement, frequent interruptions
of ongoing movement, and inability to perform two or more tasks simultaneously. |
|
|
Term
A 50-year-old male CMV driver has chronic kidney failure for which is undergoes hemodialysis
three times each week. His treating physician provided him with a medical report indicating that
he can work normally except on the days he is undergoing dialysis. He is also suffering from
hypertension. This CMV driver would be: |
|
Definition
Disqualified.
According to the FMCSA, drivers with stage 5 chronic kidney disease,
requiring dialysis, must be disqualified. The hypertension condition of the driver in this case does
not imply any exemption, because of the severity of the kidney disease. In general, persons who
undergo dialysis are prone to fatigue and sleepiness, which jeopardize their ability to drive safely. |
|
|
Term
A 56-year-old male driver applying for a new certificate admitted that he suffered a myocardial
infarction 3 months before. He provides you with a clearance certificate by a cardiologist. He
also informs you that he is not feeling any chest pain post MI. Is this information sufficient to
determine his health history? |
|
Definition
No, need information on post-MI LVEF, ETT, ECG, and tolerance to medication.
According to FMCSA guidelines a person who has had an MI at least 2
months before and who is asymptomatic, must still demonstrate an LVEF > 40%, normal ETT, no
ischemic changes on ECG and good tolerance to medications before she/he can be certified. |
|
|
Term
A driver with a history of an allergy-related life-threatening condition, such as angioedema,
is required by federal guidelines to have a certification of no more than: |
|
Definition
An individual with an allergy-related life-threatening condition can be
certified for a maximum of two years. Individuals with a history of an allergy-related lifethreatening condition must have undertaken preventive measures in order to be considered
medically qualified |
|
|
Term
| A driver with diabetes mellitus should also be examined for which of the following? |
|
Definition
Autonomic neuropathy.
There are a number of conditions that frequently coexist with diabetes
mellitus. Therefore, if a driver presents with that condition, the medical examiner should also
evaluate the driver for the following: coronary heart disease, cerebrovascular disease,
nephropathy, and autonomic neuropathy. |
|
|
Term
In the event that a medical examiner examines a driver and finds the driver to have high blood
pressure, the medical examiner should: |
|
Definition
Refer the driver to a specialist.
”. The medical examiner’s responsibility is to determine a driver’s fitness to
operate a commercial vehicle. It is not to diagnose or prescribe medication. If a driver is tested
and found to have high blood pressure, the medical examiner should refer him/her to a specialist
for treatment. |
|
|
Term
In the event that a medical examiner examines a driver and finds the driver to have high blood
pressure, the medical examinershould: |
|
Definition
Refer the driver to a specialist.
The medical examiner’s responsibility is to determine a driver’s fitness to
operate a commercial vehicle. It is not to diagnose or prescribe medication. If a driver is tested
and found to have high blood pressure, the medical examiner should refer him/her to a specialist
for treatment. |
|
|
Term
| When examining a driver’s vision, which of the following should be permitted? |
|
Definition
a. The Snellen chart should be illuminated with white light.
b. The chart should be twenty feet away from the driver.
c. The driver should wear corrective lenses, if necessary.
***d. All of the above***
When examining a driver’s vision, each of the following should occur: The
Snellen chart must be illuminated with white light; the chart should be twenty feet away from
the driver; and if the driver normally wears corrective lenses, he/she should be permitted to
wear them during the exam. |
|
|
Term
| Select the correct statement(s): |
|
Definition
a. The Medical Examiner's Certificate, Form MCSA-5876, expires at midnight on the date written
on the form.
b. There is no grace period for the expiration date of The Medical Examiner's Certificate, Form
MCSA-5876.
c. The medical examiner is required to report the results of all examinations conducted on the
CMV Driver Medical Examination Results Form, MCSA-5850, through the individual National
Registry account by midnight (local time) of the next calendar day following the examination.
****d. All of the above are accurate.****
Correct answer “D”. Each requirement is correct as described. |
|
|
Term
What is the waiting period following a Transient Ischemic Attack (TIA) before certification canbe
considered? |
|
Definition
12 months.
A one year waiting period is mandated following a TIA. |
|
|
Term
While evaluating a school bus driver’s gait, the examiner notes a slightly antalgic gait favoring the right leg
and hip. The driver does not indicate any musculoskeletal problems in the health history. How should the
examiner proceed? |
|
Definition
Determination Pending until medically cleared by orthopedist.
This is a typical exam question that does not ask about specific rules or guidance, but
aims to emphasize that the medical examiner only assesses the driver for medical fitness for duty and
does not diagnose and treat personal medical conditions. |
|
|
Term
| The medical examiner must consider the essential job functions of the commercial driver as: |
|
Definition
The same degree of work effort and intensity for all drivers, no exceptions
DOT medical exam certification is an “all or none” proposition. Light duty restrictions are
not considered. |
|
|
Term
Which of the following medical conditions, is regulation and non-discretionary for the medical examinerper
FMCSA standards for driver qualification determination: |
|
Definition
Hearing Loss > 40 dB on average for 500, 1000 and 2000 Hz in both ears
The vision and hearing criteria are regulatory, not guidance. |
|
|
Term
A driver states that she has exercise-induced asthma well controlled by using an albuterol inhaler before
she does any aerobic activity. Her pulmonary function (forced expiratory volume in the first second of
expiration (FEV1)) must be greater than % of predicted FEV1 to qualify. |
|
Definition
65%
For obstructive pulmonary disease, a minimum FEV1 of 65% of predicted is
required for certification. |
|
|
Term
Mr. Smith is a 55 year-old driver who presents for a recertification examination. He has a 40-year smoking
history and continues to smoke despite repeated efforts to quit; however, he has cut back to only one pack
a day. He has a productive cough in the morning and a chronic lingering cough throughout the day. His
vision testing, hearing testing, and urinalysis results are all acceptable. Pulmonary Function Test (PFT)
results: forced expiratory volume in the first second of expiration (FEV1) 64% of predicted FEV1 &
FEV1/forced vital capacity (FVC) ratio 66%. He exhibits a barrel chest appearance and auscultation of his
lungs reveals expiratory wheezes and rails over the lower lobes of both lungs, with decreased diaphragm
excursion. He becomes mildly dyspneic when performing muscle testing during the examination. No
clubbing or cyanosis is noted. The remainder of the physical examination was unremarkable. According to
medical guidance, what do Mr. Smith’s PFT test results indicate doing next? |
|
Definition
Refer to specialist for arterial blood gas and evaluation.
FMCSA guidance says that additional testing is indicated if the FEV1 is less than 65% of
the predicted value and if the FEV1/FVC ratio is less than 65%. This individual should have an arterial blood
gas. Also, his results are borderline; the FMCSA also encourages erring on the side of public safety.
Additional pulmonary testing is a reasonable course of action. |
|
|
Term
A driver is taking Lithium and provides a recent lithium level and clearance from his psychiatristindicating
he has had stable moods over past 5 years. What limitation, if any, should be placed on the CDL medical
certificate? |
|
Definition
Two-year certificate can be issued for treatment of stable chronic illness with no recent
medication changes
A chronic mood disorder that is stable over time can be issued a 2-year certification. |
|
|
Term
The medical examiner notes that the driver is taking Metformin for the treatment of diabetes, disulfiram
(Antabuse) for chronic alcohol use, and rosuvastatin (Crestor) to reduce serum cholesterol levels. He
reports no side effects from any of the medications. The rest of the examination is unremarkable. The
examiner should: |
|
Definition
Disqualify the driver and refer to a DOT substance abuse professional
The driver is taking Disulfiram (Antabuse) which is used to treat alcohol addiction.
This indicates that the driver currently suffers from a clinical diagnosis of alcoholism. |
|
|
Term
During the examination, all systems were found to be normal. The CME measures the driver’s
peripheral horizontal vision at 70 degrees on the left and 80 degrees on the right. The examiner should? |
|
Definition
Qualify the driver for 2 years.
The driver must exhibit a minimum peripheral vision of 70 degrees bilaterally. |
|
|
Term
A motor carrier calls to request a copy of one of its driver’s Medical Examination Report F. What is the
next step? |
|
Definition
Contact the driver and obtain a signed release of medical information prior to sending the form
to the employer.
The medical exam form is considered medical information protected by HIPPA. |
|
|
Term
A medical examiner observes that a driver has a blood pressure of 160/94. The driver has no prior
knowledge of high blood pressure and has not been prescribed medication. He states recent blood
pressure at the primary care provider was “in the 130s”. The remainder of his exam is unremarkable.
Which of the following is the appropriate subsequent action for the medical examiner? |
|
Definition
Repeat the blood pressure and if it is normal issue a 2-yearcertification
A repeat, second Blood Pressure reading is always a good approach to confirm an initial
high reading. |
|
|
Term
The driver was disqualified on the examination date 4/16/2017 due to diagnosis of benign positional vertigo
3/15/2011. He returns to medical examiner for certification exam on 5/20/2017 and has been
asymptomatic since 3/11/2017. He is qualified for two years. What date should be noted as ME certificate
expiration? |
|
Definition
5/20/2019
The date of the follow up visit is used to calculate the certification when a driver
presents while in determination pending status. |
|
|
Term
| What differentiates whether certification is required for interstate versus Intrastate? |
|
Definition
The origination and/or destination of the commerce or goods
The date of the follow up visit is used to calculate the certification when a driver
presents while in determination pending status. |
|
|
Term
| By marking the SPE option, you certify that thedriver: |
|
Definition
a. Fails to meet one or more of the limbrequirements
b. Meets all other physicalrequirements
c. Must have both a valid SPE certificate and Medical Examiner's Certificate to drive
***d. All of the above***
Essentially you are stating that with the excep |
|
|
Term
| Which of the following are NOT acceptable for commercial driving? |
|
Definition
Telescopic lenses for stable macular degeneration.
The necessity for telescopic lenses for stable macular degeneration is disqualifying. |
|
|
Term
A driver with a known history of COPD is found to have an FVC of less than 60% of the predicted valued
on pulmonary function testing. A reasonable next step is to order a: |
|
Definition
Arterial Blood Gas.
Screening pulse oximetry and/or arterial blood gas analysis is indicated when a driver has a condition that
causes airway obstruction and pulmonary function test results are FEV1 less than 65% of the predicted value
or the FEV1/FVC ratio is less than 65% or the driver has a restrictive impairment and the FVC is less than 60%
of the predicted value. |
|
|
Term
A driver has been diagnosed with an acute pulmonary embolism and is appropriately anticoagulated.
How long must you wait following the PE event before certifying the driver, assuming there has been no
recurrence? |
|
Definition
Three months.
A driver may be certified 3 months following a pulmonary embolism assuming that there has been no
recurrence, he is asymptomatic, is appropriately anticoagulated, and has no disqualifying cardiovascular
disease. |
|
|
Term
A driver sustained a closed head injury in a motor vehicle accident. There was loss of consciousness for
approximately 15 seconds. A CT scan of his head was normal. His course was not complicated by the
development of seizures. How much time must elapse before this driver can be certified to driver a CMV
in interstate commerce? |
|
Definition
There is no applicable waiting period.
By definition, this driver has a history of mild TBI not complicated by seizures. Therefore, no waiting period
applies |
|
|
Term
| What is your next step if the driver fails the forced whisper test |
|
Definition
Have an audiometric test performed.
To meet the Federal hearing standard, the driver must successfully complete one hearing test with one ear:
First perceive a forced, whispered voice in one ear at not less than five feet OR on an audiometric test not
have an average hearing loss in one ear greater than 40 decibels at 500 Hz, 1,000 Hz, and 2,000 Hz. Either test
may be administered first. |
|
|
Term
A driver presents for a certification exam and notes that he chews tobacco. On examination you find
several oral lesions. You should: |
|
Definition
Certify the driver, recommending a referral to a dentist and noting this on the chart.
The presence of oral lesions does not compromise safe driving so you may certify the driver, but you should
ensure that the driver is referred to a dentist or oral surgeon to evaluate for the possibility of oral cancer. |
|
|
Term
On dipstick urinalysis performed as part of the DOT exam, a driver is found to have 1+ proteinuria.
A reasonable next test would be: |
|
Definition
Serum creatinine
This is another general knowledge question; the FMCSA is just making sure the examiner is aware of that the
first sign of nephropathy commonly is the development of proteinuria. |
|
|
Term
A driver with no prior medical history and on no medications, is found to have moderate glycosuria on
urine dipstick. What is your next step? |
|
Definition
Perform a fingerstick glucose.
Glycosuria should prompt a blood glucose test to determine if the driver actually has hyperglycemia. |
|
|
Term
| How often is a driver with stage 3 hypertension recertified? |
|
Definition
|
|
Term
| On an exercise tolerance test the driver should be able to exercise to a workload capacity of atleast: |
|
Definition
6 Metabolic Equivalents.
The exercise tolerance test is the most common test used to evaluate workload capacity and detect cardiac
abnormalities. Driver should be able to exercise to a workload capacity greater than 6 Metabolic Equivalents
(METs) (through Bruce protocol stage II or equivalent). |
|
|
Term
A driver sustained a shoulder injury at work two years earlier. He has developed significant pain in the
shoulder which is severely limiting use of the arm. He is now presenting for his certification exam. You
should: |
|
Definition
Disqualify the driver
It would appear that the driver’s shoulder injury prevents him from safely performing all tasks of a CMV. An
SPE would not have role here, as it is used for a fixed deficit of an extremity. DOT certification is an “all or
none” proposition, so work restrictions have no place in DOT certification. |
|
|
Term
Which of the following clinical symptoms poses a significant risk to public safety when present in
a Commercial Motor Vehicle driver? |
|
Definition
Vertigo.
The presence of uncontrolled vertigo/dizziness is disqualifying. |
|
|
Term
| Which of the following lab values warrants disqualification? |
|
Definition
Serum creatinine = 9 mg/dL.
A serum creatinine of 9 mg/dL indicated renal failure to a degree that dialysis is likely warranted. Dialysis is
disqualifying. |
|
|
Term
| A driver with a recent myocardial infarction requires which of the following tests? |
|
Definition
Echocardiogram
An echocardiogram demonstrating a post-MI ejection fraction of at least 40% is required for certification. |
|
|
Term
| Which of the following medications is considered potentially disqualifying? |
|
Definition
Diphenhydramine
First generation antihistamines such as diphenhydramine are quite sedating; The driver should abstain from
the medication for 12 hours prior to operating a CMV. If this is not possible, the driver should not be
certified. |
|
|
Term
| A driver is found to have leukocytes on a urine dipstick. As the medical examiner, you should: |
|
Definition
Refer the driver to his primary care provider.
The purpose of questions such as this is to emphasize the role of the examiner is not to act as the driver’s
PCP. |
|
|
Term
| A Romberg test is used to investigate the cause of: |
|
Definition
Ataxia.
This is another example of a general knowledge question often asked on the NRCME exam. The Romberg test
is a test of the body's sense of proprioception, which requires healthy functioning of the dorsal columns of
the spinal cord. |
|
|
Term
| Which of the following must be included on the Medical Examination Report Form? |
|
Definition
a. The Medical Examiner’s office address.
b. The Medical Examiner’s phone number.
c. The Medical Examiner’s state license.
**d. All of the above.**
Review the components of the MER before taking the NRCME exam. |
|
|
Term
On an exercise tolerance test, the driver must attain a heart rate of what level (assuming he is not taking
a beta-blocker): |
|
Definition
At least 85% of predicted maximum.
The acceptable threshold for an ETT is for the driver to attain a heart rate greater than or equal to 85% of
predicted maximum (unless on beta blockers). |
|
|
Term
On examination of a driver, you note xanthelasma palpebrarum. Which of the following tests should
be obtained? |
|
Definition
Serum lipids and cholesterol.
This is another example of a general knowledge question that the FMCSA likes to ask. Xanthelasma
palpebrarum is a marker for hyperlipidemia. |
|
|
Term
Which of the following is a concern for sudden incapacitation in a driver who describes right upper
quadrant abdominal pain? |
|
Definition
Cholelithiasis
Gall bladder disease would be the concern |
|
|
Term
A driver reports recently completing a drug rehabilitation program. Which of the following is needed
before you can certify this driver? |
|
Definition
Certification typically requires successful completion of a substance abuse professional (SAP)-required drug
rehabilitation program. |
|
|
Term
A driver with a history of diabetes complains of tingling and numbness in his left lower extremity. What
test would you perform? |
|
Definition
Monofilament testing.
The patient likely has a diabetic peripheral neuropathy and monofilament testing is the first step to assess
cutaneous sensation. |
|
|
Term
The examiner should not certify a driver who exhibits which of the following results on an arterial blood gas
a. PaO2 less than 65 mm Hg at altitudes below 5,000feet.
b. PaO2 less than 60 mm Hg at altitudes above 5,000 feet.
c. PaCO2 greater than 45 mm Hg at any altitude.
***d. All of the above are disqualifying.*** |
|
Definition
| D. Each answer is disqualifying |
|
|
Term
| Which of the following is NOT documented on the medical evaluation report form? |
|
Definition
c. Driver respiratory rate.
Driver weight, height, blood pressure, and heart rate are all documented on the MER. |
|
|
Term
| A male driver is found to have a grip strength of 8 lbs. Do you certify this driver? |
|
Definition
No.
The FMCSA notes that grip strength must be adequate for the driver to safely perform all tasks required of a
CMV driver. However, the FMCSA does not mandate any minimum threshold of grip strength. Average grip
strength of a man is 105-113 lbs. Therefore, a g |
|
|
Term
A driver is found to have anisocoria. He passes the vision test and the rest of the exam is normal. Can
you certify this driver? |
|
Definition
Yes
Anisocoria, or unequal pupil size, can be caused by many benign conditions. If the driver passes the vision
test and the rest of the ocular exam and the neurologic exam is normal, he can be certified. |
|
|
Term
| Which of the following is true regarding the audiometric test used for the hearing qualification? |
|
Definition
The hearing requirement for an audiometric test is based on hearing loss only at the 500 Hz, 1,000
Hz, and 2,000 Hz frequencies.
The test results are for an audiometer calibrated to the American National Standards Institute (ANSI)
standard. There is no requirement to repeat the test with a backup device. The hearing qualification
requirement for the Audiometric test is that the driver has an average hearing loss (average of test results for
500 hertz (Hz), 1,000 Hz, and 2,000 Hz) in one ear less than or equal to 40 dB. |
|
|
Term
Select the correct statement regarding the Medical Evaluation Report Form (MER) and the
Medical Examiner’s Certificate (MEC): |
|
Definition
You must denote on the MER if the driver used a hearing aid for the hearing test and, if so, for which
ear(s).
You do not record uncorrected vision for a driver using corrective lenses. |
|
|
Term
As part of the DOT exam, the medical examiner must obtain a urine dipstick for glucose. If the result
reveals moderate glycosuria, the reasonable next step is for the examiner to: |
|
Definition
. Obtain a blood glucose test.
As it is quite possible for a patient to spill glucose in the urine despite having a normal serum glucose, the
first step is to make sure that the driver truly has hyperglycemia before prompting further evaluation and
testing. |
|
|
Term
The CAGE questionnaire asks the following questions:
• Have you ever felt you needed to Cut down on your drinking?
• Have people Annoyed you by criticizing your drinking?
• Have you ever felt Guilty about drinking?
• Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your
nerves or to get rid of a hangover?
How many “yes” responses suggest that the possibility of alcoholism should be investigated further? |
|
Definition
|
|
Term
| Examination of which of the following is not part of the DOT medical exam? |
|
Definition
|
|
Term
| Which standard or guideline allows Medical Examiner discretion? |
|
Definition
Put the exam in Determination Pending until wax is removed.
The ME must view the tympanic membrane and auditory canal prior to issuing a
medical examiner's certification. |
|
|
Term
A driver had to use a hearing aid to pass the hearing standard. What should the examiner advise
the driver? |
|
Definition
Carry extra batteries
The driver should be counseled to carry an extra hearing aid battery or power
source and that he must wear the hearing aid while driving. The driver does not need a hearing
exemption. |
|
|
Term
The driver admits during the examination that he drinks frequently, usually only on the weekends,
maybe a total 12 to 14 beers each week to help him unwind. The examiner provides a "CAGE"
questionnaire and the driver scores a 1 on the questionnaire. The rest of the examination is
unremarkable. The examiner should: |
|
Definition
Certify the driver for 2 years
Despite admitting to drinking up to 14 beers a week, with less than a score of 2
on the CAGE questionnaire, and showing no other clinical evidence to indicate a current active diagnosis
of alcoholism, the driver would be certified for up to 2 years. |
|
|
Term
| A driver exhibits clubbing of the fingers. The examiner should consider: |
|
Definition
Referral to a pulmonary specialist prior to certification.
The driver shows signs of clubbing of the fingers which is most closely associated
with pulmonary disease, but can be cause by other etiologies such as cardiac disease. Referral to a
pulmonary specialist is the most correct answer for the purposes of the NRCME exam. |
|
|
Term
A driver is prescribed "Bentyl" for his Irritable Bowel Syndrome. He reports that the condition is
well managed and he has had no difficulty driving over the past few years. The examiner should: |
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Definition
Certify the driver for 2 years.
The driver’s condition and treatment appear to be safe, stable, and not a risk to
safe driving. |
|
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Term
When asked to differentiate traffic signal green, red, and amber using colored cards, the driver
can differentiate which color is which, but reports that the red card actually appears "greenish grey" and
green card appears "grayish". What is the next step? |
|
Definition
Certify the driver for 2 years
To pass the color vision standard, drivers are only required to differentiate
traffic signal green, red and amber. It does not matter what color they actually report seeing. |
|
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Term
Of the following medical conditions, which one is most likely to cause a restriction of peripheral
vision: |
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Definition
Glaucoma.
The classic symptom of glaucoma is limited peripheral vision |
|
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Term
A driver reports a history of previously being treated for alcoholism. He continues to attend AA
meetings, and reports being in remission for over 5 years. He does not take any medication to control
his alcoholism. His examination is free of any signs of alcoholism and is otherwise unremarkable. The
examiner provides a CAGE questionnaire and the driver scores a 0 out of 4. The best certification
decision would be to: |
|
Definition
Certify the driver for 2 years.
Certify for a period of 2 years. Had there been signs of alcoholism, an SAP
evaluation would have been required. Voluntary attendance at self-help meetings is not disqualifying. |
|
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Term
| All of the following meet the FMCSA definition of epilepsy except: |
|
Definition
2 or more provoked seizures
Provoked seizures due to a known cause (not epilepsy) are not part of the
FMCSA definition of epilepsy. |
|
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Term
A 43-year old male driver reports for a re-certification examination. His previous certification was
good for 2 years. His history is benign. Further questioning reveals an appendectomy 8 years ago, and no
current medications. His examination is as follows:
Visual Acuity: 20/30 left; 20/20 right; 20/20 both
Able to distinguish signal red, amber, green
Lateral Horizontal Vision: 80 degrees left, 80 degrees right.
Whisper test: 5 ft. right; 4 ft. left
BP 148/88; pulse: 86
UA: Specific Gravity: 1.010; Protein: trace; Blood: Negative; Sugar: Negative.
The rest of the examination is unremarkable.
The examiners best decision would be to: |
|
Definition
Certify the driver for 1 year.
The driver suffers from Stage 1 hypertension. There is no previous history of
hypertension, the driver may be certified for 1 year.
An SPE is not available for this driver because CTS is not a "Fixed Deficit". If the
driver can meet the functions of a CMV driver involving hand strength, s/he should be certified to drive
but may be required to have more frequent monitoring of this potentially progressive disease. |
|
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Term
A driver complains of painless gradual loss of night vision, peripheral vision, and decreased color
discrimination. Distance visual acuity has not changed. The most likely cause is: |
|
Definition
Glaucoma.
. Intraocular pressure causes progressive atrophy of nerve cells. Symptoms include
redirection of visual attention, and decreased peripheral, night vision, and color discrimination for
certain colors. |
|
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Term
| Which is NOT an appropriate Hours of Service regulation for CMV drivers? |
|
Definition
Must carry driving logs for last 48 hours.
The driver must have the driving log for the last 7 days. Some recent versions of
the NRCME exam have included a question asking this. |
|
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Term
A driver complains of loss of central vision and difficulty recovering from bright lights such as
headlights at night. The most likely cause is: |
|
Definition
Macular degeneration.
Classic findings of macular degeneration |
|
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Term
The primary mission to reduce crashes, injuries, and fatalities involving large trucks and buses is
associated with: |
|
Definition
The FMCSA.
The primary mission of the FMCSA is to reduce crashes, injuries and fatalities
involving large trucks and buses. |
|
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Term
A driver living in a state where recreational marijuana use is legal admits to using marijuana.
Which of the following is correct? |
|
Definition
a. Medical Examiners are not to issue a Medical Examiner's Certificate to anyone who currently
uses marijuana.
b. Medical Examiners may issue a Medical Examiner's Certificate once it has been determined
that marijuana use ended, that the driver is not currently under the influence of marijuana,
and it is not expected that the driver will use marijuana in the future.
c. Medical Examiners may issue up to a 2-year Medical Certificate to those who no longer and
are not expected to use marijuana.
***d. All of the above are correct.***
Comment: Once it has been determined that the person being examined is no longer and is not expected to return
to marijuana use, the medical examiner may issue a MEC for up to two years. |
|
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Term
A driver complains of slow progressive diminished distance visual acuity and glare particularly at
night from oncoming headlights and decreased contrast. The most likely cause is: |
|
Definition
Cataracts.
Cataract formation causes diminished visual acuity in all fields, and night glare
from headlights is one of the first changes to appear. Near vision may be improved. |
|
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Term
A driver with diabetes reports partial loss of central vision, color discrimination, and obscured
vision in other vision fields. The most likely cause is: |
|
Definition
Retinopathy
Diabetes is the most common cause of retinopathy. Partial loss of central and
obscured vision in other fields possible. Color discrimination also affected. |
|
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Term
A driver with a current medical certificate that does not expire for another year had an injury that
interfered with his ability to drive. What is the next step? |
|
Definition
The driver must return to the ME for a medical examination.
When a driver returns from an illness or injury that interferes with driving ability,
the driver must undergo a medical examination even if the medical examiner’s certificate has not
expired. |
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Term
| A driver admits to regularly taking his wife’s hydrocodone. The best next step would be: |
|
Definition
Refer the driver for an SAP evaluation.
The driver must have a prescription for narcotic use. Use of prescription
medication that is not prescribed is illegal and is not allowed by federal drug and alcohol program policy.
Admitting to drug use is a violation of drug policy and an SAP evaluation is required. |
|
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Term
| During the ear and hearing portion of the examination, the medical examiner must always: |
|
Definition
Complete testing for both ears even if one passed.
If one ear passes while performing the whisper test or an audiometric test, the
ME must complete that test on both ears. |
|
|
Term
| Functional evaluation of hand function in a CMV driver is based upon: |
|
Definition
Prehension and power grasping.
Evaluation of hand function is based on prehension and power grasping |
|
|
Term
| A driver cannot be considered for an SPE if: |
|
Definition
The deficit affects the torso.
Drivers with deficits that affect the torso cannot be consider for an SPE. |
|
|
Term
| Which of the following antidepressants is usually disqualifying? |
|
Definition
Elavil (Amitriptyline)
First generation antidepressants have consistently been shown to interfere with
safe driving |
|
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Term
A driver is missing all digits of his right foot. He demonstrates good plantar and dorsiflexion. The
next step is: |
|
Definition
Certify for a period of 2 years.
If the driver can demonstrate sufficient power and movement even though all
digits are missing on the foot, they can be certified to drive without a SPE. When less than full function is
lost in the hand or foot, it is up to the medical examiner to determine if the driver can be qualified to
drive or should have an SPE. In this case, the driver appears to have sufficient ability to drive. |
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Term
| Who gets the original copy of the exam report form that is used during medical exam? |
|
Definition
The Medical Examiner.
The original copy of the Medical Examination Report form, which is the copy used
during the examination, is kept by the medical examiner. This can be either a paper or electronic copy. |
|
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Term
A driver currently does not meet the visual acuity requirement but states that he is going to have
lasik surgery in the next month. What is the next best step? |
|
Definition
Complete the physical exam and disqualify the driver
The correct answer is to complete the physical exam and disqualify the driver
because the vision standard is a non-discretionary standard. The driver can return after the procedure
for another certification exam. |
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