vision requirements
20/40 each eye and 20/40 both eyes
peripheral vision
70 degrees
Federal exemption for monocular vision: can certify for how long?
1 year
hearing requirements
whisper at not less than 5 feet better ear, or average hearing loss no greater than 40 dB at 500Hz, 1000Hz, 2000 Hz.
name 4 otic conditions that are automatic DQs
Meniere’s, uncontrolled vertigo, labyrinthine fistula, nonfunctioning labyrinth
Max cert period for Syncope
1 year (needs neurologist clearance)
Post MI drivers can be certified for 1 year with all 5 of these criteria: (almost the same criteria for post CABG) (first 4 also apply for CHF drivers)
- Asymptomatic
- Tolerating meds
- Satisfactory ETT with workload capacity of 6 METs (has to have this biennially)
- LVEF >=40%
- No ST depression on ECG – for post CABG this one is replaced by completely healed sternal incision
Stable angina: max cert period
1 year
minimum waiting period post CABG
3 months
Min waiting period for post heart transplant
1 year
Max cert period for post heart transplant
6 months
Min waiting period post PCI (percutaneous coronary intervention)
1 week
Min waiting period for pacemaker implantation for sinus node dysfunction
1 month
Min waiting period for pacemaker implantation for neurocardiogenic syncope or hypersensitive carotid sinus with syncope
3 months
Min waiting period post AAA repair
3 months
Max cert period for being on anticoagulation for a CV condition
1 year
3 criteria for certification if patient on anticoagulation for a CV condition
- Stable on meds for 1 month
- Provide copy of INR at exam
- Have INR checked and monitored at least monthly
True or false: driver on anticoagulation for CVA can be certified for max 1 year
False. Should not be certified due to high risk of bleeding
5 reasons to DQ a driver with AAA
- Symptomatic
- AAA >5cm
- AAA 4-5 cm and does not have clearance from a cardiologist
- AAA increased in size 0.5cm in 6 months
- Surgical repair was recommended but not done
Max size of a thoracic aneurysm that can be certified
3.5 cm
Min waiting period for PE
3 months
True or false: having an ICD is automatic DQ
true
True or false: dx of severe aortic stenosis is automatic DQ
true
Max certification post aortic valve repair
1 year
Do not certify for moderate aortic stenosis if they have 1 of these 5 things
angina, CHF, A fib, LVEF <50%, thromboembolic disease
How often to repeat echo for aortic stenosis? (answer for both mild and moderate AS)
Mild: 5 years
moderate: 1-2 years
Max certification for severe aortic regurgitation
6 months and must be asymptomatic, normal LV function, LVEDD <=60mm, LVESD <=50mm
Max cert period for balloon mitral valvotomy
1 year
Min waiting period for balloon mitral valvotomy
4 weeks
BP above which you must treat and do one time 3 month certificate
160/100. For 140/90 and above up to this level, it says 3 month certificate but does not say must treat.
BP above which you cannot certify until lowered below 140/90
180/110 – and then this patient can only be certified for 6 months
Max cert period for diabetic patients
Technically 2 years, but 1 year is RECOMMENDED. What the hell.
The rule for DQ if they have history of hypoglycemic reactions
1 episode in 12 months resulting in seizure, LOC, etc; or 2 episodes in 5 years that are as above or also include loss of position sensation, orthostatic hypotension, etc.
Max cert period for asthma
2 years
Must DQ COPD patients if 1 of 3 things:
- hypoxemia at rest
- chronic resp failure
- Continuing cough with cough syncope
if FEV1 on pulm function testing is < (blank) % of predicted, then must also test ABG
65%
Max cert period for CPAP
1 year (1 month waiting period after starting CPAP or 3 months after surgery)
Should instruct drivers to refrain from driving for how many hours after cold or cough medicines?
12 hours
How many of these rules are stupid and arbitrary as hell?
I’m gonna say 40%
Max cert period for pulmonary hypertension
1 year
4 reasons to DQ a pulmonary hypertension patient
- dyspnea at rest
- dizziness
- hypotension
- PaO2 <65mmHg
Name 3 reasons you should check PFTs/ spirometry prior to certifying
- Hx of specific lung disease (asthma, CF, COPD)
- symptoms of SOB, cough, chest tightness, wheezing, etc
- Smokers over age 35
If pulse oximetry is less than blank, you have to do ABG
92% (you would do the pulse ox if FEV1 <65% of predicted or FEV1/FVC ratio <65%)
Apnea-hypopnea index of [blank] or more episodes per hour is diagnostic of OSA
30
Min waiting period for diagnosis of epilepsy or viral encephalitis with early seizures
10 years
Min waiting period for dx of bacterial meningitis with early seizures or single unprovoked seizures
5 years with no seizures and no seizure meds (or for single unprovoked seizure, they can be cleared by a neurologist sooner)
Min waiting period for acute seizure secondary to acute structural insult to CNS
2 years
Max certification for acute seizure secondary to acute structural insult to CNS
1 year
Min waiting period for TBI with early seizures, stroke with risk for seizures, intracranial bleed with risk for seizures
5 years
Min waiting period for TIA or stroke with no risk for seizures
1 year
Min waiting period for vertigo/ dizziness caused by dx of BPV or peripheral vestibulopathy
2 months
6 neuromuscular conditions that are automatic DQ
- congenital myopathies
- metabolic muscle diseases
- motor neuron diseases
- muscular dystrophies
- neuromuscular junction disorders
- peripheral neuropathies
Max certification for single unprovoked seizure
1 year
Max certification for embolic/ thrombotic stroke
1 year and they have to be cleared by neuro
Max certification for TIA
1 year
If you have a fixed (not progressive) deficit of an extremity, you can be certified normally if you have this thing
Skill Performance Evaluation (SPE) certificate
Max certification for adult ADHD
1 year (needs clearance from a mental health professional)
Min waiting period for bipolar disorder (there are 2 different ones)
6 months after depressive episode with no suicidal behavior. 1 year after severe depressive episode, suicidal attempt, or manic episode
Max certification for schizophrenia and related disorders
1 year, but it has to be well controlled (no side effects from meds, no active psychosis or compromised judgment)
Max certification for personality disorders
1 year
Max certification for alcoholism
2 years but only for history of alcoholism, not current dx of alcoholism
max certification for history of drug abuse
2 years
Glaucoma causes what main clinical concern?
loss of peripheral vision
Diabetics on insulin who have an exemption certificate should test sugars when?
before driving and every 2-4 hours while driving
Min waiting period for thoracic aneurysm repair
3 months
Min waiting period for stable angina
3 months with no rest angina or change in pattern
Min waiting period for post acute MI
2 months
Max certification for history of stage 3 hypertension (>180/110)
6 months
3 requirements for a passing ETT
- increased SBP of at least 20 without angina
- workload capacity >6 METs
- no significant ST depression
Min waiting period for bypass graft in extremity
3 months
Max certification for a diabetic on insulin with a federal exemption
1 year
Recommended max certification for diabetic not on insulin
2 years
min waiting period for valve surgery
3 months
Min waiting period post MI
2 months
Examiners must retain records for how many years?
3
FMCSA Mission Statement
To reduce crashes, injuries, fatalities involving large trucks/buses
Medical Examiner
Licensed, certified, registered provider who can perform PEs in accordance with laws and regulations ; registered through NRS ; has unique identifier ; passes MEC test
FMCSA
Federal Motor Carrier Safety Administration
NRCME
National Registry of Certified Medical Examiners
Commerical Motor Vehicle
Weight >1000 lb ; or transports >8 people for compensation ; or >15 people without compensation ; transports hazardous materials requiring placarding
Interstate commerce
vs.
Intrastate commerce
Interstate: multiple states or international
Intrastate: within 1 state
Who regulates treatment/management and aftercare of substance abuse for drivers?
SAP (Substance Abuse Professional)
Who determines the origin of abnormal drug test results, determining whether the driver has violated drug use regulations?
Medical Review Officer
Title 49 CFR 391.41
Medical Examiner Report Form
- Paperwork completed during DOT physical
- Physical exam requirements for driver
- Determines if Certificate is granted
Title 49 CFR 391.43
Describes responsibilities of Medical Examiner, instructions for exam, and requirements for medical certification
- Supporting information to explain 391.41
When was DOT established?
1966
Became separate entity on Jan 1, 2000
Motor Carrier Safety Improvement Act of 1999
Established DOT as separate federal entity
Omnibus Transportation Employee Testing Act of 1991
Required drug testing for drivers
The driver must always keep a copy of ________ with them while driving
Medical Certificate
SPE if applicable
Does the driver need to sign a medical release before you release their Medical Certification?
No. Certificate is provided to employer.
(Release is required for a copy of medical report form)
How many standards are used to determine driver fitness for duty?
13
How many standards of “driver fitness for duty” are discretionary?
9
(according to my review course)
- Other sources say 10 and say that T2DM is discretionary
How many standards of “driver fitness for duty” are NON- discretionary?
4
- Vision
- Hearing
- Epilepsy
- T2DM
(Some sources say 3 and do not include T2DM)
Age requirement for drivers
21+
Language requirement for drivers
Must be able to read/speak English well enough to read signs, communicate
Height/weight requirement for drivers
There is none
What is tested for in urine?
USG
PRO
BLO
GLU
How long are you (the provider) required to keep a copy of a driver’s Medical Certificate?
3 years
After a reading of Stage 3 hypertension, how often can a driver be certified?
Only every 6 months max
- Disqualify until BP <140/90
- 3 month cert if <160/100 and they are initiating treatment for the first time
- May certify Q1 year post surgical correction of secondary HTN
Which generation of antihistamines should be used for drivers?
2nd gen
- Nonsedating
A driver must wait _ hours after taking a sedating med before driving
12+ hours
Urine drug testing includes:
MJ
Tobacco
Amphetamines
Cocaine
Opiates
Which type of stroke only requires a 1 year waiting period?
Cerebellar or brainstem, which has low risk for seizures
- And NO hx of seizure
- + Neuro clearance and normal neuro exam
What is the A1C requirement for drivers with T2DM?
There is not one
Vision requirements
20/40 in each eye and both eyes (or better)
Field >70 degrees
Can see amber, red, green colors
Exam: Fundoscopic, PERRLA, ocular movements
Hearing requirements
Whisper at not less than 5 feet in 1 ear, or average hearing loss no greater than 40 dB at 500Hz, 1000Hz, 2000 Hz in 1 ear.
- Can use hearing aids – mark on paperwork
- Only 1 ear required (“the better ear”)
Blood pressure requirement for 2-year certification
<140/90 with no HTN therapy
No previous diagnosis of HTN
Blood pressure requirement for 1-year certification
First finding of Stage 1 hypertension (140-159/90-99)
or
History of Hypertension or taking 1+ HTN med and BP is controlled at <140/90
BP requirement for 3-month certification
- Has not yet had antihypertensive therapy
- Previously had a 1-year certificate for uncontrolled Stage 1 BP
- OR: first finding of Stage 2 HTN
Required Echocardiography criteria
- LVEF >40%
- No Pulm HTN (Right heart pressure < 50 mmHg)
When is Echo required?
- Aortic Regurg
- Aortic stenosis (Q1 year moderate, Q5 years mild)
- Mitral stenosis (annual)
- MVP (annual)
One time:
Eval of CHF, CHD
Post CABG, MI
Which conditions require an annual Echo?
- Mitral stenosis
- MVP
- Moderate aortic stenosis
Exercise Tolerance Test (ETT) requirements
- Attain >85% max HR
- SBP >20 mmHg increase without sx
- Tolerate 6 METs
- No ST depression or ischemic changes
When is an ETT (stress test) required?
- Unstable angina (Biennial)
- CABG (annual starting 5 years after surgery)
- Congenital heart defect (x1)
- CHF (x1)
- PCI (6 months post-procedure, then biennial)
- MI (prior to re-certification)
- Severe mitral regurg (Q6 months)
Which conditions result in a max recertification period of 6 months?
- Heart transplant
- Stage 3 hypertension without surgical correction
- Severe Aortic regurg or Aortic stenosis without surgical correction
PFT requirements
- FVC >60%
- FEV1 >65%
- FEV1/FVC ratio > 65%
- Pulse ox > 92%
If above are not met, do an ABG and PaO2 must be >65
1 week waiting period:
Post PCI
4 week waiting period:
Post mitral balloon valvuloplasty
1 month waiting period:
- A-fib, stabilized
- Anticoagulation, stabilized (a-fib)
- SVT
- Post-pacemaker for AV block or SV arrythmia
2 month waiting period:
- Post MI
- BPPV or vertigo
3 month waiting period:
- Post surgery (CABG, CV, aneurysm repair, PVD, PAD, OSA, 2ry hypertension)
- PE
- Unstable angina
- Syncopal episode
- Post-pacemaker for carotid hypersensitivity or neurogenic syncope
6 month waiting period:
ECT therapy
1 year waiting period:
- TIA or Stroke with no seizure/risk
- Acute provoked seizure, mild/no insult
- Heart transplant
- Brain tumor resection with no seizure
2 year waiting period:
- TBI with moderate insult (such as LOC)
- Acute seizure, unprovoked, mild
5 year waiting period:
- Seizure with moderate insult
- TBI with seizure
- Stroke/TIA with seizure
10 year waiting period:
- Epilepsy
- Febrile seizures
AAA requirements
<4 cm
Asymptomatic
If symptomatic or > 4 cm, surgical eval
Angina requirements
- Stable (unstable has 3 month waiting period)
- Tolerating all meds
- Cardiac clearance
- ETT
Certification for symptomatic aortic regurg or aortic stenosis
Q6 months if no surgical repair
Q1 year if post-surgical repair (3 month waiting)
How often do you need an Echo for aortic stenosis:
Mild: Q5Y
Moderate: Q1-2 years
Severe: surgical eval or disqualifying
Waiting period for a-fib
1 month
Requirements post-CABG
- Tolerating meds
- Cardiac clearance
- Echo criteria (LVEF >40%)
- Healed sternal incision
- Asymptomatic
- Annual ETT starting 5 years later
Waiting period for symptomatic claudication
Disqualify until surgical eval – 3 months post-surgery
When is hypoglycemia disqualifying
2+ episodes of severe hypoglycemia in the past 5 years
- (requiring assistance, LOC, AMS, syncope)
Requirements for recert of T2DM
- Max 1 year
- Tolerating therapy, no AEs, maximum efficacy
- No hypoglycemia
- No peripheral neuropathy or end organ damage
IF on insulin: 3 months of stable CBG readings
Requirements for CHF
- LVEF >40% on Echo, no pulm HTN
- Cardiac clearance
- Asymptomatic, tolerating all meds
- ETT requirements met
Requirements for MI
- 2 month waiting
- Asymptomatic, tolerating all therapy
- Cardiac clearance
- ETT
- Echo meets requirements
- No CAD
- ECG with no ischemic changes
ECG, ETT, Echo
What testing is required for driver with Mitral Valve Prolapse?
Echo annually
What testing is required for driver with Mitral stenosis?
Annual CXR, Echo, ECG
Waiting period for PE
3 months
Warfarin is disqualifying if it is used for…
History of CVA/TIA
Post-PCI requirements
- 1 week waiting
- ETT 3-6 months later
- Asymptomatic, tolerating therapy
- ECG with no ischemic changes
- Cardiac clearance
Which conditions require an ECG?
- MI
- Post-PCI
- Mitral stenosis
Waiting period for an acute, provoked seizure with no risk for recurrence
1 year (seizure free, off meds, neuro clearance)
Waiting period for an UNprovoked seizure, mild insult
2 years (seizure free, off meds, neuro clearance)
Waiting period for a moderate TBI (with LOC) but NO seizure
2 years (seizure free, off meds, neuro clearance)
Waiting period for TBI with seizure
5 years (seizure free, off meds, neuro clearance)
Waiting period for unprovoked seizure with moderate insult
5 years (seizure free, off meds, neuro clearance)
Visual disqualifiers
- Monocular vision (without federal exemption)
- Telescopic lens
- Failure to meet vision requirements
Cervical ROM must be
45 degrees both directions
Points of contact for entering a truck
Hand, arm, leg
Regulations vs. Guidelines
Regulations are law
Guidelines are based on expert panel, are “best practice” – document if you make alternative decision
Injury severity =
Relative velocity change
Can a driver be certified with medical marijuana use?
No – Schedule I drugs are disqualifying
Can a driver take Methadone?
No – Schedule 1 is disqualifying
Stage 2 hypertension (per FMCSA)
160-179 / 100-109
- Requires 3 month certification while BP is controlled, f/u in 3 months
What generation of antidepressants has fewer side effects and is preferred for drivers?
2nd Gen
Smoking/tobacco use requirements
None
- Not required to ask about tobacco use
Visual acuity is measured in:
In each eye separately, and together and if corrective lens are worn, both with and without corrective lens
What should always be discussed the driver regarding their medications?
- Tolerance
- AEs
- Frequency of monitoring (if applicable)
What do you do if you cannot assess a driver’s visual acuity or visual fields in the office?
Disqualification and referral to specialist for precise visual measurements.
What do you do if a driver is missing fingers on a hand?
- Assess grip strength
- Document the effect that this has on driving ability
- Determine if driver requires SPE/renewal of SPE
Factors contributing to commercial driving stressors include:
Long relay routes, abrupt schedule changes, responsibility for passenger safety.
FMCSA definition of severe hypoglycemic reaction
Need of assistance from another person, loss of consciousness, any period of impaired cognitive function that occurs without warning, or seizure
A driver with a single unprovoked seizure can
Be cleared if seizure-free and off anticonvulsant medication(s) for at least 5 years after a single unprovoked seizure.
Key word “unprovoked”
After completing the 2 month waiting period for vertigo, a driver can be recertified for (1 or 2) years
2 years
Exercise stress tests after CABG should be obtained:
In 5 years, then annually thereafter.
FMCSA “medical fitness for duty” includes:
includes the ability to perform the specific tasks related to driving the vehicle and strenuous labor.
What do you do if urinalysis reveals 3+ protein?
Determine if additional evaluation is required and request or recommend primary care provider follow-up
Required cognitive skills for drivers:
Problem solving, communication, judgment, and appropriate behavior in both normal and emergency situations.
A driver is missing 2 fingers, but has normal grip strength. Exam is otherwise normal. What do you do?
Certify x 2 years
What do you do if driver indicates frequent alcohol use?
Determine the Time pattern for alcohol use (e.g., every day) as well as the quantity of alcohol ingested (e.g. a 6 pack a day)
- Determine if referral to SOAP is necessary prior to certification
A driver follows up after their 3 month certificate due to Stage 2 HTN – BP is now <140/90 and therapy is tolerated. How do you document this visit?
Check “follow up”, don’t need to do a complete examination, just document any new/pertinent information
- Issue 1 year cert. from the ORIGINAL exam
Driver with heart failure may be certified if meets these requirements:
Is asymptomatic, tolerates medications, ETT tolerance to 6 METS, LVEF > 40%.
True or false:
Anticonvulsant use for seizure disorder is disqualifying
True.
(Anticonvulsants used for OTHER diagnoses are not necessarily disqualifying)
The federal vision exemption program is only for __
monocular vision
- Requires annual ophthalmologist exam
- Renewable q2Y
- Max cert 1 year
Physical abilities required by driver:
- Grip strength
- Upper body strength
- Balance
- Flexibility
- Cervical spine rotation >45 degrees bilaterally
A 3 month certificate:
Is issued for the first time a driver exhibits stage 2 hypertension.
What are reasons for biannual ETT?
Post-PCI
History of Unstable angina
Which heart murmur requires Echo Q6 months if not surgically repaired?
mitral regurgitation
Corrective lenses that are prohibited by the FMCSA, including:
lenses that correct distance vision in one eye and near vision in the other.
telescopic lenses
Medical guidelines for the driver with diabetes mellitus include:
Annual medical examination.
Annual ophthalmologist or optometrist eye evaluation.
Disqualification for a diagnosis of unstable proliferative retinopathy.
Monocular Vision
Monocular vision is disqualifying.
However, the driver who has monocular vision that with the better eye meets all vision qualification requirements may be considered for a Federal Vision Exemption if the Medical Examiner finds the driver otherwise medically fit for duty.
Monocular vision is defined as vision that is at least 20/40 for distance in one eye with or without correction and vision that is less than 20/40 for distance in one eye with or without correction.
The driver must meet other vision requirements in each eye, including visual fields (horizontal field of vision).
Federal Vision Exemption: the driver with monocular vision who is applying for or has a federal exemption or is qualified by operation of 49 CFR 391.64 must have an annual physical examination.
Drivers with vision loss who meet standards may be certified for up to two years.
A driver who wears contact lenses which correct farsightedness in one eye and nearsightedness in the other, but has no other visual impairments can be certified under what additional conditions?
Only if the driver wears prescription glasses which provide the same correction as the contact lenses.
FMCSA guidance indicates that a driver should not be certified under these circumstances.
Only by federal exemption.
The driver is always certifiable under these conditions.
FMCSA guidance indicates that a driver should not be certified under these circumstances.
Explanation: FMCSA guidance indicates that contact lenses that correct one eye for distance and one eye for near vision are not acceptable.
Guidance recommends not to certify with ear problem diagnoses of:
a) Uncontrolled vertigo.
b) Ménière’s disease.
c) Nonfunctioning labyrinth.
d) Nonfunctioning fistula.
The medical examiner’s role in the exemption process includes _.
Issuing the exemption.
Issuing the prescription for the driver’s contact lenses and/or glasses.
Providing the driver with contact information for the Federal Vision Exemption Program.
Assuring that the driver has peripheral vision of at least 110 degrees in each eye.
Providing the driver with contact information for the Federal Vision Exemption Program.
Explanation: The medical examiner’s role in the exemption process is limited to performing the driver examination and providing the driver with contact information for the FMCSA related to the exemption process.
An audiometric test produces the following results: Left ear: 500 Hz, 35dB Loss; 1,000 Hz, 35 dB loss; 2,000 Hz 45 dB loss. Right ear: 500 Hz, 40 dB loss; 1,000 Hz, 45 dB loss; 2,000 40 dB loss. What is the certification?
Certify for one year.
Certify for two years.
Do not certify.
Certify only when accompanied by hearing aid.
Certify for two years.
Explanation: Drivers with an average hearing loss of < 40 decibels averaged across 500, 1000, and 2000 Hz in the better ear may be certified for two years.
What eye conditions must the medical examiner ask the driver about?
Cataracts, color deficiencies, retinitis pigmentosa, aphakia, glaucoma.
Lazy eye, cataracts, aphakia, floaters, retinopathy.
Glaucoma, macular degeneration, retinitis pigmentosa, color deficiencies.
Retinopathy, cataracts, aphakia, glaucoma, macular degeneration.
Retinopathy, cataracts, aphakia, glaucoma, macular degeneration.
Explanation: These are the “ask about” vision conditions. The medical examiner may ask the driver about any eye conditions, but should ask the driver about these specified conditions.
Which of the following drivers’ tests meet hearing certification standards?
Whisper test 4 feet right ear, 3 feet left ear.
Whisper test 5 feet right ear with hearing aid, 3 feet left ear without hearing aid.
Audiogram left 30/500 Hz, 40/1000 Hz, 60/2000 Hz; right 25/500 Hz, 35/1000 Hz, 80/2000 Hz.
Audiogram left 35/500 Hz, 50/1000 Hz, 40/3000 Hz; right 35/500 Hz, 35/1000 Hz, 60/3000 Hz.
Whisper test 5 feet right ear with hearing aid, 3 feet left ear without hearing aid.
Explanation: Whisper test results require 5 feet in at least one ear for passing, with or without a hearing aid. Audiometric testing results require an average of 40 dB loss in the better ear for results averaged across 500, 1000, and 2000 Hz. Although testing may be performed at 3000 Hz, results obtained are not used to determine whether the driver meets hearing requirements.
A driver has loss of hearing in the better ear of 25 dB loss at 500 Hz, 40 dB loss at 1000 Hz, and 60 dB loss at 2000 Hz. With respect to the hearing requirement for medical certification, the driver __.
May be certified for one year.
May be certified for two years.
May not be certified.
May be certified if examined by an otolaryngologist who is familiar with the CMV driving duties who certifies the driver as medically qualified to drive a CMV.
May not be certified.
Explanation: An average hearing loss of 41.7 decibels averaged across 500, 1000, and 2000 Hz in the better ear is disqualifying. The driver should be referred to obtain a hearing aid and may be certified if the driver passes while wearing a hearing aid. A specialist cannot determine certification, and a specialist cannot override medical qualification standards such as the minimum hearing requirement.
Which of the following is acceptable for a driver who wears a hearing aid?
Testing of the driver’s hearing is waived if the driver presents a letter from a qualified specialist.
Testing of the driver’s hearing may be performed by the medical examiner using audiometric testing equipment.
Testing of the driver’s hearing may be performed by an audiologist or otolaryngologist using specialized audiometric testing equipment.
Testing of the driver’s hearing may be performed at 1,000 Hz only.
Testing of the driver’s hearing is waived if the driver presents a letter from a qualified specialist.
Testing the hearing of a driver who wears a hearing aid may be accomplished in three ways: 1) whisper test, 2) audiometric testing by an otolaryngologist using specialized audiometric testing equipment, or 3) audiometric testing by an audiologist using specialized audiometric testing equipment. Audiometric testing is required to be conducted at 500 Hz, 1000 Hz, and 2000 Hz.
Passing Requirements for Vision Tests
Corrective lenses, eye glasses and/or contact lenses may be used.
Distance binocular acuity of at least 20/40 (Snellen) in each eye with or without corrective lenses. Field of vision of at least 70º in the horizontal meridian in each eye. Monocular vision – vision meeting requirements in only one eye – is disqualifying by regulation.
The ability to recognize the colors of traffic signals and devices showing standard red, green, and amber.
Contact lenses that correct vision in one eye for distance and the other eye for near are not acceptable.
Results must be converted to Snellen values if another test is used.
Measured in each eye individually and both eyes.
Drivers who wear corrective lenses should be advised to carry spare glasses.
In general, any vision condition, such as lazy eye, glaucoma, cataract, and others, is not disqualifying as long as the driver meets minimum vision testing parameters.
FMCSA is
Federal Motor Carrier Safety Administration. Is overseen by the DOT. The FMCSA creates standards for driver examinations. Regulates Interstate commercial operations, including the driver.
Many states use federal FMCSA standards to govern intrastate commercial operations, including the driver, but the FMCSA does not directly regulate any intrastate functions.
a division of the US Department of Transportation (DOT).
Conditions which are usually disqualifying, but for which qualification can be considered on a case-by-case basis include __.
Autonomic neuropathy.
Methadone use.
Monocular vision.
Carpal tunnel syndrome.
Correct Answer: Autonomic neuropathy.
Explanation: Methadone use and monocular vision are always disqualifying. Carpal tunnel syndrome is not usually disqualifying.
A driver experienced a pneumothorax four weeks ago. The medical examiner tests the driver’s respiratory function and the forced vital capacity (FVC) is 58% of predicted. What should the certification decision be?
Do not certify pending additional testing.
Certify for three months, pending driver follow up with personal physician and/or specialist.
Certify one year.
Certify two years.
Correct Answer: Do not certify pending additional testing.
Explanation: The driver may not be certified until FVC is > 60% predicted or additional testing reveals acceptable respiratory parameters – e.g., pulse oximetry with O2 > 92%.
Stage 1 Hypertension Two certification options:
One Year: recommend to certify for one year if it is the first examination at which the driver has blood pressure equivalent to Stage 1 hypertension, and the driver has no history of hypertension and does not use medication for blood pressure control.
Three Months: recommend to certify for a three month certification if the driver has been given a one-year certificate for untreated Stage 1 hypertension in the past, whether or not the driver is taking medication to lower blood pressure.
If the driver is on blood pressure medication, the medication should be well-tolerated with no side effects that could affect safe driving.
Do not certify the driver with Stage 1 hypertension if the driver has been given a three-month certificate related to blood pressure within the past three months.
Do not certify a driver with Stage 1 hypertension who has a history of Stage 3 hypertension (> 180/110).
The driver with Stage 1 hypertension is at low risk for hypertension-related acute incapacitation.
Recertification:
Recertification examinations should be done annually thereafter, and driver BP should be at or below 140/90.
If at recertification examination the driver with a history of Stage 1 hypertension has a BP greater than 140/90 but less than 180/110, certification may be extended for three months.
The Medical Examiner should advise the driver:
That the driver should follow-up with her/his primary care physician for consideration of hypertension treatment,
About the nature of hypertension and the importance of hypertension as a risk factor for cardiovascular disease (CVD), and
That failure to lower BP to 140/90 or less will render the driver medically unqualified for continued certification.
That if blood pressure is uncontrolled at future examinations the driver may be temporarily disqualified.
Which of the following is a requirement for a driver with a history of alcoholism to be certified?
Complete driver certification examination.
Successful treatment with naltrexone.
Successfully completed counseling and/or treatment.
Passed a drug test.
Correct Answer: Successfully completed counseling and/or treatment.
Explanation: A driver certification examination is not a requirement for return to driving. Treatment with naltrexone is not required for driver certification for a driver with a history of alcoholism. Passing a drug test is not a requirement, although passing an alcohol test is a requirement.
Which of the following is true with respect to drivers with psychological disorders?
Drivers with chronic schizophrenia must be evaluated at least yearly by a qualified specialist such as a psychiatrist or psychologist who understands the function and demands of CMV driving.
The waiting period for a brief reactive psychosis or schizophreniform disorder is three months.
Alcohol and drug dependency and abuse are profound risk factors in the presence of personality disorders.
The waiting period following electroconvulsive therapy for treatment of depression is one year.
Correct Answer: Alcohol and drug dependency and abuse are profound risk factors in the presence of personality disorders.
Explanation: Drivers with chronic schizophrenia should be disqualified. The waiting period for a brief reactive psychosis or schizophreniform disorder is six months as is the waiting period for electroconvulsive therapy treatment.
After a heart transplant, the minimum waiting period is and the maximum certification period is .
Six months, six months.
Six months, one year.
One year, six months.
One year, one year.
One year, six months.
Explanation: Following heart transplant, the waiting period is one year and the maximum certification interval is six months.
Which of the following is a requirement for drivers with insulin-treated diabetes mellitus (ITDM) evaluated according to 49 CFR Part 391.46?
Possess a rapidly absorbable form of glucose while driving.
Maintain a hemoglobin A1c value less than 7.
Submit blood glucose monitoring records with each certification examination.
Check blood glucose 1 hour prior to driving and at least every 2 hours while driving.
Correct Answer: Submit blood glucose monitoring logs for each annual certification.
Explanation: Drivers with ITDM (insulin-treated diabetes mellitus) must submit at least 3 months of blood glucose monitoring records as part of the annual examination process described in 49 CFR Part 391.46. Although the other practices may represent best practice guidelines, none are required as part of 49 CFR Part 391.46.
A driver with a history of bacterial meningitis with early seizures or a single unprovoked seizure requires a waiting period of __ seizure free and off anticonvulsant medications.
One year.
Two years.
Five years.
Ten years.
Correct Answer: Five years.
Explanation: The waiting period for a history of bacterial meningitis with early seizures or single unprovoked seizure is five years seizure free and off anticonvulsant medications.
To apply for an exemption
the driver with monocular vision must demonstrate that he or she meets all other medical certification requirements, and must submit the Medical Examination Report and the Medical Examiner’s certificate with the exemption application to the FMCSA.
NRCME
Created by the Federal Motor Carrier Safety Administration (FMCSA),
The NRCME establishes a registry of health care providers who may perform medical examinations on commercial motor vehicle (CMV) drivers (DOT examinations).
National Registry of Certified Medical Examiners (NRCME)
Which of the following is a disqualifying condition?
A past clinical diagnosis of alcoholism.
A breath alcohol result of 0.019%.
An alcohol-related stable physical condition.
Use of methadone.
Correct Answer: Use of methadone.
Explanation: A current diagnosis of alcoholism is disqualifying, a past history is not. A breath alcohol result of 0.02% or higher renders the driver unqualified to drive. Just because a condition is alcohol-related does not make it disqualifying.
Which of the following is true with respect to bipolar disorder?
Treatment with lithium has not been shown to increase risk for CMV accidents.
The maximum certification interval is six months.
The driver should be advised to report manic or severe depressive episodes within 10 days of onset to the driver’s employer, medical examiner, or appropriate health professional and to seek medical intervention.
Onset of manic episodes is uniformly sudden.
Correct Answer: Treatment with lithium has not been shown to increase risk for CMV accidents.
Explanation: Treatment with lithium has not been shown to increase CMV driving risk. The maximum certification interval for a driver with bipolar disorder is one year. The driver should be advised to report manic or depressive episodes within 30 days. Manic episode onset may be gradual or sudden.
Stage 1 hypertension blood pressure
140-159/90-99
Drivers with initial Stage 1 hypertension should be advised that the condition will allow one-year certification and may or may not require medication treatment for control of the condition.
Code of Federal Regulations (CFR)
contains the rules of the federal government,
laws that must be followed. By regulation, disqualifying medical conditions are epilepsy, monocular vision, and hearing loss.
Which of the following is true?
The FMCSA does not consider feasibility or impact in the rule-making process.
Only the Medical Review Board can provide advice and opinions on FMCSA rulemaking.
FMCSA medical standards and guidelines are subject to public notice and comment rulemaking.
The Code of Federal Regulations provide guidance that the medical examiner may or may not follow.
FMCSA medical standards and guidelines are subject to public notice and comment rulemaking.
Explanation: The FMCSA must consider feasibility and impact in rulemaking. Members of the public are allowed to comment on FMCSA rulemaking. The Code of Federal Regulations are laws that must be followed.
Which of the following is true?
A driver with diabetes who uses insulin must be evaluated according to the procedures specified in 49 CFR Part 391.46.
The most important concern related to medication use for treating diabetes is hyperglycemia.
Peripheral neuropathy is not a disqualifying condition.
Diabetes is not a coronary heart disease (CHD) equivalent condition.
Correct Answer: A driver with diabetes who uses insulin must be evaluated according to 49 CFR Part 391.46.
Explanation: The greatest risk for medication use for drivers with diabetes is hypoglycemia, not hyperglycemia. Peripheral neuropathy is a disqualifying condition. Diabetes is a coronary heart disease (CHD) risk equivalent condition.
For mild aortic stenosis, an echocardiogram should be repeated every years. For moderate aortic stenosis, an echocardiogram should be repeated every years.
Two, two.
Five, one to two.
One, one.
Five, five.
Five, one to two.
Explanation: An echocardiogram is recommended every five years for mild aortic stenosis, every one to two years for moderate aortic stenosis.
- Pulse oximetry O2 saturation = 90%. Arterial blood gas (ABG): PaO2 = 60 mm Hg, PaCO2 = 42 mm Hg. What is the certification determination?
Do not certify.
Certify three months pending additional testing.
Certify for one year.
Certification depends on whether testing is conducted at altitudes above or below 5,000 feet.
Correct Answer: Certification depends on whether testing is conducted at altitudes above or below 5,000 feet.
Explanation: The certification determination related to arterial blood gas (ABG) testing depends on the altitude at which testing is performed. A PaO2 of less than 65 mm Hg is disqualifying at altitudes of less than 5,000 feet; a PaO2 of less than 60 mm Hg is disqualifying at altitudes of greater than 5,000 feet.
A Skill Performance Evaluation (SPE) certificate pursuant to 49 CFR 391.49 is granted under which of the following conditions?
The driver has a fixed deficit of the torso.
The driver has progressive deficit of an extremity.
The driver has a medical evaluation summary completed by a board qualified or certified physiatrist or orthopedic surgeon.
The driver has completed a driving evaluation per FMCSA standards.
Correct Answer: The driver has a medical evaluation summary completed by a board qualified or certified physiatrist or orthopedic surgeon.
Explanation: A driver with a torso deficit should not be certified. To be considered for a Skill Performance Evaluation (SPE) certificate, the driver must have a fixed, not progressive, deficit of an extremity. A driving evaluation is not required for issuance of a SPE certificate.
Transient ischemic attacks (TIA’s) are automatically disqualifying for __. After the minimum waiting period the certification depends on the interval history, general health, neurological examination, and compliance with the treatment program.
Three months.
Six months.
Nine months.
One year.
Correct Answer: One year.
Explanation: The minimum waiting period for transient ischemic attacks (TIA’s) is one year.
A driver with a history of major depression should be evaluated at least every __ by an appropriate mental health specialist, such as a psychiatrist or psychologist, who understands the functions and demands of commercial motor vehicle driving.
Six months.
One year.
Two years.
Such evaluation is not required.
Correct Answer: Two years.
Explanation: The maximum certification interval for a driver with a history of major depression is one year. Regulatory guidance requires evaluation every two years by a specialist, such as psychiatrist or psychologist, who understands the functions and demands of commercial driving.
Passing parameters for hearing tests:
Driver first perceives a forced, whispered voice in the better ear at not less than five (5) feet with or without the use of a hearing aid.
Driver, if tested by use of an audiometric device, does not have an average hearing loss in the better ear greater than 40 decibels at 500 Hz, 1,000 Hz, and 2,000 Hz, with or without a hearing aid.
The driver meets the hearing qualification requirements if hearing passes one test in one ear.
Hearing aid: When a hearing aid is to be worn during audiometric testing, an audiologist or hearing aid center should perform the test using appropriate audiometric equipment.
Stage 2 hypertension blood pressure
160-179/100-109
Drivers with Stage 2 hypertension should be advised that a limited certification interval of three months will be provided and that medication treatment is indicated and must be initiated prior to reconsideration of certification beyond the three-month interval.
Which of the following is considered by the FMCSA as a mental health professional that the medical examiner may refer to or consult with?
A urine drug screen collector.
A FMCSA administrator.
Medical review officer (MRO).
Any licensed medical provider.
Correct Answer: Medical review officer (MRO).
Explanation: According to the FMCSA, mental health professionals the medical examiner may consult with include breath alcohol technicians (BATs), designated employer representatives (DERs), medical review officers (MROs), and substance abuse professionals (SAPs).
Can you certify a driver who has a known AAA?
Yes if : less than 4 cm and asymptomatic,
4 cm but < 5 cm – Certify if: and asymptomatic with a vascular specialist clearance.
5 cm with waiting 3 month post repair and specialist clearance.
No if: 4.5 cm and symptomatic with surgery recommendations
5 cm with the repair and specialist clearance.
Recommendation to NOT surgically repair, does NOT mean driver is certified
Maximum certification period: one year.
Do not certify if:
5.0 cm
Aneurysm has increased more than 0.5 cm during six-month period regardless of size.
Surgical repair has been recommended by a cardiovascular specialist, regardless of size, but has not yet been performed.
Driver is symptomatic, regardless of size.
Which of the following is not associated with safety risks in drivers with psychological disorders?
The mental disorder, including symptoms and/or disturbances in performance that are an integral part of the disorder and may pose hazards for driving.
Residual symptoms occurring after time-limited reversible episodes or initial presentation of the full syndrome that can interfere with safe CMV driving.
Physical disorders which may be compromised by the mental disorder and may increase risk of CMV accidents.
Psychopharmacology, as many psychotropic medications can compromise performance to the degree that CMV driving would be hazardous.
Correct Answer: Physical disorders which may be compromised by the mental disorder and may increase risk of CMV accidents.
Explanation: Physical disorders are not noted by the FMCSA to increase risk related to psychological disorders.
Department of Transportation (DOT)
U.S. federal government body with primary responsibility for transportation safety regulation. Oversees the FMCSA.
Stage 2 Hypertension Maximum certification period
three months.
Recommend to certify if it is the first examination at which the driver has blood pressure equivalent to Stage 2 hypertension and the driver has no history of hypertension and does not use medication to control blood pressure.
Recommend to certify if the driver has a diagnosis of hypertension treated with medication and tolerates treatment with no side effects that interfere with driving.
Do not certify the driver who has been given a three-month certificate within the past three months.
Advise the driver issued a three-month certificate that:
To qualify at follow-up, blood pressure must be less than or equal to 140/90.
If the driver qualifies on follow up examination (has a blood pressure less than or equal to 140/90), a one-year certificate may be issued from the date of the follow up examination, not the expiration date of the three-month certificate.
If the driver fails to lower blood pressure by the expiration date of the one-time, three-month certificate, the driver will be disqualified until blood pressure is equal to or below 140/90 at exam.
Stage 2 hypertension is an absolute indication for anti-hypertensive drug therapy.
intrastate
within a state
Stage 3 Hypertension bp
BP > 180/110
A commercial motor vehicle (CMV) is defined as…
- A vehicle with a gross weight over 26,001 lbs
- A vehicle transporting hazardous materials
- A vehicle transporting 16 or more passengers
Which of the following is true with regard to adult Attention Deficit Hyperactivity Disorder (ADHD)?
The maximum certification interval is two years.
The driver should be disqualified if the driver has another psychological disorder, such as depression.
Risks related to adult ADHD includes comorbid antisocial or borderline personality disorders and a high incidence of substance abuse.
Treatment with amphetamines and amphetamine derivatives is disqualifying.
Correct Answer: Risks related to adult ADHD include comorbid antisocial or borderline personality disorders and a high incidence of substance abuse.
Explanation: The maximum certification interval is one year. As long as other psychological conditions are stable, a driver with adult attention deficit hyperactivity disorder (ADHD) may be certified. Treatment with amphetamines and amphetamine derivatives is not disqualifying.
Examples of adapting clinical evaluation of the musculoskeletal system include which of the following?
Using resistive force or a dynamometer to the have the driver demonstrate grip strength necessary to grasp a steering wheel.
Nerve conduction study testing.
Two-point discrimination testing.
Audiometric testing.
Correct Answer: Using resistive force or a dynamometer to the have the driver demonstrate grip strength necessary to grasp a steering wheel.
Explanation: Nerve conduction study testing, testing of two point discrimination, and audiometric testing are not clinical evaluations of musculoskeletal function.
What is the recommended certification interval for a driver with diabetes mellitus who does not use insulin?
Three months.
Six months.
One year.
Two years.
Correct Answer: One year.
Explanation: Drivers with non-insulin dependent diabetes should be certified for a maximum of one year.
A driver with peripheral neuropathy __.
May be certified for one year.
Should not be certified by regulation.
Should not be certified by guidance.
May be certified for three months pending specialist evaluation.
Correct Answer: Should not be certified by guidance.
Explanation: Peripheral neuropathy is a disqualifying condition. However, this is a guidance recommendation, not a regulatory requirement, so Medical Examiners may consider qualification for a driver with peripheral neuropathy.
The maximum certification interval for a driver diagnosed with asthma is __.
Three months.
Six months.
One year.
Two years.
Correct Answer: Two years.
Explanation: The maximum certification interval for asthma is two years.
A driver underwent surgical repair of a 6 cm abdominal aortic aneurysm three months ago. The driver may be certified for __.
Three months.
One year.
Two years.
The driver should be medically disqualified.
One year.
Explanation: The minimum waiting period for surgical repair of an abdominal aneurysm is three months. The maximum certification interval is one year.
disqualifying ear conditions and waiting periods
Drivers with conditions affecting the inner ear and balance should not be certified. The minimum symptom free waiting period for drivers with dizziness or vertigo is two months.
Guidance recommends a two-month, symptom-free waiting period for diagnoses of:
a) Acute and chronic peripheral vestibulopathy.
b) Benign positional vertigo.
Guidance recommends not to certify with diagnoses of:
a) Uncontrolled vertigo.
b) Ménière’s disease.
c) Nonfunctioning labyrinth.
d) Nonfunctioning fistula.
Stage 3 Hypertension certification period?
The driver is disqualified.
The driver disqualified due to Stage 3 (uncontrolled hypertension > 180/110) should not be certified until the blood pressure is stabilized at less than or equal to 140/90 with treatment well tolerated.
Once certified, a driver with a history of Stage 3 hypertension may only be certified for six-month certification intervals.
The driver with Stage 3 hypertension is at risk for an acute hypertensive event and should be advised to seek, or should be provided, immediate medical attention and must be medically disqualified.
The Medical Examiner should provide the driver and/or the driver’s physician(s), with information regarding required follow-up and treatment, and necessary BP reduction in order to be considered for qualification.
Once the driver has a documented BP of equal or less than 140/90, the driver may be certified for no more than six months, and future certifications of the driver should be for no more than six months.
The driver should be counseled about the potentially serious health risks posed by uncontrolled hypertension, including Target Organ Damage (TOD) – heart failure, stroke or transient ischemic attack, peripheral artery disease, retinopathy, left ventricular hypertrophy, and nephropathy.
The Medical Examiner may disqualify a driver if target organ damage significantly impairs the driver’s work capacity even after adequate BP control is achieved. The driver should have no excess sedation or orthostatic change in BP.
FMCSA medical program responsibilities include __.
Oversee the Department of Transportation.
Regulation of intrastate commercial motor vehicle operations.
Conduct and oversee the agency’s medical exemption and certificate programs.
Provide commercial motor vehicle driver examinations.
Conduct and oversee the agency’s medical exemption and certificate programs.
Explanation: The FMCSA is overseen by the DOT, not vice versa. The FMCSA does not oversee intrastate commercial motor vehicle operations. The FMCSA creates standards for driver examinations, but is not responsible to provide examinations.
FMCSA responsibilities:
Oversee the national medical certification process for CMV drivers who operate in interstate commerce.
Develop and implement medical regulations, policies, and procedures.
Oversee and support the Medical Review Board in accordance with the Federal Advisory Committee Act.
Develop and implement the national registry program – a national Medical Examiner system and a linked national driver medical reporting system.
Conduct and oversee the agency.
Oversees medical exemption and certificate programs.
Serve as the lead federal agency for the regulation of CMV driver health and safety and conduct relevant medical research.
The maximum certification interval for a driver with a history of drug abuse or alcoholism is __.
Six months.
One year.
Two years.
Do not certify.
Correct Answer: Two years.
Explanation: Drivers with a history of drug or alcoholism may be certified for up to two years. Drivers may be subject to drug and/or alcohol testing more frequently, but such testing is performed under 49 CFR Part 40 drug and alcohol testing regulations, not under 49 CFR Part 391.41 driver qualification standards.
Spirometry testing should be performed on drivers who smoke and who are over __ years of age.
30
35
40
45
Correct Answer: 35
Explanation: Spirometry is required for smokers over 35 years of age.
A driver with congestive heart failure (CHF) recently had an echocardiogram demonstrating an ejection fraction of 44%. The driver may be certified for __ if the driver meets all other qualifications for CHF.
One year.
Two years.
Six months.
The driver should not be certified.
One year.
Explanation: The minimum left ventricular ejection fraction (LVEF) for certification with any cardiovascular condition is 40%. The maximum certification interval for drivers with CHF is one year.
documentation requirement with schizophrenia
for a driver with progressive schizophrenia cannot be certified, document:
Medical Examiner observations and examination.
Medical Examiner rationale not to certify.
Which of the following is true regarding why regulation is needed to protect public safety?
There is little environmental risk from crashes involving hazardous materials.
There is greater risk of injury and fatalities to individuals in smaller vehicles from crashes involving commercial motor vehicles.
The economic cost of crashes involving commercial vehicles is relatively low.
Commercial vehicles do not carry members of the public.
There is greater risk of injury and fatalities to individuals in smaller vehicles from crashes involving commercial motor vehicles.
Explanation: There is significant environmental risk from crashes involving hazardous materials. The economic cost of CMV crashes is very high compared with crashed involving personal and private vehicles. Some CMV’s do carry members of the public.
Levodopa/carbidopa may cause the driver to be disqualified because it is used for the treatment of what condition?
Parkinson’s disease.
Peripheral neuropathy.
Isaac’s disease or Stiff Man Syndrome.
Epilepsy.
Correct Answer: Parkinson’s disease.
Explanation: Although all of the conditions listed are disqualifying, levodopa/carbidopa is used to treat Parkinson’s disease.
If glucose is detected on urinalysis in a driver with no history of diabetes, an appropriate next step is __.
Endocrinology consultation.
One year clearance and recommendation to see personal physician.
Fingerstick or blood glucose determination.
Temporary disqualification.
Correct Answer: Fingerstick or blood glucose determination.
Explanation: The medical examiner should first determine blood glucose, make an appropriate certification determination, and consider appropriate referral to the driver’s personal physician.
The maximum certification interval for a driver with a Skill Performance Evaluation (SPE) certificate is __.
Three months.
Six months.
One year.
Two years.
Correct Answer: Two years.
Explanation: A Skill Performance Evaluation (SPE) certificate may be issued for up to two years. It must be renewed within 30 days of expiration.
A three-month medical certificate is recommended in two cases of elevated BP:
Where the driver has a BP that is equivalent to Stage 2 hypertension, or
A driver that was certified with Stage 1 hypertension for one year and has not achieved a BP less than or equal to 140/90 at recertification.
The purpose of the three-month certificate is to allow the driver with high blood pressure that is an absolute indication for antihypertensive drug therapy to continue to drive while taking steps to lower elevated blood pressure. When certified three months, the driver is to seek evaluation and initiation of drug therapy to lower BP to equal to or less than 140/90.
Medical guidelines for the driver with diabetes mellitus include:
Annual medical examination.
Annual ophthalmologist or optometrist eye evaluation.
Disqualification for a diagnosis of unstable proliferative retinopathy.
Can Medical Examiner perform alcohol and drug testing as part of the driver examination using any alcohol or drug testing methodology?
yes, and ME may consider such results in assessing driver fitness for duty. If such testing is performed based on the Medical Examiners assessment, and is not conducted in compliance with FMCSA drug and alcohol testing rules, the Medical Examiner must be sure to advise the driver of this circumstance – that the testing is being performed based on the Medical Examiner’s assessment, not on the basis of FMCSA regulation.
A driver with an impairment of an arm, leg, hand, or foot who is otherwise medically qualified, may be certified if the driver does what?
gets an SPE certificate.
Driver must apply for the SPE certificate from the FMCSA and the FMCSA determines if driver is qualified for the SPE certificate.
Driver examination 6/18/2011. Driver disqualified due to benign positional vertigo with last symptoms noted 5/15/2011. Driver advised to return after a _ symptom free interval for a maximum _ certification interval.
One month, one year.
Two month, one year.
Two month, two year.
Three month, one year.
Correct Answer: Two month, two year.
Explanation: The waiting period for benign positional vertigo, as well as dizziness and acute or chronic vestibulopathy, is two months symptom free, with a maximum certification interval of two years.
Suicide attempt affect on certification
loss of certification and create the start of a minimum one-year waiting period for consideration of certification.
FMCSA content sources rules and regulations include __.
49 CFR Part 16 DOT Procedures for Drug and Alcohol Testing.
49 CFR 391.41 Physical Qualifications for Drivers.
49 CFR 391.82 Medical examination; certificate of physical qualification.
49 CFR Part 73: Medical Review Board procedures.
49 CFR 391.41 Physical Qualifications for Drivers.
Explanation:
Drug and alcohol testing regulations described in 49 CFR Part 40.
49 CFR 391.43 describes medical examiner responsibilities for driver examination.
49 Part CFR Part 391.41 describes physical qualifications for drivers. Medical Review Board procedures are described in internal FMCSA documents.
Drivers with Stage 2 hypertension should be advised that:
a limited certification interval of three months will be provided and that medication treatment is indicated and must be initiated prior to reconsideration of certification beyond the three-month interval.
also, the risk for gradual or sudden incapacitation is higher with Stage 2 hypertension than with Stage 1 hypertension.
Drivers with Stage 1 or Stage 2 hypertension should be advised of the risk that hypertension could progress to Stage 3 hypertension, which would be disqualifying.
Which of the following is true?
For drivers on Coumadin, INR should be measured every 3 months and records should be provided by the driver to the medical examiner.
On exercise tolerance testing (ETT), a driver should exercise to greater than a 10 MET capacity.
Left ventricular ejection fraction (LVEF) of at least 40% is required for certification.
The waiting period for pacemaker implantation for cardiogenic syncope is two months.
Left ventricular ejection fraction (LVEF) of at least 40% is required for certification.
Explanation: For patients on warfarin (Coumadin), INR should be checked monthly and records provided to the medical examiner. Exercise tolerance testing (ETT) should be performed to at least 6 METS. The waiting period for pacemaker implantation for cardiogenic syncope is three months.
Which of the following is disqualifying?
PaCO2 less than 45 mm Hg.
PaO2 less than 70 mm Hg at altitudes less than 5000 feet.
PaO2 less than 65 mm Hg at altitudes above 5000 feet.
PaCO2 greater than 45 mm Hg.
Correct Answer: PaCO2 greater than 45 mm Hg.
Explanation: PaCO2 of less than 45 mm Hg is not disqualifying, but PaCO2 of greater than 45 mm Hg is disqualifying. An PaO2 saturation of less than 65 mm Hg is disqualifying at altitudes below 5,000 feet and an PaO2 saturation of less than 60 mm Hg is disqualifying at altitudes above 5,000 feet.
Drug and Alcohol Testing
Who must be tested?
All drivers, including part-time drivers, holding a commercial driver’s license (CDL) and operating CMVs (greater than 26,000 combined gross vehicle weight rating, or transporting more than 16 passengers, or carrying placarded hazardous materials) on public roadways must be subject to testing according to U.S. Department of Transportation (DOT) drug and alcohol regulations.
This means any driver required to possess a CDL, including drivers employed by Federal, State, and local government agencies and owner operators.
Equivalently licensed drivers from foreign countries are also subject to these rules.
NOTE: Drivers who only operate CMVs on private property not open to the public are not subject to testing.
Which of the following is not a criteria that the FMCSA uses to define a severe hypoglycemic reaction?
Seizure.
Dizziness.
Need of assistance from another person.
Coma
Correct Answer: Dizziness.
Explanation: The FMCSA defines severe hypoglycemia as a reaction that results in seizure, loss of consciousness, need of assistance from another person, or coma.
When is Drug and/or Alcohol Testing Required?
Pre-employment: Drug testing is required. However, a driver may be exempted from testing if the driver was in a testing program within the last 30 days and tested within the last six months or in a testing program for the previous 12 months.
Pre-employment alcohol testing is not required; however, the employer may require alcohol testing before the driver can perform safety-sensitive functions. The employer may make job offers contingent upon passing an alcohol test.
Post-accident drug and/or alcohol testing is required for all fatal crashes, when the driver is cited for a moving traffic violation, and when crashes meet specific criteria related to the cost of vehicular damage or personal injury.
Random drug and/or alcohol testing is conducted on a random, unannounced basis just before, during, or just after performance of safety-sensitive functions.
Reasonable suspicion testing is conducted when a trained supervisor or company official observes behavior that is characteristic of drug and/or alcohol misuse.
Return-to-duty and follow-up testing is conducted when an individual who has violated the prohibited drug and/or alcohol conduct standards returns to performing safety-sensitive duties.
Skill Performance Evaluation (SPE) can be applied for what impairment?
The requirements for a Skill Performance Evaluation (SPE) certificate cited in 49 CFR 391.49 are an alternate standard for 391.41(b)(1) and (2) and can be applied only in cases of fixed deficits of the extremities.
The impairment must be fixed and stable, not the result of a progressive disease (e.g., multiple sclerosis).
The impairment must affect an extremity and may not involve the neck or torso.
The Medical Examiner:
Determines if the driver is eligible for a SPE certificate.
Determines that the driver is otherwise medically qualified.
Directs the driver to obtain a SPE certificate.
Completes documentation necessary for the SPE certificate process.
The SPE certificate:
Issued by FMCSA, not Medical Examiner.
Issued up to two years; may be renewed.
To legally operate a CMV, the driver must carry a SPE certificate and a valid Medical Examiner’s certificate. The driver is responsible for ensuring that both certificates are renewed prior to expiration.
The SPE application and renewal application must include a medical evaluation summary completed by a board-certified orthopedist or physiatrist.
Examinations must document that the driver is eligible for a SPE certificate.
Follow-up examinations must document that there has been no change in the driver’s condition that would affect the driver’s eligibility for a SPE certificate (determination that the deficit remains fixed and stable).
The Medical Examiner determines, on a case-by-case basis, that a Skill Performance Evaluation (SPE) is required when the severity of the limb loss or impairment is less than the whole hand or foot.
If the driver is otherwise qualified, the Medical Examiner should check the SPE certificate box on both the Medical Examination Report and the Medical Examiner’s certificate that indicates the driver is qualified when accompanied by a SPE certificate.
Employer Responsibilities related to drug and alcohol testing and violations and counseling
Employer responsibilities include:
Implementing and conducting drug and alcohol testing programs.
Providing a list of substance abuse professionals (SAPs) for drivers who violate drug and alcohol regulations.
Ensuring that the driver who is returning to a safety- sensitive position has complied with SAP recommendations.
Conducting follow-up testing to monitor that the driver is compliant with DOT alcohol conduct guidelines and abstaining from unauthorized drug use.
Employer responsibilities do not include:
Providing SAP evaluations.
Paying for driver SAP evaluation, education, or treatment.
The Medical Examiner should obtain additional evaluation by appropriate mental health professionals, which may include:
Breath alcohol technicians (BATs).
Designated employer representatives (DERs).
Medical review officers (MROs).
Substance Abuse Professionals (SAPs).
Additional medical assessment may include referral to substance abuse specialists (in addition to a SAP) and/or drug and/or alcohol testing.
FMCSA guidelines require evaluation by a Substance Abuse Professional (SAP) even if the driver has seen other mental health professionals, and requires that the driver complete any rehabilitation program recommended by the SAP prior to return to duty.
A current clinical diagnosis of drug abuse or alcoholism cert period?
disqualifying.
When INR is required, it should be monitored how often?
monthly and the driver should provide monthly records to the Medical Examiner.
Which of the following is true?
By May 21, 2015, medical providers that perform medical examinations for commercial motor vehicle drivers must have completed an approved training program and passed a national certification examination.
The Medical Examiner may request that an appropriate specialist provider make the driver certification determination.
The purpose of the commercial motor vehicle driver examination is for treatment of driver medical conditions.
FMCSA guidance recommendations may or may not be followed by the Medical Examiner.
FMCSA guidance recommendations may or may not be followed by the Medical Examiner.
Explanation: The deadline for training and certification of medical examiners was May 21, 2014. Only the medical examiner may make a certification determination; the medical examiner cannot cede the certification decision to any other medical provider. The purpose of the CMV driver examination is a medical fitness for duty determination, not for the treatment of driver medical conditions.
Do Not Certify for BP of:
The driver with Stage 3 hypertension – a BP greater than or equal to 180/110 – as the driver is at risk for an acute hypertensive event that could occur while operating a CMV thus endangering the driver and public safety.
The driver who had Stage 2 hypertension on initial examination, and on reexamination three months later still has Stage 2 hypertension.
The driver with disqualifying side effects from medication use – e.g., the driver who reports that after starting a beta blocker for hypertension treatment the driver has noted extreme fatigue and occasional dizziness and weakness one to two hours after taking the medication.
Disqualify the driver when a condition exists that will interfere with the safe operation of a commercial motor vehicle.
Document the rationale for disqualification.
At least two BP readings should be taken and documented.
Which of the following is a common symptom of congestive heart failure (CHF)?
Chest pain.
Swelling in the legs, ankles, or other parts of the body.
Irregular pulse.
Slow pulse rate.
Swelling in the legs, ankles, or other parts of the body.
Explanation: Although chest pain is common to many cardiovascular conditions, it is not common with CHF. A driver with chest pain should be evaluated for coronary heart disease including angina or myocardial infarction. An irregular pulse is not a common finding with CHF. CHF is associated with a rapid, not slow, pulse rate.
Health History questions that specifically address respiratory conditions include:
Shortness of breath
Lung disease
Emphysema
Asthma
Chronic bronchitis
Fainting, dizziness
Sleep disorders
Pauses in breathing while asleep
Daytime sleepiness
Loud snoring
The driver must indicate onset date, diagnosis, treating provider’s name and address, and any current limitations related to respiratory (pulmonary) disease.
Which of the following conditions are disqualifying?
Myotonia.
Stiffman Syndrome.
Isaac’s Syndrome.
Amyotrophic lateral sclerosis (ALS).
All of the above.
Correct Answer: All of the above.
Explanation: All of these conditions are disqualifying.
Which of the following is true of nephropathy?
Nephropathy is a disqualifying condition.
The maximum certification interval for nephropathy is two years.
A driver with 3+ proteinuria should not be certified.
A renal specialist should make the certification determination for a driver with nephropathy.
Correct Answer: The maximum certification interval for nephropathy is two years.
Explanation: Certification of drivers with nephropathy should be considered on a case-by-case basis. The medical examiner determines what evaluation or monitoring is necessary for a driver with 3+ proteinuria, and may qualify or disqualify the driver. The certification determination is always made by the medical examiner and cannot be deferred to a specialist.
Recommend not to certify if driver has following musculoskeletal impairment:
An impairment that affects the torso.
Not provided proof of compliance with skill performance evaluation (SPE) certification requirements.
A disqualifying limb impairment caused by a progressive disease (e.g., multiple sclerosis).
The maximum period for which a driver with a history of a psychological disorder should be certified is
one year.
disqualifying drugs
Do not certify a driver who uses methadone.
Even though other narcotic drugs may have similar effects and dependence and abuse potential, methadone is the only narcotic specified by the FMCSA as disqualifying.
Schedule I drugs, including marijuana, are disqualifying. This also includes “medical marijuana” or marijuana for “medicinal use.”
Schedule I drugs currently have no accepted medical use in the United States, have a high abuse potential, and are not considered safe, even under medical supervision.
A driver should be disqualified if the driver uses a controlled substance, including a narcotic, an amphetamine, or another habit-forming drug, without a prescription from the treating physician.
Even with a prescription, the Medical Examiner should obtain certification from the prescribing provider that the driver is safe to driver a CMV while using the medication as prescribed.
The prescribing provider should be familiar with the driving duties of a CMV driver.
If such certification from the prescribing provider is not obtained, the driver using such medications should be disqualified.
Drivers with which of the following conditions should be disqualified?
Cancer requiring chemotherapy treatment.
Umbilical hernia not surgically repaired.
Renal failure on peritoneal dialysis.
Hemochromatosis.
Correct Answer: Renal failure on peritoneal dialysis.
Explanation: Dialysis of any type is disqualifying.
A driver with history of moderate traumatic brain injury with early seizures, stroke with risk for seizures, or intracerebral or subarachnoid hemorrhage with risk for seizures requires a waiting period of __ seizure free and off anticonvulsant medications.
One year.
Two years.
Five years.
Ten years.
Correct Answer: Five years.
Explanation: Each of these conditions requires a symptom-free waiting period of five years.
Drivers with a history of alcoholism or alcohol or drug misuse or abuse may be certified for a maximum of
two years.
Skill performance evaluation (SPE) initial and renewal applications require a medical evaluation summary completed by
either a board qualified or certified physiatrist or orthopedic surgeon.
Do not certify for following mental conditions
If an active psychosis is present.
If prominent negative symptoms are present, including:
Substantially compromised judgment.
Attention difficulties.
Suicidal behavior or ideation.
If side effects from medications interfere with safe driving.
Guidelines for supraventricular tachycardias include:
- Certification should be granted only after adequate anticoagulation is demonstrated for three months.
- Certification for atrial flutter may be considered if the driver is one month following isthmus ablation.
1 only.
2 only.
Both 1 and 2.
Neither 1 nor 2.
2 only.
Explanation: The minimum waiting period for anticoagulation for a cardiovascular condition is one month.
Cert period for Stage 1 hypertension who is not on treatment
One-year certification.
What are the differences between the medical standards and the medical guidelines?
Regulations are laws and are mandatory. The medical examiner must use the standards found in 49 CFR 391.41 to determine interstate CMV driver medical fitness for duty. Medical guidelines are not regulatory; the medical examiner may choose not to follow the medical guidance. They are based on expert review and intended to assist the medical examiner in determining driver certification.
before return to duty, The driver disqualified for alcohol or drug abuse must:
Have an evaluation by a Substance Abuse Professional (SAP) and
complete any rehabilitation program required by the SAP.
Have a negative return to duty drug and/or alcohol test result.
Be subject to follow up random drug and/or alcohol testing.
NOTE: drivers who violate FMCSA drug and alcohol testing regulations are not required to undergo a return to duty medical examination.
A driver with a history of recent drug abuse must
be evaluated by a substance abuse professional (SAP) and must complete a rehabilitation program as recommended by the SAP.
A driver with a history of recent drug abuse must pass a DOT return-to-work drug test and is then subject to follow-up random drug testing at a frequency determined by the SAP.
Refer a driver with limitations in extremity movement for an
on-road performance evaluation and/or skill performance evaluation.
many Medical Examiners routinely include sleep apnea screening questionnaires, such as
the Epworth Sleepiness Scale or the Berlin Questionnaire, on every driver examination
waiting period for myocardial infarction
two-month waiting period for myocardial infarction and three-month waiting period for coronary artery bypass graft (CABG) operation. The longer of the two waiting periods should apply. If a driver has had a myocardial infarction and then subsequently has a CABG operation, the waiting period should be three months from the date of the CABG operation.
FMCSA medical guidance recommends that diagnosis and evaluation of neuromuscular conditions be performed by an appropriate specialist, usually a
neurologist or neurosurgeon.
For musculoskeletal conditions, appropriate specialists are usually a
physiatrist or orthopedist.
if driver has a diagnosis of a neuromuscular disorder
Recommend not to certify by guidance not regulatory
tricyclic antidepressants
Amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine.
Antidepressants which interfere with safe driving
First-generation antidepressants have consistently been shown to interfere with safe driving.
First-generation antidepressants include amitriptyline and imipramine.
Second-generation antidepressants have fewer side effects and are generally safe; however, these medications can still interfere with safe driving and require case-by-case evaluation.
Second-generation antidepressants include selective serotonin reuptake inhibitors such as fluoxetine, Celexa (citalopram), and sertraline; and norepinephrine reuptake modulators such as venlafaxine; and unicyclic aminoketones such as bupropion.
Which of the following conditions is not disqualifying?
Multiple sclerosis.
Congenital myopathies.
Metabolic muscle diseases.
Muscular dystrophies.
Correct Answer: Multiple sclerosis.
Explanation: Multiple sclerosis may or may not be disqualifying, depending on whether the driver has symptoms that interfere with safe driving. Congenital myopathies, metabolic muscle diseases, and muscular dystrophies are all disqualifying.
Guidelines for reconsideration of the decision not to certify a driver with a diagnosis of a neuromuscular disorder include:
Evaluation by a neurologist or physiatrist who understands the demands of commercial motor vehicle driving.
Specialist may recommend a simulated driving skills test or equivalent functional test.
Annual recertification that repeats specialist evaluation and driving test may be performed when indicated.
These conditions include:
Congenital myopathies
Central core disease.
Centronuclear myopathy.
Congenital muscular dystrophy.
Rod (nemaline) myopathy.
Inflammatory myopathies
Dermatomyositis.
Inclusion body myositis.
Polymyositis.
Motor neuron diseases and muscular dystrophies
Spinal muscular dystrophies
Amyotrophic lateral sclerosis (ALS – Lou Gehrig’s Disease)
Neuromuscular junction disorders – myathenia gravis
Note: guidelines Recommend not to certify if driver has a diagnosis of a neuromuscular disorder.
Which of the following is true?
Regulations are advisory and are not mandatory.
Driver qualification standards are found in 49 CFR 391.43.
Medical guidelines are regulatory and must always be followed by the medical examiner.
Medical guidelines are based on expert review and intended to assist the medical examiner in determining driver certification.
Medical guidelines are based on expert review and intended to assist the medical examiner in determining driver certification.
Driver qualification standards are found in 49 CFR Part 391.41.
49 CFR Part 391.43 contains the instructions to medical examiners for performing the driver certification examination. Regulations are mandatory and must be followed. Guidance is not regulatory and the medical examiner may choose whether or not to follow guidance recommendations.
Cert period for Stage 1 hypertension who is on treatment.
Three-month certification.
The waiting period for hypertrophic cardiomyopathy is __.
One month.
Two months.
Three months.
There is no waiting period. Hypertrophic cardiomyopathy is a disqualifying condition.
There is no waiting period. Hypertrophic cardiomyopathy is a disqualifying condition.
Explanation: Hypertrophic cardiomyopathy is a disqualifying condition.
If a significant abnormal finding for urinalysis specific gravity, protein, or blood is found, the medical examiner should __.
Disqualify the driver.
Request that a renal specialist determine if the driver is medically qualified.
Use clinical expertise to determine if additional evaluation is required and request or recommend primary care provider follow-up.
Obtain blood chemistries for renal function.
Correct Answer: Use clinical expertise to determine if the driver is medically qualified.
Explanation: Use clinical expertise to determine if additional evaluation is required and request or recommend primary care provider follow-up. Abnormalities on urinalysis may indicate the presence of serious medical conditions that can affect driving safety, but also occur in the context of normal conditions (e.g., female driver currently menstruating).
visual acuity test
standard eye examination to determine the smallest letters a person can read on a Snellen chart, or E chart, at a distance of 20 feet
Cert period Stage 2 hypertension who is not on treatment.
Three-month certification.
When a driver tests positive for alcohol or controlled substances under Part 382, the driver is not required to be medically re-examined or to obtain a new Medical Examiner’s certificate provided the driver is seen by
a substance abuse professional (SAP) and the driver completes any rehabilitation recommended by the SAP.
The SAP provides the driver with documentation allowing the driver to return to work after the SAP evaluation and the completion of any required rehabilitation.
If the SAP determines that alcoholism exists, the driver is not qualified to drive a commercial motor vehicle in interstate commerce until the driver completes any recommended rehabilitation and is determined to no longer have a current clinical diagnosis of alcoholism.
The SAP determines that recommended treatment for drug abuse has been completed, and specifies requirements for return to work and follow-up testing.
The ultimate responsibility rests with the motor carrier to ensure the driver is medically qualified and to determine whether a new medical examination should be completed.
regulatory standard requirements include:
Vision requirements:
including distant visual acuity, horizontal vision, and color vision. Drivers who do not meet standards cannot be certified unless accompanied by a vision exemption/waiver.
Diabetes requirements:
drivers using insulin cannot be certified unless special procedures for evaluation and certification of such drivers are followed.
Epilepsy:
drivers with a diagnosis of epilepsy cannot be certified unless accompanied by an epilepsy waiver/exemption.
Hearing:
drivers who cannot meet whisper test or audiometric test requirements cannot be certified unless accompanied by a hearing waiver/exemption.
Stage 2 hypertension who is on treatment cert period?
Three-month certification.
Cert period for driver with a three-month certificate and continued Stage 1 hypertension.
Driver certified to maximum three-month certificate date; if driver has not achieved blood pressure equal to or less than 140/90 by the end of the three-month certificate date, the driver is disqualified until blood pressure equal to or less than 140/90 is achieved.
peripheral neuropathy guidelines
The FMCSA lists peripheral neuropathy as a disqualifying condition. However, this is a guidance, not regulatory, listing. Thus, peripheral neuropathy is usually disqualifying, but the Medical Examiner may consider certifying a driver with peripheral neuropathy.
Guidelines for reconsideration of the decision not to certify include evaluation by a neurologist or physiatrist who understands demands of commercial motor vehicle driving. The specialist or the Medical Examiner may recommend a simulated driving skills test or equivalent functional test. Annual recertification that repeats specialist evaluation and driving test may be performed when indicated.
Major depression waiting period? Max cert period?
Waiting period:
Minimum — six months symptom free following nonpsychotic major depression unaccompanied by suicidal behavior.
Minimum — one year symptom free following a severe depressive episode, a suicide attempt, or a manic episode.
NOTE: If more than one waiting period applies examine driver after the longest waiting period.
Maximum certification — one year.
Recommend to certify if the driver:
Completes an appropriate symptom-free waiting period.
Complies with treatment program.
Tolerates treatment without disqualifying side effects (e.g., sedation or impaired coordination).
Has a comprehensive evaluation from an appropriate mental health professional who understands demands of CMV driving.
Monitoring/Testing: – Evaluation and clearance from a mental health specialist every two years.
Advise the driver with a major mood disorder to report any manic or severe major depressive episode within 30 days of onset to the driver’s employer, Medical Examiner, or appropriate health care professional and to seek medical intervention.
Follow-up: annual medical examinations.
The waiting period for a driver with a history of acute seizures secondary to a systemic metabolic illness is _ and the driver may be certified for up to _.
No waiting period, two years.
One month, one year.
Three months, one year.
One year, one year.
Correct Answer: No waiting period, two years.
Explanation: As long as risk for recurrence of the metabolic illness is low, there is no waiting period and the driver may be certified for two years. This is another example of a neurological condition for which the driver may be certified for up to two years, even though the FMCSA states that the maximum certification interval for a driver with a neurological condition is one year. This training program cannot resolve the contradictions in FMCSA guidance, but will point these out whenever possible.
A driver with a history of kidney disease with or without transplant __.
Is medically disqualified.
Must be assessed regarding severity, stability, medication use and medication side effects/adverse reactions.
Should not be assessed for functional ability to operate a CMV safely.
Should have the medical certification determination made by a renal specialist.
Correct Answer: Must be assessed regarding severity, stability, medication use and medication side effects/adverse reactions.
Explanation: Assessment for kidney disease must be made on a case-by-case basis. Dialysis of any kind is disqualifying. The medical examiner may choose to test the driver for functional ability to operate a CMV safely. The medical certification decision must be made by the medical examiner.
Indicators for obtaining pulmonary function testing (PFT) spirometry include:
Presence of COPD.
History of any lung disease.
Symptoms of shortness of breath, cough, chest tightness, or wheezing.
Cigarette smoking in drivers 35 years of age or older.
Chronic respiratory failure.
Recommendations for exercise tolerance testing (ETT) for drivers with coronary heart disease include:
Every year after myocardial infarction (MI).
Every year with angina pectoris.
3-6 months after percutaneous coronary intervention (PCI) and then every two years thereafter.
Every two years beginning five years following coronary artery bypass grafting (CABG).
3-6 months after percutaneous coronary intervention (PCI) and then every two years thereafter.
Explanation: Exercise tolerance testing (ETT) is required every 2 years following MI and with angina. ETT is required annually beginning five years after CABG due to increased risk of graft closure.
On examination, a BP of 140/90 is obtained. A follow-up BP is 140/90. What certification options may be considered?
The medical examiner should certify for two years if the driver is not taking anti-hypertensive medications.
If the driver is taking antihypertensive medications, six months would be the maximum certification period.
The medical examiner may obtain an additional reading or use his/her clinical judgment and consider BP and overall driver medical fitness for duty to determine certification status and certification period.
The medical examiner may choose not to certify based on the BP readings.
The medical examiner may obtain an additional reading or use his/her clinical judgment and consider BP and overall driver medical fitness for duty to determine certification status and certification period.
Explanation: The medical examiner may use clinical judgment to make an appropriate certification determination.
Certification/Recertification – Alcoholism
Waiting period: No recommended time frame. Do not certify the driver until the driver has successfully completed counseling and/or treatment.
Maximum certification — one year.
Recommend to certify if the driver with a history of alcoholism has:
No residual disqualifying physical impairment.
Successfully completed SAP required rehabilitation.
No current disqualifying alcohol-related disorders.
Do not certify the driver if the driver has:
A current clinical diagnosis of alcoholism.
Signs of a current alcohol-related illness and/or non-compliance with DOT alcohol conduct guidelines.
An alcohol-related unstable physical condition, regardless of the time element.
Not met return-to-duty requirements including return-to-duty alcohol testing.
Ongoing voluntary attendance at self-help groups (e.g., 12-step programs) for maintenance of recovery is not disqualifying – attendance is allowed but not required. Attendance at such programs does not fulfill requirements for substance abuse professional evaluation.
Monitoring/Testing: on a case-by-case basis obtain additional tests and/or consultation to adequately assess driver medical fitness for duty.
Blood pressure (BP) guidelines
if a driver has hypertension and/or is being medicated for hypertension: he or she should be recertified more frequently.
An individual diagnosed with Stage 1 hypertension (BP is 140/90-159/99): may be certified for one year. At recertification, an individual with a BP equal to or less than 140/90 may be certified for one year; however, if his or her BP is greater than 140/90 but less than 160/100, a one-time certificate for 3 months can be issued.
An individual diagnosed with Stage 2 (BP is 160/100-179/109):
should be treated and a one-time certificate for 3-month certification can be issued. Once the driver has reduced his or her BP to equal to or less than 140/90, he or she may be recertified annually thereafter.
An individual diagnosed with Stage 3 hypertension (BP equal to or greater than 180/110) should not be certified until his or her BP is reduced to 140/90 or less, and may be recertified every 6 months. Note, however, that these are guidance recommendations, not regulatory requirements.
Which of the following is true with regard to hypertension?
The lower value of either systolic or diastolic blood pressure determines the stage of hypertension.
Stage 1 hypertension is BP of 140-149/90-99.
Stage 2 hypertension is BP of 170-179/100-109.
Stage 3 hypertension is BP of greater than or equal to 180/110.
Stage 3 hypertension is BP of greater than or equal to 180/110.
Explanation: The higher value of either systolic or diastolic blood pressure determines blood pressure stage. Stage 1 hypertension is SBP 140-159, DBP 90 – 99. Stage 2 hypertension is SBP 160 – 179, DBP 100-109.
The maximum period for which a driver with any cardiovascular disease should be certified is
one year.
This is a guidance, not regulatory, recommendation so there may be rare circumstances in which a driver with a cardiovascular condition could be certified for two years.
PFT testing should include, at a minimum:
Forced expiratory volume in the first second of expiration (FEV1).
Forced vital capacity (FVC).
FEV1/FVC ratio.
No further testing is necessary if the lung function is normal and no other abnormality is suspected. Abnormal lung function should be further evaluated.
Which of the following is not a disqualifying condition?
Peritoneal dialysis.
Hemodialysis.
Hernia.
Peripheral neuropathy.
Correct Answer: Hernia.
Explanation: Any type of dialysis is disqualifying. Peripheral neuropathy is usually disqualifying. Although a hernia may be disqualifying, often a driver can be certified if the symptoms and/or examination findings are mild or if the hernia has been surgically repaired and the condition has stabilized (there is no specified waiting period following hernia treatment, including surgery).
With Major depression, Recommend not to certify if the driver has:
Active psychosis.
Prominent symptoms, including: Substantially compromised judgment.
Attentional difficulties.
Suicidal behavior or ideation.
Personality disorder repeatedly manifested by overt, inappropriate acts.
Treatment side effects that interfere with safe driving.
marijuana use requirements
Marijuana is a Schedule I drug and use by drivers, even if medically prescribed, is prohibited.
It is unnecessary to drug test a driver who has admitted to marijuana use. Such admission indicates disqualifying marijuana use and the driver should be referred for SAP evaluation.
Any marijuana use requires SAP evaluation.
waiting period for MI
two-month waiting period for myocardial infarction.
Screening pulse oximetry and/or arterial blood gas (ABG) analysis are indicated when:
Airway obstruction is present and pulmonary function test results are FEV1 less than 65% predicted.
FEV1/FVC ratio less than 65%.
Restrictive impairment is present and FVC is less than 60%.
Pulse oximetry results of less than 92% are an indication for ABG testing.
disqualifying diabetic comorbidities
Peripheral neuropathy is a disqualifying condition due to effects on the driver’s use of hands and feet for vehicle control. The Medical Examiner should require that a driver with peripheral neuropathy see a neurologist and only consider certifying the driver if the neurologist with knowledge of the driver’s job requirements indicates that the driver is safe to drive.
Autonomic neuropathy is usually disqualifying due to effects on heart rate and blood pressure control. Drivers with autonomic neuropathy should not be certified if the driver has resting tachycardia or orthostatic blood pressure caused by autonomic neuropathy.
Diabetic retinopathy is usually disqualifying due to effects on vision and the risk of sudden visual loss from retinal hemorrhage. The Medical Examiner should require that a driver with diabetic retinopathy see an ophthalmologist and only consider certifying the driver if the ophthalmologist with knowledge of the driver’s job requirements indicates that the driver is safe to drive, and if the driver’s vision meets minimum standards. Drivers with significant non-proliferative retinopathy or with proliferative retinopathy should be disqualified.
There are four required tests:
Vision –
Hearing –
Blood pressure/pulse –
Urinalysis – record the test results of the required dipstick urinalysis (UA) in the Laboratory and Other Medical Test Findings section of the Medical Examination Report form.
The certification determination for a driver who presents with a confirmed BP of 182/86 is __.
Qualify 3 months.
Disqualify until BP is < 180/110.
Disqualify until BP is < 160/100.
Disqualify until BP is < 140/90.
Disqualify until BP is < 140/90.
Explanation: Drivers with Stage 3 hypertension are disqualified until blood pressure is stabilized at < 140/90.
waiting period following a transient ischemic attack (TIA)
one year
Certification/Recertification – Adult ADHD
Maximum certification – one year.
Recommend to certify if the driver:
Complies with treatment program.
Tolerates treatment without disqualifying side effects (e.g., sedation or impaired coordination).
Has comprehensive evaluation from mental health professional with understands demands of commercial driving.
Recommend not to certify if the driver has:
An active psychosis.
Prominent negative symptoms, including:
Substantially compromised judgment.
Attentional difficulties.
Suicidal behavior or ideation.
Personality disorder that is repeatedly manifested by overt, inappropriate acts.
Side effects that interfere with safe driving.
Monitoring/Testing: On a case-by-case basis obtain additional tests and/or specialist consultation from a psychiatrist or psychologist.
Follow-up: The driver should have annual medical examinations.
Exercise tolerance testing (ETT) is required every how often following MI and with angina.
every 2 years following MI and with angina.
alcoholism requirements
If the SAP determines that alcoholism exists, the driver is not qualified to drive a commercial motor vehicle in interstate commerce until the driver completes any recommended rehabilitation and is determined to no longer have a current clinical diagnosis of alcoholism.
The SAP determines that recommended treatment for drug abuse has been completed, and specifies requirements for return to work and follow-up testing.
The ultimate responsibility rests with the motor carrier to ensure the driver is medically qualified and to determine whether a new medical examination should be completed.
disqualifying medications for neurological conditions
Medications that may indicate treatment for a usually disqualifying condition, e.g., Sinemet for treatment of Parkinson’s disease.
Use of blood thinning medications in drivers with a neurological conditions, which is considered disqualifying due to the risk for intracranial hemorrhage.
Arterial blood gas (ABG) measurements: do not certify the driver when ABG measurements reveal partial pressure of arterial oxygen (PaO2) less than:
Or, Partial pressure of arterial carbon dioxide (PaCO2) greater than:
partial pressure of arterial oxygen (PaO2) less than:
65 millimeters of mercury (mm Hg) at altitudes below 5,000 feet.
60 mm Hg at altitudes above 5,000 feet.
Partial pressure of arterial carbon dioxide (PaCO2) greater than 45 mm Hg at any altitude.
The dipstick urinalysis must:
Measure specific gravity, and
Test for protein, blood, and glucose.
Positive test results for any dipstick tests may indicate that additional evaluation is needed.
Results are recorded on the second page of the Medical Examination Report form.
The one-time use of a three-month certificate for blood pressure greater than 140/90 can be provided to a driver __.
Once in the driver’s lifetime.
On consecutive examinations until the driver’s blood pressure is less than 140/90.
When the driver was diagnosed with Stage 1 hypertension on a previous examination and now has a blood pressure of 162/84.
When the driver has a blood pressure of 182/84.
When the driver was diagnosed with Stage 1 hypertension on a previous examination and now has a blood pressure of 162/84.
Explanation: A three-month certificate may be issued more than once in a driver’s lifetime. A three-month certificate should not be issued consecutively. A driver with blood pressure of greater than or equal to 180/110 is not eligible for a three-month certificate.
The process for the evaluation of drivers with ITDM includes:
Annual or more frequent examinations with maximum 1 year certification.
Evaluation by the driver’s Treating Clinician (TC). The TC sees the driver prior to the ME examination.
No later than 45 days after completion, the driver provides the completed MCSA-5870 form to the ME.
After receipt of the form, the ME will examine the driver and determine whether the driver meets FMCSA qualification standards.
All ITDM drivers must provide the TC with at least the preceding 3 months of blood glucose self-monitoring records.
If the driver provides less than 3 months or records to the TC, the ME may grant the driver no more than a 3-month certification to allow the driver time to collect the required 3 months of records.
49 CFR 391.46 requires drivers with ITDM to be evaluated by her/his treating clinician (TC). The TC must evaluate the driver and provide required information by completing the ITDM Assessment Form, MCSA-5870.
Certification/Recertification – CNS Stimulant Therapy
Waiting period: No recommended time frame.
Do not certify the driver until medication has been shown adequate/effective, safe, and stable.
Maximum certification – one year.
Recommend to certify if driver has:
Non-disqualifying underlying condition (e.g., adult ADHD).
No drug-induced impairment.
No tendency to increase the dose.
Recommend not to certify if the driver has:
Disqualifying underlying condition (e.g., narcolepsy).
Treatment side effects that interfere with safe driving.
Monitoring/Testing: On a case-by-case basis obtain additional tests and/or consult with a mental health specialist who understands demands of CMV driving.
Evaluate:
Dose, plasma concentration, and duration of drug therapy.
Severity of the underlying mental disorder.
Follow-up: The driver should have annual medical examinations.
Neurological Physical Examination and Evaluation At a minimum, note and/or describe:
Impaired equilibrium, coordination, or speech pattern;
Paresthesia;
Asymmetric deep tendon reflexes;
Sensory or positional abnormalities;
Abnormal patellar and Babinski’s reflexes;
Ataxia and other gait disturbance.
Strength.
Any neurological condition should be evaluated for the nature and severity of the condition, the degree of limitation present, the likelihood of progressive limitation, and the potential for sudden incapacitation.
Chest X-ray is indicated for:
Annual monitoring of mitral stenosis.
Evaluation of significant respiratory abnormalities.
Evaluation for hypersensitivity pneumonitis.
Evaluation of a positive PPD test.
Evaluation of spontaneous pneumothorax.
Disqualify a Driver using which drug?
Who is currently using methadone; or who uses a controlled substance including a narcotic, an amphetamine, or another habit-forming drug without a prescription from the treating physician.
The maximum certification interval for a driver disqualified for Stage 3 hypertension, but whose blood pressure has declined to less than or equal to 140/90, is __.
Three months.
Six months.
One year.
Two years.
Six months.
Explanation: Once diagnosed with Stage 3 hypertension, a driver may be certified for six-month intervals.
disqualifying diabetic eye diseases
Drivers diagnosed with:
severe non-proliferative diabetic retinopathy or with
proliferative diabetic retinopathy are permanently disqualified. However, specialized eye examinations to evaluate possible vision complications related to diabetes are not required by the rule but certainly represent best practice.
Certification/Recertification – Bipolar Mood Disorder
Waiting period:
Minimum – six months symptom free after nonpsychotic major depression episode without suicidal behavior.
Minimum – one-year symptom free after severe depressive episode, a suicide attempt, or manic episode.
NOTE: If more than one waiting period applies examine the driver after completion of longest waiting period.
Maximum certification — one year.
Recommend to certify if driver:
Completes symptom-free waiting period.
Complies with treatment program.
Tolerates treatment without disqualifying side effects (e.g., sedation or impaired coordination).
Has comprehensive evaluation from a mental health professional who understands demands of CMV driving.
Recommend not to certify if driver has:
Active psychosis.
Compromised judgment.
Attention difficulties.
Suicidal behavior or ideation.
Personality disorder manifested by inappropriate acts.
Treatment side effects that interfere with safe driving.
Monitoring/Testing:
Evaluation and clearance from a mental health specialist every two years.
Advise the driver with a major mood disorder to report any manic or severe major depressive episode within 30 days of onset to the driver’s employer, Medical Examiner, or appropriate health care professional and to seek medical intervention.
Follow-up: annual medical examinations.
Use of blood thinning medications in drivers with a neurological conditions
is considered disqualifying due to the risk for intracranial hemorrhage.
Disqualify a driver with diagnosis of?
Who has a current clinical diagnosis of alcoholism
Who has a diagnosis of a regulatory disqualifying condition such as epilepsy, monocular vision, or hearing loss.
When evidence shows a condition exists that will likely interfere with the safe operation of a CMV. Such evidence may include supporting opinions and information from other medical providers including primary care providers and specialists.
Minimally invasive cardiovascular procedures that a lay person may not consider “surgical”, or significant for health history purposes, include
coronary stenting and arrhythmia ablation procedures.
Skill Performance Evaluation (SPE) certificate
SPE certificates are issued by the FMCSA for fixed extremity deficits if the driver demonstrates the ability to meet FMCSA safe driving requirements.
Are BP rules medical guidance or regulatory?
Medical guidance should be used by Medical Examiners to determine certification status for drivers with hypertension. Note that medical guidance for hypertension are recommendations. The Medical Examiner may use his/her clinical expertise and results of the individual driver examination to determine the length of time between recertification examinations, which may vary from medical guidance. If the Medical Examiner makes a certification determination that does not follow guidance recommendations, the Medical Examiner should document the rationale for that determination in the Medical Examination Report.
example of medication side effects of BB
beta blockers that may cause fatigue/weakness;
when is a driver disqualified who is ITDM?
ITDM drivers with licenses issued in Canada or Mexico are prohibited from operating CMVs in the US.
Certification/Recertification – Personality Disorders
Waiting period: No recommended time frame. Do not certify driver until etiology confirmed and treatment shown adequate/effective, safe, and stable.
Maximum certification – one year.
Recommend to certify if the driver:
Complies with treatment program.
Tolerates treatment without disqualifying side effects (e.g., sedation or impaired coordination).
Has comprehensive evaluation from mental health professional who knows CMV driving demands.
Recommend not to certify if the driver has:
An active psychosis.
Prominent negative symptoms, including substantially compromised judgment, attentional difficulties, suicidal behavior or ideation, or a personality disorder that is repeatedly manifested by overt, inappropriate acts.
Treatment side effects that interfere with safe driving.
Monitoring/Testing: on a case-by-case basis obtain additional tests and/or consult with a mental health specialist to adequately assess driver medical fitness for duty.
Follow-up: annual medical examinations.
The Medical Examiner has the authority to indicate the driver is medically qualified “only when” in compliance with one or more of the six requirements printed on the Medical Examiner’s certificate:
Wearing corrective lenses
Wearing a hearing aid.
Accompanied by a __ waiver/exemption. (E.g. federal vision).
Driving within an exempt intracity zone (49 CFR 391.62).
Accompanied by a Skill Performance Evaluation (SPE) certificate.
Qualified by operation of 49 CFR 391.64 (grandfathering for a limited number of drivers who participated in diabetes and vision waiver study programs).
Examples of sleepiness surveys include:
Epworth sleepiness scale.
Berline Questionnaire.
Stanford sleepiness scale.
anticoagulation medications, are disqualifying for drivers with
neurological conditions
Certification/Recertification — Schizophrenia and Related Psychotic Disorders
Except for confirmed diagnosis of schizophrenia, determination not based on diagnosis alone.
Waiting period:
Minimum – six months symptom free if brief reactive psychosis or schizophreniform disorder.
Minimum – one-year symptom free if any other psychotic disorder.
NOTE: If more than one waiting period applies examine driver for certification after completion of longest waiting period.
Maximum certification – one year.
Recommend to certify if the driver:
Completes an appropriate symptom-free waiting period.
Complies with treatment program.
Tolerates treatment without disqualifying side effects (e.g., sedation or impaired coordination).
Has a comprehensive evaluation from an appropriate mental health professional who knows demands of CMV driving.
Recommend not to certify if the driver has:
Diagnosis of schizophrenia.
Active psychosis.
Prominent negative symptoms, including: substantially compromised judgment; attentional difficulties; suicidal behavior or ideation.
Personality disorder that is repeatedly manifested by overt, inappropriate acts. Treatment side effects that interfere with safe driving.
NOTE: Chronic schizophrenia is usually clear-cut. Persons with this condition tend to be severely incapacitated and lack cognitive skills needed for steady employment, have impaired judgment and poor attention, and have high risk for suicide.
Monitoring/Testing: At least every two years, the driver with a history of mental illness with psychotic features should have evaluation and clearance for CMV driving from a mental health specialist who knows demands of CMV driving. Advise the certified driver with a major mood disorder to report any manic or severe major depressive episode within 30 days of onset to the driver’s employer, Medical Examiner, and/or appropriate health care professional and to seek medical intervention.
Follow-up: The driver should have annual medical examinations.
According to FMCSA medical guidance, determination is not based on diagnosis alone, because it may not affect individual driver ability to function. However, a diagnosis of schizophrenia is usually disqualifying.
when using a 3 month cert period, what is expiration date of cert period when BP is less than 140/90?
Once the driver’s blood pressure is less than 140/90, a new complete examination should be performed, and the expiration date should be 1 year from the date of this new examination. The expiration date for one-year certification following issuance of a one-time, three-month certificate is based on the date of the last full examination of the driver.
CV treatment that is disqualifying
implantable defibrillators are disqualifying.
guidelines regarding blood glucose monitoring and A1c
There is no requirement for assessment of hemoglobin A1c levels and no specified A1c levels that are disqualifying.
There are no specified blood glucose levels or ranges that are considered acceptable. Other than the requirement for blood glucose self-monitoring, there are no specific requirements as far as timeframes or frequency. ITDM drivers must self-monitor blood glucose at whatever frequency is required by the TC.
disqualifying medications
Any anti-seizure medication used for the prevention of seizures;
Methadone,
insulin unless the driver is certified by following the special requirements related to insulin-dependent diabetes.
Marijuana: including medical marijuana use.
anticoagulant medications in drivers with neurological conditions due to the risk of hemorrhage causing a cerebrovascular accident.
option/exception to a disqualifying medication
The use of some classes of medications, such as narcotics, or other habit-forming medications, is considered disqualifying according to FMCSA guidance. However, FMCSA guidance states that if the physician who prescribes the medication indicates in writing that the driver is safe to drive a CMV while taking the medication as prescribed, the driver may be cleared to drive.
A driver cannot take a controlled substance or prescription medication without a prescription from a licensed practitioner. If a driver uses a Schedule 1 medication or any other substance such as amphetamine, a narcotic, or any other habit forming drug, the driver is medically unqualified.
There is an exception: the prescribing doctor can write that the driver is safe to be a commercial driver while taking the medication. In this case, the Medical Examiner may, but does not have to, certify the driver. The exception does not apply to Schedule 1 medications.
Any anti-seizure medication used for the prevention of seizures is disqualifying.
Methadone use is disqualifying.
he use of Provigil needs careful supervision. Provigil may affect concentration, function or may hide signs that an individual is tired. It is recommended that until an individual knows how Provigil affects him/her, they may not drive, use machinery or do any activity that requires mental alertness.
Chantix (varenicline) is used for smoking cessation. The FMCSA has issued guidance that states that drivers should not be certified while taking Chantix.
The use of insulin is disqualifying, unless the driver is certified by following the special requirements related to insulin-dependent diabetes.
Marijuana use is disqualifying, including medical marijuana use. There are no exceptions. Marijuana is a Schedule 1 drug. CBD is problematic because it is no longer Schedule 1 at low concentrations (< 0.1% or less) but how and if that is measured by CBD manufacturers is unknown.
Use of anticoagulant medications is disqualifying for neurological conditions.
Recommendations use what percent blood alcohol concentration as the impairment benchmark, which was chosen based on FMCSA rules related to alcohol use.
a 0.04 percent blood alcohol concentration as the impairment benchmark
required test
urinalysis (dipstick), measuring specific gravity and the presence of glucose, blood, and protein.
examples of supplements that cause CV side effects
Ephedra can cause dangerous and life threatening increases in heart rate and blood pressure.
Garlic and Ginkgo can cause excessive bleeding in drivers taking blood thinning medications, as can Goldenseal.
Licorice root can raise blood pressure.
The waiting period for benign positional vertigo is
two months symptom free.
The maximum period for which a driver with any neurologic disease should be certified is
one year.
This is a guidance, not regulatory, recommendation so there may be rare circumstances in which a driver with a neurological condition could be certified for two years.
Objective tests for sleep disorders include:
Polysomnography in a controlled sleep laboratory.
Napping tests.
Maintenance of wakefulness test.
Multiple sleep latency test (MSLT).
Additional tests above and beyond what are necessitated by the examination process should be performed only when __.
The examination was unable to determine if the driver passed one or more requirements.
The examination was unable to determine if the driver passed a majority of the requirements.
The driver requests that additional tests be run.
Requested by the driver’s employer.
The examination was unable to determine if the driver passed one or more requirements.
Explanation: Additional testing should only be performed if the results of standard testing and examination procedures do not provide a clear result as to whether or not the driver meets federal standards in one or more categories.
The correct way to comment on abnormal findings
Discuss any “Yes” answers in detail,
If organic disease is present, note that it has or has not been compensated for.
Abnormal findings should be discussed with the driver and the discussion documented.
The effect of an abnormality on the ability of the driver to operate a CMV safely should be noted.
regarding certification when Sleep Apnea Screening and Testing is positive
Drivers diagnosed with sleep apnea should not be certified until it is determined that sleep apnea symptoms have been controlled, most notably daytime sleepiness, and treatment is safe, effective, adequate, and stable.
Minimum physical examination requires assessment of target organ disease associated with diabetes, including:
Retinopathy and macular degeneration.
Peripheral neuropathy.
Renal disease (kidney failure).
Peripheral vascular disease (peripheral vascular insufficiency).
Neurological Risk Assessment
Consider for documented conditions the rate of progression, degree of control, and likelihood of gradual or sudden incapacitation (e.g., cardiovascular, neurologic, respiratory, musculoskeletal).
When the Medical Examiner is uncertain about the severity of the condition or prognosis, the decision for certification should be postponed until the additional necessary information is obtained.
FMCSA general guidelines for certification of the driver with a neurological condition include:
Has the driver completed any recommended waiting period?
Do test results meet minimum recommended guidelines?
Has the treating provider, usually a neurologist, who is familiar with the driver’s duties, cleared the individual for driving?
Has the condition medically stabilized?
Does the driver tolerate medication(s) and/or treatment?
Is treatment disqualifying?
What is the medical examiner certificate expiration date? Examination 11/16/2011; disqualified due to diagnosis of benign positional vertigo last episode 10/11/2011; return to medical examiner’s office for complete new certification examination on 1/2/2012. Note asymptomatic since 10/11/2011 – driver qualified for two years.
Expiration date 10/11/2013.
Expiration date 1/2/2013.
Do not certify – waiting period has not been completed.
Expiration date 1/2/2014.
Expiration date 1/2/2014.
Explanation: The certification date is always based on the date of the last complete examination.
Examples of findings that may indicate the Medical Examiner should obtain additional testing and/or evaluation of the driver with diabetes include:
Glycosuria.
Elevated blood glucose.
Vision issues.
Evidence of peripheral neuropathy on physical examination.
Indications for additional evaluation by a primary care provider or specialist (usually a pulmonologist) include:
Symptoms that may need treatment.
Side effects of medications prescribed.
Pulmonary function tests that are abnormal or equivocal.
Symptoms that may interfere with safe driving.
Abnormal lung function testing such as an FEV1 < 65%, low oxygen saturation.
Severe allergic pulmonary reactions, side effects of medications used to treat conditions.
Clubbing of the fingers.
Cyanosis.
Prolonged expiration.
Tachypnea at rest.
Pulmonary wheezes and rhonchi, pulmonary rales.
Absent or decreased breath sounds.
Pleural friction rub.
Unequal inflation-deflation contours of the right and left thorax.
Significant kyphosis or scoliosis of the thoracic spine.
Use of accessory muscles of ventilation at rest.
Cardiovascular studies include
electrocardiograms, stress tests, ejection fraction, and vascular studies.
Blood analyses (e.g., electrolytes, blood chemistries, toxicology).
Chest radiographs.
Drug level monitoring (e.g., digoxin, theophylline).
Monitoring requirements, such as monthly international normalized ratio (INR) measurements used for some anticoagulant medications such as Coumadin (warfarin), may be considered for some conditions. Since this is medical guidance, any Medical Examiner decision not to monitor monthly INR measurements must be accompanied by the Medical Examiner rationale as to why such monitoring is not necessary.
disqualifying medications for neurological conditions
For example, the use of anticoagulants in drivers with neurological conditions is disqualifying, due to the risk of intracerebral hemorrhage.
anti-seizure medications may indicate the presence of epilepsy, which is disqualifying (by regulation)
The maximum period for which a driver with diabetes that does not require insulin for control should be certified is?
cert period for ITDM?
one year
This is a guidance, not regulatory, recommendation so there may be rare circumstances in which a driver with diabetes could be certified for two years.
Drivers with ITDM may be certified for no more than 1 year.
Refer a driver who exhibits evidence of any cardiac conditions for
follow-up care and evaluation by an appropriate specialist or primary care provider including but not limited to any CV surgery or problem and blood pressure control.
Integrate specialists’ evaluations with other driver information.
Additional cardiovascular disease evaluation and tests must include documentation of:
Rationale for qualifying or disqualifying the driver.
Test results and corresponding medical guidelines.
The presence of organic disease and whether or not compensation is sufficient to meet physical qualification requirements.
The FMCSA directly regulates __.
Interstate commercial operations, including the driver.
Intrastate operation, including the vehicle and motor carrier.
Intrastate operation, including the transport of hazardous materials.
Intrastate commercial operations, including the driver.
Interstate commercial operations, including the driver.
Explanation: Many states use federal FMCSA standards to govern intrastate commercial operations, including the driver, but the FMCSA does not directly any intrastate functions.
Driver Examination 2/17/2012, blood pressure 144/102. Driver given three-month certification to 5/17/12. The driver returns on 3/16/12 with blood pressure of 124/82. The next step for the medical examiner is?
Perform a complete examination and certify the driver for one year if the driver passes the examination.
Certify the driver for one year from 2/17/12.
Require the driver to return for additional blood pressure checks since the blood pressure still does not meet certification requirements.
Disqualify the driver.
Perform a complete examination and certify the driver for one year if the driver passes the examination.
Explanation: The driver’s blood pressure meets certification requirements. Given the previous elevated blood pressure, with respect to blood pressure guidelines the driver now qualifies for a one year certification. However, a complete examination is required each time a new certification interval has been designated, so a complete examination is now required and the date of expiration should be determined from the last date of full driver examination.
Disqualifying neurological diagnoses
Parkinson’s disease, which is disqualifying (by guidance).
epilepsy, which is disqualifying (by regulation)
Epilepsy
Severe TBI
AV malformation not surgically treated
Dementia
Parkinson’s
Iatrogenic parkinsonism
Cerebellar ataxia
Frequent or severe headaches
ITDM drivers who experience a severe hypoglycemic episode are disqualified until they have
seen their treating clinician (TC) and have been determined by their TC to be safe to drive. The TC must complete a new form MCSA-5870 and provide this to the driver; the driver may resume driving without seeing the Medical Examiner but must provide the MCSA-5870 form to the Medical Examiner at the next certification examination.
Risks associated with Antihistamines
Some antihistamines cause drowsiness.
Drivers should not be certified if taking antihistamines that have been associated drowsiness within 12 hours of driving.
neurological diagnoses that according to medical guidance should be disqualifying include:
Severe traumatic brain injury.
Meniere’s disease – the severity of symptoms and whether the symptoms have been recent or remote may inform the certification decision.
Arteriovenous malformation/aneurysm that has not been surgically repaired.
Dementia – temporary dementia related to a reversible, treatable condition is not permanently disqualifying.
Parkinsonism.
Iatrogenic Parkinsonism.
Cerebellar ataxia of any etiology.
Frequent or severe headaches that interfere with safe driving.
Peripheral neuropathy.
Epilepsy – by regulation, not guidance – is disqualifying.
peripheral neuropathy exception
The Medical Examiner should require that a driver with peripheral neuropathy see a neurologist and only consider certifying the driver if the neurologist with knowledge of the driver’s job requirements indicates that the driver is safe to drive.
autonomic neuropathy
Drivers with autonomic neuropathy should not be certified if the driver has resting tachycardia or orthostatic blood pressure caused by autonomic neuropathy.
The maximum period for which a driver with a neurological condition should be certified is
one year For all neurological conditions
Cardiovascular disease “do not certify” diagnoses include
hypertrophic cardiomyopathy and
restrictive cardiomyopathy.
Disqualify a driver when evidence shows that a condition exists that will likely interfere with the safe operation of a CMV, especially when opinions from primary care providers and specialists so indicate.
Medical Examiner Role:
Determine Medical “Fitness For Duty”
Supplemental oxygen use is
disqualifying.
After seizure, Recommend to certify if:
The driver has completed the minimum waiting period seizure free and off anticonvulsant medication.
There is a normal physical examination, normal neurological examination including neuro-ophthalmological evaluation, and normal neuropsychological test.
Clearance is obtained from a neurologist who understands the functions and demands of commercial driving.
Non-modifiable CVD risk factors include:
Age (over 45 at higher risk, over 60 at much higher risk).
Gender (males at higher risk, postmenopausal women at higher risk).
Family history (premature CVD in 1st degree relative – in male relatives less than age 55, in female relatives less than age 65).
Race (African Americans are at higher risk).
diabetic retinopathy exception
the Medical Examiner should require that a driver with diabetic retinopathy see an ophthalmologist and only consider certifying the driver if the ophthalmologist with knowledge of the driver’s job requirements indicates that the driver is safe to drive, and if the driver’s vision meets minimum standards. Drivers with proliferative diabetic retinopathy or severe non-proliferative retinopathy are disqualified.
FMCSA guidance suggests driver disqualification for a FEV1 of <
65% predicted
If test results do not meet minimum guidelines, e.g., FEV1 < 65% predicted, the driver should be disqualified unless or until further treatment improves the driver’s test results such that minimum recommended guidelines are met.
modifiable CVD risk may change driver’s risk for CVD. Modifiable risk factors include:
Hypertension.
Smoking.
Cholesterol (high LDL and low HDL).
High triglycerides.
Obesity.
Sedentary lifestyle.
Diabetes.
cert period for dialysis
With a history of renal failure on dialysis, dialysis of any kind is a disqualifying condition. If the driver gives a history of dialysis the Medical Examiner should certify the driver only if dialysis is not a current treatment and only if the condition that was treated by dialysis has been stabilized so that the driver does not pose a safety risk (e.g., successful kidney transplant).
monocular vision
requires driver disqualification
Epilepsy definition
a history of two or more unprovoked seizures.
A second unprovoked seizure, regardless of the elapsed time between seizures, would constitute a medical history of epilepsy and the driver would no longer meet the physical requirements for 49 CFR 391.41(b)(8).
CHD risk-equivalent conditions include:
Diabetes.
Peripheral vascular disease.
Framingham risk predicting 20% CHD event risk over the next 10 years.
or being over 45 years of age with multiple risk factors for CHF
Certify if:
Asymptomatic.
No ischemic changes on electrocardiogram (ECG).
No functional incapacitation by any of the conditions.
No exercise tolerance test (ETT) abnormalities.
Waiting period: None/variable – the driver should not be certified until etiology of the condition is confirmed and treatment is adequate, effective, safe, and stable.
Maximum certification period: one year.
The physical examination “Check For” list includes:
General appearance. Marked overweight, tremor, signs of alcoholism, problem drinking, or drug abuse.
Mouth and throat. Irremediable deformities likely to interfere with breathing or swallowing.
Abdomen and viscera. Enlarged liver, enlarged spleen, masses, bruits, hernia, and significant abdominal wall muscle weakness.
Genitourinary system. Hernias.
Possible certification outcomes of the Medical Examiner determination include:
Certification with maximum certification interval of 2 years
Determination pending for up to 45 days while obtaining additional evaluation or information – the driver remains certified for as long as the driver has a current medical certification. If the driver does not have a current medical certification, the driver remains uncertified unless and until the driver returns with the requested information and is deemed qualified by the Medical Examiner at that time.
If the driver’s current certification expires before the driver completes required evaluation or provides required additional information, the driver is then disqualified until the driver completes the evaluation or provides the information.
If the driver fails to complete required evaluation or provide required additional information by the end of the 45-day period, a new medical examination must be performed.
If the driver returns or provides the necessary information within the Determination Pending timeframe, the Medical Examiner then makes a certification determination. The timeframe for certification is based upon the date the Medical Examiner makes the certification determination, not on the date the original medical examination was performed.
Disqualification – may be permanent or temporary.
The driver who must wear corrective lenses, a hearing aid, or have a Skill Performance Evaluation certificate may be certified for up to two years when there are no other conditions that require periodic monitoring.
Discuss the disqualification decision with the driver, including what the driver can do to meet the Federal qualification requirements for commercial drivers.
Epilepsy is disqualifying according to
by regulation, not guidance
The following drivers cannot be qualified:
A driver who has a medical history of epilepsy or a current clinical diagnosis of epilepsy.
A driver who is taking anti-seizure medication for control of seizures.
Normal ETT results
The driver should exercise to a workload capacity of > 6 METS – through Bruce Stage II or equivalent – attain a heart rate > 85% of predicted maximum (unless on beta blockers), should have a rise in SBP > 20 mmHg without angina, have no significant ST segment depression or elevation and no marked T wave abnormality, and have no ventricular dysrhythmia.
There are seven domains identified in the DCO:
- Identification and Health History
- Physical Examination and Evaluation
- Diagnostic Tests and Referrals
- Documentation of Ancillary Information
- Health Education Counseling
- Risk Assessment
- Certification Outcomes and Intervals
A Detailed Content Outline (DCO) was created by the FMCSA
Do not certify the driver with these respiratory conditions:
Hypoxemia at rest.
Untreated symptomatic obstructive sleep apnea (OSA).
Narcolepsy.
Primary (idiopathic) alveolar hypoventilation syndrome.
Idiopathic central nervous system hypersomnolence.
Restless leg syndrome associated with excessive daytime somnolence (EDS).
Following an initial, single, unprovoked seizure, the CMV driver should be seizure-free and off anticonvulsant medication for at least
five years
to distinguish between a medical history of a single instance of seizure and a diagnosis of epilepsy.
when is a driver with h/o epilepsy certifiable?
Current advisory criteria allow that some drivers with a history of epilepsy/seizures off anti-seizure medication and seizure-free for 10 years may be qualified to drive a CMV in interstate commerce.
For the entire waiting period related to seizures, before being considered for certification, the driver should be both:
Seizure-free.
Off anticonvulsant medication prescribed for control of seizures.
if prescription narcotic pain medications have been prescribed, the driver must obtain
medical clearance for the use of such medications including the prescribing physician’s certification that the use of the medications as prescribed will not increase risks associated with driving CMV’s.
option for a disqualified driver
discuss The option of applying for a federal exemption for the otherwise medically qualified driver with monocular vision.
There are 3 waiver/exemption programs for drivers with medical conditions that are disqualifying by regulation. These include the longstanding waiver/exemption program for vision, and more recent programs for hearing and epilepsy.
The driver submits to the FMCSA medical examinations, employment history, driving experience, and motor vehicle records.
A final decision is made by the FMCSA within 180 days of application receipt.
Waivers/exemptions are granted for 2-year intervals unless otherwise specified.
However, even when the waiver/exemption is granted for 2 years, annual medical examinations are required.
Waivers/exemptions are issued by the FMCSA (they are not issued by the medical examiner).
The Skill Performance Evaluation (SPE) is a certificate that may be issued to drivers with the loss of an arm, leg, hand, or foot.
Sleep disorder guidelines are
advisory, not regulatory.
if not followed:
The medical examiner should document awareness of the guidelines and provide a rationale for not following the guidelines.
The medical examiner should obtain supporting opinions from medical specialists and treating providers.
Certification/Recertification — Epilepsy
waiting period?
Waiting period: Minimum 10 years off anticonvulsant medication and seizure-free.
Recommend to consider certification if:
The driver has completed a waiting period of 10 years off anticonvulsant medication and seizure-free.
The nature and severity of the medical condition of the driver does not endanger the health and safety of the driver and the public.
The driver has clearance from a neurologist specializing in seizure disorders and has a normal electroencephalogram (EEG).
regarding epilepsy, Do not certify (according to regulation) if the driver:
Has an established medical history of epilepsy or a clinical diagnosis of epilepsy.
Is taking anticonvulsant medication because of a medical history of one or more seizures, or is at risk for seizures.
Has any other condition likely to cause loss of consciousness or any loss of ability to control a CMV.
DOT Examination Process Summary
Note that the Medical Examination Report Form MCSA 5875 includes detailed step-by-step instructions for completion.
Verify driver identification with photo ID
Driver completes forms
MCSA 5875 – Medical Examination Report Form driver history
Confirm driver signature and date
Recommend driver sign HIPAA compliant release form(s)
tests:
Vision testing (Snellen or equivalent)
Hearing – whisper test or audiometry
Dipstick urinalysis
Blood pressure, pulse
Height and weight
Medical Examiner examination:
Review driver history
Acknowledge driver “Yes” answers and clarify with questions and additional information
Ask if driver has ever received less than a 2-year certification at any prior DOT medical examination
Physical examination – driver should be in medical gown or equivalent
Medical Examiner notes abnormal findings with comments
Medical Examiner completes forms (MCSA 5875 and MCSA 5876)
Provide copy of Driver Certificate to driver and, if requested, to employer
Complete online completion of driver certification information no later than midnight (local time) of the calendar day following the date of the examination
The driver must sign the Medical Examiner’s certificate.
Myocardial Infarction (MI) Certification is not recommended if the driver has:
Recurrent angina symptoms.
Post-MI ejection fraction < 40% (by echocardiogram or ventriculogram); an ejection fraction of < 40% is considered disqualifying for any cardiac condition, not just MI.
Abnormal exercise tolerance test (ETT) with evidence of ischemia, arrhythmia, or other findings indicating increased risk of recurrent cardiac events.
Ischemic changes on rest electrocardiogram (ECG).
Poor tolerance to current cardiovascular medications.
Unprovoked Seizure definition
Unprovoked seizure: An unprovoked seizure occurs in the absence of an identifiable acute alteration of systemic metabolic function or acute insult to the structural integrity of the brain.
There may be a known or distant cause of the seizure. While individuals who experience a single unprovoked seizure do not have a diagnosis of epilepsy, they are clearly at a higher risk for having further seizures.
The overall rate recurrence rate is estimated to be 36% within the first five years following the seizure. After five years, the risk for recurrence is down to 2% to 3% per year for the total group.
renal and gastric conditions that Do not certify:
A driver with nephropathy associated with fluid retention requiring high doses of diuretics, driver weight fluctuating widely, disease not stable, no indication from treating physicians that the condition will not affect safe driving, or who is receiving dialysis of any kind.
A driver with cholecystitis with severe nausea, vomiting, and/or abdominal pain requiring frequent use of high doses of narcotic pain medication for control, surgery recommended but deferred due to driver concerns regarding the cost of surgery.
Sleep disorder testing guidelines recommend a sleep study for drivers with at least two of the following three criteria:
A body mass index (BMI) greater than or equal to 35 kg per meter squared.
A neck size > 17 inches in men or 16 inches in women.
Hypertension that is new, uncontrolled, or requires at least 2 medications to control.
Guidelines also recommend testing if any of the following criteria are met:
Sleep history suggestive of obstructive sleep apnea (OSA).
Epworth Sleepiness Scale > 10.
Previously diagnosed sleep disorder.
Previous sleep study with apnea/hypoapnea index > 5 but less than 30.
Following an initial unprovoked seizure, the driver should be seizure-free and off anticonvulsant medication for at least
five years
to distinguish between a medical history of a single unprovoked seizure and epilepsy (two or more unprovoked seizures).
for Myocardial infarction, Certification is recommended if the driver is:
At least two months post-MI.
Cleared by a cardiologist with knowledge of the driver’s duties.
Satisfactory exercise tolerance test.
No angina.
Post-MI ejection fraction greater than or equal to 40% (by echocardiogram or ventriculogram).
Tolerant of current cardiovascular medications.
Annual recertification requirements include an exercise tolerance test (ETT) at least every two years. If an ETT is positive or inconclusive, imaging stress test may be indicated. Cardiologist examination is recommended.
In the case of any loss or impairment to an extremity which may interfere with the driver’s ability to operate a commercial motor vehicle safely, the medical examiner should state on the medical certificate:
“medically unqualified unless accompanied by a Skill Performance Evaluation Certificate.” The driver must then apply to the Field Service Center of the FMCSA, for the State in which the driver has legal residence, for a Skill Performance Evaluation Certificate under § 391.49.
Single Unprovoked Seizure waiting period? Max cert period?
Minimum – five years seizure-free and off anticonvulsant medication.
A possible earlier return to driving may be considered if the driver has a normal neurological examination by a specialist in epilepsy who understands the functions and demands of commercial driving, and the driver has a normal electroencephalogram.
Maximum certification – one year.
Recommend to certify if:
The driver has completed the minimum waiting period seizure free and off anticonvulsant medication.
Clearance from a neurologist who specializes in epilepsy and understands the functions and demands of commercial driving.
Follow-up: The driver should have at least annual medical examinations.
if certifying for less than 2 years
For a driver with an “other disease” who requires periodic monitoring, note the date of certificate expiration on the Medical Examination Report and the Medical Examiner’s certificate.
On the Report and the Certificate, the box should be checked stating “Meets standards, but periodic monitoring due to __“, noting the condition responsible for a certification period of less than two years.
On the Report, in the Comments section or in an addendum to be included with the report, document the condition(s) necessitating periodic monitoring and discussion with driver regarding the condition(s) and related issues.
If a driver with an “other disease” is disqualified.
The box on the Report should be checked indicating that the driver “Does not meet standards.”
In the Comments section or an addendum to be included with the Report, the Medical Examiner should document the reason(s) that the driver does not meet standards, whether there are conditions that could be met that would allow the driver to meet standards, and document discussion with the driver regarding these issues.
Percutaneous Coronary Intervention (PCI)
Certify if:
At least one week after procedure.
Cardiologist approval.
Tolerance to medications.
Negative Exercise Tolerance Test (ETT) three to six months after PCI and then every two years thereafter.
No rest angina.
No ischemic ECG changes.
No evidence of incomplete healing or complication at vascular access site.
Waiting period: one week.
Maximum certification period: one-year.
Sleep Apnea definitions:
Apnea – airflow ceases for more than 10 seconds.
Hypopnea – airflow decreases for more than 10 seconds.
Severity (apnea-hypopnea index):
Mild – 5+ episodes/hour.
Moderate – 15+ episodes/hour.
Severe – 30+ episodes/hour.
More than 30 episodes per hour of sleep is considered a diagnosis of obstructive sleep apnea.
GUIDELINES ARE ADVISORY, NOT REGULATORY
Certification/Recertification: Childhood Febrile Seizures Max cert period?
Waiting period: No recommended time frame. You should not certify the driver until etiology is confirmed and treatment has been shown to be adequate/effective, safe, and stable.
Maximum certification – two years.
Recommend to certify if: The history of seizures is limited to childhood febrile seizures.
Recommend not to certify if: As the Medical Examiner, you believe that the nature and severity of the medical condition of the driver endangers the health and safety of the driver and the public.
Federal Diabetes Exemption Program
Prior to November 18, 2018, drivers with diabetes requiring insulin for control were required to obtain a waiver/exemption from the FMCSA in order to be medically qualified.
As of November 18, 2018, the waiver/exemption process for drivers with insulin-treated diabetes mellitus (ITDM) is now replaced by the procedures described in 49 CFR Part 391.46.
Coronary Artery Bypass Graft Surgery (CABG)
Certify if:
At least three months after CABG.
Left ventricular ejection fraction (LVEF) greater or equal to 40% after CABG.
Cardiologist approval.
Asymptomatic.
Tolerance to medications.
After five years, annual exercise tolerance test (ETT) required (imaging stress may be indicated).
Waiting period: at least three months after CABG.
Maximum certification period: one-year.
The driver treated for sleep apnea should:
Remain symptom free.
Agree to continue uninterrupted therapy.
Undergo yearly objective testing (e.g., multiple sleep latency test or maintenance of wakefulness test).
Follow-up: Driver should have follow-up dependent upon clinical course of the condition and recommendation of the treating healthcare provider, not to exceed one year.
Structural Insult to the Brain caused by?
After a structural insult to the brain of any kind, risk of seizures is increased.
Therefore any structural insult to the brain must entail a waiting period prior to certification, and all waiting periods must be seizure-free and off anticonvulsant medication.
Structural insults to the brain may result from embolic or thrombotic strokes, hemorrhage, and surgical intervention.
Structural insults are divided into mild, moderate, and severe.
EDS
excessive daytime somnolence (EDS).
waiting period following:
Stroke without risk for seizures.
Mild insult without early seizures.
Intracerebral or subarachnoid hemorrhage without risk for seizures.
Minimum one year
Waiting period following:
Moderate insult without early seizures.
Mild insult with early seizures.
Minimum two years
Heart Transplantation Waiting period?
Maximum certification interval?
Certify if the driver:
Waiting period: 1 year.
Maximum certification interval: 6 months.
Certify if the driver:
Is asymptomatic.
Tolerates medications.
Has clearance from a cardiovascular specialist who understands the functions and demands of CMV driving.
Has no signs of transplant rejection.
waiting period following:
Moderate insult with early seizures.
Stroke with risk for seizures.
Intracerebral or subarachnoid hemorrhage with risk for seizures.
Minimum five years
Structural Insult to the Brain. Max cert period?
Waiting period – all waiting periods are seizure-free and off anticonvulsant medication.
Maximum certification – one year.
Recommend to certify if the driver with a history of mild or moderate insult has:
Completed the minimum waiting period seizure-free and off anticonvulsant medication.
Normal physical examination, normal neurological examination including neuro-ophthalmological evaluation and normal neuropsychological testing.
Clearance from a neurologist who understands the functions and demands of commercial driving.
if the driver has a history of a severe brain insult with or without early seizures.
Recommend not to certify
recommended waiting period for sleep apnea and max cert period
You should not certify the driver with suspected or untreated sleep apnea until the etiology of the condition is confirmed and treatment has been shown to be stable, safe, adequate, and effective.
Waiting period: Minimum – one month after starting CPAP.
Minimum – three months symptom free after surgical treatment.
examine the driver for certification after the completion of the longest waiting period.
Maximum certification – one year.
Recommend to certify if the driver has successful nonsurgical therapy with:
Multiple sleep latency testing values within the normal range.
Resolution of apneas confirmed by repeated sleep study during treatment.
Continuous successful nonsurgical therapy for one month.
Compliance with continuing nonsurgical therapy.
Resolution of symptoms following completion of post-surgical waiting period.
brain injuries or surgeries not to certify
history of a severe brain insult with or without early seizures.
NOTE: For those individuals who survive severe head injury, the risk for developing unprovoked seizures does not decrease significantly over time. Based upon the risk for unprovoked seizures alone, the driver should not be considered for certification.
NOTE: Surgical procedures involving dural penetration have a risk for subsequent epilepsy similar to that of severe head trauma. Individuals who have undergone such procedures, including those who have had surgery for epilepsy, should not be considered for certification.
Angina Pectoris (Stable and Unstable)
certification? waiting period? Maximum cert period?
Certify if:
Unstable angina – certification is not recommended.
Stable angina – certification is recommended.
Waiting period: three months with no rest angina or change in angina pattern.
Maximum certification period: one year.
Certify if:
Stable angina.
Asymptomatic (except for stable angina, no associated symptoms); no resting blood pressure on physical examination < 95 mmHg systolic; and no systolic blood pressure decline > 20 mmHg upon standing.
Tolerates medications – general tolerance to cardiovascular related medications. Many patients may be taking anti-angina medications. Hypotension or orthostatic hypotension is an occasional side effect of such medications.
Has satisfactory ETT. The driver should exercise to a workload capacity of > 6 METS – through Bruce Stage II or equivalent – attain a heart rate > 85% of predicted maximum (unless on beta blockers), a rise in SBP > 20 mm Hg without angina, have no significant ST segment depression or elevation and no marked T wave abnormality, and have no ventricular dysrhythmia.
Periodic monitoring:
Biennial ETT.
Cardiovascular specialist evaluation.
Certification/Recertification: Acute Seizures – Systemic Metabolic Illness waiting period? Max cert period?
Waiting period: No recommended time frame. You should not certify the driver until etiology is confirmed and treatment has been shown to be adequate, effective, safe, and stable.
Maximum certification – two years.
Recommend to certify if
The underlying systemic metabolic dysfunction has been corrected.
The driver has no disqualifying risk of recurrence of the primary condition.
Monitoring/Testing: You may on a case-by-case basis obtain additional tests and/or consultation to adequately assess driver medical fitness for duty.
Regardless of etiology, general certification guidelines for vertigo or dizziness require at least
a two month symptom-free interval before certification can be considered.
medications that are disqualifying for vertigo or dizziness treatment
Use of either benzodiazepines or phenothiazines for the treatment of vertigo or dizziness is disqualifying.
Certification is not recommended if CHF is secondary to a diagnosis of
Hypertrophic Cardiomyopathy or Restrictive Cardiomyopathy.
EDS may also be a symptom of another underlying condition, such as:
Neurological disease.
Depression.
Alcohol or other drug use.
Prescription and/or over-the-counter medication use.
More serious, and usually disqualifying causes of vertigo and dizziness are
Meniere’s disease,
labyrinthine fistula, and
nonfunctioning labyrinths.
Recommend not to certify if the driver has these respiratory conditions:
Hypoxemia at rest.
Diagnosis of untreated symptomatic obstructive sleep apnea.
Narcolepsy.
Primary (idiopathic) alveolar hypoventilation syndrome.
Idiopathic central nervous system hypersomnolence.
Restless leg syndrome (RLS) associated with EDS.
The most common causes and treatment medications of vertigo and dizziness are
benign positional vertigo and acute and chronic vestiulopathy.
The most common medications used to treat vertigo and dizziness are antihistamines, benzodiazepines, and phenothiazines.
The waiting period for dizziness, benign positional vertigo, and acute and chronic peripheral vestibulopathy is
two months symptom free.
Syncope, It is critical that the Medical Examiner establish that?
Certification/Recertification? Waiting period? Max cert period? When to recommend and not recommend certification?
the cause(s) for any syncopal episodes have been identified and that treatment has addressed any underlying conditions.
In general, supraventricular arrhythmias are treatable and the risk of syncope can be reduced to an acceptably small risk, while this may not be possible for drivers with a history of ventricular arrhythmias.
Certification/Recertification
Waiting period: There is no recommended time frame. Do not certify a driver until etiology is confirmed and treatment has been shown adequate, effective, safe, and stable. If applicable, refer to pacemaker guidelines since the cardiovascular causes of syncope are often related to cardiac arrhythmias.
Distinguish between treatments that reduce risk for syncope and treatments where the driver remains at risk for syncope. Certification also depends on the risk for syncope and gradual or sudden incapacitation from the underlying heart disease that may remain even after successful treatment of conduction system disease that may have produced arrhythmias.
Maximum certification period – one year.
Recommend to certify if the driver:
Has been treated for symptomatic disease.
Is asymptomatic.
Tolerates medications.
Is at low risk for syncope/near syncope.
Has clearance from an appropriate specialist (e.g., cardiologist, neurologist) who understands the functions and demands of commercial driving.
Recommend not to certify if the driver:
Experiences syncope as a consequence of a disease process, regardless of the underlying condition, if that condition has not been adequately treated or controlled.
Is at high risk for syncope/near syncope, regardless of the underlying heart disease and/or treatment.
Vertigo and Dizziness max cert period?
Maximum certification – two years.
A driver with deficits that require special evaluation and screening should be recertified annually or more frequently.
Recommend to certify if the driver has completed the appropriate symptom-free waiting period.
if the driver has a diagnosis of, Benign positional vertigo or acute or chronic vestibulopathy and has been symptomatic within the past two months.
Recommend not to certify
Recommend not to certify if the driver has a diagnosis of these ear conditions:
Benign positional vertigo or acute or chronic vestibulopathy and has been symptomatic within the past two months.
Ménière’s disease.
Labyrinthine fistula.
Nonfunctioning labyrinths.
if CHF is secondary to Idiopathic Dilated Cardiomyopathy certification is recommended only if:
The driver is asymptomatic (do not qualify if symptomatic) and tolerates medications.
The driver has no ventricular arrhythmias.
Left ventricular ejection fraction (LVEF) must be greater or equal to 40%.
Requires annual cardiology evaluation including echocardiography and Holter monitoring.
Monitoring/Testing and follow up for driver with sleep apnea
Monitoring/Testing: The driver who is being treated for sleep apnea should remain symptom free and agree to continue uninterrupted therapy and undergo yearly objective testing (e.g., multiple sleep latency test or maintenance of wakefulness test).
Follow-up: The driver should have follow-up dependent upon the clinical course of the condition and recommendation of the treating healthcare provider, not to exceed one year.
What may produce simulated visual disturbance.
Headaches
Chronic or chronic-recurring headache syndromes can potentially interact with other neurological diagnostic categories in two ways:
Through complications (e.g., stroke in relation to migraine).
As a result of associated features of a particular syndrome (e.g., the visual distortion or disequilibrium associated with a migraine attack).
The following types of headaches may interfere with the ability to drive a commercial motor vehicle safely:
Migraines.
Tension-type headaches.
Cluster headaches.
Post-traumatic head injury syndrome.
Headaches associated with substances or withdrawal.
Cranial neuralgias.
Atypical facial pain.
Consider headache frequency and severity when evaluating a driver whose history includes headaches.
In addition to pain, inquire about other symptoms caused by headaches, such as visual disturbances, that may interfere with safe driving.
Headaches: waiting period? cert period?
Waiting period: No recommended time frame.
You should not certify the driver until etiology is confirmed and treatment has been shown to be adequate/effective, safe, and stable.
Maximum certification — two years.
Recommend to certify if:
As the Medical Examiner, you believe that the nature and severity of the medical condition of the driver does not endanger the health and safety of the driver and the public.
Recommend not to certify if:
As the Medical Examiner, you believe that the nature and severity of the medical condition of the driver endangers the health and safety of the driver and the public.
Follow-up: The driver should have at least biennial medical examinations.
Neurocardiogenic Syncope
Certify if? waiting period? Max cert period?
Waiting period: three months after pacemaker implantation (due to possible vasodepressor component of syndrome not necessarily treated by pacing).
Documented correct function by pacemaker center.
Absence of symptom recurrence.
Maximum certification period: one year.
Annual examination: documented pacemaker checks required and absence of symptom recurrence.
NOTE: Risk of syncope may be due to cardioinhibitory (slowing heart rate) symptoms, vasodepressor (drop in blood pressure), or both; pacemaker affects only the cardioinhibitory component, but lessens effect of vasodepressor component.
Embolic or Thrombotic Stroke Evaluation by a neurologist is necessary to
confirm the area of involvement.
Drivers with embolic or thrombotic cerebral infarctions will usually have residual intellectual or physical impairments. Fatigue, prolonged work, and stress may exaggerate the neurological residuals from a stroke.
Most recovery from a stroke will occur within one year of the event.
The neurological examination should include assessment of cognitive abilities, judgment, attention, concentration, vision, physical strength and agility, and reaction time.
waiting period cerebellum or brainstem vascular lesions
minimum one year
waiting period cortical or subcortical deficits/stroke
minimum 5 years
brain stroke area at risk for seizure?
cortical or subcortical deficits
Embolic or Thrombotic Stroke waiting period?Certification/Recertification?
Waiting period:
Minimum – one year if not at risk for seizures (cerebellum or brainstem vascular lesions).
Minimum – five years if at risk for seizures (cortical or subcortical deficits).
Maximum certification – one year.
Certification/Recertification and testing for driver with Chronic Obstructive Pulmonary Disease (COPD)
Waiting period: No recommended time frame. You should not certify the driver until etiology is confirmed and treatment has been shown to be adequate/effective, safe, and stable.
Maximum certification – two years.
Recommend to certify if: As the Medical Examiner, you believe that the nature and severity of the medical condition of the driver is stable and does not endanger the health and safety of the driver and the public.
Follow-up: The driver should have follow-up dependent upon the clinical course of the condition and recommendation of the treating healthcare provider.
The risk for seizures following intracerebral and subarachnoid hemorrhages is associated with the location of the hemorrhage. Which area is associated with an increased risk for seizures?
cerebellum and brainstem vascular hemorrhages are not associated with an increased risk for seizures. Cortical and subcortical hemorrhages are associated with an increased risk for seizures.
COPD: when to perform Monitoring/Testing:
Obvious difficulty breathing in a resting position is an indicator for pulmonary function testing.
Pulmonary function testing – spirometry – should be performed on all drivers with a diagnosis of COPD and in all smokers over the age of 35.
Intracerebral or Subarachnoid Hemorrhage waiting period? max cert period?
Appropriate evaluation by a neurologist is required to confirm the area of involvement. The recommendations for intracranial and subarachnoid hemorrhages parallel recommendations for strokes.
Certification/Recertification – Intracerebral or Subarachnoid Hemorrhage
Waiting period:
Minimum — one year if not at risk for seizures (cerebellum or brainstem vascular lesions).
Minimum — five years if at risk for seizures (cortical or subcortical deficits).
Maximum certification — one year.
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.
Hypersensitive Carotid Sinus with Syncope
Certify if? Waiting period? Max cert period?
Waiting period: three months after pacemaker implantation (due to possible vasodepressor component of syndrome not necessarily treated by pacing).
Documented correct function by pacemaker center.
Absence of symptom recurrence.
Maximum certification period: one year.
Annual examination: documented pacemaker checks required and absence of symptom recurrence.
NOTE: Risk of syncope may be due to cardioinhibitory effects (slowing heart rate), vasodepressor effects (drop in blood pressure), or both; pacemaker affects only the cardioinhibitory component, but lessens effect of vasodepressor component.
COPD: Recommend not to certify if the driver has
hypoxemia at rest or chronic respiratory failure or history of continuing cough with cough syncope.
Use of supplemental oxygen is disqualifying.
The risk of recurrent events is highest during the first few weeks and months following the TIA, declining by one year to less than
5% per year.
The risk of recurrent strokes may be lowered by medical or surgical interventions.
Transient Ischemic Attacks (TIAs) waiting period? max cert period?
Waiting period: Minimum – one year.
Maximum certification – one year.
Follow-up: The driver should have an annual medical examination.
The Medical Examiner determines certification on a case-by-case basis considering the interval history, general health, neurological examination, and compliance with the treatment program.
TIAs are considered an important warning sign for cerebrovascular accident (CVA).
“Lone atrial fibrillation”
is atrial fibrillation in the absence of other risk factors for stroke, such as previous stroke or TIA, diabetes mellitus, hypertension, heart failure, age greater than 75 years, or valvular heart disease. _ is the only anti-thrombotic therapy required for patients with lone atrial fibrillation.
Certification driver with Pneumothorax if:
Max cert period?
Waiting period – no recommended time frame.
Complete recovery should be assured with x-rays; if there is air in the pleural space or mediastinum, do not certify.
Certify if:
Asymptomatic.
Confirmed resolution.
Meets pulmonary testing parameters.
Maximum certification: two years
Temporary dementia
related to treatable and reversible organic disease is not permanently disqualifying.
Lone Atrial Fibrillation – Cert period
Maximum certification period: one year.
Annual examination.
Dementia waiting period? cert period?
Dementia Waiting period: Not applicable.
Recommend to certify if: Not applicable.
Recommend not to certify if: The driver has a diagnosis of dementia
Monitoring/Testing: Not applicable.
Follow-up: Not applicable.
Unless dementia is the result of a reversible metabolic disorder, dementia is disqualifying.
Atrial Fibrillation certify? max cert period?
Lone Atrial Fibrillation – Certify if the diagnosis is lone atrial fibrillation.
Maximum certification period: one year.
Annual examination.
Asthma – Certification and Recertification
Max cert period?
Waiting period: No recommended time frame. You should not certify the driver until the etiology is confirmed and treatment has been shown to be adequate/effective, safe, and stable.
Perform pulmonary function testing or other respiratory testing if symptoms warrant.
Maximum certification – two years.
TBI is classified by depth of dural penetration and duration of loss of consciousness. The three classes are:
Severe head injury penetrates the dura and causes a loss of consciousness lasting longer than 24 hours. There is a high risk for unprovoked seizures, and the risk does not diminish over time.
Moderate head injury does not penetrate the dura but causes a loss of consciousness lasting longer than 30 minutes, but less than 24 hours.
Mild head injury has no dural penetration or loss of consciousness and lasts for fewer than 30 minutes.
Be sure to distinguish mild TBI with or without early seizures.
The length of time an individual is seizure-free and off anticonvulsant medication is considered the best predictor of future risk for seizures.
cert period for Surgical procedures involving dural penetration
have a risk for subsequent epilepsy similar to that of severe head trauma. Individuals who have undergone such procedures, including those who have had surgery for epilepsy, should not be considered eligible for certification.
following moderate TBI Traumatic Brain Injury (TBI) without early seizures or mild TBI with early seizures. waiting period? max cert period?
waiting period: Minimum two years seizure-free and off anticonvulsant medication
Maximum certification – one year.
Maximum certification – two years for mild TBI without early seizures.
following moderate TBI with early seizures waiting period? max cert period?
Waiting period:
Minimum five years seizure free and off anticonvulsant medication following moderate TBI with early seizures.
Maximum certification – one year.
Atrial fibrillation as cause of or risk for stroke – Certify if:
Anticoagulated adequately for at least one month.
Anticoagulation monitored by at least monthly INR.
Rate/rhythm control deemed adequate.
Cardiologist assessment recommended.
Maximum certification period: one year.
Certification/Recertification — Allergy-Related Life-Threatening Conditions
Max cert period?
Waiting period: Individuals with a history of an allergy-related life-threatening condition must have undertaken successful preventive measures and/or treatment without adverse effects before the driver can be considered medically qualified.
Maximum certification – two years.
Preventive measures include carrying an epinephrine injection device in the truck cab and evaluating the driver for immunotherapy.
Central Nervous System (CNS) Tumors waiting period
Waiting period.
Minimum — one year post-surgical removal of: Infratentorial meningioma, acoustic neuromas, pituitary adenomas, spinal benign tumors, benign extra-axial tumors.
Minimum — two years post-surgical removal of: Benign supratentorial tumors, spinal tumors.
Maximum certification – one year.
Recommend to certify if the driver has:
Completed the appropriate minimum waiting period.
Stable non-progressive deficit or no neurological deficit.
Imaging that shows no tumors.
NOTE: If the driver has a history of seizures, use the appropriate seizure guidelines.
Monitoring/Testing: Since meningiomas may be multiple, residual examinations must show no evidence of recurrent or new tumors. Evaluation should be performed by a neurologist or physiatrist who understands the functions and demands of commercial driving.
Follow-up: The driver should have an annual medical examination.
Brain tumors when Recommend not to certify if the driver has:
Not completed appropriate waiting period.
Primary or metastatic malignant tumors of the nervous system.
Benign nervous system tumors.
Atrial fibrillation following thoracic surgery – Certify if:
Anticoagulated adequately for at least one month.
Anticoagulation monitored by at least monthly INR.
Rate/rhythm control deemed adequate.
Cardiologist assessment recommended.
Maximum certification period: One year.
Pulmonary Hypertension Recommend not to certify if the driver has:
Dyspnea at rest, dizziness, hypotension, or
Partial pressure of arterial oxygen (PaO2) < 65 millimeters of mercury (mm Hg).
Monitoring/Testing: On a case-by-case basis obtain additional tests and/or consultation to assess driver medical fitness for duty.
Pulmonary Hypertension Maximum certification interval
one year.
Atrial Flutter – Certify if:
Asymptomatic.
Isthmus ablation performed and at least one month after procedure.
Arrhythmia successfully treated.
Cleared by electrophysiologist.
Rate/rhythm control deemed adequate.
Maximum certification period: one-year.
Medical guidelines for infections of the central nervous system include:
The guidelines for central nervous system (CNS) infection consider diagnosis and whether or not the driver has a history of early seizures with the condition.
Aseptic meningitis is not associated with any increase in risk for subsequent unprovoked seizures; therefore, no restrictions should be considered for such individuals, and they should usually be considered medically if they have fully recovered and have no sequalae of the condition that may be disqualifying.
A driver with a current clinical CNS diagnosis or signs and symptoms of a CNS infection should not be considered for certification until the etiology is confirmed and treatment has been shown to be adequate/effective, safe, and stable.
For illnesses such as the common cold, influenza, and acute bronchitis, the driver should:
Be relieved from duty until proper treatment for the illness has been completed.
Abstain from driving a vehicle for at least 12 hours after taking sedating medications.
Avoid operating a vehicle during the time that the disease is contagious.
Underlying Diagnosis Coronary Heart Disease (CHD)
Certify if:
No sustained ventricular tachycardia (VT).
Left ventricular ejection fraction (LVEF) greater than or equal to 40%.
Asymptomatic.
At least one month after drug or other therapy.
Cleared by cardiologist.
Waiting period: At least one month after drug or other therapy.
Maximum certification period: one year.
Annual examination: Cardiology examination required.
waiting period following bacterial meningitis without early seizures or viral encephalitis without early seizures.
Minimum — one year seizure free and off anticonvulsant medication
Maximum certification – two years.
waiting period following bacterial meningitis with early seizures.
Minimum — five years seizure free and off anticonvulsant medication
Maximum certification – two years.
Certification/Recertification – Allergic Rhinitis.
Waiting period: No recommended time frame.
The driver should abstain from antihistamine medications for at least 12 hours prior to driving.
Recommend not to certify if the driver has complications and/or treatment that impairs function, including severe conjunctivitis affecting vision.
Inability to keep eyes open.
Photophobia.
Uncontrollable sneezing fits.
Sinusitis with severe headaches.
Medications that cause sedation or other side effects that interfere with safe driving.
Symptoms should be treated with non-sedating antihistamines or with local steroid sprays that do not interfere with driving ability.
waiting period following viral encephalitis with early seizures.
Minimum — 10 years seizure free and off anticonvulsant medication
Maximum certification – two years.
Infections of the Central Nervous System waiiting period?
Waiting period:
Minimum — one year seizure free and off anticonvulsant medication following bacterial meningitis without early seizures or viral encephalitis without early seizures.
Minimum — five years seizure free and off anticonvulsant medication following bacterial meningitis with early seizures.
Minimum — 10 years seizure free and off anticonvulsant medication following viral encephalitis with early seizures.
Maximum certification – two years.
Recommend to certify if the driver has a history of:
Aseptic meningitis.
Bacterial or viral meningitis and has completed the appropriate recommended waiting period.
Recommend not to certify if the driver has a current CNS infection.
One or two year certification intervals may be considered.
Underlying Diagnosis Dilated Cardiomyopathy/Idiopathic Left Ventricular Ventricular Tachycardia (VT)
Certify if:
No history of sustained VT.
No history of nonsustained VT with LVEF < 40%.
No syncope or near syncope.
Maximum certification period: one year.
Annual examination.
Cardiologist examination recommended.
Certification/Recertification – Pulmonary Tuberculosis
Waiting period: No recommended time frame.
Do not certify until:
Driver is determined not to be contagious.
Etiology is confirmed and treatment is adequate/effective, safe, and stable.
Maximum certification – two years.
Recommend to certify if the driver:
Is not contagious.
Has completed streptomycin therapy without affecting hearing and/or balance. Is compliant with antitubercular therapy.
Has no side effects that interfere with safe driving.
Recommend not to certify if the driver has:
Advanced TB with respiratory insufficiency not meeting PFT criteria or chronic TB.
Exhibited noncompliance with antitubercular therapy.
Not completed streptomycin therapy.
Cranial nerve damage that affects balance or hearing to an extent that interferes with safe driving.
A positive intermediate tuberculin skin test (5 tuberculin units) indicates a previous TB infection.
A positive purified protein derivative (PPD) skin test with a normal chest X-ray requires no further action.
If X-ray changes are present suggesting pulmonary TB findings, there is need for further evaluation.
If conversion occurred within the last year, active disease may develop and prophylactic therapy should take place. This circumstance would not require limiting the activities of the driver unless medication side effects and/or adverse reactions occur.
Do Not Certify cardiac Conditions
Hypertrophic Cardiomyopathy
Long QT Interval Syndrome
Brugada Syndrome
Heart murmurs, extra sounds, enlarged heart, and pacemaker are not disqualifying in and of themselves, but may be indications of potentially disqualifying conditions.
Certification/Recertification – Atypical Tuberculosis
Waiting period: No recommended time frame.
You should not certify the driver until etiology is confirmed and treatment has been shown to be adequate/effective, safe, and stable.
Maximum certification – two years.
Recommend to certify if the disease remains stable and the driver has normal lung function and tolerates the medical regimen.
Certification/Recertification — Cor Pulmonale
Recommend not to certify if the driver has dyspnea at rest or dizziness or hypotension or partial pressure of arterial oxygen (PaO2) in arterial blood less than 65 millimeters of mercury (mm Hg).
Monitoring/Testing: 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.
May be certified after successful treatment.
Should have evaluation by an appropriate respiratory or cardiovascular specialist familiar with the job duties of a CMV driver.
Pacemaker – Sinus Node Dysfunction and AV Block
Certify if? Waiting period? max cert period?
One month after implantation.
Documented correct function by pacemaker center.
Underlying disease is not disqualifying.
Waiting period: one month after implantation.
Maximum certification period: one year.
Annual examination: documented pacemaker checks required.
Implantable Defibrillators certify if? max cert period?
Do not certify regardless of reason for implantation.
Abdominal Aortic Aneurysms (AAA) < 4.0 cm – Certify if:
< 4.0 cm and the driver is asymptomatic.
At least three months after surgical repair and meets post-surgical repair guidelines.
Cleared by cardiovascular specialist.
Maximum certification period: one year.
Abdominal Aortic Aneurysms (AAA) > 4 cm but < 5 cm – Certify if:
Driver is asymptomatic and cleared by a cardiovascular specialist who understands CMV driving demands.
At least three months after surgical repair and meets post-surgical repair guidelines.
Maximum certification period: one year.
Abdominal Aortic Aneurysms (AAA) Do not certify if:
5.0 cm
Aneurysm has increased more than 0.5 cm during six-month period regardless of size.
Surgical repair has been recommended by a cardiovascular specialist, regardless of size, but has not yet been performed.
Driver is symptomatic, regardless of size.
EXAMPLE: If a driver has had a 10 cm aneurysm repaired, and after repair the aneurysm is resolved or is less than 5.0, the driver may be cleared once the 3-month waiting period following surgery is met.
NOTE: Ultrasound monitoring recommended.
Thoracic aneurysm- Certify if:
< 3.5 cm. NOTE: The FMCSA guidelines suggest certification for thoracic aneurysms < 3.5 cm, but suggests disqualification for thoracic aneurysms > 3.5 cm, but fails to provide a specific recommendation for thoracic aneurysms = 3.5 cm.
At least three months after surgical repair.
Cleared by cardiovascular specialist.
Maximum certification period: one year
Aneurysms in visceral and peripheral arteries and venous vessels – Certify if:
At least three months after surgical repair.
Cleared by cardiovascular specialist.
Maximum certification period: one year.
Peripheral Vascular Disease and Treatments.
Certify if? Do not certify if?
No other disqualifying cardiovascular conditions.
Do not certify if:
Symptomatic.
Pain at rest.
Waiting period: at least three months since surgical revascularization.
NOTE: Peripheral Vascular Disease is usually a slow, progressive disease with a benign course that carries little to no risk for gradual or sudden incapacitation. For the driver, pain at rest represents a critical degree of ischemia and is disqualifying because of the likelihood of reduced dexterity in the affected limb. PVD can necessitate surgical revascularization, angioplasty, or amputation.
Adequate treatment with anticoagulants decreases the risk of recurrent thrombosis
by approximately 80%.
DVT, Certify if:
The driver has no residual, acute DVT.
Etiology confirmed and treatment has been shown to be adequate/effective, safe, and stable.
Maximum certification period – one year.
Annual recertification.
Monitoring/Testing: When DVT treatment includes anticoagulant therapy, the driver should meet monitoring guidelines.
Drivers with an underlying neurological condition should not be certified if on anticoagulant medication due to the risk of cerebrovascular bleeding.
Superficial Phlebitis and/or Varicose Veins
Certify if:
Etiology is confirmed and treatment has been shown to be adequate, effective, safe, and stable.
No associated deep venous thrombosis.
Maximum certification: two years.
Additional testing or follow up may be considered on a case-by-case basis.
Anticoagulation Monitoring/Testing/follow-up? when is anticoagulation therapy disqualifying?
If the driver is using Coumadin (warfarin) for anticoagulation, the driver should obtain INR monitoring at least monthly and the Medical Examiner should receive and review the monthly monitoring results.
Follow-up: The driver should bring results of INR monitoring to the examination.
Anticoagulant therapy may be utilized in the treatment of cardiovascular or neurological conditions. However, use of anticoagulant therapy in a driver with a neurological condition is disqualifying, due to the increased risk for cerebrovascular hemorrhage.
The guidelines emphasize that the certification decision should be based on the underlying medical disease or disorder requiring medication, not the medication itself.
Aortic Stenosis waiting period? max cert period? certify if?
Waiting period: 3 months post-surgery
Maximum certification interval: one year
Certify if the driver has:
Mild aortic stenosis – requires echocardiogram every 5 years.
Moderate aortic stenosis that is asymptomatic and driver meets all other medical qualification criteria – requires echocardiogram every 1-2 years.
Severe aortic stenosis that is surgically repaired, waiting period met, and clearance obtained from a cardiovascular specialist familiar with the demands of CMV driving.
The driver should have two-dimensional echocardiography with Doppler prior to discharge
Anticoagulant Therapy, when to certify? waiting period? max cert period?
Underlying Cardiovascular Condition.
Waiting period: Minimum – one month stabilized.
Maximum certification period – one year.
Certify if:
Driver is stabilized on medication for at least one month.
Driver provides a copy of the International Normalized Ratio (INR) results at the examination.
Driver has at least monthly INR monitoring.
Monitoring/Testing: The driver should obtain INR monitoring at least monthly and the Medical Examiner should receive and review the monthly monitoring results.
For some newer anticoagulation medications INR monitoring may not be necessary or appropriate.
Do not certify if:
INR is not being monitored.
INR is not therapeutic.
Underlying disease is disqualifying.
Do not certify a driver on anticoagulant therapy for a cardiovascular condition if driver also has a cerebrovascular disorder with risk for hemorrhagic cerebral vascular accident. The rationale for disqualification is the high rate of complications associated with bleeding that can incapacitate the driver while operating a vehicle.
Which of the following is a requirement for drivers with a diabetes exemption?
A) Possess a rapidly absorbable form of glucose while driving
B) Self—monitor blood glucose one hour before driving and at least once every 2 hours while driving
C) Plan to submit blood glucose monitoring logs every 6 months
D) Maintain a Hemoglobin A1C value less than 7
A. Drivers with diabetes should self monitor blood glucose before driving and every 4 hours while driving. Blood glucose monitoring logs should be submitted annually. There is no specific requirement for HgA1C level.
Drivers with insulin dependent diabetes:
A) May be certified for a maximum of 6 months
B) Must maintain a hemoglobin A1C level of less than 7 to qualify for certification
C) Cannot be certified if they have a history of myocardial infarction
D) May be eligible for a diabetes exemption
D) Drivers with insulin dependent diabetes cannot be certified but may be eligible for a diabetes exemption
Which of the following is true?
A) A driver with diabetes who uses insulin does not meet the minimum requirements of 49 CFR Part 391.41
B) The most important concert related to medication use for treating diabetes is hyperglycemia
C) Peripheral neuropathy is not a disqualifying condition
D) Diabetes is not a coronary heart disease (CHD) equivalent condition
A) The greatest risk for medication use for drivers with diabetes in hypoglycemia, not hyperglycemia. Peripheral neuropathy is disqualifying condition. Diabetes is a CHD equivalent condition.
What is the recommended certification interval for a driver with diabetes mellituse who does not use insulin?
A) Three months
B) Six months
C) One year
D) Two years
C) Drivers with non-insulin dependent diabetes should be certified for a maximum of one year
A diabetes exemption may be issued by:
A) An endocrinologist
B) The Medical Examiner
C) The driver’s personal physician
D) The FMCSA
D) Only the FMCSA can grant exemptions
A driver with diabetes mellliktus who uses insulin is determined to be otherwise medically qualified. The medical examiner must indicate that a diabetes exemption is required on the :
A) Medical Examination Report status section and Medical Examiners Certificate
B) Letter to the FMCSA
C) Employer authorization form
D) Endocrinology consultation form
A) Exemption requirements must be noted on the Medical Examination Report status section and the Medical Examiners Certificate
If glucose is detected on urinalysis in a driver with no history of diabetes, an appropriate next step is:
A) Endocrinology consultation
B) One year clearance and recommendation to see personal physician
C) Fingerstick or blood glucose determination
D) Temporary disqualification
C) The medical examiner should first determine blood glucose and then make an appropriate certification determination and referral
Drivers with a history of _ severe hypoglycemic reactions in the past year or _ severe hypoglycemic reactions in the past five years should not be certifed.
A) one, three
B) one, two
C) two, three
D) two, five
B) A driver should not be certified if the driver has had one hypoglycemic reaction in the past year or two in the past five years.
Which of the following is not a criteria that the FMCSA uses to define a severe hypoglycemic reaction?
A) Seizure
B) Dizziness
C) Need of assistance from another person
D) Period of impaired cognitive function that occurred without warning
B) FMCSA defines severe hypoglycemia as reactions that result in seizure, loss of consciousness, need of assistance from another person, and a period of impaired congitive function that occurred without warning
Which diabetes mellitus risk poses the greatest threat to public safety
A) Hyperglycemia
B) Peripheral neuropathy
C) Hypoglycemia
D) Metabolic encephalopathy
C) Although hyperglycemia, peripheral neuropathy, and metabolic encephalopathy all pose significant risks for safe driving, hypoglycemia poses the greatest risk. The risk is particularly pronounced in drivers who use insulin. FMCSA defines a hypoglycemia episode as one that results in seizure, loss of consciousness, need of assistance from another person, or a period of impaired cognitive function that occurs without warning.
A driver with a diabetes exemption should check glucose levels when?
A) One hour before driving and at least once every four hours while driving
B) One hour before driving and at least every eight hours while driving
C) Once after four hours of driving
D) Once a day after driving period has ended
A) Driver’s with diabetes exemption should check glucose values one hour before driving and once every four hours while driving
Which of the following is true for diagnosis of a hernia?
A) The driver should be referred to a surgeon to determine whether repair of a hernia is necessary
B) The waiting period following hernia surgery is two weeks
C) Inguinal hernias have been associated with an increased risk for CMV accidents
D) The maximum certification interval for a driver with a hernia is two years
D) The medical examiner can use his/her judgment as to whether a driver should be referred to a surgeon or other specialist. There is no specified waiting period following hernia surgery – the driver should not be certified until the medical examiner determines that treatment is safe and effective, and that the condition is stable. No evidence has linked hernias of any type to increased CMV accident risk.
Which of the following is true of nephropathy?
A) Nephropathy is a disqualifying condition
B) The maximum certification interval for nephropathy is two years
C) A driver with 3+ proteinuria should not be certified
D) A renal specialist should make the certification determination for a driver with nephropathy
B) Nephropathy is considered on a case-by-case basis. The medical examiner determines what evaluation or monitoring is necessary for a driver with 3+ proteinuria and may disqualify the driver. The certification is always made by the medical examiner and cannot be deferred to a specialist.
Drivers with which of the following conditions should be disqualified?
A) Cancer requiring chemotherapy treatment
B) Umbilical hernia not surgically repaired
C) Renal failure on peritoneal dialysis
D) Hemochromatosis
C) Dialysis of any type is disqualifying
If a significant abnormal finding for urinalysis specific gravity, protein, or blood is found, the medical examiner should:
A) Disqualify the driver
B) Request that a renal specialist determine if the driver is medically qualified
C) Use clinical expertise to determine a certification decision and to determine if additional evaluation is required or recommended
D) Obtain blood chemistries for renal function
C) The medical examiner must determine whether additional evaluation is needed and whether the certification decision should be postponed or limited
A driver with a history of kidney disease with or without transplant:
A) Is medically disqualified
B) Must be assessed regarding the severity, stability, medications used, and medication side effects/adverse reactions
C) Should not be assessed for functional ability to operate a CMV safely
D) Should have the medical certificaton determination made by a renal specialist
B) ASsessment for kidney disease must be ade on a case-by-case basis. Dialysis of any kind is disqualifying. The medical examiner may choose to test the driver for functional ability to operate a CMV safely. The medical certification decision must be made by the medical examiner.
Which of the following is not a disqualifying condition?
A) Peritoneal dialysis
B) Hemodialysis
C) Hernia
D) Peripheral neuropathy
Any type of dialysis is a disqualifying condition. Peripheral neuropathy is usually disqualifying. Although a hernia may be disqualifying, often a driver can be certified if the symptoms and/or examination findings are mild or if the hernia has been surgically repaired and the condition has stabilized (there is no specified waiting period following hernia treatment, including surgery).
Urinalysis is required for the driver physical examination and the results must include
A) Specific gravity, creatinine, bilirubin, and glucose
B) Creatinine, bilirubin, blood, and protein
C) Specific gravity, protein, blood, and glucose
D) Specific gravity, bilirubin, blood, and protein
C) Specific gravity, protein, blood, and glucose should be checked at every driver examination
Disqualifying conditions include:
A) Chronic constipation
B) Obesity
C) Cystitis
D) Dialysis
D) Dialysis of any type of disqualifying
A driver who has Hepatitis C who is stable and whose condition does not represent a safety risk may be certified
A) True
B) False
A) Hepatitis C is not disqualifying
A driver with a history of acute bleeding ulcer may be certified if:
A) Pain has subsided
B) Driver tolerates food without nausea and vomiting
C) Bleeding has subsided
D) The underlying cause has been identified and recurrence risk is low following treatment
D) Drivers with bleeding ulcers should not be certified until the underlying cause has been identified and the recurrence risk is low
A driver with a successful kidney transplant can be certified
A) True
B) False
A) Kidney transplants are not disqualifying
Which of the following is true?
A) Medical marijuana use if disqualifying
B) The medical examiner should drug test the driver for marijuana if the driver gives a history of recent marijuana’s
C) A driver with a history of only occasional marijuana may not have to complete a substance abuse professional assessment
D) Marijuana is a Schedule II drug
A) If a driver gives a history of recent marijuana use, the driver should be referred for substance abuse professional evaluation regardless of drug test result. Drivers with a history of marijuana use, or a drug test positive for marijuana, must undergo substance abuse professional assessment and complete any recommended rehabilitation prior to returning to driving. Marijuana is a Schedule I drug.
Which of the following is a requirement for a driver with a history of alcoholism to be certified?
A) No residual disqualifying physical impairment
B) Successful treatment with naltrexone
C) Currently in counseling and/or treatment
D) No more than one current alcohol-related disorder
A) Treatment with naltrexone is not required for driver certification for a driver with a history of alcoholism. A driver with a history of alcoholism must have completed counseling and/or treatment and must not have a current alcohol-related disorder in order to be certified.
Which of the following is a disqualifying condition?
A) A past clinical diagnosis of alcoholism
B) A breath alcohol result of 0.019%
C) An alcohol-related stable physical condition, regardless of the time element
D) Use of methadone
D) A current diagnosis of alcoholism is disqualifying. A breath alcohol result of 0.02% or higher renders the driver unqualified to drive. An alcohol-related unstable physical condition is disqualifying.
Ongoing voluntary attendance at self-help groups (e.g. 12 step programs) for maintenance of recovery from alcoholism:
A) Is required for all drivers recovering from alcoholism
B) Is disqualifying
C) Is allowed but not required for drivers recovering from alcoholism
D) Fulfills the requirement for rehabilitation following a violation of alcohol rules.
C) 12-step or similar programs do not fulfill rehabiliation requirements for drivers with a violation of alcohol (or drug) regulations. Participation in such programs is allowed, but not required, and is not disqualifying.
Which of the following is a mental health professional that the medial examiner may refer to or consult with?
1) Breath alcohol technician (BAT)
2) Designated employer representative (DER)
3) Medical review officer (MRO)
4) Substance abuse professional (SAP)
A) 1, 2, and 3
B) 1 and 3 only
C) 2 and 4 only
D) 4 only
E) all of the above
According to the FMCSA, all of these are defined as mental health professionals
The maximal certification internal for a driver with a history of drug abuse or alcoholism is
A) Six months
B) One year
C) Two years
D) Do not certify
C) Drivers with a history of drug abuse or alcoholism may be certified forup to two years. Drivers may be subject to drug and/or alcohol testing more frequently, but such testing is performed under 49 CFR Part 40 drug and alcohol testing regulations, not under 49 CFR Part 391.41 driver qualification standards
Which of the following is true?
A) One of the requirements for the CMV drier physical examination is testing for controlled substances
B) A driver taking multiple medications reports daily, regular or moderate use of alcohol. The Medical Examiner should evaluate the possibility of medication interactions with alcohol that may cause impairment
C) Even in remission, alcoholism is disabling for the CMV driver
D) Use of Schedule I drugs is not disqualifying
B) Testing for controlled substances if not required for the CMV driver examination. Alcoholism in remission is not a disqualifying condition. Use of Schedule I drugs is disqualifying.
Ongoing attendance at self-help groups
A) Fulfills the requirement to complete a rehabilitation program
B) Is not disqualifying when used for maintenance of recovery
C) Eliminates the need for follow-up testing
D) Is mandated by the FMCSA
B) Attendance at self-help groups is to disqualifying but does not fulfill the requirement for participation ina rehabilitation program. Follow-up testing must be performed according to FMCSA guidelines, regardless of participation in a self-help group. The Substance Abuse Professional (SAP) determines the need for attendance at self-help groups as a condition of return to work as a CMV driver.
A driver taking methadone for substance abuse treatment may be certified for three months.
A) True
B) False
B) False, methadone is disqualifying
Schedule I drugs, including marijuana or medical marijuana, are disqualifying
A) True
B) False
A) Driver’s taking Schedule I drugs are disqualifying
Recertification o the driver disqualifying for alcohol abuse requires the driver to
A) Have an evaluation y a substance abuse professional (SAP)
B) Have a referral by the driver’s primary care physican stating the driver is attending a self-help group
C) Have a complete physical examination
D) Have a drug test
A) A driver disqualified for alcohol abuse must be evaluated by a substance abuse professional prior to return to duty and complete any rehabilitation program recommended by the substance abuse professional. The driver also must undergo return to duty alcohol testing.
The Medical Examiner should be familiar with DOT drug and alcohol testing requirements as outlined in:
A) 49 CFR Part 40
B) 40 CFR Part 38
C) 49 CFR Part 66
D) 49 CFR Part 12
A) DOT drug and alcohol testing regulations are described in 49 CFR Part 40
If the Substance Abuse Professional determines that current alcoholism exists, the driver is not qualified to drive a commercial motor vehicle in interstate commerce
A) True
B) False
A) Drivers with a current diagnosis of alcoholis are disqualified
The impairment benchmark for FMCSA for alcohol is
A) 0.01
B) 0.03
C) 0.04
D) 0.08
C) FMCSA recommendations use the degree of imipairment produced by a 0.04 percent food alcohol concentration as a benchmark for impairment
A driver with monocular vision who has been granted a federal vision exemption or who is qualified by operation of 49 CFR 391.64 must have an annual physical examination.
A) True
B) False
A) Even though a vision exemption is provided for two years, the driver must undergo annual examinatin
Who of the following is not qualified to perform the vision testing portion of the interstate CMV driver physical examination?
A) An optometrist
B) The medical examiner
C) A licensed vision testing technician
D) An ophthalmologist
C) Vision testing must be performed by the medical examiner, an optometrist, or ophthalmology
Which of the following is true with regard to horizontal field of vision testing include:
A) Passing parameters are 75 degrees in left and right eye visual fields
B) Medial examiners may use a variety of methods in the clinical setting to measure field of vision, including reasonably reliable and accurate tests
C) Telescopic lenses that redirect peripheral vision to compensate for loss of central vision are acceptable corrective lenses for meeting commercial driving qualificatin requirements
D) Specialized ophthalmological equipment should not be used for precise measurement to determine if vision meets the 70 degree requirement
B) Passing parapets for field of vision are 70 degrees in left and right visual fields. Telescopic lenses that redirect peripheral vision to compensate for loss of central vision are not acceptable. Specialized ophthalmological equipment may be used to measure vision parameters.
Which of the following will always disqualify a driver from being certified without federal exemption?
A) Abnormal reactivity to light
B) 70 degrees horizontal field of vision in each eye
C) Monocular vision
D) Floaters
C) Without a federal exemption or grandfathered status, monocular vision will always disqualify a driver from being certified.
For a driver to be certified without a waiver for color recognition, they must ____
A) Correctly identify the true colors of signs and traffic lights
B) Sufficiently recognize traffic signals and devices showing the standard red, amber and green traffic signal colors
C) Be able to identify the different signs and traffic lights through shape and positional analysis
D) Pass an Ishahara color vision test
B) Drivers must be able to recognize red, yellow, and green traffic signal colors
A driver with monocular vision who has been grandfathered must provide proof of grandfathered status at what time?
A) Within three oaths of certification
B) When the certification is issued
C) Before the certification process is complete
D) Never
C) Drivers with monocular vision who have grandfathered status must provide proof of such status before the medical examiner may issue certification
The maximum duration of a federally-granted waiver or exemption is ___
A) Three months
B) Six months
C) One year
D) Two years
D) Waiver durations may vary, although they cannot exceed two years
The medical examiner’s role in the exemption process is ___
A) Issuing the exemption
B) Advising the FMCSA on the severity of the driver’s impairment
C) Providing the driver contact information for the Federal Vision Exemption Program
D) Performing vision testing
C) The medical examiner’s role in securing a vision exemption is to help the driver get in contact with the Federal Vision Exemption Program
Under what conditions may a driver diagnosed with lazy eye be certified?
A) Under any conditions — lazy eye is not considered a visual impairment for CMV operators
B) Only if the driver has a visual acuity of 20/70 or better, or a federal exemption
C) Only if the driver has a visual acuity of 20/40 or better, or a federal exemption
D) Only by federal exemptoin
C) Drivers with lazy eye must meet federal vision standards for certification (20/40 visual acuity in both eyes) or seek a federal exemption
Medical examiners may grant vision exemptions for drivers that do not meet vision qualification standards
A) True
B) False
B) Only the FMCSA may grant exemptions of any type
Under what circumstances is an ophthalmologist and only an ophthalmologist qualified to perform an examination?
A) Under no conditions — optometrist and medical examiners are always qualified to perform vision testing
B) Only when the driver is diagnosed with aphakia
C) Only when specialized testing is required to resolve an inconclusive examination
D) Under no conditions — ophthalmologists are not qualified to examine CMV drivers
C) The assistance of an ophthalmologist is only required if specialized testing is necessary
Which of the following is considered grounds for additional testing?
A) Blurry vision
B) Presence of floaters
C) Distance vision uncorrected 20/35 in each eye
D) Field of vision testing of 70 degrees in each eye
A) The presence of floaters is not in and of itself an indication for additional testing. Distance vision of 20/40 or better is considered acceptable, and field of vision of 70 degrees in each eye meets vision testing requirements.
A driver with monocular vision who has been granted a federal vision exemption or who is qualified by operation of 49CFR391.64 must have a physical examination every ____________?
A) Six months
B) Year
C) Two years
D) Within six onths of the date of renewal of the vision exemption
B) Although a federal vision exemption is usually granted for two years, the driver must be examined annually.
To pass the interstate CMV driver vision exam, a visual acuity of _______ corrected or I corrected is required.
A) 20/20 in each eye individually and both eye combined
B) 20/40 in each eye individually and both eyes combined
C) 20/20 in at least one eye
D) 20/40 in at least one eye
B) Monocular vision is disqualifying. Drivers must be able to see at least 20/40 in each eye and both eyes combined.
What eye conditions must the medical examiner ask the driver about?
A) Cataracts, color deficiencies, retinitis pigmentosa, aphasia, glaucoma
B) Lazy eye, cataracts, aphasia, floaters, retinopathy
C) Glaucoma, macular degeneration, retinitis pigmentosa, color deficiencies
D) Retinopathy, cataracts, aphasia, glaucoma, macular degeneration
D) These “ask about” eye conditions require referral to an eye specialist if the driver indicates a history of these conditions
FMCSA vision testing standards require field of vision of at least in the horizontal meridian of __ eye (s).
A) 50, one
B) 70, both
C) 85, one
D) 85, both
B) Field of vision should be performed on both eyes, and adequate field of vision of at least 70 degrees in each eye must be demonstrated
Certification of vision testing results may be performed by any of the following except:
A) An ophthalmologist
B) The medical examiner
C) Automated vision testing equipment
D) An optometrist
C) The FMCSA allows the medical examiner, an ophthalmologist, or an optometrist to perform and certify vision testing results.
The driver requiring vision correction may be certified for up to
A) Six months
B) One year
C) Two years
D) Five years
C) Drivers requiring vision correction may be certified for up to two years.
A driver may use telescopic lenses that redirect peripheral vision to compensate for loss of central vision as corrective lenses for meeting CMV qualification requirements
A) True
B) False
B) Use of such lenses is prohibited
Required vision testing does not include:
A) Distance visual acuity
B) Near visual acuity
C) Peripheral horizontal visual fields
D) Color
B) Near vision testing is not required.
Conditions which are usually disqualifying, but which qualification can be considered ona case-by-case basis include:
1) Autonomic neuropathy
2) Congenital myopathy
3) Neuromuscular disorders
4) Carpal tunnel syndrome
A) 1, 2, and 3 only
B) 1 and 3 only
C) 2 and 4 only
D) 4 only
E) all of the above
A) Carpal tunnel syndrome is not usually disqualifying
Only _______ can grant drivers a Skill Performance Evaluation (SPE) certificate
A) The FMCSA
B) The Department of Transportation
C) A certified medical examiner
D) A physiatrist or orthopedic specialist
A) Only the FMCSA can grant waivers/exemptions and SPE certificates
The maximum certification period for Skill Performance Evaluation (SPE) certificate is __
A) six months
B) one year
C) two years
D) determined on a case-by-case basis
C) A SPE certificate is granted for a maximum of two years
A driver presents for clearance to return to driving a CMV four weeks after arthroscopic carpal tunnel repair to his left hand. The certification decision should be:
A) The driver must complete a two-month waiting period for carpal tunnel surgery
B) The driver may be certified if he completes a functional capacity evaluation
C) The driver may be certified for a maximum of one year, as long as he meets all the other qualification standards
D) The driver may be certified for a maximum of two years, as long s he meets all the other qualification standards
D) Ther is no waiting period following carpal tunnel surgery. The driver may be certified for up to two years if the medical examiner considers the driver to have recovered sufficiently from surgery
A Skilled Performance Evaluation (SPE) certificate pursuant to 49 CFR 391.49 is granted under the following conditions except:
A) the driver has a fixed deficit of an extremity
B) the driver meets all the other standards
C) The driver has a medical evaluation summary completed by a board qualified or certified physicatrist or orthopedic surgeon
D) The driver has completed a driving evaluation per FMCSA standards
D) A driving evaluation is not required for issuance of an SPE certificate
A Skill Performance Evaluatioin (SPE) certificate:
A) Is valid for one year from the date of issuance
B) May be renewed 60 days prior to expiration
C) Is required when the severity of a fixed deficit of an extremity includes the loss or impairment of a hand, arm, foot or leg
D) Is issued by the medical examiner
C) A SPE certificate is valid for 2 years, may be renewed 30 days prior to expiration, and is required for a fixed deficit of an extremity includes of loss or impairment of a hand, arm, foot or leg. A SPE certificate is issued by the FMCSA, not the medical examiner. The medical examiner determines that the driver is otherwise medically qualified and meets the criteria for a SPE.
Examples of adapting clinical evaluation of the musculoskeletal system to ensure applicability when assessing CMV driver fitness for duty could include all of the following except:
A) Using resistive force or a dynamometer to have the driver demonstrate grip strength
B) Nerve conduction study testing
C) Have the driver simulate the range of motion and coordination of hands and legs required for steering and changing gears when operating a CMV and/or have the driver demonstrate shoulder joint mobility, arm and leg muscle strength. Required to enter and exit the cab, and other driver-related duties.
D) Have driver perform activities that demonstrate the ability to maneuver and maintain balance while under the trailer and having the driver demonstrate cervical range of motion sufficient to look in either side mirror of an oversized CMV
B) Nerve conduction study testing is not a clinical evaluation of musculoskeletal function
According to regulation, what medical examiner documentation is required when a driver applies for a SPE certificate?
1) The Medication Examination Report
2) Certification from a board certified or eligible physiatrist or orthopedic surgeon that the driver is otherwise qualified to drive
3) The Medical Examiner’s certificate, indicating that medical certification must be accompanied by a SPE certificate
4) Results of the functional capacity evaluation (FCE)
A) 1,2, and 3 only
B) 1 and 3 only
C) 2 and 4 only
D) 4 only
E) all of the above
A) A functional capacity evaluation (FCE) is not a requirement for SPE certificate application
Which of the following conditions are disqualifying?
1) Acute or chronic vestibulopathy after a one-month symptom free interval.
2) Nonfunctioning labyrinths after a three-month free interval.
3) Labyrinthe fistula after a six month symptom free interval.
4) Meniere’s disease After a one-year symptom free interval.
A) 1, 2 and 3 only
B) 1 and 3 only
C) 2 and 4 only
D) 4 only
E) all of the above
E) Nonfunctioning labyrinths labyrinthine fistula, and Ménière’s disease are all disqualifying and there is no symptom free interval that allows certification. The waiting period for acute and chronic vestibulopathy is two months symptom free.
Which of the following drivers meets hearing certification standards?
A) Whisper test 4 feet right ear, 3 feet left ear.
B) Whisper test 5 feet right ear with hearing aid, 3 feet left ear without hearing aid
C) Audiogram left 30/500 Hz, 40/1000 Hz, 60/2000 Hz; right 25/500 Hz, 35/1000 Hz, 80/2000 Hz
D) Audiogram left 25/500 Hz, 50/1000 Hz, 40/3000 Hz; right 25/500 Hz, 35/1000 Hz, 60/3000 Hz
Whisper test results require 5 feet in at least one ear for passing, with or without a hearing aid. Audiometric testing results require an average of 40 dB loss in the better ear for results averaged from 500, 1000, and 2000 Hz. Although testing may be performed at 3000 Hz, results obtained are not used to determine whether the driver meets hearing requirements.
Which of the following is true with respect to hearing testing?
A) Audometric testing should be done using International Organization for Standardizaation (ISO) standard
B) Drivers requiring a hearing aid to meet hearing requirements may wear a hearing aid only in the ear that was tested and passéd with the hearing aid
C) Drivers requiring a hearing aid must be tested using specialized audio metric testing equipment if audio metric testing is required
D) Drivers requiring a hearing aid to meet standards should be certified for no more than one year
Audiometric testing should be done using American National Standards Institute (ANSI) Z24.5-1951 standard. ISO results should be converted to the ANSI standard. To convert ISO results to ANSI, subtract 14 dB at 500, 10 dBat 1000, and 8.5 dB for 2000. Hearing requirements are for the better ear; a driver may use a hearing aid in only one ear to meet standards. drivers wearing a hearing aid may first be tested with a whisper test; if the driver passes the whisper test, the driver must be referred to an audiologist or otolaryngologist with specialized equipment for performing audio metric testing with use of a hearing aid. Drivers sho require a hearing aid to meet standards may be certified for up to two years.
An audio metric test results in the following results:
L ear: 500 Hz, 35 dB loss
1000 Hz, 35 dB loss
2000 Hz, 45 dB loss
R ear: 500 Hz 40 dB loss
1000 Hz 45 dB loss
2000 Hz, 40 dB loss
What is the certification determination?
A) Certify for one year
B) Certify for two years
C) Do not certify
D) Certify only when accompanied by a hearing aid.
B) Drivers with an average hearing loss of <= 40 decibels averaged across 500, 1000, and 2000 Hz in the better ear may be certified for two years.
Which of the following conditions is not disqualifying?
A) Meniere’s Disease
B) Cochlear Implant
C) Labyrinthine Fistula
D) Nonfunctioning Labyrinth
Cochlear implants are not disqualifying
When audiometric testing is used, audio metric testing is not required to be performed at which of the following Hz levels?
A) 500
B) 1000
C) 2000
D) 3000
Audiometric testing, when used, must be performed at 500, 1000, and 2000 Hz
Which of the following is true?
1) If a driver wears a hearing aid, the whisper hearing test can be administered
2) According to FMCSA requirements the driver must pass the hearing requirements with both ears using either forced whisper or audiometric testing
A) 1 only
B) 2 only
C) both 1 and 2
D) neither 1 nor 2
A) a driver with a hearing aid may be tested using the whisper test. Hearing requirements must be met in at least one ear for either forced whisper or audiometric tesitng, not both ears
A driver with Meniere’s Disease may be certified
A) True
B) False
B) Meniere’s Disease is a disqualifying condition
If a driver has whisper test results of : |Rt. Ear: 4 feet| Lt. Ear 4 Feet| s/he meets hearing standards for CMV driver certification.
A) True
B) False
B) Whisper test minimums are at least 5 feet in at least one ear.
Hearing must be tested using audio metric testing equipment.
A) True
B) False
Of a driver passes a whisper test in at least a one ear, audiometric testing is not required.
Which of the following is true?
1) Acute and chronic peripheral vestibulopathy do not require a symptom free waiting period.
2) Benign positional vertigo requires a symptom free waiting period.
3) Uncontrolled vertigo requires a symptom free waiting period.
4) Meniere’s Disease is disqualifying.
A) 1, 2 and 3 only
B) 1 and 3 only
C) 2 and 4 only
D) 4 only
E) all of the above
C) The minimum waiting period is two month symptom free for both acute and chronic vestibulopathy and for benign positional vertigo. Uncontrolled vertigo is disqualifying.
Drivers must be able to meet minimum hearing requirements in both ears in order to be medically certified.
A) True
B) False
B) Adequate hearing in only one ear is required.
A driver who requires a hearing aid to meet certification requirements must be examined annually.
A) True
B) False
B) A driver who needs a hearing aid to meet requirements may be certified for up to two years.
If audiometric testing is performed, testing should include which of the following frequencies?
A) 1000, 2000, 3000 Hz
B) 500, 2000, 4000 Hz
C) 500, 1000, 3000 Hz
D) 500, 1000, 2000 Hz
D) Although additional testing frequencies may be used, minimum FMCSA audio metric testing requirements include testing at 500, 1000, and 2000 Hz. The driver may be certified if the driver does not have more than 40 dB of hearing loss averaged across the three frequencies in the better ear.
An audio metric test yields the following results:
Left ear: 500 Hz, 35 dB loss
1000 Hz, 35 dB loss
2000 Hz, 55 dB loss
Right ear: 500 Hz, 40 dB loss
1000 Hz, 45 dB loss
2000 Hz, 40 dB loss
What is the certification determination?
A) Certify only when accompanied by a hearing aid.
B) Do not certify
C) Certify for two years
D) Certify for one year
B) The passing requirements for audio metric testing are an average loss in the better ear of not more than 40 dB for when averaged across 500, 1000, 2000 Hz
Which of the following is true?
A) Stage 1 hypertension is associated with immediate safety risks.
B) Stage 2 hypertension is associated with immediate safety risks.
C) Stage 3 hypertension is associated with unacceptable risk for sudden incapacitation of the driver.
D) All stages of hypertension are associated with immediate safety risks.
C) Stage 1 and 2 hypertension’s are not associated with immediate safety risks.
On examination, a BP of 140/90 is obtained. A follow up BP is 140/90. What certification option may bee considered?
A) The medial examiner should certify for 6 months if the driver is not taking antihypertension medications.
B) If the driver is taking antihypertensive medications, 6 months should be the maximum certification period.
C) The medical examiner may obtain additional BP readings and/or use his/her clinical judgment ad consider BP and overall driver fitness for duty to determine certification status and certification period.
D) The medial examiner should not certify based not the BP readings.
C) The medical examiner may use additional BP readings and/or clinical judgment to make an appropriate certification determination.
What date is used to determine the expiration date for a driver with a one-time, three month certificate who achieves a BP less than or equal to 140/90 before the three-month certificate expires, and what is the certification period?
A) Two-year certification based on date of initial certification examination.
B) One-year certification based on the date of the initial certification examination.
C) One-year certification based on date of documented BP <=140/90.
D) If the medical examiner performs a complete recertification examination, in addition to the following up on BP, then two-year expiration would be based on the current date.
B) Certification is determined from the last date of complete examination. If a new complete certification examination was performed on the date of the confirmation of acceptable blood pressure, then a one-year certification would have been based on the date of that last complete certification examination.
Which of the following is true with regard to hypertension?
A) The higher value of either systolic or diastolic blood pressure determines the stage of hypertension.
B) Stage 1 hypertension is BP of 140-149/90-99.
C) Stage 2 hypertension is BP of 150-169/100-109.
D) Stage 3 hypertension is BP >=170/110
A) The higher value of either systolic or diastolic blood pressure determines blood pressure stage. Stage 1 is 140-159/90-99, Stage 2 is 160-179/100-109, and Stage 3 is >=180/110
What is the BP range for stage 1 hypertension?
A) 140/90 through 159/99 or 140-159/90-99
B) 140/90 through 149/99 or 140-149/90-99
C) 150/90 through 159/99 or 150-159/90-99
D) 160/100 through 179/109 or 160-179/100-109
A) Stage 1 hypertension is SBP/DBP of 140-159/90-99
The certification determination for a driver who presents with a confirmed BP of 182/86 is
A) Qualify for 3 months
B) Disqualify until BP is <180/110
C) Disqualify until BP is <160/100
D) Disqualify until BP is <=140/90
Drivers with Stage 3 hypertension are disqualifying until blood pressure is stabilized at <=140/90.
The maximum period of certification for a driver disqualified for Stage 3 hypertension, but who has, at the certification examination, a BP less than or equal 140/90, is:
A) One year
B) Six months
C) Three months
D) Two years
B) Drivers with Stage 3 hypertension are certified for maximum six-month intervals.
A driver treated for hypertension presents on September 8, 2012 with a blood pressure of 142/96. The driver is given a three-month certification until December 8, 2012. On blood pressure check one month later, on October 14, 2012, the driver’s blood pressure is 144/72. The driver should be certified for ______.
A) Do not certify
B) Three months to January 14, 2013
C) One year to September 8, 2018
D) The driver remains certified for the three month-interval until December 8, 2012
D) The three month certification reminds valid. The driver did not qualify for a one-year certification, nor did the driver’s blood pressure disqualify the driver. If the driver fails to meet the requirement to lower blood pressure to >=140/90 by December 8, 2012,, the driver will be disqualified until blood pressure is stabilized at <=140/90
The one-time use of a 3-month certificate for blood pressure greater than 140/90 can be provided to a drivers:
A) Only once in the driver’s lifetime
B) On consecutive examinations until the driver’s blood pressure is less than or equal to 140/90
C) When the driver has no previous history of the hypertension and has a blood pressure of 162/84
D) When the driver has a blood pressure of 182/84
C) A 3-month certificate may be issued more than once in a driver’s lifetime. A 3-month Certificate may not be issued consecutively – a driver may not receive consecutive 3-month certificates. A blood pressure of 182/84 is disqualifying, and the driver may not be certified until the driver has a blood pressure of <=140/90.
The maximum certification period for a driver with Stage 1 hypertension is:
A) Three months
B) One year
C) Two years
D) Do not certify
B) Stage 1 hypertension (SBP 140-159, DBP 90-99) has a maximum certification interval of one year. This interval is used when the driver has no history of or treatment for hypertension. If the driver has a history of or treatment for hypertension, the driver should be certified for a maximum of three months.
What is the certification for a driver with a one-time, three month certificate, who achieves a BP<=140/90?
A) Six-month certification from the date of the initial certification examination
B) One-year certification from the date of the initial certification examination
C) One-year certification from the date of the documented BP<=140/90
D) Two-year certification from the date of the documented BP<=140/90
B) The date of the last complete examination is always used as the basis for the certification interval. A driver with a one-time three-month certificate may be certified for one year after documentation of a BP <=140/90.
The stage of BP elevation should be based on the lower of the systolic or diastolic BP result (e.g. if systolic equals Stage 1 and diastolic equals Stage 2, the driver should be certified according to Stage 1 guidelines.)
A) True
B) False
B) Blood pressure stage is based on the highest level of either systolic or diastolic blood pressure.
The FMCSA considers _______ elevated BP readings at consecutive examinations as readings that confirm elevated BP.
A) Three
B) Four
C) Two
D) Five
C) Two consecutive blood pressure readings, either at the same examination or on consecutive examinations, are considered by the FMCSA as an indication of elevated blood pressure.
What is the maximum certification period for drivers with hypertension?
A) Three months
B) One year
C) Two years
D) Six months
B) For a driver diagnosed with hypertension, the maximum certification interval is one year.
When a driver has a BP equivalent to Stage 2 hypertension a medical certification for what time period can be issued?
A) One time, six months
B) One time, one year
C) One time, three months
D) One time, two years
C) The maximum certification interval for Stage 2 hypertension is three months. This is intended to allow the driver to follow up with his/her treating physician to be placed on medication for hypertension treatment
The expiration date for one-year certification, following issuance of a one-time, three month certificate:
A) Should be noted on the Medical Examiner’s Certificate
B) Should be noted in the comments section or elsewhere in the Medical Examination Report
C) Both a and b
D) Neither a and b
C) The expiration date must be noted on both the Medical Examiners Certificate and in the Medical Examination Report
Which of the following is true?
1) CMV drivers have an increased propensity for the development of hypertension that exceeds the risk seen in other professions
2) There should be at least three BP readings taken and documented during the course of the physical examination
A) 1 only
B) 2 only
C) Both 1 and 2
D) Neither 1 nor 2
A) At least two BP readings should be taken and documented during the driver examination.
Do not certify a driver who:
A) Has Stage 1 hypertension not on therapy
B) Has had Stage 2 hypertension on initial examination and on reexamination three months later still has stage 2 hypertension
C) Has stage 2 hypertension currently on therapy
D) Has stage 1 hypertension currently on therapy
B) A driver with Stage 2 hypertension who has not been able to reduce her/his blood pressure to 140/90 or less after three months should be disqualified until achieving a blood pressure of 140/90 or less
The driver should remain under the supervision of a treating physician to:
A) Monitor weight fluctuation with medications
B) Monitor driver nutritional modifications
C) Monitor possible medication side effects
D) Monitor attitudinal/behavioral changes
D) Drivers using prescription medications should be monitored by a supervising or treating physician for possible medications side effects
Which of the following is not considered a secondary cause of hypertension?
A) Sodium consumption
B) Alcohol consumption
C) Tobacco use
D) Thyroid disease
D) Hypertension may be affected by sodium and alcohol consumption, tobacco use, use of NSAIDS, and renal artery disease, a month other conditions. Thyroid disease is not considered a secondary cause of hypertension.
The certification determination for a driver with a diagnosis of hypertension who presents with a confirmed BP of 182/112 is:
A) Qualify 3 months
B) Disqualify until BP is <=180/110
C) Disqualify until BP is <=160/100
D) Disqualify until BP is <=140/90
D) This is Stage 3 hypertension and the driver is disqualified until blood pressure less than or equal to 140/90 is attained.
Which of the following is true?
A) Stage 1 hypertension is systolic BP 140-149 and/or diastolic BP 90-99
B) Stage 2 hypertension is systolic BP 150-169 and/or diastolic BP 100-109.
C) Stage 3 hypertension is systolic BP 170 or greater and/or diastolic BP 110 or greater.
D) FMCSA considers two elevated blood pressures, whether follow-up or recertification, as readings that confirm elevated blood pressure.
D) Stage 1 hypertension is systolic BP 140-159 and/or diastolic BP 90-99, Stage 2 is systolic BP 160-179 and/or diastolic BP 100-109, and Stage 3 hypertension is systolic BP>=180 and or diastolic BP>=110.
A driver previously diagnosed and treated for hypertension presents on April 4, 2014 with blood pressure of 150/84. The driver is given a three-month certification until July 4, 2014. At follow-up two months later, on June 4, 2014, a complete driver examination is performed, and the driver’s blood pressure is 124/74. The driver should be certified for ___________.
A) Three months until September 4, 2014
B) One year until April 4, 2015
C) One year until June 4, 2015
D) Two years until April 4, 2016
Which of the following is true with respect to drivers with psychological disorders?
A) With some exceptions (e.g. schizophrenia), exclusion from CMV driving is not based solely on diagnosis.
B) Recommendations related to effects and/or side effects of medication use the degree of impairment produced by a 0.08 percent blood alcohol concentration as a benchmark.
C) Medical examiners may not request medical records related to treatment of psychological disorders due to HIPAA regulation.
D) Treatment with antipsychotic medications is disqualifying
A) The degree of of impairment produced by a 0.04 percent blood alcohol level is considered the impairment benchmark by the FMCSA. HIPAA regulations do not preclude a medical examiner from requesting records related to treatment of psychological disorders. The medical examiner requesting such records should have the driver sign a HIPAA-compliant consent form for the release of such records. Treatment with antipsychotic medications is not in and of itself disqualifying, although the underlying diagnosis for which such medications are used may be disqualifying.
Which of the following is true with respect to drivers with psychological disorders?
A) Drivers with chronic schizophrenia must be evaluated at least yearly by a qualified specialist such as a psychiatrist or psychologist who understands the function and demands of CMV driving.
B) The waiting period for a brief reactive psychosis or schizophreniform disorder is three months
C) Alcohol and drug dependency and abuse are profound risk factors in the presence of personality disorders
D) The waiting period following electroconvulsive therapy for treatment of depression is one year
C) Drivers with chronic schizophrenia are disqualified. The waiting period for a brief reactive psychosis or schizophreniform disorder is six months as is the waiting period for electroconvulsive therapy treatment.
Which of the following is true with respect to bipolar disorder?
A) Treatment with lithium has not been shown to increase risk for CMV accidents
B) The maximum certification interval is six months
C) The Drivers should be advised to report manic or sever depressive episodes within 10 days of onset to the driver’s employer, medical examiner, or appropriate health professional and to seek medical intervention
D) Onset of manic episodes is uniformly sudden.
A) Treatment with lithium has not been shown to increase CMV driving risk. The maximum certification interval for a driver with bipolar disorder is one year. The driver should be advised to report manic or depressive episodes within 30 days. Manic episode onset may be gradual or sudden.
Categories of risk associated with psychological disorders include:
1) The mental disorder including symptoms and/or disturbances in performance that are in integral part of the disorder and may pose hazards fro driving
2) The type of treatment provider who is treating the condition.
3) Psychopharmacology, as many psychotropic medications can comprise performance to the degree that CMV driving would be hazardous
4) Physical disorders which may be compromised by the mental disorder and may increase risk of CMV accidents
A) 1, 2, and 3 only
B) 1 and 3 only
C) 2 and 4 only
D) 4 only
E) All of the above
B) Type of treatment provider is unrelated to driving risk. Physical disorders are not noted by the FMCSA to increase risk related to psychological disorders.
Which of the following is true with regard to Adult Attention Deficit Hyperactivity Disorder?
A) The maximum certification interval is two years.
B) The driver should be disqualified if the driver has another psychological disorder, such as depression.
C) Risk related to adult ADHD include comorbid antisocial or borderline personality disorders and a high incidence of substance abuse
D) Treatment with amphetamines and amphetamine derivatives is disqualifying
C) The maximum certification interval is one year. As long as other psychological conditions are stable, a driver with adult ADHD may be certified. Treatment with amphetamines and amphetamine derivatives is not disqualifying.
A driver with bipolar disorder must meet a waiting period of __ following a nonpsychotic episode of major depression unaccompanied by suicidal behavior or a waiting period of ______ following a nonpsychotic episode of major depression with suicidal behavior.
A) One year, two years
B) Six months, one year
C) Three months, six months
D) Three months, one year
B) Whatever the underlying medical condition, nonpsychotic episodes of major depression unaccompanied by suicidal behavior require a waiting period of six months and nonpsychotic episodes of major depression with suicidal behavior require a one year waiting period.
A driver with a history of major depression should be evaluated at least every ___ by an appropriate mental health specialist who understands the functions and demands of commercial motor vehicle driving.
A) Six months
B) One year
C) Two years
D) Such evaluation is not required
B) The maximum certification interval for a driver with a history of major depression is one year. Regulatory guidance is somewhat confusing: guidance recommends annual evaluation by a mental health professional who understands the functions and demands of commercial driving, but requires evaluation every two years by a specialist, such as psychiatrist or psychologist who understands the functions and demands of comical driving
Drivers with schizophreniform disorder, brief reactive psychosis, schizoaffective disorder, or delusional disorder may be certified after a _________ waiting period for a brief reactive psychosis or schizophreniform disorder and after a _____ waiting period for any other psychotic disorder.
A) Six weeks, three months
B) Three months, six months
C) Six months, one year
D) One year, two years
C) The waiting period is six on this for a brief reactive psychosis or schizophreniform disorder and one year for any other psychotic disorder
Which of the following is true?
A) Bipolar disorder effects usually manifest immediately after disease onset
B) Manic or depression symptoms may impair judgment or function and make it impossible for the driver to function effectively
C) Rapid onset of debilitating symptoms of depression are unlikely to be triggered by personal, social, financial, or job-related difficulties
D) Schizophrenia is not a progressive condition
B) Symptoms of bipolar disorder often do not manifest for months or years but can be progressive and severe symptoms may then occur with relatively sudden onset. Debilitating symptoms associated with depression may be triggered by a variety of conditions or circumstances. Schizophrenia is usually a progressive condition, so certification of a driver even with mild symptoms is usually not warranted.
Which of the following is an adverse effect of neuroleptic?
A) Hyperactivity
B) Motor dysfunction that affects coordination and response time
C) Auditory hallucinations
D) Migraines
B) Neuroleptics can cause a variety of adverse effects that can interfere with driving, such as motor dysfunction that affects coordination and response time, sedation, and visual disturbances (especially at night).
Adult ADHD is associated with
A) Comorbid antisocial and borderline personality disorder and/or other disorders
B) Unlikely adverse effects of medication
C) Seizures
D) Low incidence of substance abuse
A) Risks to safe driving with adult ADHD include: comorbid antisocial or borderline personality disorder and/or other disorders; adverse effects of medication; and high incidence of substance abuse.
If there is any doubt in the Medical Examiner’s mind regarding driver certification related to mental health issues, the Medical Examiner should:
A) Certify for only three months
B) Certify for only six months
C) Request medical records from the treating physician
D) Not certify the driver
D) The Medical Examiner should not certify the driver and should require additional evaluation by an appropriate mental health professional who is advised of the nature of commercial motor vehicle driving and concerns identified by the Medical Examiner
Driver suicide attempts could result in:
A) Temporary three-month loss of certification and start of minimum six month waiting period for consideration of certification
B) Temporary six month loss of certification and start of minimum nine month waiting period for consideration of certification
C) Loss of certification and start of minimum one year waiting period for consideration of certification
D) Temporary six month loss of certification and start of minimum one year waiting period for consideration of certification
C) The Medical Examiner should advise the driver that suicide attempts will result in loss of certification and create the starting of a minimum one year waiting period for consideration of certification.
The maximum period for which a driver with a history of a psychological disorder should be certified is:
A) Three months
B) One year
C) Six months
D) Nine months
B) The maximum period for which a driver with a history of psychological disorder should be certified is one year.
Which of the following symptoms are characteristic of major depression?
A) Manic episodes
B) Improved concentration and memory
C) Relentless and fatigue
D) Increased interest in personal environment
C) Symptoms of major depression include depressed or irritable mood, loss of interest or pleasure, social withdrawal, appetite and sleep disturbance, weight change and fatigue, restlessness and agitation or malaise, impaired concentration and memory functioning, poor judgment, and suicidal thoughts or attempts
A driver with a history of bacterial meningitis with early seizures or a single unprovoked seizure requires a waiting period of _ seizure free and off anticonvulsant medications.
A) One year
B) Two years
C) Five years
D) Ten years
C) The waiting period for a history of bacterial meningitis with early seizures or single unprovoked seizure is five years
The driver on anticoagulant treatment for a neurological condition can be certified for a maximum of __________
A) Six months
B) One year
C) Two years
D) Do not certify
D) The driver on anticoagulant therapy for a cardiovascular condition may be certified for up to one year. The driver on anticoagulant therapy for a neurological condition should not be certified due to a risk of cerebrovascular hemorrhage.
Transient ischemic attacks (TIA’s) are automatically disqualifying for __ months; after the minimum waiting period the certification depends on the interval history, general health, neurological examination, and compliance with the treatment program.
A) 3
B) 6
C) 9
D) 12
D) The minimum waiting period for TIA’s is 12 months or one year
A driver with peripheral neuropathy:
A) may be certified for one year
B) may be certified for two years
C) should not be certified
D) may be certified for 3 months pending specialist evaluation
Peripheral neuropathy is a disqualifying condition.
Episodic neurological conditions that are usually disqualifying include:
1) Epilepsy
2) Multiple sclerosis
3) Narcolepsy
4) Headaches
A) 1, 2, and 3 only
B) 1 and 3 only
C) 2 and 4 only
D) all of the above
B) Epilepsy and narcolepsy are usually disqualifying. Multiple sclerosis may be disqualifying but is not usually so. Headaches are occasionally, but not usually, disqualifying — disqualification would occur if there were symptoms or medication effects that interfere with safe driving.
Levodopa/carbidopa may cause the driver to be disqualified because it is used for the treatment of what neurological condition?
A) Parkinson’s Disease
B) Peripheral neuropathy
C) Isaac’s Disease or Stiff Man Syndrome
D) Epilepsy
A) Although all of the conditions listed are disqualifying, levodopa/carbidopa is used to treat Parkinson’s Disease
Which of the following is not considered important in determining that a driver who has suffered from TIA’s may be certified?
A) Clearance from a neurologist who understands the functions and demands of commercial driving
B) Completed the appropriate waiting period
C) Normal electroencephalogram
D) On no oral anticoagulant therapy due to risks associated with excess bleeding
A normal encephalopathy is not a condition for certification. The waiting period for TIAs is one year. Drivers may be certified on anticoagulant therapy for a cardiovascular condition but may not be certified if the driver has a cerebrovascular disorder.
Which of the following is true with regard to TIA’s?
A) A driver on anticoagulant therapy for a cardiovascular disorder may not be certified if the driver has a history of TIA’s
B) The rate of recurrence for TIA’s is highest in the first six months, declining after six months to less than 5% per year
C) TIA’s are not considered warning signs for a cerebrovascular accident (CVA).
D) The maximum certification interval for a driver with a history of TIA’s is six months.
The rate of recurrence for TIA’s is highest in the first year, declining after one year to less than 5% per year. TIA’s are considered warning signs for a CVA. The max certification interval for a driver with a history of TIA’s is one year.
Driver examination 6/18/2011. Drivers disqualified due to benign positional vertigo, last symptoms 5/15/2011. Driver advised to return after a _ symptom free interval for a maximum _ certification interval.
A) 1 month, 1 year
B) 2 months, 1 year
C) 2 months, 2 years
D) 3 months, 1 year
C) The waiting period for benign positional vertigo, as well as dizziness and acute or chronic vestibulopathy, is 2 months symptom free with a maximum certification interval of 2 years.
Driver examination 3/14/2012. Driver describes dizziness with last symptoms 2/18/12. The driver was advised to return after a 2-month symptom free interval. The driver returned on 7/12/12 with medical records documenting last dizziness symptoms on 5/4/2012, and the driver confirms he has been symptom free since that date. The medical examiner determines that the driver should be certified for a two year certification interval. What is the expiration date of that certificate?
A) 2/18/2014
B) 3/14/2014
C) 5/4/2014
D) 7/12/2014
B) The certification interval should be determined from the date of the last full driver examination. Unless the examiner performed another full driver examination on 7/12/2012, the appropriate expiration date for a two-year certification is 3/14/2014. If the examiner had performed a full examination on 7/12/2012, then the certification date would have been 7/12/2014.
Common medications used to treat vertigo include:
A) Sedative hyponotics
B) Beta blockers
C) Narcotics
D) Phenothiazines
D) Sedative hypnotics, beta blockers, and narcotics are not commonly used to treat vertigo. Medications commonly used to treat vertigo include antihistamines, benzodiazepines, and phenothiazines.
FMCSA guidance includes:
A) A driver may be cleared after a single unprovoked seizure after a two-year seizure free interval off anticonvulsant medication
B) A driver with a history of childhood febrile seizures may be cleared
C) A driver may be cleared with a diagnosis of epilepsy (2 or more unprovoked seizures) after a 5-year seizure free period off anticonvulsant medication
D) the minimum waiting period after a TIA is six months
B) The seizure free interval off anticonvulsant medication is five years for a driver with a history of a single unprovokeseizure. The waiting period for epilepsy is 10 years seizure free and off anticonvulsant medication. The waiting period for TIA is one year.
The symptom free waiting period for acute and chronic vestibulopathy and benign positional vertigo is ____.
A) One month
B) Two months
C) Three months
D) There is no waiting period; drivers with these conditions should not be certified.
B) The waiting period for these conditions is two months symptom free
A driver with a history of acute seizure secondary to an acute structural insult requires a waiting period of one-year seizure free and off anticonvulsant medications for:
A) Mild insult without early seizures
B) Moderate insult without early seizures
C) Mild insult with early seizures
D) Stroke with risk for seizures
A) A history of seizure secondary to acute structural insult requires a waiting period of one year for mild insult without early seizure, stroke without risk for seizure, or intracerebral hemorrhage without risk for seizure. Moderate insult without early seizures and mild insult with early seizures requires a two-year waiting period, and stroke with risk for seizures requires a five-year waiting period.
A driver with a history of moderate traumatic brain injury with early seizures, stroke with risk for seizures, or intracerebral or subarachnoid hemorrhage with risk for seizures requires a waiting period of _ seizure free and off anticonvulsant medications.
A) One year
B) Two years
C) Five years
D) Ten years
C) Each of these conditions requires a symptom free waiting period of five years
The Medical Examiner should recommend do not certify if the driver has the following:
A) Acute otitis media
B) Ménière’s disease
C) A history of TIA’s three years ago
D) Multiple sclerosis
B) Meriere’s disease is disqualifying
The following conditions are disqualifying except:
A) Multiple sclerosis
B) Congenital myopathies
C) Metabolic muscle diseases
D) Muscular dystrophies
A) Multiple sclerosis may or may not be disqualifying, depending on whether the driver has symptoms that interfere with safe driving. Congenital myopathies, metabolic muscle diseases, and muscular dystrophies are all disqualifying.
The waiting period for a driver with a history of acute seizures secondary to a systemic metabolic illness is _ and the driver may be certified for up to ______.
A) No waiting period, two years
B) One month, one year
C) Three months, one year
D) One year, one year
A) As long as risk for recurrence of the metabolic illness is low, there is no waiting period. And the driver may be certified for two years.
The maximum certification period for a driver with diagnosis of autonomic neuropathy is:
A) Do not certify
B) Six months
C) One year
D) Two years
D) As long as the autonomic neuropathy does not cause orthostatic hypertension, resting tachycardia, or other organ autonomic neuropathy that interferes with driving ability, the driver may be certified for two years. Note that while FMCSA guidelines state that drivers with neurological conditions should be certified for a maximum of one year, FMCSA guidelines for several neurological conditions indicate a maximum certification interval of two years. Since these inconsistencies appear in the FMCSA guidelines themselves, this leaves medical examiners with unclear guidelines for those conditions.
Which of the following is true?
A) A diagnosis of multiple sclerosis is permanently medically disqualifying for interstate CMV driver certification
B) Drivers with a history of dementia (metabolic) should be considered permanently medically disqualified for driving
C) TIAs are automatically disqualifying for one year; after one year, the certification would depend on the interval history, general health, neurological examination, and compliance with the treatment program.
D) Acute seizures due to systemic metabolic illness is considered a permanently disqualifying condition.
C) Multiple sclerosis may or may not be disqualifying. Dementia (metabolic) and seizures secondary to metabolic illness are not permanently disqualifying.
Which of the following is true?
A) Cognitive demands of the CMV driver include quick reactions, appropriate behavior, sustained alertness and attention.
B) DRiver history does not include OTC medications.
C) Fatigue is an uncommon side effect of neurological agents
D) The severity of seizure episodes is considered the best predication of future risk for seizures
A) Driver history should include OTC medications. Fatigue is a common side effect of neurological agents. The length of time an individual is seizure free and off anticonvulsant medication is considered the best predictor of the future risk of seizures.
During the neurological examination the Medical Examiner should note the following:
A) Range of motion
B) Gait disorders, sensory or positional abnormalities
C) Prior fractures
D) Weight gain/loss
B) Range of motion and prior fractures should be noted on the musculoskeletal examination. WEight gain or loss is noted int he general examination.
The maximum period for which a driver with a neurological condition should be certified is:
A) two years
B) Three months
C) Six months
D) One year
D) The maximum certification interval for a driver with a neurological condition is one year. Note that while FMCSA guidelines state that drivers with neurological conditions should be certified for a maximum of one year, FMCSA guidelines for several neurological conditions indicate a maximum certification interval for two years. Since these inconsistencies appear in the FMCSA guidelines themselves, this leaves medical examiners with unclear guidelines for these conditions.
The risk of recurrent events following a TIA falls to less than 5% in what time frame?
A) the first 24 hours
B) the first year
C) The first few weeks
D) The first 12 hours
TIA risk falls to less than 5% after one year.
Which of the following is true?
A) Cerebellum and brain stem vascular lesions are associated with an increased risk for seizures.
B) Drivers with emboli or thrombotic cerebral infractions are unlikely to have residual intellectual or physical impairments
C) Intracerebral hemorrhage results from bleeding primarily into the spaces around the brain and subarachnoid hemorrhage reflects bleeding into the substance of the brain
D) Cortical and subcortical hemorrhages are associated with an increased risk for seizures
D) Cerebellum and brainstem vascular lesions are not associated with increased risk for seizures. Emboli and thrombotic cerebral infractions often have residual intellectual or physical impairments. Intracerebral hemorrhage reflects bleeding into the substance of the brain while subarachnoid hemorrhage reflects bleeding into the spaces around the brain.
Which of the following is true?
A) Following a TBI behavioral/emotional functioning issues may result in disability and/or psychological impairment
B) For a single unprovoked seizure FMCSA guidelines state that the driver should be seizure free and off anticonvulsant medication for 10 years
C) Most neurological conditions in which seizures may occur are not associated with future risk for unprovoked seizures
D) Most individuals who have experienced a febrile seizure in infancy are at significantly increased risk for seizures as adults
A) FMCSA guidelines require a minimum 5 year waiting period seizure free and off anticonvulsant medication following a single unprovoked seizure. Most neurological conditions associated with any seizure activity present an increased risk for future seizures. Febrile seizures in infants are not associated with significant increased risk for adult seizures.
A mild head injury has:
A) No dural penetration with LOC that lasts fewer than 30 minutes
B) Dural penetration with LOC that lasts fewer than 30 minutes
C) No dural penetration with LOC that lasts for more than 30 minutes but less than 24 hours
D) Dural penetration with LOC that lasts for more than 30 minutes but less than 24 hours
A) A mild head injury has no dural penetration and LOC that lasts fewer than 30 minutes
What is the minimum waiting period for certification following a moderate TBI with early seizures?
A) Two years seizure free and off anticonvulsant medication
B) one-year seizure free and off anticonvulsant medication
C) Six months seizure free and off anticonvulsant medication
D) Five years seizure free and off anticonvulsant medication
D) The minimum waiting period for a moderate TBI with early seizures is five years seizure free and off anticonvulsant medicatin
What is the minimum waiting period for certification for a driver following a viral encephalitis with early seizures?
A) Two years seizure free and off anticonvulsant medication
B) Ten years seizure free and off anticonvulsant medication
C) Five years seizure free and off anticonvulsant medication
D) One-year seizure free and off anticonvulsant medication
C) The minimum waiting period for certification of a driver following an episode of viral encephalitis with early seizures is five years seizure free and off anticonvulsant medication
The waiting period for certification of a driver after removal of an ingrate trial meningioma is:
A) One year
B) Two years
C) Six months
D) Five years
A) The waiting period following removal of an infratentorial meningioma is one year seizure free and off anticonvulsant medication
How often should a driver who had a meningioma removed be examined?
A) Every six months
B) Every two years
C) Annually
D) Every three months
C) The maximum certication interval for a driver following the removal of a meningioma is one year
The most common medications used to treat vertigo are:
A) Antihistamines
B) Antibiotics
C) Aspirin
D) Antipsychotics
A) Antihistamines are the most commonly prescribed medication for the treatment of vertigo
A driver with asthma describes using an albuterol inhaler several times a day. He has not seen his primary care physician in several years but is still getting frequent refills on his inhaler. The driver has been hospitalized twice in the last eight months for asthma. The certification decision should be:
A) Do not certify
B) Certify for 3 months, pending driver follow up with personal physician and/or specialist
C) Certify one year
D) Certify 2 years
A) The driver should not be certified until evaluated by his personal physician and/or specialist
A driver experienced a pneumothorax four weeks ago. The pneumothorax reduced the driver’s forced vital capacity (FVC) to 58% of predicted forced vital capacity. What should the certification decision be?
A) Do no certify
B) Certify for 3 months, pending driver follow up with personal physician and/or specialist
C) Certify for one year
D) Certify for 2 years
A) The driver may not be certified until FVC is >60% of predicted
A driver presents for examination with a history of pneumothorax 6 weeks ago. Available medical records indicate that this is the second spontaneous pneumothorax on the same side. The driver’s forced vital capacity (FVC) is 68% of predicted forced vital capacity with no surgical intervention. What is the certification determination?
A). Do not certify
B) Certify for 3 months, pending driver follow up with personal physician and/or specialist
C) Certify for one year
D) Certify for 2 years
A) A driver with a history of two or more spontaneous pneumothoraxes on the same side must undergo surgical treatment to prevent recurrence prior to certification.
Medical guidance does not recommend which of the following tests for initial pulmonary function testing?
A) Forced expiration volume in one second (FEV1)
B) FEF 25%-75%
C) Forced vital capacity (FVC)
D) FEV/FVC ratio
FEF 25%-75% is not a recommended pulmonary function test for certification determination
PFT results: FEV1 62% of predicted, FEV1/FVC ratio 68%. What is the certification determination?
A) Do not certify pending additional testing
B) Three-month certification pending additional testing
C) Certify one year
D) Certify two years
A) FEV1 of less than 65% predicted requires additional testing prior to certification
Pulse oximetry O2 saturation – 90%; ABG – PaO2=60 mm Hg, PaCO2 = 42 mm Hg. What is the certification determination?
A) Do not certify
B) Certify three months pending additional testing
C) Certify for one year
D) Certification depends on whether the testing is performed at altitudes of > 5000 feet.
D) PaO2 of less than 65 mm Hg is disqualifying unless the testing is conducted at altitudes above 5000 feet. At altitudes above 5000 feet, a PaO2 of less than 60 mm Hg is disqualifying. Note that FMCSA guidelines use the altitude at which the testing is performed to determine driver certification, but also recommend that medical examiners may consider the history of whether the driver has recently been above 5000 feet in making certification determinations based on PaO2 results
Driver qualification standards include not certifying an individual with which of the following?
A) PaCO2 greater than 40 mm Hg
B) Diagnosis of pulmonary hypertension, with or without cor pulmonale, accompanied by symptoms of dyspnea, dizziness, or hypotension
C) Cough
D) FEV1< 75%
B) Pulmonary hypertension is usually disqualifying regardless of the underlying condition, especially when symptomatic
Driver qualification standards include not certifying an individual with which of the following:
A) PaCO2 greater than 40 mm Hg
B) Diagnosis of COPD
C) Paroxysms of cough leading to cough syncope
D) FVC < 75%
C) Any condition involving syncope is disqualifying
Driver qualification standards include not certifying any individual with which of the following:
A) PaCO2 greater than 45 mm Hg
B) Diagnosis of asthma
C) Smoking history of more than 2 packs per day
D) FEV1 < 70%
A) PaCO2 greater than 45 mm Hg disqualifying
The maximum certification interval for a driver diagnosed with asthma is __________.
A) Three months
B) Six months
C) One year
D) Two years
D) The maximum certification interval for asthma is two years
Spirometry testing should be performed on drivers who smoke who are over _ years of age:
A) 30
B) 35
C) 40
D) 45
B) Spirometry is recommended for current smokers over 35 years of age
Arterial blood gas (ABG) testing should be performed on drivers with a FEV1 of less than _ on spirometry testing?
A) 60% of predicted
B) 65% of predicted
C) 70% of predicted
D) 80% of predicted
B) ABG testing is required with FEV1 of less than 65% of predicted
Arterial blood gas (ABG) testing is indicated if pulse oximetry is less than _
A) 90%
B) 92%
C) 94%
D) 95%
B) ABG testing is required for pulse oximetry less than 92%
Which of the following is disqualifying?
A) PaCO2 less than 45 mm Hg
B) PaO2 less than 70 mm Hg at altitudes less than 5000 feet
C) PaO2 less than 65 mm Hg at altitudes above 5000 feet
D) PaCO2 greater than 45 mm Hg
D) PaCO2 of more than 45 mm Hg is disqualifying. PaO2 of less than 65 mm Hg at altitudes less than 500 feet or less than 60 mm Hg above 5000 feet are disqualifying
An apnea/hypoapnea index of more than _ episodes per hours is diagnostic for sleep apnea
A) 20
B) 25
C) 30
D) 35
C) An apnea/hypoapena index of more than 30 episodes per hour is diagnostic for sleep apnea
Guidelines for obstructive sleep apnea
A) Are regulatory
B) Require a waiting period of 2 months after initiation of CPAP treatment
C) Include a 2 month waiting period after surgical treatment
D) Require disqualification if the driver has restless leg syndrome (RLS) associated with excessive daytime sleepiness (EDS)
D) OSA guidelines are not regulatory, so the medical examiner may choose not to follow the guidelines but should document the rational for doing so The waiting period after CPAP treatment is one month and after surgical treatment is three months
Indications for pulse oximetry and/or ABG include:
A) FEV1 less than 70% of predicted
B) FEV1/FCVC ratio less than 70% of predicted
C) Restrictive impairment present and FVC less than 70% predicted
D) If oximetry is less than 92%, the driver must have ABG analysis
D) Pulse oximetry should be performed if FEV1 is less than 65% predicted, if FEV1/FVC ratio is less than 65% predicted, and if restrictive impairment is present and the FVC is less than 60% predicted.
Pulmonary conditions that should result in a disqualification decision include:
A) Any pulmonary process that is likely to interfere with driver ability to operate a CMV safely, either due to history or clinical diagnosis.
B) Chronic obstructive pulmonary disease (COPD)
C Asthma
D) Pulmonary tuberculosis
A) Any condition, pulmonary or otherwise, likely to interfere with safe driving is disqualifying. COPD and asthma may be disqualifying depending on symptoms and the results of pulmonary function testing. Pulmonary TB is disqualifying until treatment is established as adequate/effective, safe, and stable and the driver is determined not to be contagious.
The maximum certifcation interval for. Driver diagnosed with asthma is:
A) 3 months
B) 6 months
C) 1 year
D) 2 years
D) The maximum certifcation interval for a driver with asthma is 2 years
The driver diagnosed with COPD may be certified if the driver has:
A) Hypoxemia at rest
B) FEV1>=65%
C) Chronic respiratory failure
D) History of continuing cough with cough syncope
B) Hypoxemia at rest, chronic respiratory failure, and cough syncope are all disqualifying
Drivers with sleep apnea should have all of the following except:
A) multiple sleep latency testing values within the normal range
B) Resolution of apneas confirmed by a sleep study
D) Certification by a sleep apnea specialist
D) Certification by a sleep apnea specialist is not a requirement for drivers diagnosed with sleep apnea
Drivers should refrain from driving for ___ after taking antihistamines (prescription or OTC) or narcotic antitussives
A) 6 hours
B) 8 hours
C) 12 hours
D) 24 hours
A minimum of 12 hours is required before driving for a driver that has taken an antihistamine or narcotic antitussive medication
Supplemental oxygen use is disqualifying
A) True
B) False
A) Supplemental oxygen use is disqualifying
The maximum certification period for a driver with cystic fibrosis is __
A) 6 months
B) 1 year
C) 2 years
D) Do not certify
C) Drivers with cystic fibrosis may be certified for up to 2 years
ABG testing is required if pulse oximetry is less than
A) 96%
B) 94%
C) 92%
D) 90%
C) ABG testing is indicated with pulse oximetry less than 92%
A driver takes Benadryl 25 mg, 2 to 3 times per day, to treat nasal congestion. The medical examiner should:
A) Advised the driver to use diphenhydramine nor more than twice daily
B) Advise the driver to consult with PCP to evaluate chronic congestion and obtain treatment that does not interfere with safe driving
C) Prescribe a non-sedating inhaler
D) Contact DOT to advise of a safety concern
B) Drivers should be advised to follow up with their treating physicians to obtain treatments that are not sedating
Pulse oximetry or ABG testing is indicated when the driver has an obstructive respiratory condition and results of spirometry testing are _:
A) FEV1 <70% predicted
B) FEV1/FVC ratio less than 65%
C) FVC <80% predicted
D) FEF 25/75<80% predicted
Pulse oximetry or ABG testing is indicated if FEV1/FVC ratio is less than 65%
An apnea/hypoapnea index or more than _ episodes per hour is diagnostic for sleep apnea
A) 20
B) 25
C) 30
D) 35
An apnea/hypoapena index or more than 30 episodes per hour is diagnostic for sleep apnea
Drivers with chronic pulmonary tuberculosis (tB) should be disqualified regardless of disease severity
A) True
B) False
B) Pulmonary tuberculosis is not automatically disqualifying