DOT Exam Study Guide With Complete Solutions
DOT Exam Study
Guide With
Complete Solutions
DOT Exam Study Guide With Complete
Solutions
5 Feet – Answer A CMV driver must perceive a forced whispered voice in the better
eat at not less than _ with or w/o a hearing aid Audiogram – Answer This test is performed only when the Forced Whisper Test is failed in both ears 40 decibels – Answer If tested by the use of an audiometric device, they must not have an AVERAGE hearing loss in the better ear greater than _ at 500Hz, 1000Hz, and 2000Hz One – Answer ear and two eyes certifies!
Audiologist – Answer A driver with a hearing aid usually must go to an __ or a
hearing aid center for audiometry testing
2 Years – Answer How long can a driver who meets the hearing requirements in one
ear be certified?
Acute and Peripheral Vesitbulopathy – Answer Inflammation of the inner ear that
causes a sudden onset of vertigo. This requires a 2 month waiting period.
Benign Positional Vertigo – Answer This occurs when a small piece of bone-like
calcium breaks free and floats inside the Eustachian tube sending confusing
messages to your brain about your body’s position. This requires a 2-month waiting
period.
False – Answer T/F It is OK to certify someone with Uncontrolled Vertigo, Meniere’s
Disease, Labrythine Fistula, or Non-Functioning Labryinthes
Meniere’s Disease – Answer An inner ear disorder that affects balance and hearing.
Labrythine Fistula – Answer An abnormal opening in the bony capsule of the inner
ear resulting in the leakage of the peri lymph from the semicircular canals of the
middle ear.
Non-Functioning Labryinths – Answer Loss of vestibular function in both Labryinths
leading to characteristic dysfunction in vision and balance. These symptoms reflect
how crucial our Labryinth sense is for generating proper reflexes so that we can see
clearly when we are moving and not lose our balance when we are standing or
walking.
Inner Ear – Answer Another name for the Labryinth
Elevated Blood Pressure – Answer 1 or 2 readings greater than or equal to 140/90 on
the same day
Hypertension – Answer Two readings greater than or equal to 140/90 on consecutive
exams on two different days
The examiner – Answer Who should remeasure abnormal BP and or pulse rate or
rhythm, especially if they are significant factors in determining certification?
Even with the Sternum or right atrium of the driver – Answer When measuring a
driver’s BP they should sit in the chair for at least 5 min, back is supported, legs are
uncrossed, and feet are touching the ground. Support the drivers arm at the elbow
so the midpoint of the BP cuff is…
140-159/90-99 – Answer Stage 1 HTN
1 year – Answer How long can you certify someone who comes in for certification for
the first time and has Stage 1 HTN?
1 year on BP meds – Answer If someone with Stage 1 HTN comes into the clinic for
recertification how long can you certify them for if they are on BP meds and their BP
is less than 140/90?
1-2 years if not on any BP meds – Answer If someone with Stage 1 HTN comes into
the clinic for recertification how long can you certify them for if they are not on any
BP meds?
1 time, 3 month certification card – Answer If a patient with Stage 1 HTN comes in for
recertification and their BP is 140-159/90-99 what type of certification would they
receive?
1 year from the date of the of the complete exam – Answer If a patient with Stage
one HTN who comes back in for a 3-month recheck and their BP is <140/90 how long can they be certified for? 160-179/100-109 – Answer What is Stage 2 HTN? 3 months – Answer When does a person need to come back to be seen with Stage 2 HTN after their first exam for recertification? 1 year from the date of the complete exam – Answer A person with Stage 2 HTN returns for their recheck exam after 3 months. How long can they be certified if their BP is <140/90 and they are on BP meds? 1-2 years from the date of the complete exam – Answer A person with Stage 2 HTN returns for their recheck exam after 3 months. How long can they be certified if their BP is <140/90 and they are not on BP meds? Providers discretion – Answer A person with Stage 2 HTN returns for their recheck exam after 3 months. How long can they be certified if their BP is >140/90?
180/11 – Answer Stage 3 HTN
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DOT Exam Study Guide
- A CMV driver must perceive a forced whispered voice 5 Feet
in the better eat at not less than _ with or w/o a
hearing aid - This test is performed only when the Forced Whisper Audiogram
Test is failed in both ears - If tested by the use of an audiometric device, they 40 decibels
must not have an AVERAGE hearing loss in the better
ear greater than __ at 500Hz, 1000Hz, and 2000Hz - _ ear and two eyes certifies! One
- A driver with a hearing aid usually must go to an __ Audiologist
or a hearing aid center for audiometry testing - How long can a driver who meets the hearing require- 2 Years
ments in one ear be certified? - Acute and Peripheral Vesitbulopathy
Inflammation of the inner ear that causes a sudden
onset of vertigo. This requires a 2 month waiting period. - Benign Positional
Vertigo
This occurs when a small piece of bone-like calcium
breaks free and floats inside the Eustachian tube
sending confusing messages to your brain about
your body’s position. This requires a 2-month waiting
period. - T/F It is OK to certify someone with Uncontrolled False
Vertigo, Meniere’s Disease, Labrythine Fistula, or
Non-Functioning Labryinthes - An inner ear disorder that affects balance and hear- Meniere’s Disease
ing. - An abnormal opening in the bony capsule of the inner Labrythine Fistula
ear resulting in the leakage of the peri lymph from the
semicircular canals of the middle ear.
1 / 24
DOT Exam Study Guide - Non-Functioning
Labryinths
Loss of vestibular function in both Labryinths leading
to characteristic dysfunction in vision and balance.
These symptoms reflect how crucial our Labryinth
sense is for generating proper reflexes so that we
can see clearly when we are moving and not lose our
balance when we are standing or walking. - Another name for the Labryinth Inner Ear
- Elevated Blood
Pressure
1 or 2 readings greater than or equal to 140/90 on the
same day - Two readings greater than or equal to 140/90 on con- Hypertension
secutive exams on two different days - Who should remeasure abnormal BP and or pulse The examiner
rate or rhythm, especially if they are significant factors in determining certification? - Even with the
Sternum or right
atrium of the driver
When measuring a driver’s BP they should sit in the
chair for at least 5 min, back is supported, legs are
uncrossed, and feet are touching the ground. Support
the drivers arm at the elbow so the midpoint of the BP
cuff is… - Stage 1 HTN 140-159/90-99
- How long can you certify someone who comes in for 1 year
certification for the first time and has Stage 1 HTN? - 1 year on BP
meds
If someone with Stage 1 HTN comes into the clinic
for recertification how long can you certify them for if
they are on BP meds and their BP is less than 140/90? - 1-2 years if not on
any BP meds
If someone with Stage 1 HTN comes into the clinic
for recertification how long can you certify them for
if they are not on any BP meds? - 1 time, 3 month
certification card
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DOT Exam Study Guide
If a patient with Stage 1 HTN comes in for recertification and their BP is 140-159/90-99 what type of
certification would they receive?
- 1 year from the
date of the of the
complete exam
If a patient with Stage one HTN who comes back in for
a 3-month recheck and their BP is <140/90 how long
can they be certified for? - What is Stage 2 HTN? 160-179/100-109
- When does a person need to come back to be seen 3 months
with Stage 2 HTN after their first exam for recertification? - 1 year from the
date of the complete exam
A person with Stage 2 HTN returns for their recheck
exam after 3 months. How long can they be certified
if their BP is <140/90 and they are on BP meds? - 1-2 years from the
date of the complete exam
A person with Stage 2 HTN returns for their recheck
exam after 3 months. How long can they be certified
if their BP is <140/90 and they are not on BP meds? - Providers discretion
A person with Stage 2 HTN returns for their recheck
exam after 3 months. How long can they be certified
if their BP is >140/90? - Stage 3 HTN > 180/11
- If a person comes in for an exam and their BP is Disqualified
180/110 then they should be …? - Certify for 6
months with recertification every six
months
Stage 3 HTN patient returns for a recheck. How long
can they be certified and how often should they be
recertified? - The patient should
be disqualified.
What should happen if a Stage 3 HTN patient comes
in for a recheck and their BP is greater than 140/90??
33.
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DOT Exam Study Guide
One Time 3 month
card
This certificate is included in the annual certification
interval and is not an extension of the certification
period. It can not be used in consecutive increments.
- Drivers who must
be tested for drugs
and alcohol
Drivers who operate CMVs of 26,001 pounds or more,
transport 16 or more passengers, or who carry placarded hazardous material on the public roadway — All
drivers operating CMVs in interstate commerce — All
drivers required to have a CDL - If they were in
a testing program
within the last 30
days and was tested within the last
6 months or a
was a program for
the previous 12
months
When is a driver exempt from Pre-Employment testing? - 8 hours for ETOH
and 32 hours for
drugs
What is the time frames for ETOH and drug testing
after a crash? - Post-Accident
Testing
Testing that has to occur when the crash involves the
loss of human life, the driver receives a citation within
8 hours of the accident, there is bodily injury to a
person who immediately received medical treatment
away from the scene, or if 1 or more MVs must be
transported away by tow truck - 6 drug tests within
the first year
When a driver returns to duty after violating drug
and ETOH standards, how many f/u drug and ETOH
tests would they need in the first year of returning to
driving? - Directly Observed
Testing
Employee must raise shirt and lower underpants to
mid-thigh to show no device is being worn during
what kind of urine testing?
4 / 24
DOT Exam Study Guide - >2 drinks/day for
men
1 drink/day for
women
Heavy drinking average for men and women?
- A pattern of ETOH consumption that brings the Blood Binge Drinking
Alcohol Concentration (BAC) level to 0.08% or more
in a 2-hour period – Men 5 or more drinks and Women
4 or more drinks- A pattern of drinking that results in harm to one’s Alcohol Abuse
health, interpersonal relationships, or ability to work.
Long term use can turn into dependence.- Alcohol Dependence
A chronic disease that includes a strong craving for
ETOH despite repeated physical, psychological, or
intepersonal problems; An inability to limit drinking- SAP (Substance
Abuse Professional)
Evaluates employees who have violated DOT drug
and ETOH regulations and makes recommendations
concerning education, treatment, F/U testing, and aftercare- MRO (Medical Review Officer)
Licensed MD responsible for receiving and reviewing
labs generated by a drug testing program, contacts
the user when there is a positive result for an interview to determine if there is an alternate explanation
for drug findings in the urine specimen- DER (Designated
Employee Representative)
Individual who receives communications and test results from service agents, authorized to take immediate action to remove employees from safety sensitive
duties, and to make required decisions in the testing
and evaluation process– Must be an employee of the
company- When in remission, _ is not disabling unless Alcoholism
transient or permanent neurological changes have
occurred
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DOT Exam Study Guide
- REVIEW MEDICATIONS AND IF THEY ARE SAFE FOR
CMV DRIVERS - A1C: 5% Normal Labs
Fasting Glucose: 99 or below
Oral GTT: 139 or Below - A1C: 5.7-6.4% Prediabetes
Fasting Glucose: 100-125
Oral GTT: 140-199 - A1C: 6.5% or greater Diabetes
Fasting Glucose: 126 or above
Oral GTT: 200 or above - Lack of insulin production, must receive insulin, se- Type 1 DM
verely compromised counter-regulatory mechanisms - Adult Onset or Non-Insulin Taking, patient can pro- Type 2 DM
duce insulin, treatment is diet and oral medication which preserves blood glucose mechanisms for
years - If the driver takes
insulin
Certification of a CMV driver with diabetes is based
on what? - Macrovascular
Disease
Accelerated atherosclerosis of coronary, cerebral,
and peripheral vessels, higher risk for cardiovascular
disease, can cause TIA or stroke, leading cause of
death among diabetics - Microvascular Disease
Neuropathy, Nephropathy, Retinopathy, Macular Degeneration - Disturbance in sensation and touch, loss of position Neuropathy
sense, loss of vibratory sense, autonomic neuropathy - Fatigue, lethargy, sluggishness, transient cognitive
disruption; Sudden onset unlikely; May begin around
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DOT Exam Study Guide
Symptoms of
Acute Hyperglycemia
280-300% but is more likely with a sustained plasma
glucose of greater than 400%
- The FMCSA Medical Examiner Handbook states that >10%
a Hgb A1C of __ (275%) indicates poor glucose
control - Mild Hypoglycemia
Rapid heart rate, sweating, weakness, and hunger - Severe Hypoglycemia
Seizure, loss of consciousness, need of assistance
from another person, period of impaired cognitive
function without warning - When performing a UA… A MA detects glycosuria. Blood Glucose
What should be the test that she performs? - Glomerular Damage
Diabetics with excessive proteinuria may be indicative of what? - How often should diabetics be recertified because of Annualy
the progressive nature of DM and the potential for
complications? - Transportation Equity Act of 1998
The act revised the authority of the Secretary of
Transportation to grant waivers or exemptions and
established procedures for pilot exemption programs - This 2005 act eliminated the 3-year driving require- SAFETEA-LU
ment of driving a CMV while on insulin, adopted new
waiting periods - New Diabetic
Waiting Periods because
of the 2005
SAFETEA-LU
Minimum 1-month if the driver was previously diagnosed and treated with oral mess but now requires
insulin
Minimum 2-months of the driver is newly diagnosed
with no prior treatment and is now starting insulin
7 / 24
DOT Exam Study Guide - There are no specific FMCSA guidelines regarding True
meeting musculoskeletal tasks of lifting, pushing,
pulling, and bending - Skill Performance
Evaluation
If a driver has limitations in extremity movement the
medical examiner can send the driver for an on-road
performance eval or a…? - L3-L4 (Nerve Root
L4)
Motor Weakness: Extension of Quadriceps
Screening Exam: Squat and Rise
Reflexes: Knee Jerk Diminished - L4-L5 (Nerve Root
5)
Motor Weakness: Dorsiflexion of the Great Toe and
Foot
Screening Exam: Heel Walking
Reflexes: None Reliable - L5-S1 (Nerve
Root S1)
Motor Weakness: Plantar flexion of the great toe and
foot
Screening Exam: Walking on toes
Reflexes: Ankle
jerk diminished - This is a one-time driving examination by the FMCSA
so it is not appropriate for a progressive or fluctuating limb disorder; Formerly called the Limb Waiver;
Allows a person with the loss of an extremity (wrist up
or ankle up) or with a fixed musculoskeletal impairment to be certified to drive a CMV; This loss can be
more anatomically distal if the examiner determines
that it impairs the ability to drive safely - Physically qualified to drive a CMV if a distant visual Vision Standard
acuity of 20/40 in each eye w/ or w/0 corrective lenses
or visual acuity separately corrected to 20/40 or better
with corrective lenses AND distant binocular acuity
of 20/40 in both eye w/ or w/o corrective lenses AND
a field of vision at least 70 degrees AND the ability
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DOT Exam Study Guide
to recognize the colors of traffic control signals and
devices showing standard red, green, and amber
- Due to persistent or acute damage to the retina of the Retinopathy
eye; Ongoing inflammation and vascular remodeling
may occur over periods of time where someone is not
aware of the extent of the disease; Usually any ocular
manifestation of systemic disease - The most common cause of blindness. It is a clouding Cataracts
of the lens inside the eye which leads to a decrease
in vision. Can be corrected with surgery. - The absence of the lens of the eye due to surgical Aphakia
removal. Without the focusing power of the lens the
eye becomes very far sighted. This can be corrected
by wearing glasses, contact lenses, or implanting an
artificial lens. - A term describing a group of ocular eye disorders Glaucoma
that damage the optic nerve often associated with
increased fluid pressure in the eye. It affects vision
by decreasing the visual field by first affecting the peripheral vision and then potentially leading to blindness. - Macular Degeneration
This usually affects older adults and causes a loss of
vision in the center of the visual field due to damage
of the retina. It can make it difficult or impossible to
read or recognize faces, although enough peripheral
vision remains to allow other ADL - Distant Visual
Acuity
Peripheral Vision
along the horizontal meridian in
each eye
Color vision
Required vision tests
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DOT Exam Study Guide - If a driver has an inconclusive vision test, the next An eye specialist
step should be to refer them to…? - Causes a progressive decrease in peripheral vision Glaucoma
- Diminished visual acuity, contrast, and color resolu- Cataracts
tion; also causes increased glare - Macular Degeneration
Leading cause of untreatable blindness in the US,
Affects the central vision - DM is the most common cause; Can affect central Retinopathy
vision, contrast sensitivity, and color discrimination. - 1 ear, _ certifies! Max certification is one year. 2 eyes
- Can someone be certified if they have contact lenses No
that correct distant acuity in one eye and near acuity
in another eye? - Vision in one eye; In low illumination or glare it can Monocular Vision
cause deficiencies in contrast, recognition, and depth
perception compared to binocular vision - Allows drivers with monocular vision to operate a Vision Exemption
CMV – Should be recertified annually - Transient Ischemic Attack
Focal neurological dysfunction, lasts > than a few
seconds but less than 30-40 min - Waiting period after TIA 1 year
- Max certification for someone with TIA 1 year
- Most common cause of stroke ages 45-65, caused Thrombotic Stroke
by large artery atherosclerosis, often preceded by
TIA; Treatment: Medical: Antiplatelet agents Surgical:
Carotid Endardectomy - Embolism Stroke
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DOT Exam Study Guide
The heart is usually the source of the embolus,
prognosis often worse than thrombotic stroke because of larger stroke area and an increased incidence of blood at the stroke site; Treatment: Medical- Coumadin, Requires INR monitoring, Increased
Bleeding Risks
- 1 year if the driver is not at risk for
seizures
Waiting period after a stroke - Intracerebral Hemorrhage
Bleeding into the substance of the brain, Caused by
ruptured arteriovenous malformation, there are also
other causes as well - Subarachnoid Hemorrhage
Bleeding primarily in the space around the brain;
often from a ruptured aneurysm - 1 year; No additional time if no
increased seizure
risk and not on any
anti-seizure meds
Waiting period for cerebellum or brain stem stroke - Cortical or Subcortical Stroke
waiting period
1 year for stroke plus an additional 4 years if there is
a seizure risk; Must be seizure free and off meds for 5
years but this waiting period may be shortened after
consultation - Requires an individual assessment
Loss of position sense with peripheral neuropathies
is disqualifying but loss of sensation… - Peripheral Neuropathies
Hereditary or aquired conditions that affect nerves,
including the axon, myelin, or the myelin outside the
spinal cord; common complication of DM - Seizure free and
off anticonvulsants for 10 years
If a clinician chooses to certify a driver with an established medical history of epilepsy the driver must
be…
11 / 24
DOT Exam Study Guide - Two or more unprovoked seizures Epilepsy
- Minimum 5 years seizure free and off anti-convulsants meds; Requires annual recertification and biennial medical examination
- Severe Head Injury
Dural penetration, loss of consciousness for >24
hours, with or without a prior history of seizures the
risk of unprovoked seizures does not decrease over
time, driver should not be considered for certification. - Moderate Head
Injury
No Dural penetration, loss of consciousness >30 min
but <24 hours, 5 years waiting period off of anticonvulsants and seizure free if there were early seizures,
2 year waiting period if there was no early seizure,
Max certification = 1 year - No Dural penetration, loss of consciousness <30 min- Mild Head Injury
utes, waiting period 2 years if there was an early
seizure, max 1 year certification, No seizure = No
waiting period; Max certification = 2 years - Waiting period for History of Epilepsy and Viral En- 10 years
cephalitis with an Early Seizure - Waiting period for Single, unprovoked seizure, Bac- 5 Years
terial meningitis with early seizures, Moderate TBI
with early seizures, Stroke with risks of seizures, intracerebral or subarachnoid hemorrhage with risk for
seizure - 2 year waiting period
Waiting period for Seizure with acute structural insult
to the brain, Moderate TBI without early seizure, Surgically removed supratentorial or spinal tumor - 1 year waiting period
Waiting period for TIA, stroke, intracerebral or subarachnoid hemorrhage with no risk for seizure, Surgically repaired arteriovenous malformation/aneurysm
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DOT Exam Study Guide
with no risk for seizure, Surgically removed infratentorial meningioma, acoustic neuromas, pituitary adenomas, benign spinal tumors, or other benign extra-ataxial tumor with no risk for seizures
- Excessive daytime sleepiness
Sleepiness when an individual is supposed to be
awake and alert, Daily or almost daily for 3 months
or greater - Mallampati Score
of 3 or 4
A risk factor for OSA… Upper airway narrowing; This
standardizes the assessment of the oropharynx - Any driver with a neurological defecit that requires Annually
special evaluation and screening should have a medical certification how often? - Transient Ischemic Attack
(TIA)
Focal Neurological Dysfunction in which there is inadequate blood supply to a portion of the brain; Usually last a few sections but usually less than 30-40
minutes - How long is the waiting period for someone who has 1 Year
had a TIA? - Annual Certification
How often should someone be recertified if they have
a history of TIA? - Caused by large artery atherlosclerosis, often pre- Thrombotic Stroke
ceded by TIA; Treatment: Antiplatelet agents (Aspirin,
Plavix) and Surgical: Carotid Endarterectomy - The heart is usually the source; This prognosis is Embolic Stroke
usually worse than the thrombotic stroke because the
emboli is larger, a larger stroke area, and there in
increased incidence of blood at the stroke site; Treatment: Medical – Coumadin, Requires INR Monitoring,
Increases bleeding risks - Intracerebral Hemorrhage
Bleeding into the substance of the brain, caused by
ruptered arteriovenous malformation (AVM)
13 / 24
DOT Exam Study Guide - Subarachnoid Hemorrhage
Bleeding primarily into the space around the brain,
often from a ruptured aneurysm - WHAT IS THE WAITING PERIOD FOR THROMBOTIC
AND EMBOLIC STROKE - Cortical or Subcortical Stroke
1 year for the stroke plus an additional 4 years if
there is a seizure risk; Must be seizure-free and off
anticonvulsant meds for 5 years; may shorten waiting
periods after consultation with an expert in epilepsy - Off all seizure
meds, Seizure
free for 1o years,
has a neuro clearance
A clinician can only certify drivers with an established hx of epilepsy if: - 5 years seizure
free and off of anticonvulsants
Minimum waiting period after a single, unprovoked
seizure - Excessive Daytime Sleepiness
Sleepiness when the individual is expected to be
awake and alert; Daily or almost daily for nearly 3
months or greater - OSA, Narcolepsy,
Restless Leg Syndrome
3 Primary Sleep Disorders - OSA (Obstructive
Sleep Apnea)
The most common sleep disorder that causes Excessive Daytime Sleepiness - Apnea Hypopnea
Index (AHI)
This index and the blood oxygen saturation determines the severity of the Obstructive Sleep Apnea - This score standardizes the assessment of the Mallampati Score
oropharynx - A score of 3 or 4
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DOT Exam Study Guide
A Mallampati Score of what standardizes the assessment of the oropharynx
- A hallmark of OSA but a poor predictor because of Chronic Snoring
the prevelance in the general population - Witnessed apneas or breathing
pauses during a
sleep study
A good predictor of OSA but not its severity; 6% of the
population without OSA experience this during sleep - Men >17″ and
Women >16″
Measurement of neck size in men or women that is a
predictor of OSA - Neck circumference
In men with the a BMI >40 what is the greatest predictor of OSA severity? - A neck circumference of _ indicates high risk of 20″
OSA - Epworth Sleepiness Scale of 16 or higher Disqualified
- Grant a limited-time certification (Typically
around 30 days)
A driver presents with suspected OSA. What can the
provider give them while awaiting a sleep study? - Full, Attended
Polysomnography
or = to 7 channels in a lab setting, gold standard, diagnoses all sleep disorders, this is required when the
examiner suspects another sleep disorder in addition
to sleep apnea
- Full, Unattended
Polysomnography
or = to 7 channels- Home sleep tests use what type of tests? Limited Type 3 or 4
channel devices and usually uses oximetry as a parameter
142.
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DOT Exam Study Guide
Maintenance of
Wakefullness Test
A test based on staying awake as an indicator of a
sleep disorder or of treatment effectiveness
- Multiple Sleep Latency Tests
A test based on going to sleep as an indicator of a
sleep disorder or of treatment effectiveness - Airflow ceases for 10 or more seconds Apnea
- Airflow decreases for 10 or more seconds Hypopnea
- Apnea/Hypopnea
Index
Mild: 5+ Episodes/Hour
Moderate: 15+ Episodes/Hour
Severe: 30+ Episodes/Hour - Airflow ceases
while effort to
breathe continues followed by
arousal after airflow resumes
Polysomonogram shows what happens when - An AHI >_/hour needs treatment 20
- A sleep study diagnostic for OSA that requires treat- Disqualifying
ment is __ until treatment is documented - At least 4
hours/night for
70% of nights
PAP compliance is - According to the FMCSA how long should you wait to 1 month
certify after patient starts PAP? - The use of _ _ cannot be considered an accept- Dental Appliances
able alternative in treating OSA - 3 month certification
If a driver is PAP compliant at one month, how long
of a certification can they be issued? - 1 year certification
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DOT Exam Study Guide
If a driver is PAP compliant at 3 months, how long of
a certification can they be issued?
- A BMI of __ requires a sleep study according to the 35
FMCSA - Usually requires 6 months or more to lose weight, Bariatric Surgery
may use CPAP until there is adequate weight loss to
treat OSA, requires annual certification, reevaluate if
there is a 5% weight gain or symptoms recur - Oropharyngeal
UPPP
This surgery removes tissue in the throat, 1 month
waiting period, annual recertification is required, 50%
failure rate - Driver sees examiner 1-month post-op, no excessive Tracheostomy
sleepiness, annual recertification is required - Limited Certification
A _ _ can be granted to someone who had an
OSA dx, claims compliance, but does not have a co
p,iance report - Cognitive Abilities
and Behavorial Inhibitors
Is the presence of a mental disorder or its residual
symptoms disqualifying because it interferes with
_ and _? - The ability to process environment cues rapidly and Cognitive Abilities
make appropriate responses - Behavioral Inhibitors
The ability to suppress inappropriate, irresponsible,
or violent actions - People with chronic schizophrenia should be disqual- Disqualified
ified - At least every two
years
How often should a driver with a psychotic disorder
be evaluated and cleared by a medical specialist? - 6 months
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DOT Exam Study Guide
Minimum _ symptom free waiting period if the driver suffered a brief reactive psychosis or schizophreniform disorder
- Waiting period for every other psychotic disorder be- 1 year
sides brief psychosis or schizophreniform disorder - Those on antipsychotic drugs like Rispersdal, 1 year
Zyprexa, Seroquel, and Abilify can only be certified
for how long? - Loss of interest or motivation, poor sleep, appetite Major Depression
disturbance, fatigue, poor concentration, and indecisiveness - Severe Depression
Characterized by psychosis, significant percentage
commit suicide, there is a risk of relapse, severe psychomotor retardation or agitation, cognitive impairment, and poor judgement - Not in therapeutic
range
Lithium is used to treat acute mania and bipolar disorders. A driver should be disqualified if they have a
disqualifying psychological condition or if their lithium levels are… - Interfere with safe
driving
1st generation anti-depressants - Case by Case
Evaluation
2nd Generation Anti-Depressants have fewer side effects and are generally safe but can interfere with driving and require… (Examples include Prozac, Zoloft,
Effexor, Wellbutrin) - Complies with the
treatment program, tolerates
treatment, and
has a comprehensive eval from an
Recommend certifying someone with a Personality
disorder if they
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DOT Exam Study Guide
appropriate medical professional
- How long max can you certify someone with Adult 1 year
ADHD? Symptoms include age-inappropriate inattention, impulsiveness, hyperactivity, mood liability, low
frustration, and explosiveness - How long can you certify someone using CNS stimu- 1 year
lants like Adderral, Ritalin, and Pemoline? - Complex intellectual functions
CNS stimulants improve performance on simple
tasks but not on tasks requiring - The FMCSA recommends that you _ someone on Do not certify
benzodiazepines ex. Ambien - Comprehensive
eval from a
medical
professional and
no disqualifying
side effects
Electro convulsive therapy is used to treat major
depression, schizophrenia, and related psychotic
episodes. Causes confusion, disorientation, and a
loss of short-term memory that usually resolve. The
examiner should not certify a driver who has maintenance ECT but can certify a driver if… - The use of _ oxygen is disqualifying Supplemental
- Inflammation of the nasal portion of the respiratory Allergic Rhinitis
tract that causes sneezing, coughing, watery eyes,
and rhinorrhea; Max certification is two years - 1st generation antihistamines
Are avaliable without an RX and are sedating – You
should abstain from antihistatimes for 12 hours prior
to operating a CMV - Chronic reduction of the maximal expiratory flow COPD
most often caused by a combination of chronic bronchitis and emphysema, need PFT to diagnose, smoking is the primary cause
183.
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DOT Exam Study Guide
Pulmonary Function Test
Obtain this test if there is any history of specific lung
disease, any symptoms of SOB, chest tightness, or
wheezing
- Airway Obstruction
FEV1 <65% of predicted; FEV1/FVC ratio <65% - Restrictive Impairment
FVC <60% of predicted, Obtain Oximetry - If the oximetry is less that 92% then what is the next Obtain ABGs
step that needs to be taken? - Do not certify if _ <65mm HG at altitudes below PaO2
5000 feet and <60 mm HG at altitudes above 5000 feet - Do not certify if _ >45 mm HG at any altitude PaCO2
- Compliant with antitubercular therapy and has no side
effects interfering
with safe driving
The risk of recurrence of pulmonary TB is low after
adequate therapy – Advanced TB may cause respiratory insufficiency – You should not certify a driver if
they are not _ and _ - TB treatment can cause what eye issues that can be Color Blindness
disqualifying? - Max certification for someone with Cystic Fibrosis 1 year
(They must have continuous antibiotic therapy and
daily respiratory therapy to mobilize secretions) - Can be traumatic or spontaneous, treated with a Pneumothorax
chest tube, complete recovery confirmed by CXR,
max certification is two years - Two or more spontaneous pneumothorax on one
side if no procedure has been
Who should not certify someone with Pneumothorax
whos has hypoxemia with rest, Chronic respiratory
failure, cough with syncope, and…
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DOT Exam Study Guide
done to prevent recurrence
- Hypertrophy and/or dilation of the right ventricle sec- Cor Pulmonale
ondary to disorders that affect lung structure or function – Secondary to left heart disease - Major symptoms of Cor Pulmonale include dizziness, Vasodilators
hypotension, and syncope. What medication does
someone with Cor Pulmonale possibly take that can
interfere with safe driving? - You may certify someone diagnosed with Cor Pul- Pulmonary HTN
monale if their _ __ is treated and has resolved.
They should be recertified every 3-6 months. - This driver should be disqualified because it means Disqualified
that they have chronic fixed pulmonary hypertension - A pulmonary emboli is a clot. How long is the waiting 3 months
period for this clot in which a DVT is a major source? - 1 month waiting
period
If a user is on Coumadin they must be properly monitored, shift needs to focus on the underlying condition, and user must wait _ prior to certification - There is a one month waiting period for Coumadin, Monthly
driver needs to also bring a copy of INR results to the
exam, and you must monitor the INR how often? - Exercise Tolerance Test
Most commonly used to detect CAD, less expensive,
love sensitivity - Left Ventricular
Function
Major prognostic indicator in CAD, Ejection Fraction
40%, LVEF does not correlate with exercise capacity,
LVEF does correlate with risk for sudden death
- The measurement of how much blood the left ventri- Ejection Fraction
cle pumps out with each contraction
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DOT Exam Study Guide
- To be certified, a driver with heart disease should >6 METS
exercise to a workload capacity of __ - Waiting period after an MI 2 months
- Stable Angina
Pectoris
Predictable causes, lower end of adverse CAD outcomes, at least one coronary artery has hemodynamically significant narrowinng - There is a maximum one year certification for Stable No waiting period
Angina Pectoris. What is the waiting period? - Unpredictable, symptoms can include pain at rest, Unstable Angina
change in angina (increased frequency and longer
duration), precursor to CV event - 3 months before
the exam
DO NOT certify if: Unstable Angina in the _ _ _ _ __, there has been no waiting period, and needs
evaluation - Coronary Artery
Bypass Graft
(CABG)
For multi-vessel CAD, left coronary artery, extensive
atherosclerosis with debilitating angina, re-occlusion
risk increases after 5 year - Angina should prompt what? Imaging Study
- >6 METS, LVEF >
40%, NYHA Class
1
With heart failure 10-30% of all deaths are sudden. Do
not certify a driver until you confirm that treatment is
adequate, effective, and safe. What are the minimum
METS, LVEF, and NYHA classifications? - New York Heart
Association Classicications
NYHA - No limitations; No symptoms from ordinary activities NYHA Class 1
- Supraventricular
Tachycardia
Can compromise cerebral function and cause loss of
consciousness, Catheter ablation is usually curative
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DOT Exam Study Guide - Major risk is cardiac embolism causing stroke Atrial Fib
- 1 month waiting
period, 1 year certification
_ waiting period post-ablation or other treatment for Atrial Fib, certify for _ __ if asymptomatic,
anti-coagulated adequately, heart rate controlled, no
disqualifying underlying disease - A person presents with WPW with A-Fib, loss of con- Do not cerify
sciousness, sudden death resuscitated. Should they
be certified? - Durable and reliable, waiting period is 1 month post Pacemaker
implantation, annual certification if the driver complies with scheduled function checks - A symptom that occurs irregularly, hard to know if Syncope
treatment was successful, causes can be cardiac,
non-cardiac, or unknown - Most common cause of non-cardiac syncope Vasovagal
- If a person is syncope free for 3 months and it is not 1 year
recurrent, how long can they be certified for? - A person presents with neurocardiogenic syncope. Do not certify
Can they be certified? - 13 Regualatory Standards that are enforced by the 49 CFR 391.41
FMCSA and must be followed. 9 are discretionary and
4 are non-discretionary. - 49 CFR
391.41 Non-Discretionary Standards (No examiner discretion)
4 Standards: Hearing, Vision, Epilepsy, Insulin Treated Diabetes - Ear disorders, loss
of hearing or
Health History Hearing/Ear Form
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DOT Exam Study Guide
balance, fainting,
dizziness - Stage 1 HTN and on BP med. How long can you certify 1 year
for if the patient’s BP is <140/90? - Stage 2 HTN 160-179/100-109
- Stage 3 HTN >180/110
- For someone with Stage 3 HTN, if BP falls <140/90 – Every 6 months
Certify for 6 months with recertification how often? - Complete recovery from a pneumothorax should be Chest X-Ray
confirmed by? - Someone with
a pneumothorax
who you should
not certify
A history with two spontaneous pneumothoraces on
one side if no surgical procedure has been done
to prevent recurrences, hypoxemia at rest, chronic
respiratory failure, a history of continuing cough with
cough syncope - Recommend certifying a driver with
a pneumothorax
who…
Has confirmed resolution of a single spontaneous
pneumothorax, has succesful pleurodesis, and meet
acceptable pulmonary parameters - A group of medical conditions characterized y chron- COPD
ic reduction of maximal expiratory flow, most often
caused by a combination of chronic bronchitis and
emphysema
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