NRCME Test Bank Questions & Answers
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\u2014monitor 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
(Ans- 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
(Ans- 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
(Ans- 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.<\/p>\n\n\n\n
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
(Ans- 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
(Ans- 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
(Ans- 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
(Ans- C) The medical examiner should first determine blood glucose and
then make an appropriate certification determination and referral<\/p>\n\n\n\n
Drivers with a history of _<\/em><\/strong><\/em><\/strong> severe hypoglycemic reactions in A driver with a diabetes exemption should check glucose levels when? NRCME Study Guide: Questions & hearing requirements Regulation that describes the Skill Performance Evaluation (SPE) Define Stage II hypertension. NRCME Test Questions & Answers d. Consult with the cardiologist to determine if the driver suffers from “A”. A driver must exhibit a minimum peripheral vision of 70 degrees (- Correct answer is “A”. Medical clearance is required for all mental health NRCME DOT Exam Review – NRCME What objective tests and measurements are required as part of the driver B: 4\/16\/2012 (Ans- 20\/40 on Snellen chart in each eye individually AND in both eyes NRCME Prep Exam: NRCME Certification Exam Anticoagulation for a neurologic condition may be certified up to: NRCME DOT Examiner Test Practice (- Correct Response: Comprehensive Review for NRCME A driver who wears contact lenses which correct farsightedness in one eye (Ans- Providing the driver with contact information for the Federal Vision Which of the following drivers’ tests meet hearing certification standards? NRCME (DOT) Exam: Questions & Who regulates treatment\/management and aftercare of substance abuse SPE if applicable NRCME Exam: (Prep for the examination DOT Exam: Questions & Answers a driver who has an ICD can be certified for what period of time when he or a. 50 DOT practice Questions & Answers -target educational messages to carriers, commercial drivers, and the -a review process that prevents or identifies and corrects the inappropriate DOT Certification Exam (FMCSA) Motor carriers are responsible for ensuring their commercial drivers: DOT EXAM: Questions & Answers The grace period for the expiration of a Medical Examiner’s Certification is application Ensure that the driver with an existing SPE certificate is DOT certification Exam: Questions & (Ans- driver fatigue discretionary guides\/recommendations “average” driver demographics DOT Certification Exam: Questions & (Ans – Order a spirometer test The driver presents for recertification and submits an ultrasound report The driver’s current BP is 135\/76. Your records indicate at history of Stage NRCME (DOT) Exam Test Bank: C. Motor Carrier D. Tonometry pressure NRCME Test Bank Questions & AnswersWhich of the following is a requirement for drivers with a diabetesexemption?A) Possess a rapidly absorbable form of glucose while drivingB) Self\u2014monitor blood glucose one hour before driving and at least onceevery 2 hours while drivingC) Plan to submit blood glucose monitoring logs every 6 monthsD) Maintain a Hemoglobin A1C […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[25],"tags":[],"class_list":["post-117254","post","type-post","status-publish","format-standard","hentry","category-exams-certification"],"_links":{"self":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/117254","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/comments?post=117254"}],"version-history":[{"count":0,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/117254\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/media?parent=117254"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/categories?post=117254"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/tags?post=117254"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
the past year or _<\/em><\/strong><\/em><\/strong> severe hypoglycemic reactions in the past
five years should not be certifed.
A) one, three
B) one, two
C) two, three
D) two, five
(Ans- 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
(Ans- 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
(Ans- 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.<\/p>\n\n\n\n
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
(Ans- 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
(Ans- 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
(Ans- 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.<\/p>\n\n\n\n
Answers
vision requirements
(Ans- Distant vision 20\/40 each eye and 20\/40 both eyes, Peripheral vision
at least 70 degrees, Ability to recognize and distinguish between the colors
of traffic signals and devices.
If the driver presents a valid vision exemption, how long can he be
certified?
(Ans- 1 year
The driver with a vision exemption must present what 2 things before
receiving the medical examiner’s certificate.
(Ans- Valid vision exemption and copy of the specialist eye examination
report.
When applying for a vision exemption, the driver should include a copy of
the Medical Examination Report form and the medical examiner’s
certification with what marked?
(Ans- The “accompanied by” exemption checkbox and write “vision” to
identify the type of exemption.
If the driver is qualified by operation of 49 CFR 391.64 due to participation
in the vision study program, what must the driver present to qualify for
certification?
(Ans- Letter identifying the driver as a participant and copy of the specialist
eye examination.
How long can a driver who is qualified by operation of 49 CFR 391.64 be
certified.
(Ans- 1 year<\/p>\n\n\n\n
(Ans- 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.
What is the waiting period for vertigo caused by benign positional vertigo or
acute\/chronic peripheral vestibulopathy?
(Ans- 3 months
Name 4 otic conditions that are automatic disqualification
(Ans- Meniere’s, uncontrolled vertigo, labyrinthine fistula, nonfunctioning
labyrinth
Apnea-hypopnea index of [blank] or more episodes per hour is diagnostic
of OSA
(Ans- 30
3 requirements for a passing ETT
(Ans1. increased SBP of at least 20 without angina<\/p>\n\n\n\n\n
Examiners must retain records for how many years?
(Ans- 3
Regulation that describes the physical qualifications of drivers.
(Ans- 49 CFR 391.41
Regulation that describes the responsibilities of the medical examiner.
(Ans- 49 CFR 391.43
Regulation that describes the process for conflict resolution when there is a
disagreement between the primary care provider for the driver and the
medical examiner for the motor carrier concerning driving qualifications.
(Ans- 49 CFR 391.47<\/li>\n<\/ol>\n\n\n\n
Certification Program.
(Ans- 49 CFR 391.49
Regulation that describes limited exemptions for intra-city zone drivers.
(Ans- 49 CFR 391.62
Regulation that describes grandfathering for certain drivers who
participated in vision and diabetes waiver study programs.
(Ans- 49 CFR 391.64
Regulation that includes regulations for medical review officers and
substance abuse professionals, including drug and alcohol testing
procedures.
(Ans- 49 CFR 40
Define Stage I Hypertension
(Ans- BP greater than or equal to 140\/90
What is the maximum certification period for stage I hypertension if this is
the 1st examination at which the driver has BP equivalent to stage I
hypertension and has no history of hypertension?
(Ans- 1 year
What is the maximum certification period for untreated known or
inadequately controlled stage I hypertension?
(Ans- 3 months
What is the maximum certification period for blood pressure >140\/90 and
the following: follow-up 3 months certificate or history of stage III
hypertension
(Ans- None, driver is disqualified<\/p>\n\n\n\n
(Ans- BP is \u2265 160 to <180 SYSTOLIC, and is \u2265100 to < 110 Diastolic What is the maximum certification period for Stage II hypertension with blood pressure >140\/90?
(Ans- 3 months
What is the maximum certification period for Stage II hypertension with
blood pressure 180 Systolic and > 110 Diastolic
What is the maximum certification period for Stage III hypertension with
blood pressure >140\/90?
(Ans- 1 time certificate for 3 months in accordance with stage 1 or 2 HTN
guidelines, as determined by a case by case basis.
What is the maximum certification period for a driver with a history of Stage
III hypertension but t exam his BP is at or less 140\/90 and treatment is well
tolerated?
(Ans- 6 months
What is the maximum certification period for Stage III hypertension with
blood pressure >180\/110?
(Ans- None, driver is disqualified.
What is the waiting period and maximum certification period for surgical
correction of secondary hypertension?
(Ans- 3 months and 1 year post surgical correction
What is the waiting period and maximum certification period for driver on
anticoagulants for cardiovascular cause?
(Ans- 1 month stabilized and 1 year with monthly INRs<\/p>\n\n\n\n
What minimum PaO2 level is necessary if the driver has an ABG due to a
chronic respiratory disorder?
a.70mmHg
b.55mmHg
c.60mmHg
d.65mmHg
(- Correct answer is “D”. To be qualified, the driver should meet a
minimum arterial blood gas (PaO2) greater than 65.
A driver first perceives a whispered voice at 5 feet in his right ear and 4 feet
in his left ear. All other aspects of his physical examination are
unremarkable. The examiner should:
a.Permanently disqualify the driver because he “failed” the whispered voice
test.
b.Certify the driver for 2 years.
c.Certify the driver for 1 year.
d.Require an audiometric test to determine the extent of hearing loss in his
left ear.
(- Correct answer is “B”. The driver is qualified to drive without restriction as
long as he is able to perceive a whispered voice at 5 feet in 1 ear.
A driver reports for an examination 6 weeks after suffering a mild heart
attack and presents a note from his cardiologist stating that he is able to
return to work immediately without restriction. Included within the note, the
cardiologist provides recent testing information showing that the driver had
an ETT that showed he was able to reach 12 METS during the test. His
echocardiogram showed an ejection fraction of 65%. The examination of
the driver is unremarkable. The examiner should:
a. Temporarily disqualify the driver.
b. Qualify the driver for 1 year.
c. Qualify the driver for 2 years.<\/p>\n\n\n\n
angina.
(- Correct answer is “A”. The driver has not completed the required 2-
monthwaiting period, but all other requirements for medical clearance and
required testing have been met. The driver would be certified for 1 year at
the completion of the waiting period. The date of the certification would be
from the date of the original examination.
A driver provides an audiometric test documenting the following:<\/p>\n\n\n\n\n
35 Right ear; 40 Left ear 40 Right ear; 45 Left ear 40 Right ear; 45 Left ear
50 Right ear; 50 Left ear
5.
The medical examiner should:
a. Disqualify the driver because he does not meet minimum hearing
requirementsto drive.
b. Certify the driver for 2years.
c. Certify the driver for 1 year.
d. Require the driver to obtain a hearing exemption.
(- Correct answer is “B”. The examiner would average the results from 500
Hz, 1000 Hz and 2000 Hz. This average is 38.33 in the Right and 43.33 in
the Left ear. A driver must have an average hearing loss of less than or
equal to 40 in the better ear. This does not have to be met in both ears.
During the examination of a commercial driver, the examiner notices that
the driver’s peripheral vision is 70 degrees to the left and 80 degrees to the
right. The examiner should:
a. Qualify the driver for 2 years.
b. Require the driver to obtain a vision exemption because of the limitation
in the driver’s
left peripheral field.
c. Disqualify the driver.
d. Have the driver consult with an Ophthalmologist to determine if the
driver’s peripheral vision meets minimum standards. (- Correct answer is<\/li>\n<\/ol>\n\n\n\n
bilaterally.
A driver admits to the use of marijuana for the treatment of his glaucoma,
which is legal in the State in which he lives. He provides medical
documentation for the glaucoma indicating he is able to drive a truck. He
began using the marijuana about three months ago. His current medical
card has no limitations listed and is for 2 years. His certification
examination is within normal limits. The medical examiner should:
a. Disqualify the driver.
b. Perform a urine drug collection and provide the release from the testing
provider.
c. Certify the driver for 1 year.
d. Certify the driver for 2 years.
(- Correct answer is “A”. Use of marijuana is prohibited by Federal law
while driving a CMV and trumps State law in this matter.
A driver has a blood pressure of 136\/92 mm Hg. This is:
a. Within normal limits and would not affect the driver’s certification.
b. Stage 1 Hypertension.
c. Stage 2 Hypertension.
d. Stage 3 Hypertension.
(- Correct answer is “B”. This is Stage 1 Hypertension, which is defined as
140-159\/90 – 99.
A driver is taking Celexa for the treatment of what he calls a “mild
depression.” He reports he has not considered or attempted suicide. The
examiner should?
a. Temporarily disqualify the driver until he obtains written clearance for the
depression and the medication from the treating provi
b. Certify the driver for a period of 1 year.
c. Certify the driver for a period of 2 years.
d. Disqualify the driver until he is no longer requiring medication for the
treatment of depression.<\/p>\n\n\n\n
disorders. Celexa is an SSRI or 2nd Generation anti-depressant and is
acceptable.
A driver reports that he had a hunting accident wherein he suffered a left
orbital fracture. He presents a note at the time of the examination from an
ophthalmologist stating “may drive”. His exam is unremarkable except for a
limitation in peripheral vision in his left eye, which was inconclusive. His
distance vision was 20\/20 right and 20\/40 left. The medical examiner
should?
a. Council the driver on the need for a vision exemption.
b. Disqualify the driver pending vision exam to determine if it meets
peripheral vision requirements.
c. Certify the driver for 1 year.
d. Certify the driver for 2 years.
(- Correct answer is “B”. The driver must have a peripheral vision of 70
degrees bilaterally to certify to drive a CMV.
What minimum PaO2 level on an ABG performed for a chronic respiratory
disorder is necessary to certify a commercial driver?
a. 55 mm Hg.
b. 60 mm Hg.
c. 65 mm Hg.
d. 70 mm Hg.
(- Correct answer is “C”. Blood oxygen saturation must be a minimum of 65
mm Hg for the driver to certify.
A driver is taking Topamax for the treatment of migraine headaches. He
reports good management of his headaches and they never seem to
interfere with his driving ability with the medication. The medical examiner
should?
a. Obtain medical clearance for the condition and the medication.
b. Disqualify the driver because he is taking an anti-seizure medication.
c. Certify the driver for 1 year.<\/p>\n\n\n\n
Training Institute Material
What is the mission of FMCSA?
(Ans- FMCSA is focused on reducing crashes, injuries, and fatalities
involving large trucks and buses.
Who and what does the FMCSA regulate?
(Ans- Interstate commercial operation, including the driver, vehicle, motor
carrier, and the transport of hazardous materials.
Examples of CMV driver stress factors
(Ans- Interruption of normal sleep, exercising, eating pattern, and access
to social support networks resulting in fatigue, obesity, and or\/alienation of
affection. Environment that may have excessive vibration, noise, and
extremes in temperature and or\/adverse road or traffic conditions that can
interfere with driver ability to recognize a driving hazard, cause temporary
or permanent physical damage to sensory perception or affect driver
behavior. Increased potential for injury and fatalities should there be a
crash when driver is responsible for passenger safety or hazardous cargo.
What are the differences between the medical standards and medical
guidelines?
(Ans- Regulations are law and are mandatory. The ME must use
standards to determine interstate CMV driver medical fitness for duty.
Medical guidelines are not regulatory and the ME may choose not to follow
the medical guidance.
In which regulations are the driver physical qualification standards and
Medical Examiners cited?
(Ans- Driver physical qualification standards are found in 49 CFR 391.41.
ME responsibilities are found in 49 CFR 391.43<\/p>\n\n\n\n
physical examination?
(AnsHeight & weight
Vision
Hearing
BP & pulse
Urinalysis (spec gravity, protein, blood, glucose)
What are the possible outcomes of the driver physical examination?
(Ans- Certification
Disqualification
Determination pending
What date is used to determine medical examiners certificate expiration?
(Ans- The date of the exam is used as the basis for certificate expiration,
except when determination pending is chosen.
When determination pending is chosen, if the driver returns with the
necessary information prior to the expiration of the driver’s current
certificate and the driver is qualified based on that information provided, the
date used for the basis of the certification timeframe is the date the driver
returned with the necessary information.
What is the ME certificate expiration date for the following drivers?
A – Exam 4\/16\/2011, meets standards in 49 CFR 391.41, qualifies for 2
year certificate.
B – Exam 4\/16\/2011, meets standards, but periodic monitoring required due
to HTN, qualifies for 1 year certificate.
C – Exam 4\/16\/2011, determination pending due to not having results of
post-CABG stress test, pt returns and provides that info on 4\/25\/2011,
driver is qualified for 1 year.
D – Exam 4\/16\/2011, disqualified due to benign position vertigo on
3\/15\/2011, returned to ME for certification examination on 5\/20\/11. He has
been asymptomatic since 3\/11\/2011. Qualified for two years.
(Ans- A: 4\/16\/2013<\/p>\n\n\n\n
C: 4\/25\/2012
D: 5\/20\/2013
Patient example:
Karen, recertification exam
42 y\/o female
No health history, no medications.
Vision acuity: right 20\/20, left 20\/30. Both 20\/20. Horizontal field of vision Rt
80 degrees, Lt 80 degrees. Not corrected vision.
No monocular vision.
No hearing aids, Whisper test 5′ bilaterally. N\/A audiometric testing
UA: spec grav 1.020, protein 1+, blood 4+, glucose neg.
Hgb 12.4
BP 134\/88, P 80, regular.
PE: on 4th day of menses with heavy bleeding. Advised to consult PCP or
GYN for eval of excessive bleeding that could lead to anemia, leading to
fatigue that would affect her driving.
(Ans- Two year certification – no disqualifying health history or PE
abnormalities.
Ask about medication use, including OTC medications.
ME obtained hemoglobin testing based on PE findings. (not required)
The ME should correctly note the body system in which there was an
abnormal finding. The note reflects inquiry as to the affect on driving ability
and is also supported by Hgb test results. ME also documented medical
follow up advice.
Who can perform the vision portion of the interstate CMV driver physical
examination?
(Ans- The certified ME, optometrist, or an opthalmologist. If the specialist
provider performs the exam, they should complete and sign the provider’s
information on the report form and provide the results.
To pass the interstate CMV driver vision exam, a visual acuity of
_<\/em>\/___corrected or uncorrected is required.<\/p>\n\n\n\n
combined.
What eye conditions must the ME ask the driver about and if indicated,
request specialist evaluation?
(Ans- Retinopathy, cataracts, aphakia, glaucoma, and macular
degeneration.
Pt example:
Mr. Brown, 48 y\/o male. No current meds, injury 5 years ago. Hunting
accident 2 years ago with facial trauma and left orbital fracture. Presented
a “may drive” note from eye surgeon (dated 3 months prior to examination).
Uncorrected vision, right eye 20\/20. left eye 20\/40. Both 20\/20. Horizontal
field of vision Right 80 degrees, left eye is inconclusive. No monocular
vision. No hearing aids. Whisper test 5′ bilaterally. N\/A audiometric test. UA
normal. BP 122\/74, p 80, regular.
(Ans- Exam findings: Left eye muscles do not move eye to the left,
discussed disqualification pending eye exam by specialist. Explained the
specialist will get precise visual field measurements. Provided driver with
appropriate medical release and copy of medical exam report with vision
section highlighted.
Driver does not meet requirements. He is pending specialist vision exam.
Diminished vision in left eye noted. Pt could be functionally monocular.
What is the purpose of the interstate CMV driver physical examination?
(Ans- To detect the presence of physical, mental, or organic conditions of
such character and extent as to affect the driver ability to operate a CMV
safely. This exam is for public safety determination and is considered by
FMCSA to be a “medical fitness for duty” examination.
Examples of “yes” answers for hearing and ears on the health history that
may require further examination before a certification decision can be made
(Ans- Ear disorders
Loss of hearing
Loss of balance<\/p>\n\n\n\n
Review
The minimum waiting period following PCI is:
(Ans- 1 week
The minimum waiting period after pacemaker implantation is:
(Ans- 1 month
The maximum thoracic aneurysm size allowable for certification is:
(Ans- 3.5 cm
After heart replacement surgery the minimum waiting period is:
(Ans- 1 year
After heart transplant surgery the maximum certification period is:
(Ans- 6 months
For mild aortic stenosis, how often should an echocardiogram be repeated?
(Ans- 5 years
For moderate aortic stenosis, how often should an echocardiogram be
repeated?
(Ans- 1-2 years
What is the waiting period for pacemaker implantation related to syncope?
(Ans- 3 months
The waiting period following CABG is:
(Ans- 3 months
Anticoagulation for a cardiac condition may be certified up to:
(Ans- 1 year<\/p>\n\n\n\n
(Ans- DO NOT CERTIFY
What is the minimum LVEF for certification with respect to any
cardiovascular condition?
(Ans- >40%
The minimum waiting period after surgical repair of an AAA is:
(Ans- 3 months
The maximum certification after surgical repair of an AAA is:
(Ans- 1 year
The maximum certification of a patient with CHF is:
(Ans- 1 year
Drivers should exercise to a minimum of _<\/em> MET on stress test.
(Ans- 6 MET
For drivers on coumadin, how often should they have their INR rechecked?
(Ans- monthly
What is the waiting period for an implanted cardiac defibrillator?
(Ans- NONE. DO NOT CERTIFY
What is the waiting period for WPW with a fib?
(Ans- NONE. DO NOT CERTIFY
What is the waiting period for stable angina?
(Ans- 3 months
What is the waiting period following MI?
(Ans- 2 months<\/p>\n\n\n\n
Questions
According to FMCSA regulations, which of the following must the medical
examiner evaluate when examining a driver’s eyes?
A. Pupil reactivity
B. Iris symmetry
C. Conjunctival injection
D. Corneal thickness
(- Correct Response:
A. Pupil reactivity
Incorrect Responses:
B. Iris symmetry
This is incorrect because determining iris symmetry is not required by
FMCSA.
C. Conjunctival injection
This is incorrect because most causes of conjunctival injection would not
be disqualifying. Causes that are suspicious for a disqualifying condition
need additional evaluation. While this abnormal finding should be
explained, with determination of possible effects on safe driving before
making a certification decision, it is not a condition that is specified in
FMCSA regulations.
D. Corneal thickness
This is incorrect because it is not measured in an office examination except
by an eye specialist.
According to FMCSA regulations, medical qualification for two years can be
given to a driver who has\u2026 ?
A. An SPE certificate for a left below the knee amputation (BKA).
B. Hypertension.
C. A recent diagnosis of Lewy body dementia.
D. Documented medical marijuana use for pain control.<\/p>\n\n\n\n
A. An SPE certificate for a left below the knee amputation. This is the
correct response because in order to obtain the SPE certificate, the driver
had to demonstrate the ability to perform all tasks for the commercial driver
job description.
Incorrect Responses:
B. Hypertension.
This is not the correct response because drivers with hypertension are only
given a medical certificate that is good for one year.
C. A recent diagnosis of Lewy body dementia.
This is not the correct response because this is a progressive,
degenerative condition with no known treatment. The effects of Lewy body
dementia impact the ability to operate a CMV safely.
D. Documented medical marijuana use for pain control.
This is not the correct response because marijuana remains a drug listed in
Schedule I of the Controlled Substances Act. It remains unacceptable for
any safety-sensitive employee subject to drug testing under the drug
testing regulations of DOT to use marijuana. Also, FMCSA medical
guidelines state that “driving impairment due to marijuana use is well
substantiated.”
During his visit to the medical examiner, a driver complains of severe pain
in his finger for the last two weeks after it was punctured. The examination
reveals an infected, swollen finger. After the medical examiner inquiries,
the driver states that the pain is made worse when he grips the steering
wheel. Which of the following should the medical examiner do next?
A. Obtain a hand X-ray.
B. Assess capillary refill in the hand.
C. Obtain a culture and sensitivity.
D. Assess the driver’s grip strength.
(- Correct Response:
D. Assess the driver’s grip strength. This is the correct response because
the condition does not present a safety risk unless it interferes with the
ability of the driver to hold and control the steering wheel.<\/p>\n\n\n\n
Exam: NRCME DOT Comprehensive
Review Exam
Corrective lenses that are prohibited by the FMCSA, including:
(Anslenses that correct distance vision in one eye and near vision in the other.
telescopic lenses
Medical guidelines for the driver with diabetes mellitus include:
(AnsAnnual medical examination.
Annual ophthalmologist or optometrist eye evaluation.
Disqualification for a diagnosis of unstable proliferative retinopathy.
Monocular Vision
(AnsMonocular 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.<\/p>\n\n\n\n
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.
(Ans- 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:
(Ansa) Uncontrolled vertigo.
b) M\u00e9ni\u00e8re’s disease.
c) Nonfunctioning labyrinth.
d) Nonfunctioning fistula.
The medical examiner’s role in the exemption process includes _<\/em><\/strong>.
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.<\/p>\n\n\n\n
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.
(Ans- 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.
(Ans- 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.<\/p>\n\n\n\n
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.
(Ans- 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 __<\/em><\/strong>.
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.
(Ans- 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<\/p>\n\n\n\n
Answers
FMCSA Mission Statement
(Ans- To reduce crashes, injuries, fatalities involving large trucks\/buses
Medical Examiner
(Ans- Licensed, certified, registered provider who can perform PEs in
accordance with laws and regulations ; registered through NRS ; has
unique identifier ; passes MEC test
FMCSA
(Ans- Federal Motor Carrier Safety Administration
NRCME
(Ans- National Registry of Certified Medical Examiners
Commerical Motor Vehicle
(Ans- Weight >1000 lb ; or transports >8 people for compensation ; or >15
people without compensation ; transports hazardous materials requiring
placarding
Interstate commerce
vs.
Intrastate commerce
(Ans- Interstate: multiple states or international
Intrastate: within 1 state<\/p>\n\n\n\n
for drivers?
(Ans- SAP (Substance Abuse Professional)
Who determines the origin of abnormal drug test results, determining
whether the driver has violated drug use regulations?
(Ans- Medical Review Officer
Title 49 CFR 391.41 (Ans- Medical Examiner Report Form<\/p>\n\n\n\n\n
Title 49 CFR 391.43
(Ans- Describes responsibilities of Medical Examiner, instructions for
exam, and requirements for medical certification<\/li>\n\n\n\n
When was DOT established?
(Ans- 1966
Became separate entity on Jan 1, 2000
Motor Carrier Safety Improvement Act of 1999
(Ans- Established DOT as separate federal entity
Omnibus Transportation Employee Testing Act of 1991
(Ans- Required drug testing for drivers
The driver must always keep a copy of ________<\/em><\/strong><\/em><\/strong> with them
while driving
(Ans- Medical Certificate<\/li>\n<\/ul>\n\n\n\n
Does the driver need to sign a medical release before you release their
Medical Certification?
(Ans- 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?
(Ans- 13
How many standards of “driver fitness for duty” are discretionary<\/em>?
(Ans- 9
(according to my review course)<\/p>\n\n\n\n\n
How many standards of “driver fitness for duty” are NON- discretionary<\/em>?
(Ans4<\/li>\n\n\n\n
(Some sources say 3 and do not include T2DM)
Age requirement for drivers
(Ans- 21+
Language requirement for drivers
(Ans- Must be able to read\/speak English well enough to read signs,
communicate
Height\/weight requirement for drivers
(Ans- There is none<\/li>\n\n\n\n
for National Registry of Certified Medical
Examiners (for driver exams)
vision requirements
(Ans- 20\/40 each eye and 20\/40 both eyes
peripheral vision
(Ans- 70 degrees
Federal exemption for monocular vision: can certify for how long?
(Ans- 1 year
hearing requirements
(Ans- 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
(Ans- Meniere’s, uncontrolled vertigo, labyrinthine fistula, nonfunctioning
labyrinth
Max cert period for Syncope
(Ans- 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)
(Ans1. Asymptomatic<\/p>\n\n\n\n\n
biennially)<\/li>\n\n\n\n
completely healed sternal incision
Stable angina: max cert period
(Ans- 1 year
minimum waiting period post CABG
(Ans- 3 months
Min waiting period for post heart transplant
(Ans- 1 year
Max cert period for post heart transplant
(Ans- 6 months
Min waiting period post PCI (percutaneous coronary intervention)
(Ans- 1 week
Min waiting period for pacemaker implantation for sinus node dysfunction
(Ans- 1 month
Min waiting period for pacemaker implantation for neurocardiogenic
syncope or hypersensitive carotid sinus with syncope
(Ans- 3 months
Min waiting period post AAA repair
(Ans- 3 months
Max cert period for being on anticoagulation for a CV condition
(Ans- 1 year
3 criteria for certification if patient on anticoagulation for a CV condition
(Ans1. Stable on meds for 1 month<\/li>\n\n\n\n
a 30 year old driver presents for a biennial recertification. the driver notes in
his hx he’s had 3 episodes of BPV 6 months ago but has been
asymptomatic since. he provides a letter from his neurologist stating he is
cleared to work w\/o restrictions. exam is negative with no abnormalities.
how long may he be qualified
a.disqualified due to not waiting the recommended period
b.qualified up to 2 years
c.refer to tilt table test
d.refer for CT of brain
(Ans- B
use of muscle relaxants such as skelaxin, soma, or flexeril is disqualifying
(Ans- false
drivers diagnosed with the following motor neuron disease are disqualified
per FMSCA
a. ALS
b. peripheral neuropathy
c. fibromyalgia
d. myofascial pain syndrome
(Ans- A
according to the FMCSA, the driver requiring insulin may be certified for a
max of
a. 12 months
b. 6 months
c. disqualified
d. two years
(Ans- A<\/p>\n\n\n\n
she has clearance from a cardiologist
a.6 months
b.1 year
c. 2 years
d. disqualified
(Ans- D
to pass the vision exam, a visual acuity of \u2026. corrected or uncorrected is
required in each and both eyes
a. 20\/50
b 20\/40
c 20\/60
d 20\/100
(Ans- B
what eye conditions must you ask the driver about and if indicated request
a specialist?
a. retinopathy
b. cataracts
c.aphakia
d. glaucoma
e. all of the above
(Ans- E
a driver with monocular vision may apply for a federal vision exemption if
they are otherwise medically qualified
(Ans- true
examiner can only certify a driver with corrective lenses for up to 1 year per
FMSCA
(Ans- false
driver is required to have a peripheral vision of at least \u2026 in the horizontal
meridian of each eye<\/p>\n\n\n\n
b.60
c.90
d.70
(Ans- D
which of the following providers may not certify vision results
a. medical examiner
b. ophthalmologist
c.optometrist
d.neurologist
e. all may certify
(Ans- D
when corrective lenses are used to meet qualifications, the corrective
lenses must be used while driving
(Ans- true
the driver must be able to identify which colors in order to be medically fit?
a. red
b.purple
c.orange
d.blue
e.brown
(Ans- A
medical examiners have discretion when applying the vision standard to
determine if a driver can be physically qualified
a. true
b.false
c. depends on factors
(Ans- C<\/p>\n\n\n\n
Fatigue is a major concern. What do current FMCSA regulations allow from
drivers?
(Ans- 60 hours on the road over a 7 day period, or 70 hours over 8 days
(also 14 hours on the road at a stretch if given 8 hours off to rest between)
driver presents with a heart attack 1 month previous. He is following up with
his MD again in 1 week. He is unsure of his prescriptions, but is
asymptomatic. Should he be certified today?
(Ans- No. There is a minimum waiting period of 2 months and specific
criteria that must be met thereafter before certification
Driver has been trying to stop smoking for 10 years without success. 1
month ago, she began taking Chantix. She reports no blackout, suicidal
thoughts, or change in mood. The rest of the exam is normal. Can she be
qualified?
(Ans- No. Chantix is diqualifying
Which of the following diagnoses is NOT always disqualifying? (narcolepsy,
type 1 diabetes, meniere’s disease, current alcoholism, bipolar disorder)
(Ans- bipolar disorder
when asked about seizures, a driver reports several febrile seizures as a
young child. Is this disqualifying?
(Ans- No.
What does the acronym FMCSA stand for?
(Ans- Federal motor carrier safety administration
What is NOT a mission of the FMCSA?
-develop and enforce data-driven regulations that balance motor carrier
(truck and bus companies) safety with industry efficiency<\/p>\n\n\n\n
public
-partner with stakeholders including federal, state, and local enforcement
agencies, the motor carrier industry, safety groups, and organized labor on
efforts to reduce bus and truck-related crashes
-oversee the prosecution of criminally negligent cases of motor carrier
safety breaches
(Ans- oversee the prosecution of criminally negligent cases of motor carrier
safety breaches
who is NOT eligible to be a medical examiner? (APNs, DC, MD, PharmD,
DO, PA, PT)
(Ans- pharmacists and PTs cannot be medical examiners as they do not
have the training, scope of practice, or licensure that allows them to
diagnose
what is the role of the medical examiner?
-assess the driver for medical fitness to safely perform all driver duties
-ensure the driver is properly following up on any potentially dangerous
conditions
-treat the driver for health conditions
-council the driver on health conditions and consequences
-diagnose new health concerns of the driver
(Ans-
-assess the driver for medical fitness to safely perform all driver duties
-ensure the driver is properly following up on any potentially dangerous
conditions
-council the driver on health conditions and consequences
what is ensured as a part of the NRCME’s medical oversight mission?
-individuals performing medical examinations are qualified to do so and are
educated about occupational issues for drivers
-a tracking mechanism that ensures that every prior application by an
individual for medical certification is recorded and reviewed
-medical certification regulations are updated periodically<\/p>\n\n\n\n
issuance of medical certification
-all of the above
(Ans- all of the above
according to the DOT, the AVERAGE driver falls into all of these
categories, EXCEPT: (male, between 25 and 39 years of age, sedentary,
overweight, smoker, poor eating habits, less healthy than the average
person, more than 2 medical conditions, cardiovascular disease prevalent)
(Ans- between 25 and 39 years of age- the average driver is more than 40
years of age
what of these abilities is NOT required of a driver to safely perform his\/her
duties?
-perceptual skills to monitor sometimes complex driving situations
-judgment skills to make quick decisions when necessary
-manipulative\/manual skills to control his vehicle
-social sills to act kindly to interpersonal activities on the road
(Ans- social sills to act kindly to interpersonal activities on the road- mental
and physical abilities are required (social skills are not unless their absence
indicates mental illness)
fatigue is a major concern. what do current FMCSA regulations allow from
drivers?
(Ans- 60 hours on the road over a 7 day period, or 70 hours over 8 days
the motor carrier is required to make sure drivers meet certain
requirements. EXCEPT which of the following, the driver must:
-be at least 21 years old
-speak and read English well enough to understand highway\/traffic signals
and converse
-have a current medical examiner’s certificate on file
-provide their full medical examiner’s report (long form) to the motor carrier
-have provided the motor carrier with required background and violations
information<\/p>\n\n\n\n
A driver comes in for recertification. He has been diagnosed with a cataract
in his left eye and will be having surgery in a few months. He has a new
eyeglass prescription and his vision is found to be: L – cannot read the
chart uncorrected, 20\/70 corrected. R – 20\/40. You would:
(Ans – Disqualify the driver.
A driver is returning to work from an alcohol rehab program. Who should
evaluate the driver and make recommendations on education, treatment,
follow up testing, and aftercare?
(Ans – Substance abuse professional
Factors affecting the severity of chronic diseases leading to possible
disqualification include all but:
(Ans – Well tolerated medications may be needed to stabilize the condition.
Factors contributing to commercial driving stressors include:
(Ans – Long relay routes, abrupt schedule changes, responsibility for
passenger safety.
Four of the 13 Federal Motor Carrier Regulations or Standards are nondiscretionary, with objective criteria not requiring decision making by the
examiner. Which are the 4 standards?
(Ans – Vision, Hearing, Diabetes Mellitus and Epilepsy<\/p>\n\n\n\n
(Ans – Are at least 21 years old, speak and read English well enough to
converse with the general public and have a valid medical examiner’s
certificate
Which of the following is true concerning the Medical Examination Report
form?
(Ans – You should obtain a release from the driver if the employer wishes to
obtain a copy of the examination report.
Which is true of FMCSA Driver Exemption Programs?
(Ans – An exemption is valid for 2 years, with an annual medical
examination.
A 43 y\/o male driver has an otherwise normal exam except for amputation
of the ring and little fingers of the left hand. The driver:
(Ans – Can be cleared if his grip strength is normal.
Which of the following is false concerning medical standards vs. advisory
criteria\/guidelines?
(Ans – There are 4 standards and 9 guidelines for commercial driver
medical qualification.
Factors resulting in injuries and fatalities in large truck crashes include all
except:
(Ans – Injury severity equals relative velocity change.
**The greater the mass, the greater relative velocity change. **<\/p>\n\n\n\n
Upon examination of a 46 y\/o male smoker, you detect an irregularly
irregular heart rhythm. The rate is 140 bpm. This is unknown to the driver
and he denies any symptoms of lightheadedness, shortness of breath,
dizziness, palpitations, nor any cardiac history. You would:
(Ans- Disqualify and refer to his PMD or cardiologist for further evaluation.
Concerning the medical certificate, which is false?
(Ans- Provide the original to the driver being examined. Retain a copy for at
least 3 years.
You may not provide a copy to the current or prospective employer, they
must get it from the driver. The driver must carry the original certificate
during operation of a CMV.
How soon may a driver be certified after coronary artery bypass grafting
(CABG) surgery?
(Ans- 3 months with clearance by cardiologist, resting echocardiogram
with an LVEF >40% after CABG, and asymptomatic status with no angina.
FMCSA defines a severe hypoglycemic reaction as one that results in:
(Ans- Need of assistance from another person, loss of consciousness, any
period of impaired cognitive function that occurs without warning, or seizure
Medical fitness for duty includes the ability to perform strenuous labor and
to have good judgment, impulse control, and _________<\/em><\/strong><\/em><\/strong>.
(Ans- Problem solving skills
All of the following may perform and certify vision test results except:
(AnsA chiropractor
Ophthalmologist
Optometrist
or Registered Nurse<\/p>\n\n\n\n
(Ans- There is no grace period, the certification expires at midnight on the
date listed
A 28 year old female presents for her CDL physical exam. She indicates
she has been enrolled in a Methadone program for three months
secondary to a previous substance abuse issue in the recent past. She
presents a letter from the administrator of the program documenting her
compliance with the program and absence of any history of prior violations
of their agreement. According to medical guidance, can a driver be certified
while taking methadone.
(Ans- No, since Methadone is a habit-forming narcotic that can produce
drug dependence. Methadone is not an allowable drug for CMV operators.
Arriving for a recertification exam, a 48 y\/o male non-smoker is 5’4″,
275lbs. His supervisor calls you ahead of time stating he recently went off
the side of the road crashing into a guard rail. There were no injuries and
the truck sustained only minor damage. When the medical assistant goes
to bring him back, he is found asleep, snoring in the waiting room and she
needs to wake him by gently shaking him by the shoulder. She reports this
to you. When you arrive in the exam room the patient appears to be
nodding off while sitting on the exam table. Upon further questioning, he
admits that his wife frequently elbows him because of his snoring and that
he gasps and snorts in his sleep. When asked, he denies nodding off while
driving. His exam is notable for obesity, Mallampati 4 oropharynx, HTN
controlled with 2 medications, otherwise normal. Appropriate next steps:
(Ans- Disqualify and refer to PMD for sleep study.
You examine a 37 male driver with missing fingers on his left hand, you
must evaluate and do all of the following,
(Ans- Document the effect that the deficit has on the ability of the driver to
safely operate a CMV Provide a copy of the Medical Examination Report
form and medical examiner’s certificate for an SPE initial or renewal<\/p>\n\n\n\n
complying with medical requirements
You examine a 37 male driver with missing fingers on his left hand, you
must evaluate and obtained
Obtain approval from the primary care doctor
(Ans- no
When you perform a urinalysis (dip stick) test, you are to test for what?
(Ans- Specific gravity, protein (proteinuria), blood (hematuria) and glucose
(glycosuria)
Commercial drivers have a greater propensity to develop hypertension than
their peers in other professions.
(Ans- true
The percentage of drivers with hypertension increases with years of driving,
from 29% in drivers with fewer than 10 years driving experience to 39% in
drivers with over 20 years of experience.
(Ans- true
Effective hypertension management reduces overall cardiac morbidity and
mortality.
(Ans- true
The rise in hypertension prevalence is unrelated to age, increase in body
mass or physical inactivity.
(Ans- false
The FMCSA Medical Examination Report includes:
(Ans- Health questionnaire and Physical examination
For CMV drivers, “Medical fitness for duty”
(Ans- includes the ability to perform the specific tasks related to driving the
vehicle and strenuous labor<\/p>\n\n\n\n
Answers
LTCCS<\/p>\n\n\n\n\n
1 cause of fatalities with big trucks?<\/h1>\n\n\n\n
DOT organization
(Ans- all subcategories are separate entities and require different things
What is covered in NRCME training?
(Ans- federal motor carrier safety administration (FMCSA)
How long does NRCME certification last?
(Ans- 10 years with a 5 year update class
once a driver is certified, what is the longest it lasts?
(Ans- 2 years
SPE
(Ans- skill performance evaluation
Three copies of driver’s certificate: who gets them and who has original for
how long?
(Ans- driver, employer get copies
examiner keeps original for 3 years
Non discretionary standards
(Ans- immediately DQ the driver, examiner MUST follow standards<\/p>\n\n\n\n
(Ans- limits steered by recommendations and examiners judgement
list the non discretionary DQers
(Ans- Hx of epilepsy, failed hearing exam, failed Vx exam, active insulin
dependent DM
who oversees medical certification process?
(Ans- office of medical programs
how many X more is mortality rate for passenger vehicle vs large truck, in a
crash between the two?
(Ans- passenger vehicle 5X more likely to die
where are physical standards for drivers listed?
(Ans- 49 CFR 391.41
define CMV
(Ans- commercial motor vehicle: any self propelled or towed MV used on a
highway in interstate commerce to transport passengers or property\u202610k
lbs or more, 8+ passengers for $$, 15+ passengers not for $$, hazardous
materials
where is CMV defined?
(Ans- 40 CFR 390.5
where are medical examiner qualifications found?
(Ans- 49 CFR 391.43
Where are general qualifications for CMV drivers found?
(Ans- 49 CFR 391.11
list non-discretionary standards
(Ans- loss of limb, limb impairment, CV condition, respiratory dysfunction,
HTN, RA\/OA\/orthopedic\/muscular, mental disorder, drug use, alcoholism<\/p>\n\n\n\n
(Ans- male, 40+, sedentary, obese, smoker, poor eating habits
“average” driver medical health
(Ans- less healthy than average citizen, 2+ medical conditions, CV disease
list 9 occupational stressors for CMV drivers
(Ans- type of route, schedule, finances, vehicle, road conditions,
environmental, type of cargo
when can a driver on insulin be certified?
(Ans- if he\/she has FMCSA waiver – 49 CFR 391.64 OR federal exemption
program
FMCSA definition of “severe hypoglycemia”
(Ans- seizure, LOC, need assistance from others, impaired cog fxn
if severe hypoglycemia, ask if driver has had reactions how frequently?
(Ans- 1+ in last 12 months
2+ in last 5 years
what happens if driver has loss of proprioception? what about peripheral
neuropathy?
(Ans- DQ and DQ
what if DM patient has resting tachycardia or orthostatic HOTN?
(Ans- DQ
what if driver has silver wire, cotton patches?
(Ans- qualify but recommend ophthalmologist yearly
what if driver has unstable retinopathy where neovascularization extends
into vitreous?
(Ans- DQ<\/p>\n\n\n\n
Answers
An unrestricted Commercial Motor Vehicle Driver Medical Certificate must
be renewed
(Ans – Every Two Years
A driver presents with history of an isolated TIA 6 months ago. He has a
return to work letter from his primary care
provider (PCP) and neurologist. He is taking and tolerating well
hydrochlorothiazide and simvastatin. All other aspects of
the exam and history were normal. What should the medical examiner do
next?
(Ans – Disqualify driver for now
FMCSA regulates interstate commercial operation including the
(Ans – Driver, Vehicle, and Motor Carrier
During the CMV exam a driver perceived a whispered voice at 5 feet in his
left year and 4 feet in his right year. Exam
was otherwise normal. What do you do as the medical examiner?
(Ans – Certify driver for 2 years
Which of the following is an assessment of L4 nerve root pathology?
A. Plantar flexion
B. Patellar reflex
C. Hip extension
D. Babinski reflex
(Ans – Patellar reflex
A driver presents for medical exam and reports being a smoker and having
frequent shortness of breath. What do you
do next?<\/p>\n\n\n\n
According to regulation, which of the following must be evaluated as part of
the eye exam?
A. Pupil reaction
B. Iris symmetry
C. Conjunctiva injection
D. Tonometry pressure
(Ans – Pupil reaction
Continued certification of NRCE Medical Examiners requires which of the
following?
A. Periodic training at least every five years
B. Completion of recertification test every five years
C. Completion of certification test every 10 years
D. Electronic transmission to FMCSA CMV Medical Examination Results at
least monthly
(Ans – Periodic training at least every five years, Completion of certification
test every 10 years, Electronic transmission to FMCSA CMV Medical
Examination Results at least monthly
A driver presents for recertification. The only condition he lists is GERD, for
which he takes OTC omeprazole. He says
that when he is driving and eating fast foods, he is more likely to have
heartburn than when off\u2010duty. You should
(Ans – Correlate history with abdominal exam
Which of the following findings is disqualifying?
A. Oxygen saturation 90%
B. LVEF 40%
C. FEV 68% predicted
D. All of the above
(Ans – Oxygen saturation 90%<\/p>\n\n\n\n
indicating an abdominal aortic aneurysm
from two months ago, shortly before he had surgical correction. He has
surgical clearance and says he is doing well, has
no symptoms. You should
(Ans – Inform the driver of the 3 month waiting period before he can be
certified
The driver takes diphenhydramine twice a day to treat nasal congestion.
What must you document in order to
certify?
(Ans – Cannot drive within 12 hours of taking diphenhydramine
The driver has a history of carpal tunnel repair of her right hand 2 months
ago. Her grip strengths are symmetrical
and strong. What is necessary in order to qualify this driver?
(Ans – Document her findings for 2\u2010year certification
Which of the following abdominal complaints is most likely to be
incapacitating?
A. IBS
B. GERD
C. Urinary tract infection
D. Nephrolithiasis
(Ans – Nephrolithiasis
The waiting period for benign positional vertigo is
(Ans – 2 months
The driver’s BP is 148\/96. You verify her history, which indicates she has
no prior history of hypertension. If
otherwise qualified, you may certify her for
(Ans – 1 year<\/p>\n\n\n\n
III hypertension 4 years ago. The
maximum certification for this driver is
(Ans – 6 months
The driver presents for examination with a recent history (five weeks ago)
of pneumothorax. He has no prior history
of pneumothorax. In order to be considered medically qualified, his forced
vital capacity (FVC) should be greater than
(Ans – 65%
The recommended waiting period (WP) and certification period (CP) for a
driver following surgical correction for
intermittent claudication are
(Ans – WP 3 months, CP 1 year
Which of the following are disqualifying?
A. Pacemaker
B. Implanted defibrillator
C. Both a and b
D. Neither
(Ans – Implanted defibrillator
Five years post\u2010CABG, the driver must provide a copy of _<\/em><\/strong> in
order to qualify for recertification
(Ans – ETT
The driver has a 5\u2010year history of asthma, described as “well\u2010controlled”.
He carries rescue inhaler for the times
when he becomes short of breath, but says this is rare. He provides
pulmonary functions performed last week and his
FEV1 is 62% of predicted and his Pa02 is 62 mm. You should
(Ans – Disqualify and recommend that he return to his personal provider<\/p>\n\n\n\n
Questions & Answers<\/p>\n\n\n\n\n
must be renewed:
A. Annually
B. Every Two Years
C. Every Four Years
D. Whenever the State Issued Driver’s License is renewed
(Ans- B. Every two years
2 years is the max for a healthy person<\/li>\n\n\n\n
return to work letter from his primary care provider (PCP) and neurologist.
He is taking and tolerating well hydrochlorothiazide and simvastatin. All
other aspects of the exam and history were normal. What should the
medical examiner do next?
A. Certify driver for 1 year
B. Disqualify driver for now
C. Certify driver for 3 months
D. Certify driver for 2 years
(Ans- B. Disqualify the driver for now
The waiting period is 1 year for Transient ischemic attack, stroke, or
intracerebral or subarachnoid hemorrhages with no risk for seizures.<\/li>\n\n\n\n
A. Driver
B. Vehicle<\/li>\n<\/ol>\n\n\n\n
D. All of above
(Ans- D. All of the above
Self-explanatory<\/p>\n\n\n\n\n
his left year and 4 feet in his right year. Exam was otherwise normal. What
do you do as the medical examiner?
A. Required audiometric test to determine the extent of hearing loss in left
ear
B. Certify driver for 2 years
C. Certify driver for 1 year
D. Disqualify driver
(Ans- B. Certify the driver for 2 years.
Passing the forced whisper test at 5 ft in at least 1 ear is good enough.<\/li>\n\n\n\n
A. Plantar flexion
B. Patellar reflex
C. Hip extension
D. Babinski reflex
(Ans- B. Patellar Reflex (“Knee-Jerk Reflex”)
Patellar Reflex = L3-L4 (Primarily the L4)
Plantar Flexion = S1-S2 (Tibial nerve)
Hip Extension = L4-L5 (via the gluteal nerve)
Babinski Reflex (Plantar Flexion) = upper motor neuron lesion<\/li>\n\n\n\n
having frequent shortness of breath. What do you do next?
A. Order an ECG
B. Refer to a pulmonologist
C. Order a spirometer test
D. Provide 1 year certification
(Ans- C. Order a spirometry test
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.
NOTE: Smokers have a high incidence of COPD, yet individuals may have
a significant reduction in lung function without symptoms. Spirometry
should be performed in all smokers over the age of 35 years.
You should obtain forced expiratory volume in the first second of expiration
(FEV1), forced vital capacity (FVC), and FEV1\/FVC ratio when any of the
following indicators are present:<\/li>\n<\/ol>\n\n\n\n\n
No further testing is necessary if the lung function is normal and no other
abnormality is suspected. Abnormal lung function should be further
evaluated.<\/li>\n<\/ul>\n\n\n\n\n
of the eye exam?
A. Pupil reaction
B. Iris symmetry
C. Conjunctiva injection<\/li>\n<\/ol>\n\n\n\n
(Ans- A. Pupil reaction
Pupil reaction is neurological.
Iris symmetry is cosmetic
Conjunctiva injection is usually for infections
Tonometry pressure is for intraocular pressure, usually measured by
optometrists\/ophthalmologists.<\/p>\n\n\n\n\n
which of the following?
A. Periodic training at least every five years
B. Completion of recertification test every five years
C. Completion of certification test every 10 years
D. Electronic transmission to FMCSA CMV Medical Examination Results at
least monthly
(Ans- B. Completion of recertification test every 5 years<\/li>\n<\/ol>\n\n\n\n\n
FMCSA.
In December 2016, FMCSA issued a statement that it will be the sole
provider of the required 5-year refresher training, and it will provide the
training online at no cost to Certified Medical Examiners. Certified Medical
Examiners who are eligible for the 5-year periodic online training will be
notified by FMCSA when the training is available and the examiner is able
to access the training site. Training providers associated with the initial 10-
year certification process are not involved with the refresher training and
will not contact Certified Medical Examiners regarding the required 5-year
refresher training.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"