DOT TRAINING - NRCME Questions and Complete Solutions Graded A+.

  Non-discretionary standards for drivers (there are 4) - Answer: The 13 standards are used to determine driver medical fitness for duty. 4 are non discretionary Objective disqualifiers: 1. Vision 2. Hearing, 3. Epilepsy, and 4. Diabetes mellitus These standards are the "non-discretionary" standards. Medical certification is required when the driver is operating a commercial vehicle that: -weight of ____________ -designed to transport _____ passengers FOR compensation -designed to transport _____ passengers NOT for compensation -transporting __________ materials - Answer: • Has a combined gross vehicle weight or weight rating of 26,001 pounds or more, whichever is greater • Is designed or used to transport (more than 8) 9-15 passengers (including the driver) FOR compensation. • Is designed or used to transport (more than 15) 16 or more passengers (including the driver) whether for compensation or not. • Transports hazardous materials in quantities that require placarding under the hazardous materials regulations. If a driver fails the forced whisper test, what audiogram threshold levels should the examiner test per the regulation? What should the result read in decibels? - Answer: 500 Hz 1000 Hz and 2000 Hz Results should be 40 decibels in the ear that passes According to FMCSA, the whisper test is sufficient to screen for hearing acuity at what minimum distance?? - Answer: 5 feet Hearing test To convert International Organization for Standardization (ISO) test results to the ANSI standard, subtract from the ISO test results: ________ dB for 500 Hz ________ dB for 1,000 Hz ________ dB for 2,000 Hz - Answer: The most common audiometric standard is ANSI (American National Standards Institute). Some devices measure based on ISO (International Organization for Standardization) standard. If using ISO, ME must convert the test results to ANSI: subtract: 14 dB for 500 Hz 10 dB for 1,000 Hz and 8.5 dB for 2,000 Hz The driver's corrected visual acuity is: right eye 20/40, left eye 20/80, both eyes 20/40. The examiner should: - Answer: Inform driver of the process to qualify with monocular vision under the Alternate Vision Standard Vision using the Snellen Chart -what is the minimum visual acuity acceptable? -how far away should subject stand from chart? - Answer: Must be 20/40 vision at 20 feet away the smaller the bottom number the better the vision Placement of cardiac stent 9 months ago- what is needed for certification - Answer: Results of stress test obtained 6 months after PCI and clearance by cardiologist A driver was issued a 3-month medical certificate due to Stage 2 elevated blood pressure and now returns for recheck. He is prescribed only HCTZ 12.5 mg and BP is now 120/80. What length of time should you now provide certification for this driver? - Answer: One year from the initial examination A driver is prescribed warfarin after a pulmonary embolism 3 months ago. His INRs are stable, a recent CT scan shows the condition is stable and he has a medical release from the pulmonologist. According to FMCSA guidelines for pulmonary emboli, you should: - Answer: Qualify for one year only, with monthly INR checks to meet monitoring guidelines A driver is found to have a BP measured twice during the examination of 166/106 mm Hg. According to FMCSA guidelines on blood pressure, how long should you certify for? - Answer: 3 months When a driver has a medical history of myocardial infarction, which of the following are recommended by FMCSA for recertification and exercise tolerance test (ETT) monitoring intervals? - Answer: Recertification every year; ETT every 2 years What hearing diagnoses disqualify? - Answer: No certification for -Uncontrolled vertigo -Meniere's Disease -Labyrinthine fistula -Nonfunctioning fistula • 2‐month, symptom‐free waiting period for any diagnosis of Acute and chronic peripheral vestibulopathy Benign positional vertigo (BPV) Exemptions - updates - Answer: -Effective March 22, 2022.: a collaborative process involving the Medical Examiner receiving input from a licensed ophthalmologist or optometrist allows ME to make the final determination. NOTE: There is NO LONGER a vision exemption process. - Vision Requirements: -VA minimum that must be met -Ability to...? -Examine eyes for...? - Answer: VA measured each eye individually and both eyes together -Distant VA of at least 20/40 (Snellen) in each eye, with or without correction. -Distant binocular VA of at least 20/40 (Snellen) in both eyes, with or without correction. -Field of vision of at least 70° in the horizontal meridian in each eye -Ability to recognize the colors of traffic signals and devices showing standard red, green, and amber. Examine the eyes for for: • Pupillary equality • Reaction to light and accommodation • Ocular motility • Muscle imbalance • Extraocular movement • Nystagmus Exophthalmos To test vision: what can be used ? - Answer: Central Vision Acuity: Snellen Chart or Titmus Vision Tester Examples of Driver NOT Requiring CDLs: - Answer: -Driver of farm vehicle -Firefighter with certificate of authorization -Recreational motor home drivers Maintaining Medical Examiner Certification - Answer: Must maintain qualifying license • Complete NRCME reporting at least monthly and submit form for every driver EXAMINED. • Adhere to driver certification standards and record‐keeping. Keep original records of exams and certifications for at least 3 years. Submit to periodic monitoring and audits. • Complete periodic training, at minimum refresher at 5 years • Successfully pass ME certification every 10 years To qualify as a CMV Driver: - Answer: General qualifications of drivers: A person is qualified to drive a motor vehicle if he/she— (1) Is at least 21 years old; (2) Can read and speak the English language sufficiently to converse with the general public, to understand highway traffic signs and signals in the English language, to respond to official inquiries, and to make entries on reports and records; (3) Can, by reason of experience, training, or both, safely operate the type of commercial motor vehicle he/she drives; (4) Is physically qualified to drive a commercial motor vehicle ..... A person is physically qualified to drive a commercial motor vehicle if that person— (13 standards) - Answer: (1) Has no loss of a foot, a leg, a hand, or an arm, or has been granted a skill performance evaluation certificate (2) Has no impairment of: (i) A hand or finger, an arm, foot, or leg which interferes with the ability to perform normal tasks or has been granted a skill performance evaluation certificate (3) Has no diagnosis of diabetes mellitus currently requiring insulin for control; * NOW NEW OPTION (4) Has no diagnosis of myocardial infarction, angina pectoris, coronary insufficiency, thrombosis, or any other cardiovascular disease of a variety known to be accompanied by syncope, dyspnea, collapse, or congestive cardiac failure. (5) Has no respiratory dysfunction likely to interfere with his/her ability to control and drive a commercial motor vehicle safely; (6) Has no current clinical diagnosis of high blood pressure likely to interfere with his/her ability to operate a commercial motor vehicle safely; (7) Has no rheumatic, arthritic, orthopedic, muscular, neuromuscular, or vascular disease which interferes with his/her ability to control and operate a commercial motor vehicle safely; (8) Has no epilepsy or any other condition which is likely to cause loss of consciousness or any loss of ability to control a commercial motor vehicle; (9) Has no mental, nervous, organic, or functional disease or psychiatric disorder likely to interfere with his/her ability to drive a commercial motor vehicle safely; (10) Has distant visual acuity of at least 20/40 (Snellen) in each eye, field of vision of at least 70° in the horizontal Meridian in each eye, and the ability to recognize the colors of traffic signals and devices showing standard red, green, and amber; OR ALTERNATIVE STANDARD (11) First perceives a forced whispered voice in the better ear at not less than 5 feet with or without the use of a hearing aid or, if Measuring BP during CME exam - Answer: For every certification and recertification exam you must: Measure BP—use standardized equipment -Confirm BP 139/89 with 2nd measurement taken later in exam -Check pulse rate, strength, and rhythm How long can stage 1 HTN be certified for? How long can stage 2 HTN be certified for? How long can stage 3 HTN be certified for? - Answer: -Stage 1 hypertension BP is 140-159/90-99) may be certified for one year unless... -driver had a 1‐yr certificate for untreated stage 1 HTN Has not been prescribed antihypertensive; then give one time 3 month cert. -Stage 2: Stage 2 (BP is 160‐179/100‐109) should be treated and a one‐ time certificate for 3‐month certification can be issued. Once the driver has reduced his or her BP to equal to or less than 140/90, he or she may be recertified annually thereafter. Cert is good from 1 year from date of INITIAL exam if 140‐90. -Stage 3 hypertension (BP 180/110) should not be certified until his or her BP is reduced to 140/90 or less. If BP is below 140/90 the max cert time is only 6 months. Secondary HTN: -what diagnoses could cause this? -what is the waiting period to certify? - Answer: Diagnoses: pheochromocytoma, primary aldosteronism, renovascular diease, unilateral parenchymal disease. -If surgical interventions • Minimum waiting period of 3‐months post‐surgical correction • Maximum certification period then 1 year post‐surgical correction Recommend certification if BP 140/90