NRCME DOT Exam Questions and Complete Solutions Graded A+

  What minimum PaO2 level is necessary if the driver has an ABG due to a chronic respiratory disorder? a. 70 mm Hg b. 55 mm Hg c. 60 mm Hg d. 65 mm Hg - Answer: 65 mmhg 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. 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 leftear. - Answer: certify for 2 years 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. Disqualify the driver. b. Qualify the driver for 1 year. c. Qualify the driver for 2 years. d. Consult with the cardiologist to determine if the driver suffers from angina. - Answer: disqualify the driver The driver has not completed the required 2-month waiting 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 A driver provides an audiometric test documenting the following: 1. 500 Hz: 35 Right ear; 40 Left ear 2. 1000 HZ: 40 Right ear; 45 Left ear 3. 2000 HZ: 40 Right ear; 45 Left ear 4. 4000 Hz: 50 Right ear; 50 Left ear The medical examiner should: a. Disqualify the driver because he does not meet minimum hearing requirements to drive. b. Certify the driver for 2years. c. Certify the driver for 1 year. d. Require the driver to obtain a hearing exemption - Answer: certify the driver for 2 years 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 2years. 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. - Answer: Qualify the driver for two years During examination, the medical examiner notices that the driver is distant, lacks eye contact and shows absolutely no emotional response during the exam. The examiner's best response should be: a. Provide the driver with a "CAGE" questionnaire to determine if he suffers from alcoholism. b. Disqualify the driver and refer him to a mental health professional prior to consideration for certification. c. Certify the driver with a 1-time, 3-month certificate to determine if there is any effect on the driver's ability to drive a CMV. d. Require a skill performance evaluation to ascertain if the driver has any limitations with driving - Answer: Disqualify the driver and refer him to a mental health professional prior to consideration for certification. 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. - Answer: Disqualify the driver 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 1Hypertension. c. Stage 2Hypertension. d. Stage 3Hypertension. - Answer: Stage 1 HTN 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. Certify only after obtaining written clearance for the depression and the medication from the treating provider. 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. - Answer: Certify only after obtaining written clearance for the depression and the medication from the treating provider. For a driver with insulin-treated diabetes mellitus, the medical examiner can only accept Form MCSA-5870 if it has been properly completed within the last: a. 25 days. b. 30 days. c. 45 days. d. 60 days. - Answer: 45 days 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. - Answer: 65mmhg 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. d. Certify the driver for 2 years - Answer: Obtain medical clearance for the condition and the medication A 26 year-old driver presents for a first-time certification. He has a long-standing history of ADHD and is taking methylphenidate. You have verified his diagnosis and obtained clearance from his treating psychiatrist. As the certified examiner, you: a. Should disqualify the driver, explaining that use of such stimulants is cause for disqualification. b. May certify for a maximum of 6 months. c. May certify for a maximum of 12 months. d. May certify for a maximum of 2 years - Answer: May certify for a maximum of 12 months A driver has a blood pressure of 168/112 mm Hg confirmed during the examination. The driver should be: a. Disqualified. b. Certified for 6 months. c. Certified for 1 year. d. Certified for 2 years - Answer: Disqualified The driver is disqualified until his blood pressure is less than 140/90 mm Hg at which time he will have a maximum certification of 6 months. For how long would a driver be certified if he is taking Micardis HCT for hypertension, and has a confirmed blood pressure of 148/96 mm Hg at the time of the examination? a. 3 months b. 6 months c. 1 year d. 2 years - Answer: 3 months 6. During the examination, a driver is found to have a positive "Babinski" reflex. The examiner should: a. Certify the driver for 1 year. b. Certify the driver for 2 years. c. Council the driver to obtain an SPE. d. Do not certify the driver until s/he has a neurological consultation. - Answer: Do not certify the driver until s/he has a neurological consultation All of the following are required components of all DOT medical examinations EXCEPT? a. Vision b. Hearing c. Blood Pressure d. Ophthalmoscopic examination - Answer: Ophthalmoscopic examination A driver reports in his history that he was treated for epilepsy 14 years ago but stopped taking antiepileptic medication on his own since his move to your area 11 years ago. He has not seen a neurologist nor a health care provider in over 10 years and reports no seizures during this period. The examiner should: a. Request medical clearance, and if obtained the driver may be certified for 1 year. b. Request medical clearance, and if obtained the driver may be certified for 2 years. c. Refer the driver to the epilepsy/seizure exemption program. d. Disqualify the driver - Answer: Disqualify the driver A driver reports for a re-certification examination 8 weeks after having triple coronary artery bypass surgery. He presents a note from his treating provider stating that he is able to return to driving without restriction. Additionally, the note mentions that the driver's results of his ETT were normal, and his echo showed a left ventricular ejection fraction of 75%. The examiner should: a. Disqualify the driver until he has completed the required waiting period. b. Disqualify the driver because his ejection fraction is too low. c. Certify the driver for 1 year. d. Certify the driver for 2 years - Answer: Disqualify the driver until he has completed the required waiting period What is the maximum number of hours a CMV driver can drive in 7 consecutive days? a. 50. b. 60. c. 70. d. 80. - Answer: 60 A blood pressure of 166/92 mm Hg would be? a. Considered normal b. Stage 1 hypertension. c. Stage 2 hypertension. d. Stage 3 hypertension. - Answer: Stage 2 hypertension Lasegue's sign tests for: a. Lumbosacral radicular irritation. b. Early peritonitis. c. Benign vertigo, as opposed to a central etiology. d. Amblyopia - Answer: Lumbosacral radicular irritation The driver uses hearing aids during the whisper test. He is able to hear at 5 feet on the right and 4 feet on the left. a. Send the driver for an audiometric test. b. Disqualify the driver. c. Certify the driver for 1 year. d. Certify the driver for 2years - Answer: Certify the driver for 2years . The minimum acceptable spirometry values required to certify a driver are: a. FEV1 70%, FVC 65%, FEV1/FVC ratio 65% b. FEV1 65%, FVC 60%, FEV1/FVC ratio65% c. FEV1 65%, FVC 65%, FEV1/FVC ratio65% d. FEV1 60%, FVC 60%, FEV1/FVC ratio60% - Answer: FEV1 65%, FVC 60%, FEV1/FVC ratio 65% A driver presenting to your office marks down that he is taking "nitroglycerin" for angina and he has been doing so for a few years. Upon questioning he indicates that he has needed more nitroglycerin recently because his episodes have become more frequent. Your best course of action is to: a. Council the driver to increase his dose of medication. b. Certify the driver for 1 year. c. Provide a 1-time, 3-month certificate to monitor his condition. d. Disqualify the driver and refer him to his cardiologist for further evaluation. - Answer: Disqualify the driver and refer him to his cardiologist for further evaluation The longest the medical examiner would certify a driver with a history of Stage 3 hypertension is: a. 3 months b. 6 months c. 12 months d. 24 months - Answer: 6 months A driver is taking Wellbutrin to help him stop smoking. He has provided a note from his PCP stating that he has no side effects and confirms that he is taking the medication for smoking cessation.The examiner would? a. Certify the driver for 2years. b. Certify the driver for 1year. c. Disqualify the driver because the medication is not allowed. d. Council the driver to only take the medication at night - Answer: certify the driver for 2 years During the history, the driver admits to taking Benadryl for seasonal allergies. The examiner should? a. Counsel the driver to not take the medication for 12 hours prior to driving. b. Obtain medical clearance from the driver's PCP that he/she can drive. c. Disqualify the driver until he/she is no longer taking Benadryl. d. Provide a 1-time, 3-month certificate to determine the medication's effect on the driver - Answer: Counsel the driver to not take the medication for 12 hours priorto driving A driver has a history of a moderate Traumatic Brain Injury that occurred 3 years ago as a result of a car accident. He reports he has fully recovered and provides a note from his neurologist stating that he suffered no seizures and that he is able to return to driving. He does not list any medications in his history. The examiner should: a. Disqualify the driver. b. Require the driver to take a "Folstein's mini mental state exam." c. Certify the driver for one year. d. Certify the driver for two years - Answer: Certify the driver for one year A driver reports a suicide attempt 10 months earlier, following the break-up of his marriage. Henoted seeing a psychiatrist and he takes Citalopram daily and he reports he feels fine now and is moving on with his life. He provides a release from his doctor that he may return to work without restrictions. The medical examiner should: a. Disqualify the driver. b. Require a CAGE questionnaire. c. Certify the driver for 1 year. d. Certify the driver for 2 years - Answer: Disqualify the driver. The driver lists Synthroid for the treatment of hypothyroidism. He has been taking it for about 6 months and feels fine now. His examination is essentially normal. The examiner's best course of action is to? a. Request medical clearance for the medication prior to certification. b. Certify the driver for 1 year. c. Certify the driver for 2 years. d. Counsel the driver that he needs to apply for an endocrine exemption - Answer: Certify the driver for 2 years Which of the following is correct regarding the appropriate person to complete and sign Form MCSA-5870 for a driver who has insulin-treated diabetes mellitus? a. Only an endocrinologist can complete the form. b. The medical provider who manages the driver's diabetes and prescribes insulin for the driver's diabetes completes the form. c. The driver's primary care provider of record must complete the form. d. Any provider who has evaluated the driver within the last 12 months may complete the form - Answer: b. The medical provider who manages the driver's diabetes and prescribes insulin for the driver's diabetes completes the form A driver should not be certified when an ABG reveals a PaO2 of less than 65 at altitudes below: a. 2,000 feet b. 3,000 feet c. 5,000 feet d. 7,000 feet - Answer: 5,000 feet If an individual does not meet the hearing requirements with the use of a hearing aid and requires a Federal hearing exemption, the examiner should mark on the Medical Evaluation Report Form: a. "Does not meet standards". b. "Wearing hearing aid". c. "Accompanied by a hearing exemption" d. All of the above - Answer: C. "Accompanied by a hearing exemption" A driver presents for certification 6 weeks after suffering a myocardial infarction. She presents a note from her cardiologist, clearing her to drive a CMV without restrictions. Her post MI echocardiogram shows an EF of 50%. Her EKG shows no ischemia. Her ETT exceeds FMCSA standards. The medical examiner should: a. Certify the driver for 3 months. b. Certify the driver for 1 year. c. Certify the driver for 2 years d. Disqualify the driver - Answer: Disqualify the driver A driver presents for certification. He checks "yes" for "Anxiety, depression, nervousness, and other mental health problems" for the Driver Health History portion of the Medical Examiner Report Form. He clarifies he has depression which is controlled with medications and electroconvulsive therapy (ECT). Following ECT, the driver should be symptoms free for how long before being certified? a. 3 months b. 6 months c. 12 months d. 24 months - Answer: b. 6 months 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 - Answer: a. Pupil reactivity According to FMCSA regulation and guidance, medical qualification for two years can be given to a driver who has: 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 - Answer: a. An SPE certificate for a left below the knee amputation(BKA) 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 exam reveals an infected, swollen finger. After the ME inquires, the driver states that the pain is made worse when he grips the steering wheel. Which of the following should the ME 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 - Answer: d. Assess the driver's grip strength A new driver who had a myocardial infarction six months ago is certified after completing an acceptable exercise tolerance test and is cleared by a cardiologist. According to FMCSA guidelines, which of the following is recommended regarding recertification and exercise tolerance test monitoring intervals? Recertification Exercise; Tolerance Test a. Every year; Every year b. Every two years; Every year c. Every year; Every two years d. Every two years; Every two years - Answer: C. Every year; Every two year Which of the following is true of The Romberg sign: a. It is a test of proprioception. b. A positive test is an inability to maintain an erect posture over 60 seconds with eyes closed. c. BOTH of the above are correct. d. NEITHER of the above are correct - Answer: C. BOTH of the above are correct Which of the following stages of hypertension calls for a medical certificate that expires in one year? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4 - Answer: a. Stage 1 Which of the following is true of psychological disorders in drivers? a. Drivers with a mood disorder may, during a manic episode, exhibit grandiosity, impulsiveness, irritability, and aggressiveness b. Drivers with a mood disorder will exhibit quicker reaction times during a depressive episode c. Drivers with an active psychotic disorder will exhibit completely predictable behavior, accompanied with poor judgment d. Drivers with personality disorders may exhibit flexibility and adaptive behaviors with a decreased crash rate - Answer: a. Drivers with a mood disorder may, during a manic episode, exhibit grandiosity, impulsiveness, irritability, and aggressiveness A driver without a history of hypertension is found to have a blood pressure of 145/80 mm Hg during the exam. What is the next best step? a. Qualify the driver for 1 year. b. Obtain a second blood pressure reading later during the examination c. Qualify the driver for a 1 time 3-month certificate. d. Put the driver in Determination Pending to allow time for a hypertension evaluation by the PCP - Answer: b. Obtain a second blood pressure reading later during the examination When deciding if a commercial driver should be medically certified, what is the fundamental question a medical examiner should examine regarding cardiovascular health? a. Has the driver ever had a cardiovascular disease? b. Does his or her family have a history of cardiovascular disease? c. Does the driver have a cardiovascular disease that increases the risk of sudden death or incapacitation? d. What is the likelihood that he or she will contract a cardiovascular disease? - Answer: c. Does the driver have a cardiovascular disease that increases the risk of sudden death or incapacitation? If a medical examiner uses the number 1 during the physical examination, the medical examiner is indicating which of the following parts of the body system? a. Ears b. General Appearance c. Abdomen d. Heart - Answer: b. General Appearance When conducting a vision examination, a driver must have at least what distant visual acuity in each eye with or without correction? a. 20/10 b. 20/20 c. 20/40 d. 20/60 - Answer: 20/40 Which of the following is NOT true regarding the physical examination? a. The individual parts of the body system are categorized numerically b. For each body system, mark "Yes" on the Report Form if abnormalities are detected, or "No" if the body system is normal c. There is a maximum height requirement d. The medical examiner must document all abnormal findings on the Report Form, even if they are not disqualifying - Answer: c. There is a maximum height requirement Which of the following colors is not necessary to be able to distinguish and recognize in traffic signals and devices? a. Blue b. Green c. Amber d. Red - Answer: Blue A DOT driver presents for his medical exam. On his history he states that he regularly takes Dextromethorphan. This should prompt the medical examiner to: a. Give a one-year recertification b. Give a 3-month recertification c. Counsel the driver about consuming the medication within 12 hours of driving d. Disqualify - Answer: Counsel the driver about consuming the medication within 12 hours of driving Which of the following is an assessment of L4 nerve root pathology? a. Plantar flexion. b. Patellar reflex. c. Hip Extension. d. Hand in pocket paresthesia - Answer: Patellar reflex A driver presents for his DOT physical. A lateral pulsation is palpated approximately 2 inches superior of the umbilicus. Auscultation in this area reveals an obvious bruit. What is the most important next step? a. Counsel on the importance of a good diet. b. Refer for diagnostic imaging and probable emergency care. c. Refer to a gastroenterologist. d. Give the driver a 1-year recertification - Answer: c. Refer for diagnostic imaging and probable emergency care A driver has a limitation of 45 degrees of cervical rotation to the right and left but can view both side mirrors. What is the next best step?: a. Disqualify the driver. b. Certify the driver for 1 year. c. Certify the driver for 2 years. d. Disqualify the driver pending a functional evaluation - Answer: c. Certify the driver for 2 years A driver presents with a history of an isolated TIA 6 months previously. He presents with a return to work letter from his primary care physician and his neurologist. The driver is taking Hydrochlorothiazide and Simvastatin. All other aspects of the exam and history were normal. What should the examiner do next? a. Certify the driver for 1 year. b. Disqualify the driver. c. Certify the driver for 3months. d. Certify the driver for 2 years - Answer: b. Disqualify the driver Which of the following is a criterion for certification after a myocardial infarction? a. EKG showing no signs of ischemia. b. Echocardiogram showing an EF = 40%. c. ETT showing 85% of maximum predicted HR. d. All of the above. - Answer: d. All of the above A driver reports that he was hospitalized recently for palpitations. He states he was diagnosed with atrial fibrillation, and was put on warfarin therapy. Which of the following is the correct certification criteria for atrial fibrillation? a. Waiting time: 1 month INR: monthly Certify: 1 year b. Waiting time: 1 week INR: monthly Certify: 2 years c. Waiting time: none INR: annually Certify: 6 months - Answer: a. Waiting time: 1 month INR: monthly Certify: 1 year A driver presents for initial certification. His blood pressure is 180/102 mm Treated with amlodipine 5 mg daily. Which of the following best represents the medical examiner's BP staging and certification decision? a. Stage II hypertension; Certify: 3-month card b. Stage III hypertension Certify: Disqualify c. Stage III HTN; Certify: 6-month card d. Stage II hypertension; Certify: 1 year - Answer: Stage III hypertension Certify: Disqualify A driver presents for certification. She reports that she was hospitalized recently for chest pain. She states she was diagnosed with a myocardial infarction, and subsequently underwent left coronary artery balloon angioplasty. She was put on Xarelto. Which of the following best represents certification decision for this driver? a. Waiting time: 2 months b. Waiting time: 1 week INR: none INR: none Certify: 2 years Certify: 1 year c. Waiting time: 2 months INR: none Certify: 1 year d. Waiting time: I year INR: monthly Certify: 2 years - Answer: C. Waiting time: 2 months INR: none Certify: 1 year The driver presents for re-certification. He admits a cerebellar stroke 2 years ago that has resolved without any residual deficits. He presents clearance from his neurologist, and he is on no anti-seizure or stroke medication. He is otherwise medically fit. What is the certification decision? a. Disqualify, as he has not met the waiting period. b. Certify for 1 year. c. Certify for 2 years. d. Obtain head CT to rule residual deficits - Answer: b. Certify for 1 year A driver presents for examination following a spontaneous pneumothorax one month earlier. The records provided by the driver indicate that the pneumothorax reduced the driver's forced vital capacity (FVC) to 58% of predicted forced vital capacity. As the medical examiner, you should: a. Certify the driver for one year. b. Certify the driver for two years. c. Do not certify the driver. d. Disqualify the driver for 6 months and re-evaluate at 6-month recheck - Answer: c. Do not certify the driver Who can perform the vision portion of the interstate CMV driver physical examination other than the medical examiner? a. Medical assistant. b. Ophthalmologist. c. Optometrist. d. Any of the above - Answer: d. Any of the above. Which of the following mandates disqualification, per regulation? a. Idiopathic hypersomnia. b. Narcolepsy. c. ICD placement. d. ALL of the above - Answer: d. ALL of the above According to regulations, which of the following can grant drivers an SPE certificate? a. Medical examiners. b. Orthopedic surgeons. c. Physical Medicine & Rehab physicians. d. The FMCSA - Answer: d. The FMCSA As a certified medical examiner, for how long must you retain a copy of the Medical Examination Report Form for each driver? a. 1 year. b. 3 years. c. 5 years. d. 10 years - Answer: b. 3 years As a medical examiner, you will need to provide a copy of the Medical Examination Report Form to a driver who is applying for, or renewing, a: a. Skill Performance Evaluation (SPE) certificate. b. Hearing exemption certificate. c. Seizure exemption certificate. d. Any of the above. - Answer: d. Any of the above. Which of the following is true of the vision requirements for commercial drivers? a. The requirement for central distant visual acuity is at least 20/40 in each eye. b. The requirement for distant binocular visual acuity is at least 20/50. c. Contact lenses may not be worn to meet distant visual acuity requirements. d. The driver must meet either the distant visual acuity requirement for each eye OR the binocular visual acuity requirement - Answer: a. The requirement for central distant visual acuity is at least 20/40 in each eye Which is accurate regarding the hearing test required of commercial motor vehicle drivers? a. The forced whisper test must be administered first. b. Hearing aids cannot be used to pass the test. c. If the driver perceives a forced whisper in one ear at 6 feet, he has met the hearing requirement. d. If the driver attempts to meet the requirement using a hearing aid, only the audiometric test is administered. - Answer: C. If the driver perceives a forced whisper in one ear at 6 feet, he has met the hearing requirement. When a driver who wears a hearing aid is unable to pass a forced whisper test, referral to which of the following is required? a. An audiologist. b. An otolaryngologist. c. A hearing aid center. d. Any of the above is acceptable - Answer: d. Any of the above is acceptable Which of the following frequencies is NOT included as part of the audiometric hearing test for commercial motor vehicle drivers? a. 500 hertz (Hz). b. 1,000 Hz. c. 2,000 Hz. d. 4,000Hz - Answer: d. 4,000Hz A commercial driver is taking Coumadin for a diagnosis of atrial fibrillation. As the medical examiner you explain to the driver that: a. He cannot be certified to drive. b. He can be certified to drive for 2 years as long as he provides documentation that his INR is therapeutic. c. He must undergo monthly INR monitoring. d. He can be certified to drive only if he switches to a newer anticoagulant that does not require INR monitoring. - Answer: C. He must undergo monthly INR monitoring A herniated disk at L5-S1 is most likely to affect which of the following reflexes? a. Patellar reflex. b. Achilles reflex. c. Plantar reflex. d. NONE of the above - Answer: b. Achilles reflex. A driver presents for initial certification to drive 3 months following a myocardial infarction. An in-hospital post-MI echocardiogram showing at least what left ventricular ejection fraction is sufficient for certification to drive? a. 30%. b. 35%. c. 40%. d. 45% - Answer: c. 40%. . What is the minimum waiting period following Coronary Artery Bypass Grafting surgery? a. One month. b. Two months. c. Three months. d. Dependent on the type of CABG performed and the number of vessels involved. - Answer: c. Three months Following an uncomplicated, elective percutaneous coronary intervention procedure to treat stable angina, the post-procedure waiting period is: a. 1 week. b. 3 weeks. c. 1 month. d. 2 months - Answer: a. 1 week Which cardiac condition is disqualifying? a. Hypertrophic cardiomyopathy. b. Mitral valve prolapse. c. Ebstein anomaly. d. Aortic valve repair for aortic stenosis 4 months prior to exam - Answer: a. Hypertrophic cardiomyopathy A driver who exhibits difficulty breathing and has a history of COPD should undergo additional pulmonary testing. A forced expiratory volume in the first second of expiration (FEV1) less than what level of predicted should prompt arterial blood gas measurements? a. 50%. b. 55%. c. 65%. d. 70%. - Answer: c. 65%. . A driver has a fixed deficit that is less than the whole hand. Which of the following is true regarding certification of this driver? a. The driver requires a Skill Performance Evaluation (SPE) certificate. b. As a medical examiner, you determine if the severity of a fixed deficit that is less than the whole hand is medically disqualifying unless the driver has an SPE certificate. c. The patient requires referral to an orthopedic surgeon who understands the nature of commercial motor vehicle driving. d. NONE of the above are correct - Answer: b. As a medical examiner, you determine if the severity of a fixed deficit that is less than the whole hand is medically disqualifying unless the driver has an SPE certificate A urinalysis is a required part of the driver evaluations. If the UA indicates glycosuria, the medical examiner: a. Must disqualify the driver. b. Must not certify the driver until a repeat urinalysis in at least one week reveals resolution of glycosuria. c. Must obtain a consultation with an endocrinologist. d. May elect to perform a finger stick to obtain a random blood glucose. - Answer: d. May elect to perform a finger stick to obtain a random blood glucose You are required to perform a urinalysis (dip stick) as a part of every driver certification and recertification medical examination. An abnormal result for which of the following mandates temporary disqualification? a. Protein. b. Blood. c. Glucose. d. NONE of the above - Answer: d. NONE of the above Each of the following mandates disqualification in a driver with a history of alcoholism EXCEPT: a. He voluntarily attends a 12-step program to maintain his recovery. b. He has not successfully completed counseling and/or treatment. c. He has a current diagnosis of alcoholism. d. ALL of the above are disqualifying - Answer: a. He voluntarily attends a 12-step program to maintain his recovery. A female driver presents for re-certification who is in her fourth day of menses with heavy bleeding. Her US shows a Specific gravity of 1.020; Protein is +1; Blood is +4; Glucose is negative. All other aspects of her medical examination are within normal. The examiner should: a. Obtain medical clearance prior to certification. b. Disqualify the driver. c. Certify the driver for 1 year. d. Certify the driver for 2 years. - Answer: d. Certify the driver for 2 years. At initial certification, a driver is found to have a blood pressure of 165/105 mm Hg. You give him a certification for three months. Upon recheck, his blood pressure is 135/85. As medical examiner you: a. Certify him for 6-months after performing a new DOT examination. b. Certify him for one year from date of initial exam after performing a new DOT examination. c. Certify him for one year after performing a new DOT examination. d. Repeat the 3-month certification - Answer: c. Certify him for one year after performing a new DOT examination Which of the following is TRUE concerning a driver who presents for a DOT exam but does not speak English: a. He must be disqualified after the DOT exam is performed. b. It is not permissible to use an interpreter. c. When determining a driver's physical qualification, English language is not factored into the determination as long as the examiner can obtain a proper history and exam. d. The examiner should halt the exam at the start and not perform the exam. - Answer: C. When determining a driver's physical qualification, English language is not factored into the determination as long as the examiner can obtain a proper history and exam. Which of the following accurately describes the FMCSA's requirement regarding grip strength for certifying commercial drivers? a. The FMCSA requires Dynamometer testing to measure grip strength. b. The FMCSA requires Sphygmomanometer used as a screening test for grip by having the applicant repeatedly squeeze the inflated cuff while noting the maximum deflection on the gauge. c. The FMCSA accepts either Dynamometer testing or Sphygmomanometer testing for certification. d. The Federal Motor Carrier Safety Administration does not require any specific test for assessing grip power. - Answer: d. The Federal Motor Carrier Safety Administration does not require any specific test for assessing grip power. FMCSA guidance recommends drivers NOT be certified with the following conditions EXCEPT: a. Uncontrolled vertigo. b. Meniere's disease. c. Labyrinthine fistula. d. Otitis Media - Answer: d. Otitis Media. A driver with a history of congestive heart failure is asymptomatic at time of presentation for certification. What minimum left ventricular ejection fraction is required for certification? a. 40% b. 45% c. 50% d. 55% - Answer: a. 40% A driver presents for certification and notes that he is recently had a surgical repair of an aneurysm in his left leg. What is the minimum waiting period following surgical repair of an aneurysm? a. 1 month b. 3 months c. 6 months. d. 1 year. - Answer: b. 3 months Which of the following is true regarding the FMCSA Blood Pressure regulations for commercial motor vehicle drivers? a. Only BP readings taken during the driver physical or follow-up examinations may be used for certification decisions. b. A BP greater than 145/89 mm Hg should be confirmed with a second measurement taken later during the examination. c. Trained assistive personnel may take and record the BP. d. All of the above are correct. - Answer: d. All of the above are correct. As part of the evaluation of a driver presenting for initial certification, as the medical examiner, you must perform testing for: a. Alcohol. b. Marijuana. c. Opiates. d. NONE of the above - Answer: d. NONE of the above. Select the correct statement regarding evaluation and certification of a commercial motor vehicle driver: a. There are no work restrictions permitted. The commercial driver must be able to perform all job-related tasks, including lifting, to be certified. b. The SPE program is intended only for individuals with fixed deficits of the extremities (not for individuals with progressive diseases). c. A new, complete DOT exam must be performed in order to issue a new Medical Examiner's Certificate. d. ALL of the above are correct. - Answer: d. ALL of the above are correct Which of the following is NOT a mission of the FMCSA? a. Develop and enforce data-driven regulations that balance motor carrier (truck and bus companies) safety with industry efficiency. b. Target educational messages to carriers, commercial drivers, and the public. c. 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. d. Oversee the prosecution of criminally negligent cases of motor carrier safety breaches. - Answer: d. Oversee the prosecution of criminally negligent cases of motor carrier safety breaches In which of the following cases should you mark an exam as "incomplete examination"? a. When you do not have enough information to make a decision. b. When you have scheduled a follow up appointment for the to return with additional lab tests. c. When one provider begins an exam that will be completed by another provider. d. When the driver leaves before you have completed the exam and made a decision. - Answer: d. When the driver leaves before you have completed the exam and made a decision It is the responsibility of the Motor Carrier to make sure that commercial motor vehicle drivers meet each of the following requirements EXCEPT: a. Be at least 21 years old. b. Speak and read English well enough to understand highway/traffic signals and converse with law enforcement. c. Have a current Medical Examiner's Certificate on file. d. Provide their full Medical Examination Report Form to the motor carrier - Answer: d. Provide their full Medical Examination Report Form to the motor carrier What HgbA1C level is indicative of a diagnosis of diabetes? a. 4.8% b. 6.5% c. 7.9% d. 10% - Answer: b. 6.5% A driver presents for her first DOT medical exam. She is 48 years old and starting truck-driving school as a second career. She has no previous diagnosis of HTN, but her blood pressure today is 176/124 mm Hg. What time period is appropriate for certification? a. 1 year. b. 6 months. c. 1-time certification for 3 months. d. Disqualify. Refer for treatment - Answer: d. Disqualify. Refer for treatment. A Driver has no previous diagnosis of hypertension. Today his blood pressure is 146/88 mm Hg. What certificate time should be given? a. 2 years. b. 1 year. c. 6 months. d. Defer and refer for treatment. - Answer: b. 1 year A Driver has been taking medication for hypertension for 3 years. He is inconsistent about taking the medication. Today his blood pressure is 146/96 mm Hg. What should be done? a. Disqualify. b. Certify for 6 months. c. Give a 1-time certificate for 3 months. d. Certify for 1year. - Answer: c. Give a 1-time certificate for 3 months What is the maximum certification period for Obstructive Sleep Apnea? a. 6 months. b. 12 months. c. 18 months. d. 24 months. - Answer: b. 12 months. A Driver sustained a myocardial infarction one month ago. He is following up with his primary care physician again in 1 week. He is unsure of his prescriptions, but is asymptomatic. Should he be certified today? a. Yes. Give him a 6-month certificate. b. Not until you check his medication. Then, yes. c. No. There is a minimum wait period of 2 months and specific criteria that must be met thereafter before certification. d. No. He must wait 6 months at the minimum before being evaluatedfurther - Answer: c. No. There is a minimum wait period of 2 months and specific criteria that must be met thereafter before certification. A driver had heart surgery 6 months ago. He reports recovering well and is asymptomatic. Documentation from his physician shows he is indeed recovering well and tolerating his medication. Surgery included installation of an implantable cardioverter defibrillator. Can he be qualified today? a. Yes, he is stable. b. No. More information is needed on his exercise tolerance. c. No. An lCD is disqualifying. d. No. He has not yet met an adequate waiting period. - Answer: c. No. An lCD is disqualifying A driver denies using illegal drugs, but he looks haggard and has fresh needle sticks on his forearm. Can you order lab testing for drugs? a. No. Drug testing is beyond the scope of the DOT medical exam. b. Only if you call the employer and have them do a reasonable suspicion DOT drug test. c. Yes. This is outside of standard DOT drug testing, but a non-DOT drug test can be ordered. Refusal to test is a failure - Answer: C. Yes. This is outside of standard DOT drug testing, but a non-DOT drug test can be ordered. Refusal to test is a failure What is the maximum allowable BMI to qualify driver? a. 40. b. 50. c. 55. d. There is no standard. - Answer: D. there is no standard A driver has a long history of major depression. His only current medication is Paxil, and he reports no side effects. Three months ago, he attempted to commit suicide by hanging, but was unsuccessful. Physically, all is within standards. Can he be qualified? a. No. Paxil is disqualifying. b. Yes. This scenario is not disqualifying. c. No. The waiting period following a suicide attempt is 2 months minimum. d. No. The waiting period following a suicide attempt is 1 year minimum - Answer: D. No. The waiting period following a suicide attempt is 1 year minimum A driver's exam is unremarkable except for a recent history of panic attacks. These are under control with Xanax. She reports no side effects. What certification is appropriate? a. 2 years. b. Xanax required annual recertification. 1 year. c. Xanax is potentially dangerous. 6 months is appropriate. d. Xanax is generally considered to increase crash risk. Use your clinical judgment, but use of benzodiazepines is typically disqualifying. Additional consultation with treating physician may be needed. - Answer: d. Xanax is generally considered to increase crash risk. Use your clinical judgment, but use of benzodiazepines is typically disqualifying. Additional consultation with treating physician may be needed What is the minimum gross vehicle weight that will require a DOT medical exam for the driver? a. 16,501 pounds. b. 10,001 pounds. c. 26,001 pounds. d. 22,501 pounds. - Answer: b. 10,001 pounds. Drugs with no known medical use and a high potential for abuse fall into what category? a. Class C. b. Schedule I. c. Class F. d. Schedule V. - Answer: b. schedule 1 Marijuana is what listed as which of the following? a. Schedule 1 drug. b. Schedule 2 drug. c. Schedule V drug d. It used to be considered a Schedule 1 drug. It is no longer a listed drug - Answer: a. schedule 1 drug A driver is 35 years of age. He has a diagnosis of Ankylosing Spondylitis since he was 19. He has fusion throughout his spine, excluding the upper cervical spine. Neck rotation is limited to 15 degrees bilaterally. His neck is permanently flexed 25 degrees forward and he can only extend it 10 degrees. Agility is greatly diminished and he cannot climb well. He now presents for recertification, but notes he primarily does an administrative desk job. Based on this, what is the proper course of action? a. Disqualify. b. Certify for 1 year. c. Order a Skill Performance Evaluation. d. Certify for 6 months. - Answer: a. Disqualify. Transient Ischemic Attacks are a major concern. They can be one of the earliest signs of cerebrovascular disease. Symptoms usually only last 10-20 minutes. All of the following are symptoms that may present in the history as a result of a TIA, EXCEPT: a. Sudden temporary tingling, numbness, or weakness. b. Confusion. c. Sudden visual changes. d. Sciatica - Answer: d. sciatic A driver with a history of a TIA should be removed from the road for what minimum waiting period? a. 2 months. b. 6 months. c. 1 year. d. 2 years. - Answer: 1 year Epilepsy is a major concern due to risk of seizure or loss of consciousness. How many unprovoked seizures are required for a diagnosis of epilepsy? a. One. b. Two. c. There is no single definition; diagnosis is made on a case-by-case basis - Answer: b. two After a diagnosis of Meniere's disease, what is the recommendation for certification of a driver? a. Certification if no reported dizziness or vertigo. b. Certification after a 1 year waiting period if hearing standards are met and there are no symptoms of vertigo. c. Certification after a 2-month waiting period free of symptoms of vertigo. d. Meniere's disease is progressive and considered completely disabling. Disqualify. - Answer: d. Meniere's disease is progressive and considered completely disabling. Disqualify. Which of these is intrastate (as opposed to interstate) commerce? a. A UPS driver delivers packages from far and wide within a single city. b. A semi driver drives a long-haul route from Florida to Texas. c. A commercial driver makes a run from New Orleans, LA to Monroe, LA, but passes through Mississippi on the route. d. ALL of the above are examples of interstate commerce, not intrastate. - Answer: d. ALL of the above are examples of interstate commerce, not intrastate Which of the following diagnoses is NOT always disqualifying? a. Narcolepsy. b. Bipolar Disorder. c. Meniere's disease. d. Current Alcoholism. - Answer: b. Bipolar Disorder An obese driver's urinalysis shows 500mg/dL of glucose. He claims he is not diabetic, but it is simply because the 20-ounce bottle of soda he drank in the hour before the test. What should be done? a. Obtain a finger stick glucose. b. Certify for 1 year and recheck at that time. c. Use determination pending and have the patient return for a repeat glucose dipstick within 45 days. d. Disqualify. - Answer: a. Obtain a finger stick glucose. . When clinical signs exist indicating a driver may not have disclosed use of a scheduled drug or substance, the medical examiner: a. May request a non-Department of Transportation drug test. b. Must refer for a DOT drug test c. Must obtain consultation from a substance abuse professional d. Must obtain clearance from the driver's primary care provider - Answer: a. May request a non-Department of Transportation drug test. Who can grant a waiver or exemption? a. The Medical Examiner. b. The FMCSA. c. A Board-Certified Specialist in the field of the relevant disease. d. Any of the above. - Answer: b. The FMCSA. If a driver has had a cortical stroke, what is the minimum waiting period before he/she may possibly be certified to drive? a. 5 years, as potential for seizure is a concern. b. 1 year If there is no seizure. c. 6 months. d. 6 months once off anticoagulants - Answer: a. 5 years, as potential for seizure is a concern Both Schizophreniform and Bipolar Disorders can be disqualifying. Which of the following conditions is NOT a reason in and of itself to disqualify? a. Substantially compromised judgment. b. Swings in energy levels and mood. c. Attention difficulties. d. Personality disorder that is repeatedly manifested by overt inappropriate acts - Answer: b. Swings in energy levels and mood. What are the FMCSA guidelines for certification of a driver on Coumadin and compliant with INR monitoring? a. Disqualify. b. Use clinical judgment, based upon the underlying disease. c. Certify for a maximum of 1 year. d. Certify for a maximum of 6months - Answer: If a driver is only taking over-the-counter medications, what are the possibleramifications? a. OTC medications are not considered in the certification decision. b. OTC are considered whether or not to qualify the driver, but cannot limit the certification. c. OTC medications can affect the decision to certify, time limit, or disqualify as determined by the clinical judgment of the medical examiner. - Answer: c. OTC medications can affect the decision to certify, time limit, or disqualify as determined by the clinical judgment of the medical examiner. Exercise tolerance tests are needed to assess the driver after a cardiovascular incident or to assess for cardiac abnormalities. If ordered this test, there are specific measures that need to be met. Which of these is NOT one of them? a. Exercise to a workload capacity greater than 6 Metabolic Equivalents (METs) through Bruce protocol stage II or equivalent. b. Attain a heart rate greater than or equal to 85% of predicted maximum (unless on beta blockers). c. Have a rise in systolic blood pressure greater than or equal to 20 mm Hg without angina. d. Have no increase in diastolic pressure - Answer: d. Have no increase in diastolic pressure Which of the following are not required for the urinalysis portion of the DOT medical exam? a. Specific Gravity. b. Blood. c. Ketones. d. Protein - Answer: c. Ketones. If a dipstick urinalysis shows findings that are abnormal, but do not immediately threaten the driver or the public, such as mild proteinuria, which is the most reasonable course of action? a. Disqualify until further testing is done. b. Encourage the driver to seek further care from his primary care provider and document the findings for him/her to take to the PCP. c. Make a note in the medical examination report form, but take no other action until the next DOT exam - Answer: b. Encourage the driver to seek further care from his primary care provider and document the findings for him/her to take to the PCP. What is the advised minimum waiting period following coronary artery bypass surgery? a. 1 month. b. 2 months. c. 3 months. d. This is disqualifying. - Answer: C. 3 months Severe traumatic brain injuries are disqualifying. How is a "severe TBI" defined? a. Injury penetrates the dura and/or causes loss of consciousness 24hours. b. Injury causes loss of consciousness longer than 6 hours. c. Physically or chemically induced brain injury causing motor or sensory loss. d. Injury to the head resulting in permanent neurologic deficit - Answer: a. Injury penetrates the dura and/or causes loss of consciousness 24hours. A vehicle that is used to transport a minimum of which of the following number of persons (including the driver) would be defined as a commercial motor vehicle for interstate commerce? a. 4 for compensation, 10 not for compensation. b. 6 for compensation, 8 not for compensation. c. 9 for compensation, 16 not for compensation. - Answer: c. 9 for compensation, 16 not for compensation. A bipolar driver has been stable for 5 years without any manic or major depressive episodes. Paperwork from his mental health provider confirms this. He is treated with lithium. What is the best certification period? a. Disqualify due to lithium treatment. b. 3 months. c. 1 year. d. 2 years - Answer: c. 1 year. Which of the following is NOT included on the Medical Examiner's Certificate? a. The expiration date of the Medical Examiner's NRCME certification. b. The medical examiner's signature. c. The driver's signature. d. A place to denote that a drive requires a Skill Performance Evaluation certificate - Answer: a. The expiration date of the Medical Examiner's NRCME certification. The Role of the Medical Examiner specifically includes: a. Assessing the Driver for medical fitness to safely perform all driver duties. b. Refilling medications required by the driver for safe driving. c. Addressing new health concerns of the driver. d. ALL of the above - Answer: a. Assessing the Driver for medical fitness to safely perform all driver duties. It is generally accepted that a HgbA1C above what level indicates poor control of diabetes? a. 7%. b. 10%. c. 12% d. 13% - Answer: b. 10% Central vision loss is a finding suggestive of: a. Macular degeneration. b. Cataracts. c. Glaucoma. d. All of the above. - Answer: A. Macular Degeneration On examination, the medical examiner palpates an enlarged liver on a driver and find signs suggestive of early hepatic failure. The medical examiner should: a. Order an abdominal ultrasound as a first step. b. Order an abdominal CT scan as a first step. c. Order a set of Liver Function Tests as a first step. d. Refer the driver to his Primary Care Provider - Answer: d. Refer the driver to his Primary Care Provider