AK NRCME DOT EXAM STUDY SET PART 2 Questions and Complete Solutions Graded A+

  Allergic Rhinitis - Answer: Waiting Period: No recommended time Maximum Certification: 2 years Allergic Rhinitis: Recommend not to certify if- - Answer: The driver has complications and or treatment that impair function, including: - severe conjunctivitis affecting vision - inability to keep eyes open - photophobia - uncontrollable sneezing fits - sinusitis with severe HA - Medications that cause sedation or other side effects that interfere with save driving Allergy Related Life Threatening Conditions - Answer: Waiting period: no recommended time frame maximum certification: 2 years Allergy Related Life Threatening Conditions: Recommend not to certify if: - Answer: The driver has a history of an allergy related life threatening condition does not have: - Effective treatment regimen - Successful preventative measures Asthma - Answer: Waiting Period: none Max Certification: 2 year Asthma: Recommend not to certify if: - Answer: The driver exhibits either: - continual, uncontrolled, symptomatic asthma - significant impairment of pulmonary function (forced expiratory volume in the first second of expiration (FEV1) less than 65%) and significant hypoexemia (partial pressure of arterial oxygen (PaO2) less than 65 millimeters of mercury (mm Hg). — less than 65% FEV1 — less than 65 mm of mmHg Hypersensitivity Pneumonitis - Answer: Waiting period: none maximum certificate: 2 years Hypersensitivity Pneumonitis- recommend not to certify if: - Answer: - as the medical examiner, you believe that the nature and severity of the medical condition of the driver endangers the health and safety of the driver and the public COPD (chronic obstructive pulmonary disease) - Answer: Waiting period: none max certificate: 2 years COPD (chronic obstructive pulmonary disease)- Recommend not to certify if: - Answer: The driver has: - hypoxemia at rest - chronic respiratory failure Spirometry should be performed in all smokers over the age of: A) 35 YO B) 25 YO C) 45 YO D) 65 YO - Answer: 35 YO Chronic Sleep Disorders - Answer: Waiting period: 1 month after CPAP waiting period: 3 months symptom free after surgical treatment maximum certification: 1 year Chronic Sleep Disorders - Recommend not to certify if: - Answer: The driver has: - hypoxemia at rest Diagnosis of: - Untreated symptomatic OSA - narcolepsy - primary (idiopathic) alveolar hypoventilation syndrome - idiopathic central nervous system hypersomnolence - restless leg syndrome associated with excessive daytime sleepiness The driver who is being treated for sleep apnea should undergo __________________ objective testing: a) daily b) weekly c) monthly d) yearly - Answer: Yearly Acute infections diseases - Answer: Waiting period: none maximum certification: 2 years Medical examiners should educate drivers who are taking medications such as antihistamines or narcotic antitussives (which can cause drowsiness and loss of attention) that they should refrain from operating a vehicle for at least ______________ after taking a medication with sedating side effects. A) 1 hour B) 2 hours C) 12 hours D) 24 hours - Answer: 12 hours Atypical TB - Answer: Waiting period: none maximum certification: 2 years Atypical TB - Recommend not to certify if: - Answer: The Driver has: - extensive pulmonary dysfunction - weakness - fatigue - adverse reaction to medial treatment You should perform ___________________ tests if you suspect Atypical TB has become progressive and may cause extensive pulmonary symptoms. A) Pulmonary Function Tests B) Urine Analysis C) BUN test D) Blood tests - Answer: A) Pulmonary Function Tests Pulmonary TB - Answer: Waiting period: none maximum certificate: 2 years Pulmonary TB: You should not certify until - Answer: - Driver is determined not to be contagious - Etiology is confirmed and treatment has been shown to be adequate/effective, safe and stable Pulmonary TB: Recommend to to certify if- - Answer: The driver has: - advanced TB respiratory insufficiency not meeting pulmonary function test criteria - Chronic TB - Exhibited noncompliance with anti-tubular therapy - not completed streptomycin therapy - residual eighth cranial nerve damage that affects balance and or hearing to an extent that interferes with safe driving Chest Wall Deformities (kyphosis, kyphoscoliosis, pectus excavatum, AS, massive obesity, and recent thoracic/upper abdominal surgery or injury) - Answer: Waiting period: none maximum certificate: 2 years Cystic Fibrosis - Answer: Waiting Period: None maximum certificate: 2 year True or false: any driver with a deficit that requires special evaluation and screening should have __________________ recertification. A) Daily B) Weekly C) Monthly D) Annual - Answer: Annual Interstitial Lung Disease - Answer: Waiting period: none maximum certification: 2 years Pneumothorax - Answer: Waiting period: none maximum certificate: 2 years Pneumothorax: recommend not to certify if: - Answer: The driver has not: - not met certification parameters - a history of two or more spontaneous pneumothoraces on one side if no successful surgical procedure has been done to prevent recurrence - hypoxemia at rest - chronic respiratory failure - a history of continuing cough with cough syncope Indicators for obtaining pulmonary function testing (PFT) include: a) history of any specific lung disease b) symptoms of SOB, cough, chest tightness or wheezing c) cigarettes smoking in drivers 35 YO of age or older d) all of the above - Answer: a) history of any specific lung disease b) symptoms of SOB, cough, chest tightness or wheezing c) cigarettes smoking in drivers 35 YO of age or older Indicators for obtaining a spirometry test include: a) history of any specific lung disease b) symptoms of SOB, cough, chest tightness and or wheezing c) cigarette smoking in drivers 35 Years of age or older d) all of the above - Answer: a) history of any specific lung disease b) symptoms of SOB, cough, chest tightness and or wheezing c) cigarette smoking in drivers 35 Years of age or older Screening pulse oximetry and/or arterial blood gas (ABG) analysis are indicated when: Conditions causes airway obstruction and pulmonary function test results are: a) FEV1 less than 65% of the predicted value b) FEV1/FVC ratio less than 65% c) all of the above - Answer: a) FEV1 less than 65% of the predicted value b) FEV1/FVC ratio less than 65% If the Pulse oximetry is less than ________________ (oximetry equals 70), the driver must have an ABG analysis (arterial blood gas) A) 92% B) 50% C) 98% D) 10% - Answer: 92% Reccomend not to certify the driver when the ABG measurements reveal: - Answer: partial pressure of arterial oxygen (PaO2) less than: -65mm of mm Hg at altitudes below 5,000 feet - 60 mm Hg at altitudes above 5,000 feet partial pressure of arterial carbon dioxide (PaCo2) greater than 45mm Hg at any altitude Cor Pulmonale - Answer: Waiting period: none maximum certification: 2 years Pulmonary Hypertension - Answer: Waiting period: none maximum certificate: 1 year Significant pulmonary hypertension is pulmonary artery pressure greater than _______________ systemic blood ensure from any cause. A) 10% B) 20% C) 30% D) 50% - Answer: 50% An increased risk for incapacitation and sudden death is associated with: a) primary pulmonary HTN b) Secondary pulmonary HTN c) both - Answer: Both Medications such as Coumadin need to have _________________ IDR. A) Daily B) Monthly C) Yearly D) Weekly - Answer: Monthly If a person was treated by surgery for Obstructive Sleep Apnea, what is the recommendation regarding certification? A) Certify for 2 years B) 3 month wait after surgery then certified for 2 years C) One time 6 month certification D) 3 month wait after surgery then certified for 1 year - Answer: 3 month wait after surgery then certified for 1 year When evaluating a patient with known Obstructive Sleep Apnea (OSA) the medical examiner should be concerned about evaluating for symptoms of: a) excessive daytime sleepiness b) HTN c) sexual dysfunction d) obesity - Answer: Excessive daytime sleepiness Which of the following signs and symptoms of pulmonary disease would disqualify a driver under FMCSA regulations? A) cough induced syncope B) Rhinorrhea C) Wheezing treated via a bronchodilator D) mild scoliosis - Answer: Cough Induced Syncope What condition must a driver with acute or chronic cor pulmonale meet to be certified to operate an interstate CMV? A) Minimum pulse oximetry of 98% on room air B) Left Ventricular ejection fraction of greater than 60% C) Minimum arterial blood gas (PaO2) greater than 65 mm Hg D) Chest X-ray exhibiting no evidence of pulmonary edema - Answer: C) Minimum arterial blood gas (PaO2) greater than 65 mm Hg A driver states that she has exercise induced asthma well controlled by using an albuterol (Proventil, Ventolin) inhaler before she does any aerobic activity. Her pulmonary function (forced expiratory volume in the first second of expiration (FEV1)) must be greater than _________% of predicted FEV1 to qualify, a) 65 b) 45 c) 55 d) 60 - Answer: 65 A driver takes diphenhydramine (Benadryl), 25 mg, once per day, to treat nasal congestion. How many hours should this driver wait after taking the diphenhydramine before driving a CMV? A) 12 B) 6 C) 4 D) 24 - Answer: 12 The examiner notices that the driver has marked that he has asthma and lists an albuterol (Proventil, Ventolin] Inhaler among his medications. On questioning, the driver admits to using it several times a day, especially during the spring and fall; he admits that he has not seen his primary care physician in several years but is still getting frequent refills on his inhaler. The driver also admits that he has been hospitalized twice in the last six months for his asthma, ending up on a ventilator on the last visit. How long should the medical examiner certify the driver for before follow-up? A) 6 Months B) 1 Year C) 2 Years D) Do not certify - Answer: Do not certify A driver presents for examination with a history (last month) of a pneumothorax. 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. The driver is eligible to be certified: A) True B) False - Answer: False According to regulation, what neurological condition is not medically disqualifying for the interstate CMV driver certification? A) headache B) Epilepsy C) Vertigo D) Narcolepsy - Answer: Headache According to medical guidance, for which of the following diagnosed neurological conditions is the driver considered medically unqualified for driving? a) Febrile seizure b) dementia c) headache d) TIA greater than 1 year ago - Answer: Dementia A driver is taking levodopa/carbidopa (Sinemet), Levodopa/carbidopa may cause the driver to be disqualified because is it used for the treatment of what? A) CHF B) Diabetes C) Parkinson's D) HTN - Answer: Parkinson's The SPE certificate may be used to qualify an individual with MS a) true b) false - Answer: False A driver has surgery for removal of an acoustic neuroma what is the minimum recommended waiting period before certification? A) 6 months B) 1 Year C) 5 Year D) 2 years - Answer: 1 year What is the recommended waiting period before certification for an individual diagnosed with viral encephalitis with early seizure? A) 1 year B) 2 year C) 5 year D) 10 year - Answer: 10 year Alzheimer's disease causes a progressive decline in mental functioning that interferes with memory, language and spatial functions? A) True B) False - Answer: True Acute Seizures - Answer: Waiting Period: 1 year seizure free and off anticonvulsant medication following: - mild insult without early seizures - stroke without risk for seizures - intracerebral or subarachnoid hemorrhage without risk for seizures Waiting Period: 2 years seizure free and off anticonvulsant medication following: - moderate insult without early seizures - mild insult with early seizures Waiting period: 5 years seizure free and off anticonvulsant medication following: - Moderate insult with early seizures - Stroke with risk for seizures - Intracerebral or subarachnoid hemorrhage with risk for seizures Acute Seizures- Systemic Metabolic Illness - Answer: Waiting Period: None Maximum Certification: 2 year Childhood Febrile Seizures - Answer: Waiting period: none Max Certification: 2 years Epilepsy - Answer: Waiting period: 10 years off anticonvulsant medication and seizure free Headaches - Answer: Waiting Period: none maximum certification: 2 years Single unprovoked seizure - Answer: Waiting Period: 5 years off anticonvulsants and seizure free and cleared by neurologist Max Certification: 1 year Vertigo/Dizziness - Answer: Waiting Period: 2 months asymptomatic with diagnosis of: - Benign Positional Vertigo - Acute and Chronic Vestibulopathy Maximum Certification: 2 years Infections of Central Nervous System - Answer: Waiting Periods 1 year seizure free and off anticonvulsant medication following: - Bacterial Meningitis w/o early seizure - Viral Encephalitis without early seizures 5 years seizure free and off anticonvulsant medication following: - Bacterial meningitis with early seizures 10 years seizure free and off anticonvulsant medication following: - Viral Encephalitis with early seizures Autonomic Neuropathy - Answer: Waiting Period: none Maximum Certification: 2 Conditions associated with Abnormal muscle activity - Answer: Waiting period: none Maximum Certification: 2 years Congenital Myopathies - Answer: Waiting period: none DISQUALIFICATION Metabolic Muscle Diseases - Answer: Waiting Period: none DISQUALIFIED Motor Neuron Diseases - Answer: Disqualified Muscular dystrophies - Answer: DISQUALIFIED Neuromuscular Junction Disorders - Answer: Disqualified Peripheral Neuropathies - Answer: Disqualified Central Nervous System tumors - Answer: Waiting Period: 1 year post surgical removal of: - infratentorial meningiomas - acoustic neuromas - pituitary adenomas - spinal benign tumors - benign extra axial tumors waiting period: 2 years post surgical removal of: - benign supratentorial tumors - spinal tumors True or False: Anticonvulsants are grounds for disqualification - Answer: True Dementia - Answer: DISQUALIFIED Embolic and Thrombotic Strokes - Answer: Waiting Period : 1 year IF NOT at risk for seizures Waiting Period: 5 years IF AT risk for seizures Maximum certification: 1 year Intracerebral and Subarachnoid Hemorrhages - Answer: Waiting Period: 1 year if NOT at risk for seizures Waiting Period: 5 Years IF AT RISK for seizures Maximum Certification: 1 year TIA - Answer: Waiting period: 1 year maximum certification: 1 year Traumatic Brain Injury - Answer: Waiting Period: 2 years seizure free and off anticonvulsant medication following: - moderate TBI without early seizures - mild TBI with early seizures Waiting Period: 5 Yrs seizure free and off anticonvulsant medication following: - moderate TBI with early Maximum Certification: 1 year Maximum Certification: 2 years for mild TBI without early seizures Autonomic Neuropathy - Answer: Waiting Period: None Maximum certification: 2 Years Autonomic Neuropahty: Reccomend NOT to certify if: - Answer: The driver has: Cardiovascular autonomic neuropathy causes: - Resting Tachycardia - Orthostatic Blood Pressure Conditions Associated with Abnormal muscle activity - Answer: Waiting Period: none Maximum Certification: 2 years Conditions Associated with Abnormal muscle activity- Recommend NOT to certify if: - Answer: The driver has a diagnosis of: - Myotonia - Isaacs Syndrome - Stiffmans Syndrome Congenital Myopathies: - Central core disease - Centronuclear myopathy - Congenital Muscular Dystrophy - Rod (nemaline) Myopathy - Answer: Disqualified Metabolic Muscle Disease - Answer: Disqualified Motor Neuron Disease - Answer: Disqualified Muscular Dystrophy - Answer: Disqualified Neuromuscular Junction Disorders (Myasthenia Gravis or Myasthenic Syndrome) - Answer: Disqualified Peripheral Neuropathies - Answer: Disqualified Fixed Deficit of an Extremity - Answer: Waiting Period: none Maximum Certification: 2 years Fixed deficit of an extremity- Recommend Not To Certify if: - Answer: The Driver Has: - an impairment that affects the torso - not provided proof of compliance with SPE certification requirements - A disqualifying limb impairment caused by progressive disease (EX: MS) NOTE: The SPE applies only to fixed deficits of the extremeities, not those caused by a progressive disease. The driver of an extremity caused by a progressive disease must no be certified if the driver cannot meet 49 CFR 391.41 requirements Fixed deficit of an extremity- Recommend to certify (accompanied by an SPE) if: - Answer: The driver has: - a fixed deficit of an extremity and is other wise medically qualified at physical examination - A valid SPE certificate and documentation of compliance with medical requirements A 55 YO man with history of gastric bypass, htn, and a new finding of peripheral neuropathy - BP: 122/78 - Pulse 77 - Paresthesia in both feet Should you certify? - Answer: No - refer patient to neurologist - b12 work up - re exam - then certify The ___________ applies only to fixed deficits of the extremities, not those caused by a progressive disease. To be certified, the driver with a deficit of an extremity caused by progressive diseased must meet 49 CFR 391.41 requirements pms including adequate range of motion, group strength, and prehensile to safely operate a CMV. A) SPE B) SPF C) CBC D) UA - Answer: SPE According to regulation, only _____________________ can grant drivers a SPE certificate. A) the medical examiner B) A designated FMCSA regional center C) the PCP D) a neurologist - Answer: B) a designated FMCSA Regional center " A person who is not physically qualified to drive Under 391.41(b)(1) or (b)(2) and who is otherwise qualified to drive a commercial motor vehicle, may drive a commercial motor, if the Division Administrator, FMCSA ha granted a SPE to that person" What is the maximum certification period when medical certification must be accompanied by a SPE certificate? A) 1 Year B) 2 Years C) 6 Months D) 3 years - Answer: 2 years Which of the following conditions would require the driver to complete qualifying procedures under 49 CFR 391.49? 1. Missing fourth and fifth fingers of right hand; has strong hand grasp. 2. Missing right foot since age two; uses prosthesis and runs marathons. 3. Status post-crush injury to left arm; has atrophy and weakness in ulnar distribution. 4. Suffering from carpal tunnel syndrome; has weak hand grasp. a) all of the above b) 1&2 c) 3&4 d) 2&3 - Answer: 2 & 3 Muscular Dystrophy is an inherited myopathy that may lead to progressive muscle weakness a) True b) False - Answer: True A diver with diabetic neuropathy in the lower extremities would need to undergo an SPE evaluation? A) true B) false - Answer: False If a driver is missing a finger or toes they can be certified for? A) 1 year B) 2 years C) The driver must obtain a SPE before becoming certified D) Examiner determines on a case by case basis - Answer: Examiner determines on a case by case basis A driver diagnosed with a neuromuscular junction disorder may be certified under certain conditions if: a) the driver obtains an evaluation by a neurologist or psychiatrist who understands the functions and demands of commercial driving b) the driver receives approval to drive from their PCP c) The certification period is for no more than 3 months d) The driver with neuromuscular junction disorder is automatically disqualified - Answer: a) the driver obtains an evaluation by a neurologist or psychiatrist who understands the functions and demands of commercial driving nephropathy - Answer: Waiting Period: none Maximum certification: 2 years An abnormal urinalysis including but not limited to proteinuria, may indicate some degree of renal dysfunction. A) true B) false - Answer: True Hernia - Answer: Waiting period: none Max Certification: 2 years What specific test for grip strength listed below does the FMCSA require for all drivers as part of the musculoskeletal exam: a) dynamometer grip strength for grip b) sphygmomanometer used as screen test for grip c) cable weight machine d) no specific test is required but the driver must have sufficient grasp and prehension to control an oversize steering wheel , shift gears using a manual transmission, and maneuvers a vehicle in crowded areas - Answer: d) no specific test is required but the driver must have sufficient grasp and prehension to control an oversize steering wheel , shift gears using a manual transmission, and maneuvers a vehicle in crowded areas Which Federal Regulation permits the insulin-treated driver to operate a CMV? A) 49 CFR 391.49 B) 49 CFR 391.46 C) 49 CFR 391. 45 D) 49 CFR 391. 64 - Answer: B) 49 CFR 391.46 The driver with diabetes mellitus who takes oral hypoglycemic agents reports lightheadedness, dizziness, and diaphoresis after taking medications in the morning. Physical exam findings are unremarkable. For what period of time should the FMCS medical examiner certify this driver? A) One year, as long as the driver follows up with his primary care physician to have medications adjusted B) One year, and the medical examiner should advise the driver to stop taking his medications. C) The driver should be disqualified as the driver is at high risk for a severe hypoglycemic reaction. D) The medical examiner should certify the driver for 6 months and monitor the driver closely. - Answer: C) The driver should be disqualified as the driver is at high risk for a severe hypoglycemic reaction. A CMV driver with diabetes mellitus with a medical diagnosis of which of the following conditions should be permanently disqualified? A) Hypertension B) Cardiovascular disease C) Severe Non-Proliferative Diabetic Retinopathy or Proliferative Diabetic Retinopathy D) Proteinuria - Answer: C) Severe Non-Proliferative Diabetic Retinopathy or Proliferative Diabetic Retinopathy FMCSA defines a severe hypoglycemic reaction as: A) having a blood sugar less than 80 mg/dL B) having a blood sugar less than 70 mg/dL C) an event resulting in polyphagia, polyuria, and polydipsia D) an event which resulted in LOC, impaired cognitive function, needing assistance of another person, and/or seizure - Answer: D) an event which resulted in LOC, impaired cognitive function, needing assistance of another person, and/or seizure One of the most critical and challenging roles for the certified medical examiner when determining the driver with diabetes mellitus medical fitness for duty is: A) the driver's risk for a cardiovascular event B) the driver's risk for a severe hypoglycemic reaction C) the driver's risk for eye disease D) the driver's risk for daytime sleepiness - Answer: B) the driver's risk for a severe hypoglycemic reaction As per FMCSA new regulation (49 CFR 391.46), the insulin-treated CMV driver will no longer: A) require a Federal Diabetes Exemption to operate a CMV B) require an annual physical examination C) be required to monitor his or her blood sugars on a routine basis D) be required to meet physical qualification standards as outlined under 49 CFR 391.41 - Answer: A) require a Federal Diabetes Exemption to operate a CMV CMV drivers requiring insulin for glycemic control must meet all regulations as outlined under Federal regulation 49 CFR 391.46, which include: A) a physical examination by an endocrinologist B) a hemogiobin A1c (HbA1c) checked prior to seeking a DOT physical C) must have his or her treating clinican (TC) complete ITDM assessment form, MCSA-5870 before seeking a DOT physical D) must have an evaluation from an opthalmologist or optometrist - Answer: C) must have his or her treating clinican (TC) complete ITDM assessment form, MCSA-5870 before seeking a DOT physical The insulin-treated CMV driver's treating clinican completes |TDM assessment form, MCSA-5870. The form is valid for a period of: A) 60 days B) 6 months C) 90 days D) 45 days - Answer: 45 days As per FMCSA regulation outlined in 49 CFR 391.45 (e), the insulin-treated CMV driver: A) may be certified for a maximum period of one year B) may be certified for a maximum certification period of six months C) should be disqualified under this regulation D) none of the above - Answer: A) may be certified for a maximum period of one year When determining medical fitness for duty and safety for the driver taking insulin for glycemic control, who is ultimalety responsible for the final certification decision? A) the driver's treating clinican B) the driver's primary care provider C) the FMCSA certified medical examiner D)Both A & C - Answer: C) the FMCSA certified medical examiner True or False: The driver who has experienced a severe hypoglycemic reaction will need further-work/testing from his or her ____________________ to determine etiology of event before the driver should be considered for certification. a) PCP/Specialist b) the FMCA c) the MA d) all of the above - Answer: a) PCP/Specialist Permanent Disqualification if the driver: A) Has a diagnosis of severe Peripheral Neuropathy Level B) Has a diagnosis of severe Non-Proliferative Retinopathy or Proliferative Retinopathy C) has signs and symptoms of target end organ damage or advance disease as it relates to DM that would interfere with the drivers ability to safely operate a CMV D) None of the above - Answer: A) Has a diagnosis of severe Peripheral Neuropathy Level B) Has a diagnosis of severe Non-Proliferative Retinopathy or Proliferative Retinopathy C) has signs and symptoms of target end organ damage or advance disease as it relates to DM that would interfere with the drivers ability to safely operate a CMV Diabetes Mellitus - Diet Controlled - Answer: Waiting period: none Maximum Certification: 2 years but really 1 Year *****Because of the progressive nature of DM the FMCSA believes that 1 YEAR maximum certification time is reasonable when the driver has a diagnosis of DM******* Hemoglobin A1C greater than __________ is an indicator of poor blood glucose control. A) 25% B) 10% C) 50% D) 15% - Answer: 10% TRUE OR FALSE: Glycosuria may indicate poor glucose control. - Answer: True True or False: if the driver's DM can be controlled by the use of an oral medication(s) and diet, then the driver may be considered for a CMV certificate using the physical qualification requirements of 49 CFR 391. 41 - Answer: TRUE Oral Anti Diabetic Agents - Answer: Waiting Period: none Maximum Certification: 1 Year Incretin Mimetic - Answer: Waiting period: none Maximum Certification: 1 year *** The FMCSA Recommends frequent monitoring determined on a case by case basis *** True or False: The FMCSA recommends that the driver taking Incretin Mimetic provide a written statement from the treating health care professional. - Answer: True The written statement should: - describe driver tolerance to the medication - indicate how frequently the driver is monitored for adequate blood glucose control. - include efficacy of treatment True or false: Federal diabetes exemptions are no longer required? - Answer: True The medical examiner will no longer need to check off "accompanied by waiver/exemption" on the examination report form as it pertains to diabetes Insulin Therapy - Answer: Waiting period: none maximum certification: up to 1 year and no longer than 12 months per added regulation 49 CFR 391.45 (E) Insulin Therapy: recommends NOT to certify if: - Answer: The driver with DM requiring insulin glycemic control: - is not maintained on a stable insulin regimen and hair or her DM is not well controlled - the driver is not physically qualified to operate a CMV up to the maximum 12 months until he or she provides their treating clinician with at least the preceding 3 months of electronic blood glucose self monitoring record while being treated with insulin. The ME may issue the driver a 3 month certificate to all the driver time to collect such data The _____________ assessment for, MCSA-5870 is required for every new DOT examination and must be retained as part of the ME report form, MCSA-5875 by the mE for 3 years. - Answer: ITDM True or False: When the driver is able to provide 3 months of electronic blood glucose self monitoring records, the treating clinician must complete a new ITDM Assessment form, MCSA-5870 and the medical examiner may issue a medical examiners certificate that is valid for up the maximum 12 month period. - Answer: True if the driver is unable to provide the treating clinician with at least the preceding 3 months of electronic blood glucose self monitoring records, the ME may issue the driver a 3 month certificate to allow the driver time to monitor and collect the required data When evaluating a driver with a psychological disorder that might interfere with safe operation of CMV, what behaviors should an examiner look for: a) signs of being easily distracted b) signs of flat affect or lack of emotional response c) displays of unusual or bizarre ideas, auditory r visual hallucinations, dishonesty or a tendency to omit important information d) all of the above - Answer: a) signs of being easily distracted b) signs of flat affect or lack of emotional response c) displays of unusual or bizarre ideas, auditory or visual hallucinations, dishonesty or a tendency to omit important information A driver with a history of drug abuse shows you a letter from his narcotic anonymous drug counselor indicating that he has been attending meetings regularly for the past 6 months and has not used any illegal substances. Based on this information, the FMCSA medical examinaer can certify the driver for a period of? A) 1 year B) 6 months C) 2 years D) the driver should be disqualified - Answer: D) the driver should be disqualified The FMCSA medical examiner uses the CAGE questionnaire to assess a CMV driver for suspected alcohol abuse. Answering yes on at least two questions strongly indicate alcohol abuse. Which of the following questions are used as part of the CAGE tool? A) Have you ever felt shameless as a result of your drinking? B) Have you ever felt you should cut down on your drinking? C) Have you ever wanted to fight someone for accusing you of being an alcoholic? D) Have you ever had the desire to drink first thing in the morning? - Answer: B) Have you ever felt you should cut down on your drinking? When assessing a driver for consumption patterns of alcohol, the FMCS medical examiner asked the driver about the number of drinks per week or the number of drinks per occasion. Which of the following corresponds with a drinking problem? A) A male who consumes 7 or more drinks per week or 3 or more per occasion B) A male who consumes 10 or more drinks per week or 3 or more per occasion C) A male who consumes 14 or more drinks a week or 4 or more per occasion D) A male who consumes 5 or more drinks per week or 2 or more per occasion - Answer: C) A male who consumes 14 or more drinks a week or 4 or more per occasion Mr. Taylor is here for his recertification DOT examination. During the exam, the medical examiner notices that Mr. Taylor has fine hand tremors, poor coordination, and has a body odor consistent with the use of alcohol. Based on these examination findings, the next step for the medical examiner would be to: A) Send Mr. Taylor to the emergency room for treatment of alcohol intoxication B) Ask Mr. Taylor, "Are you an alcoholic?" C) Have Mr. Taylor follow up with a substance abuse specialist for further evaluation D) Contact FMCSA or Mr. Taylors employer directly for information on substance abuse and testing guidelines - Answer: D) Contact FMCSA or Mr. Taylors employer directly for information on substance abuse and testing guidelines The FMCSA medical examiner should disqualify a CMV driver who has all of the following, except: A) Signs of a current alcoholic illness and/or non compliance with DOT alcohol conduct guidelines B) Not met return to duty requirements C) A driver with a current clinical diagnosis of alcoholism D) The driver who has successfully completed counseling with a SAP - Answer: D) The driver who has successfully completed counseling with a SAP A driver with a history of depression presents taking a prescription selective serotonin reuptake inhibitor (SSRI) but appears depressed. What would the medical examiner do to adequately assess the driver? A) Certify the driver for 3 months and re evaluate them following this period. B) Educate the driver regarding the signs and symptoms of depression and assess for suicidal ideations before allowing them to drive. C) Have the driver evaluated by a mental health professional who would treat and monitor the driver before certifying them to drive D) Increase the dose of the drivers SSRI and re evaluate them in one month, prior to providing certification. - Answer: C) Have the driver evaluated by a mental health professional who would treat and monitor the driver before certifying them to drive A driver with a history of a suicide attempt eight months prior to your examination presents to your office for certification. The suicide attempt followed the drowning death of his two year old son in a swimming pool accident. Since the suicide attempt he has sought treatment from a psychiatrist and obtained clearance to return to work and normal activities. Based on this information what is the recommended certification decision in this scenario? A) Provide a 6 month certification to the driver and re evaluate him in conjunction with the mental health professional. B) Provide a 1 year certification to the driver and re evaluate him in conjunction with the mental health professional. C) Provide a 2 year certification to the driver and re evaluate him in conjunction with the mental health professional. D) Disqualify the driver. - Answer: D) Disqualify the driver. A driver with a history of suicide attempt presents to your office for recertification. What is the minimum recommended symptom-free waiting period before recertification consideration following a suicide attempt? A) 6 Months B) 1 Year C) 2 Years D) 3 Months - Answer: 1 year A driver candidate presents to your office for a new certification. While examining the driver you notice he is unkempt with dirty clothes and probably has not bathed in some time. When you question the client about his job duties he states "my boss is watching me through surveillance bugs planted in my home." You suspect the driver may be displaying symptoms of: A) Depression B) Bi Polar Disorder C) Schizophrenia D) Post Traumatic Stress Disorder - Answer: C) Schizophrenia A driver with a history of Adult Attention Deficit Hyperactivity Disorder (ADHD) presents to your office for recertification. The driver's symptoms are well controlled while taking Concerta (methylphenidate), a central nervous system stimulant medication. What is the maximum recommended certification period for this driver? A) 6 Months B) 1 Year C) 3 Months D) 2 Years - Answer: 1 year Adult Attention-Deficit/Hyperactivity Disorder (ADHD) - Answer: Waiting period: none Maximum Certification: 1 year Bipolar mood Disorder - Answer: Waiting period: 6 months symptom free following a non psychotic major depression unaccompanied by suicidal behavior waiting period: 1 year symptom free following a severe depressive episode, a suicide attempt or a maniac episode maximum certification: 1 year **Monitor/Testing** - At least every 2 years the driver with a history of a major mood disorder should have evaluation and clearance from a mental health specialist, such as a psychiatrist or psychologist, who understands the functions and demands of commercial driving. - Advice the certified driver with a major mood disorder to report any maniac or severe major depressive episode within 30 days of onset to the drivers employer, medical examiner, or appropriate health care professional and to seek medical intervention. Major Depression - Answer: Waiting period: 6 months symptoms free following a non psychotic major depression unaccompanied by suicidal behavior waiting period: 1 year symptom free following a severe depressive episode, a suicide attempt, or a maniac episode. **Monitor/Testing** - At least every 2 years the driver with a history of a major mood disorder should have evaluation and clearance from a mental health specialist, such as a psychiatrist or psychologist, who understands the functions and demands of commercial driving. - Advice the certified driver with a major mood disorder to report any maniac or severe major depressive episode within 30 days of onset to the drivers employer, medical examiner, or appropriate health care professional and to seek medical intervention. Personality Disorders - Answer: Waiting period: none Maximum Certification: 1 year Schizophrenia & Related psychotic Disorders - Answer: Waiting Period: 6 months free is a brief reactive psychosis or scizophreniform disorder Waiting Period; 1 Year symptom free if any other psychotic disorder Maximum Certification: 1 Year Alcoholism - Answer: Waiting Period: none Maximum Certificate: 2 Years Drug Abuse - Answer: Waiting Period: None Maximum Certification: 2 Years Drug Abuse: Do NOT certify if- - Answer: The Driver uses: - Schedule 1 controlled substances - Amphetamines - Narcotics - Any other habit forming drug fro which the exception guidelines do not apply - Methadone (regardless of the reason for prescription) - Marijuana (even if in a State that allows medicinal use) True or False: The driver taking medical marijuana cannot be certified? - Answer: True Heroin, Marijuana, Opiates, opiate derivatives and hallucinogenic substances are all examples of: a) schedule 1 b) schedule 2 c) schedule 3-5 d) alcoholism - Answer: Schedule 1 Natural opioids (Morphine), Synthetic Opioids (OcyContin), Opioids, depressants and amphetamines are all examples of: a) schedule 1 b) schedule 2 c) schedule 3-5 d) alcoholism - Answer: b) schedule 2 True of false: Methadone is a habit forming narcotic which can produce drug dependence and is not an allowable drug for operators of CMV - Answer: True Tranquilizers, Chlorhydrol and Phenobarbital are all examples of: a) schedule 1 b) schedule 2 c) schedule 3-5 d) alcoholism - Answer: c) schedule 3-5