NRCME DOT Comprehensive Review for Exam Already Graded A+

NRCME DOT Comprehensive Review for Exam Already Graded A+ Corrective lenses that are prohibited by the FMCSA, including: - Answer lenses that correct distance vision in one eye and near vision in the other. telescopic lenses Medical guidelines for the driver with diabetes mellitus include: - Answer Annual medical examination. Annual ophthalmologist or optometrist eye evaluation. Disqualification for a diagnosis of unstable proliferative retinopathy. Monocular Vision - Answer Monocular vision is disqualifying. However, the driver who has monocular vision that with the better eye meets all vision qualification requirements may be considered for a Federal Vision Exemption if the Medical Examiner finds the driver otherwise medically fit for duty. Monocular vision is defined as vision that is at least 20/40 for distance in one eye with or without correction and vision that is less than 20/40 for distance in one eye with or without correction. The driver must meet other vision requirements in each eye, including visual fields (horizontal field of vision). Federal Vision Exemption: the driver with monocular vision who is applying for or has a federal exemption or is qualified by operation of 49 CFR 391.64 must have an annual physical examination. Drivers with vision loss who meet standards may be certified for up to two years. A driver who wears contact lenses which correct farsightedness in one eye and nearsightedness in the other, but has no other visual impairments can be certified under what additional conditions? Only if the driver wears prescription glasses which provide the same correction as the contact lenses. FMCSA guidance indicates that a driver should not be certified under these circumstances. Only by federal exemption. The driver is always certifiable under these conditions. - Answer FMCSA guidance indicates that a driver should not be certified under these circumstances. Explanation: FMCSA guidance indicates that contact lenses that correct one eye for distance and one eye for near vision are not acceptable. Guidance recommends not to certify with ear problem diagnoses of: - Answer a) Uncontrolled vertigo. b) Ménière's disease. c) Nonfunctioning labyrinth. d) Nonfunctioning fistula. The medical examiner's role in the exemption process includes _________. Issuing the exemption. Issuing the prescription for the driver's contact lenses and/or glasses. Providing the driver with contact information for the Federal Vision Exemption Program. Assuring that the driver has peripheral vision of at least 110 degrees in each eye. - Answer Providing the driver with contact information for the Federal Vision Exemption Program. Explanation: The medical examiner's role in the exemption process is limited to performing the driver examination and providing the driver with contact information for the FMCSA related to the exemption process. An audiometric test produces the following results: Left ear: 500 Hz, 35dB Loss; 1,000 Hz, 35 dB loss; 2,000 Hz 45 dB loss. Right ear: 500 Hz, 40 dB loss; 1,000 Hz, 45 dB loss; 2,000 40 dB loss. What is the certification? Certify for one year. Certify for two years. Do not certify. Certify only when accompanied by hearing aid. - Answer Certify for two years. Explanation: Drivers with an average hearing loss of < 40 decibels averaged across 500, 1000, and 2000 Hz in the better ear may be certified for two years. What eye conditions must the medical examiner ask the driver about? Cataracts, color deficiencies, retinitis pigmentosa, aphakia, glaucoma. Lazy eye, cataracts, aphakia, floaters, retinopathy. Glaucoma, macular degeneration, retinitis pigmentosa, color deficiencies. Retinopathy, cataracts, aphakia, glaucoma, macular degeneration. - Answer Retinopathy, cataracts, aphakia, glaucoma, macular degeneration. Explanation: These are the "ask about" vision conditions. The medical examiner may ask the driver about any eye conditions, but should ask the driver about these specified conditions. Which of the following drivers' tests meet hearing certification standards? Whisper test 4 feet right ear, 3 feet left ear. Whisper test 5 feet right ear with hearing aid, 3 feet left ear without hearing aid. Audiogram left 30/500 Hz, 40/1000 Hz, 60/2000 Hz; right 25/500 Hz, 35/1000 Hz, 80/2000 Hz. Audiogram left 35/500 Hz, 50/1000 Hz, 40/3000 Hz; right 35/500 Hz, 35/1000 Hz, 60/3000 Hz. - Answer Whisper test 5 feet right ear with hearing aid, 3 feet left ear without hearing aid. Explanation: Whisper test results require 5 feet in at least one ear for passing, with or without a hearing aid. Audiometric testing results require an average of 40 dB loss in the better ear for results averaged across 500, 1000, and 2000 Hz. Although testing may be performed at 3000 Hz, results obtained are not used to determine whether the driver meets hearing requirements. A driver has loss of hearing in the better ear of 25 dB loss at 500 Hz, 40 dB loss at 1000 Hz, and 60 dB loss at 2000 Hz. With respect to the hearing requirement for medical certification, the driver __________. May be certified for one year. May be certified for two years. May not be certified. May be certified if examined by an otolaryngologist who is familiar with the CMV driving duties who certifies the driver as medically qualified to drive a CMV. - Answer May not be certified. Explanation: An average hearing loss of 41.7 decibels averaged across 500, 1000, and 2000 Hz in the better ear is disqualifying. The driver should be referred to obtain a hearing aid and may be certified if the driver passes while wearing a hearing aid. A specialist cannot determine certification, and a specialist cannot override medical qualification standards such as the minimum hearing requirement. Which of the following is acceptable for a driver who wears a hearing aid? Testing of the driver's hearing is waived if the driver presents a letter from a qualified specialist. Testing of the driver's hearing may be performed by the medical examiner using audiometric testing equipment. Testing of the driver's hearing may be performed by an audiologist or otolaryngologist using specialized audiometric testing equipment. Testing of the driver's hearing may be performed at 1,000 Hz only. - Answer Testing of the driver's hearing is waived if the driver presents a letter from a qualified specialist. Testing the hearing of a driver who wears a hearing aid may be accomplished in three ways: 1) whisper test, 2) audiometric testing by an otolaryngologist using specialized audiometric testing equipment, or 3) audiometric testing by an audiologist using specialized audiometric testing equipment. Audiometric testing is required to be conducted at 500 Hz, 1000 Hz, and 2000 Hz. Passing Requirements for Vision Tests - Answer Corrective lenses, eye glasses and/or contact lenses may be used. Distance binocular acuity of at least 20/40 (Snellen) in each eye with or without corrective lenses. Field of vision of at least 70º in the horizontal meridian in each eye. Monocular vision - vision meeting requirements in only one eye - is disqualifying by regulation. The ability to recognize the colors of traffic signals and devices showing standard red, green, and amber. Contact lenses that correct vision in one eye for distance and the other eye for near are not acceptable. Results must be converted to Snellen values if another test is used. Measured in each eye individually and both eyes. Drivers who wear corrective lenses should be advised to carry spare glasses. In general, any vision condition, such as lazy eye, glaucoma, cataract, and others, is not disqualifying as long as the driver meets minimum vision testing parameters. FMCSA is - Answer Federal Motor Carrier Safety Administration. Is overseen by the DOT. The FMCSA creates standards for driver examinations. Regulates Interstate commercial operations, including the driver. Many states use federal FMCSA standards to govern intrastate commercial operations, including the driver, but the FMCSA does not directly regulate any intrastate functions. a division of the US Department of Transportation (DOT). Conditions which are usually disqualifying, but for which qualification can be considered on a case-by-case basis include __________. Autonomic neuropathy. Methadone use. Monocular vision. Carpal tunnel syndrome. - Answer Correct Answer: Autonomic neuropathy. Explanation: Methadone use and monocular vision are always disqualifying. Carpal tunnel syndrome is not usually disqualifying. A driver experienced a pneumothorax four weeks ago. The medical examiner tests the driver's respiratory function and the forced vital capacity (FVC) is 58% of predicted. What should the certification decision be? Do not certify pending additional testing. Certify for three months, pending driver follow up with personal physician and/or specialist. Certify one year. Certify two years. - Answer Correct Answer: Do not certify pending additional testing. Explanation: The driver may not be certified until FVC is > 60% predicted or additional testing reveals acceptable respiratory parameters - e.g., pulse oximetry with O2 > 92%. Stage 1 Hypertension Two certification options: - Answer One Year: recommend to certify for one year if it is the first examination at which the driver has blood pressure equivalent to Stage 1 hypertension, and the driver has no history of hypertension and does not use medication for blood pressure control. Three Months: recommend to certify for a three month certification if the driver has been given a one-year certificate for untreated Stage 1 hypertension in the past, whether or not the driver is taking medication to lower blood pressure. If the driver is on blood pressure medication, the medication should be well-tolerated with no side effects that could affect safe driving. Do not certify the driver with Stage 1 hypertension if the driver has been given a three-month certificate related to blood pressure within the past three months. Do not certify a driver with Stage 1 hypertension who has a history of Stage 3 hypertension (> 180/110). The driver with Stage 1 hypertension is at low risk for hypertension-related acute incapacitation. Recertification: Recertification examinations should be done annually thereafter, and driver BP should be at or below 140/90. If at recertification examination the driver with a history of Stage 1 hypertension has a BP greater than 140/90 but less than 180/110, certification may be extended for three months. The Medical Examiner should advise the driver: That the driver should follow-up with her/his primary care physician for consideration of hypertension treatment, About the nature of hypertension and the importance of hypertension as a risk factor for cardiovascular disease (CVD), and That failure to lower BP to 140/90 or less will render the driver medically unqualified for continued certification. That if blood pressure is uncontrolled at future examinations the driver may be temporarily disqualified. Which of the following is a requirement for a driver with a history of alcoholism to be certified? Complete driver certification examination. Successful treatment with naltrexone. Successfully completed counseling and/or treatment. Passed a drug test. - Answer Correct Answer: Successfully completed counseling and/or treatment. Explanation: A driver certification examination is not a requirement for return to driving. Treatment with naltrexone is not required for driver certification for a driver with a history of alcoholism. Passing a drug test is not a requirement, although passing an alcohol test is a requirement. Which of the following is true with respect to drivers with psychological disorders? Drivers with chronic schizophrenia must be evaluated at least yearly by a qualified specialist such as a psychiatrist or psychologist who understands the function and demands of CMV driving. The waiting period for a brief reactive psychosis or schizophreniform disorder is three months. Alcohol and drug dependency and abuse are profound risk factors in the presence of personality disorders. The waiting period following electroconvulsive therapy for treatment of depression is one year. - Answer Correct Answer: Alcohol and drug dependency and abuse are profound risk factors in the presence of personality disorders. Explanation: Drivers with chronic schizophrenia should be disqualified. The waiting period for a brief reactive psychosis or schizophreniform disorder is six months as is the waiting period for electroconvulsive therapy treatment. After a heart transplant, the minimum waiting period is _________ and the maximum certification period is _________. Six months, six months. Six months, one year. One year, six months. One year, one year. - Answer One year, six months. Explanation: Following heart transplant, the waiting period is one year and the maximum certification interval is six months. Which of the following is a requirement for drivers with insulin-treated diabetes mellitus (ITDM) evaluated according to 49 CFR Part 391.46? Possess a rapidly absorbable form of glucose while driving. Maintain a hemoglobin A1c value less than 7. Submit blood glucose monitoring records with each certification examination. Check blood glucose 1 hour prior to driving and at least every 2 hours while driving. - Answer Correct Answer: Submit blood glucose monitoring logs for each annual certification. Explanation: Drivers with ITDM (insulin-treated diabetes mellitus) must submit at least 3 months of blood glucose monitoring records as part of the annual examination process described in 49 CFR Part 391.46. Although the other practices may represent best practice guidelines, none are required as part of 49 CFR Part 391.46. A driver with a history of bacterial meningitis with early seizures or a single unprovoked seizure requires a waiting period of __________ seizure free and off anticonvulsant medications. One year. Two years. Five years. Ten years. - Answer Correct Answer: Five years. Explanation: The waiting period for a history of bacterial meningitis with early seizures or single unprovoked seizure is five years seizure free and off anticonvulsant medications. To apply for an exemption - Answer the driver with monocular vision must demonstrate that he or she meets all other medical certification requirements, and must submit the Medical Examination Report and the Medical Examiner's certificate with the exemption application to the FMCSA. NRCME - Answer Created by the Federal Motor Carrier Safety Administration (FMCSA), The NRCME establishes a registry of health care providers who may perform medical examinations on commercial motor vehicle (CMV) drivers (DOT examinations). National Registry of Certified Medical Examiners (NRCME) Which of the following is a disqualifying condition? A past clinical diagnosis of alcoholism. A breath alcohol result of 0.019%. An alcohol-related stable physical condition. Use of methadone. - Answer Correct Answer: Use of methadone. Explanation: A current diagnosis of alcoholism is disqualifying, a past history is not. A breath alcohol result of 0.02% or higher renders the driver unqualified to drive. Just because a condition is alcohol-related does not make it disqualifying. Which of the following is true with respect to bipolar disorder? Treatment with lithium has not been shown to increase risk for CMV accidents. The maximum certification interval is six months. The driver should be advised to report manic or severe depressive episodes within 10 days of onset to the driver's employer, medical examiner, or appropriate health professional and to seek medical intervention. Onset of manic episodes is uniformly sudden. - Answer Correct Answer: Treatment with lithium has not been shown to increase risk for CMV accidents. Explanation: Treatment with lithium has not been shown to increase CMV driving risk. The maximum certification interval for a driver with bipolar disorder is one year. The driver should be advised to report manic or depressive episodes within 30 days. Manic episode onset may be gradual or sudden. Stage 1 hypertension blood pressure - Answer 140-159/90-99 Drivers with initial Stage 1 hypertension should be advised that the condition will allow one-year certification and may or may not require medication treatment for control of the condition. Code of Federal Regulations (CFR) - Answer contains the rules of the federal government, laws that must be followed. By regulation, disqualifying medical conditions are epilepsy, monocular vision, and hearing loss. Which of the following is true? The FMCSA does not consider feasibility or impact in the rule-making process. Only the Medical Review Board can provide advice and opinions on FMCSA rulemaking. FMCSA medical standards and guidelines are subject to public notice and comment rulemaking. The Code of Federal Regulations provide guidance that the medical examiner may or may not follow. - Answer FMCSA medical standards and guidelines are subject to public notice and comment rulemaking. Explanation: The FMCSA must consider feasibility and impact in rulemaking. Members of the public are allowed to comment on FMCSA rulemaking. The Code of Federal Regulations are laws that must be followed. Which of the following is true? A driver with diabetes who uses insulin must be evaluated according to the procedures specified in 49 CFR Part 391.46. The most important concern related to medication use for treating diabetes is hyperglycemia. Peripheral neuropathy is not a disqualifying condition. Diabetes is not a coronary heart disease (CHD) equivalent condition. - Answer Correct Answer: A driver with diabetes who uses insulin must be evaluated according to 49 CFR Part 391.46. Explanation: The greatest risk for medication use for drivers with diabetes is hypoglycemia, not hyperglycemia. Peripheral neuropathy is a disqualifying condition. Diabetes is a coronary heart disease (CHD) risk equivalent condition. For mild aortic stenosis, an echocardiogram should be repeated every _________ years. For moderate aortic stenosis, an echocardiogram should be repeated every _________ years. Two, two. Five, one to two. One, one. Five, five. - Answer Five, one to two. Explanation: An echocardiogram is recommended every five years for mild aortic stenosis, every one to two years for moderate aortic stenosis. 2. Pulse oximetry O2 saturation = 90%. Arterial blood gas (ABG): PaO2 = 60 mm Hg, PaCO2 = 42 mm Hg. What is the certification determination? Do not certify. Certify three months pending additional testing. Certify for one year. Certification depends on whether testing is conducted at altitudes above or below 5,000 feet. - Answer Correct Answer: Certification depends on whether testing is conducted at altitudes above or below 5,000 feet. Explanation: The certification determination related to arterial blood gas (ABG) testing depends on the altitude at which testing is performed. A PaO2 of less than 65 mm Hg is disqualifying at altitudes of less than 5,000 feet; a PaO2 of less than 60 mm Hg is disqualifying at altitudes of greater than 5,000 feet. A Skill Performance Evaluation (SPE) certificate pursuant to 49 CFR 391.49 is granted under which of the following conditions? The driver has a fixed deficit of the torso. The driver has progressive deficit of an extremity. The driver has a medical evaluation summary completed by a board qualified or certified physiatrist or orthopedic surgeon. The driver has completed a driving evaluation per FMCSA standards. - Answer Correct Answer: The driver has a medical evaluation summary completed by a board qualified or certified physiatrist or orthopedic surgeon. Explanation: A driver with a torso deficit should not be certified. To be considered for a Skill Performance Evaluation (SPE) certificate, the driver must have a fixed, not progressive, deficit of an extremity. A driving evaluation is not required for issuance of a SPE certificate. Transient ischemic attacks (TIA's) are automatically disqualifying for __________. After the minimum waiting period the certification depends on the interval history, general health, neurological examination, and compliance with the treatment program. Three months. Six months. Nine months. One year. - Answer Correct Answer: One year. Explanation: The minimum waiting period for transient ischemic attacks (TIA's) is one year. A driver with a history of major depression should be evaluated at least every __________ by an appropriate mental health specialist, such as a psychiatrist or psychologist, who understands the functions and demands of commercial motor vehicle driving. Six months. One year. Two years. Such evaluation is not required. - Answer Correct Answer: Two years. Explanation: The maximum certification interval for a driver with a history of major depression is one year. Regulatory guidance requires evaluation every two years by a specialist, such as psychiatrist or psychologist, who understands the functions and demands of commercial driving. Passing parameters for hearing tests: - Answer Driver first perceives a forced, whispered voice in the better ear at not less than five (5) feet with or without the use of a hearing aid. Driver, if tested by use of an audiometric device, does not have an average hearing loss in the better ear greater than 40 decibels at 500 Hz, 1,000 Hz, and 2,000 Hz, with or without a hearing aid. The driver meets the hearing qualification requirements if hearing passes one test in one ear. Hearing aid: When a hearing aid is to be worn during audiometric testing, an audiologist or hearing aid center should perform the test using appropriate audiometric equipment. Stage 2 hypertension blood pressure - Answer 160-179/100-109 Drivers with Stage 2 hypertension should be advised that a limited certification interval of three months will be provided and that medication treatment is indicated and must be initiated prior to reconsideration of certification beyond the three-month interval. Which of the following is considered by the FMCSA as a mental health professional that the medical examiner may refer to or consult with? A urine drug screen collector. A FMCSA administrator. Medical review officer (MRO). Any licensed medical provider. - Answer Correct Answer: Medical review officer (MRO). Explanation: According to the FMCSA, mental health professionals the medical examiner may consult with include breath alcohol technicians (BATs), designated employer representatives (DERs), medical review officers (MROs), and substance abuse professionals (SAPs). Can you certify a driver who has a known AAA? - Answer Yes if : less than 4 cm and asymptomatic, > 4 cm but < 5 cm - Certify if: and asymptomatic with a vascular specialist clearance. > 5 cm with waiting 3 month post repair and specialist clearance. No if: 4.5 cm and symptomatic with surgery recommendations > 5 cm with the repair and specialist clearance. Recommendation to NOT surgically repair, does NOT mean driver is certified Maximum certification period: one year. Do not certify if: > 5.0 cm Aneurysm has increased more than 0.5 cm during six-month period regardless of size. Surgical repair has been recommended by a cardiovascular specialist, regardless of size, but has not yet been performed. Driver is symptomatic, regardless of size. Which of the following is not associated with safety risks in drivers with psychological disorders? The mental disorder, including symptoms and/or disturbances in performance that are an integral part of the disorder and may pose hazards for driving. Residual symptoms occurring after time-limited reversible episodes or initial presentation of the full syndrome that can interfere with safe CMV driving. Physical disorders which may be compromised by the mental disorder and may increase risk of CMV accidents. Psychopharmacology, as many psychotropic medications can compromise performance to the degree that CMV driving would be hazardous. - Answer Correct Answer: Physical disorders which may be compromised by the mental disorder and may increase risk of CMV accidents. Explanation: Physical disorders are not noted by the FMCSA to increase risk related to psychological disorders. Department of Transportation (DOT) - Answer U.S. federal government body with primary responsibility for transportation safety regulation. Oversees the FMCSA. Stage 2 Hypertension Maximum certification period - Answer three months. Recommend to certify if it is the first examination at which the driver has blood pressure equivalent to Stage 2 hypertension and the driver has no history of hypertension and does not use medication to control blood pressure. Recommend to certify if the driver has a diagnosis of hypertension treated with medication and tolerates treatment with no side effects that interfere with driving. Do not certify the driver who has been given a three-month certificate within the past three months. Advise the driver issued a three-month certificate that: To qualify at follow-up, blood pressure must be less than or equal to 140/90. If the driver qualifies on follow up examination (has a blood pressure less than or equal to 140/90), a one-year certificate may be issued from the date of the follow up examination, not the expiration date of the three-month certificate. If the driver fails to lower blood pressure by the expiration date of the one-time, three-month certificate, the driver will be disqualified until blood pressure is equal to or below 140/90 at exam. Stage 2 hypertension is an absolute indication for anti-hypertensive drug therapy. intrastate - Answer within a state Stage 3 Hypertension bp - Answer BP > 180/110 A commercial motor vehicle (CMV) is defined as... - Answer * A vehicle with a gross weight over 26,001 lbs * A vehicle transporting hazardous materials * A vehicle transporting 16 or more passengers Which of the following is true with regard to adult Attention Deficit Hyperactivity Disorder (ADHD)? The maximum certification interval is two years. The driver should be disqualified if the driver has another psychological disorder, such as depression. Risks related to adult ADHD includes comorbid antisocial or borderline personality disorders and a high incidence of substance abuse. Treatment with amphetamines and amphetamine derivatives is disqualifying. - Answer Correct Answer: Risks related to adult ADHD include comorbid antisocial or borderline personality disorders and a high incidence of substance abuse. Explanation: The maximum certification interval is one year. As long as other psychological conditions are stable, a driver with adult attention deficit hyperactivity disorder (ADHD) may be certified. Treatment with amphetamines and amphetamine derivatives is not disqualifying. Examples of adapting clinical evaluation of the musculoskeletal system include which of the following? Using resistive force or a dynamometer to the have the driver demonstrate grip strength necessary to grasp a steering wheel. Nerve conduction study testing. Two-point discrimination testing. Audiometric testing. - Answer Correct Answer: Using resistive force or a dynamometer to the have the driver demonstrate grip strength necessary to grasp a steering wheel. Explanation: Nerve conduction study testing, testing of two point discrimination, and audiometric testing are not clinical evaluations of musculoskeletal function. What is the recommended certification interval for a driver with diabetes mellitus who does not use insulin? Three months. Six months. One year. Two years. - Answer Correct Answer: One year. Explanation: Drivers with non-insulin dependent diabetes should be certified for a maximum of one year. A driver with peripheral neuropathy __________. May be certified for one year. Should not be certified by regulation. Should not be certified by guidance. May be certified for three months pending specialist evaluation. - Answer Correct Answer: Should not be certified by guidance. Explanation: Peripheral neuropathy is a disqualifying condition. However, this is a guidance recommendation, not a regulatory requirement, so Medical Examiners may consider qualification for a driver with peripheral neuropathy. The maximum certification interval for a driver diagnosed with asthma is __________. Three months. Six months. One year. Two years. - Answer Correct Answer: Two years. Explanation: The maximum certification interval for asthma is two years. A driver underwent surgical repair of a 6 cm abdominal aortic aneurysm three months ago. The driver may be certified for __________. Three months. One year. Two years. The driver should be medically disqualified. - Answer One year. Explanation: The minimum waiting period for surgical repair of an abdominal aneurysm is three months. The maximum certification interval is one year. disqualifying ear conditions and waiting periods - Answer Drivers with conditions affecting the inner ear and balance should not be certified. The minimum symptom free waiting period for drivers with dizziness or vertigo is two months. Guidance recommends a two-month, symptom-free waiting period for diagnoses of: a) Acute and chronic peripheral vestibulopathy. b) Benign positional vertigo. Guidance recommends not to certify with diagnoses of: a) Uncontrolled vertigo. b) Ménière's disease. c) Nonfunctioning labyrinth. d) Nonfunctioning fistula. Stage 3 Hypertension certification period? - Answer The driver is disqualified. The driver disqualified due to Stage 3 (uncontrolled hypertension > 180/110) should not be certified until the blood pressure is stabilized at less than or equal to 140/90 with treatment well tolerated. Once certified, a driver with a history of Stage 3 hypertension may only be certified for six-month certification intervals. The driver with Stage 3 hypertension is at risk for an acute hypertensive event and should be advised to seek, or should be provided, immediate medical attention and must be medically disqualified. The Medical Examiner should provide the driver and/or the driver's physician(s), with information regarding required follow-up and treatment, and necessary BP reduction in order to be considered for qualification. Once the driver has a documented BP of equal or less than 140/90, the driver may be certified for no more than six months, and future certifications of the driver should be for no more than six months. The driver should be counseled about the potentially serious health risks posed by uncontrolled hypertension, including Target Organ Damage (TOD) - heart failure, stroke or transient ischemic attack, peripheral artery disease, retinopathy, left ventricular hypertrophy, and nephropathy. The Medical Examiner may disqualify a driver if target organ damage significantly impairs the driver's work capacity even after adequate BP control is achieved. The driver should have no excess sedation or orthostatic change in BP. FMCSA medical program responsibilities include __________. Oversee the Department of Transportation. Regulation of intrastate commercial motor vehicle operations. Conduct and oversee the agency's medical exemption and certificate programs. Provide commercial motor vehicle driver examinations. - Answer Conduct and oversee the agency's medical exemption and certificate programs. Explanation: The FMCSA is overseen by the DOT, not vice versa. The FMCSA does not oversee intrastate commercial motor vehicle operations. The FMCSA creates standards for driver examinations, but is not responsible to provide examinations. FMCSA responsibilities: Oversee the national medical certification process for CMV drivers who operate in interstate commerce. Develop and implement medical regulations, policies, and procedures. Oversee and support the Medical Review Board in accordance with the Federal Advisory Committee Act. Develop and implement the national registry program - a national Medical Examiner system and a linked national driver medical reporting system. Conduct and oversee the agency. Oversees medical exemption and certificate programs. Serve as the lead federal agency for the regulation of CMV driver health and safety and conduct relevant medical research. The maximum certification interval for a driver with a history of drug abuse or alcoholism is __________. Six months. One year. Two years. Do not certify. - Answer Correct Answer: Two years. Explanation: Drivers with a history of drug or alcoholism may be certified for up to two years. Drivers may be subject to drug and/or alcohol testing more frequently, but such testing is performed under 49 CFR Part 40 drug and alcohol testing regulations, not under 49 CFR Part 391.41 driver qualification standards. Spirometry testing should be performed on drivers who smoke and who are over __________ years of age. 30 35 40 45 - Answer Correct Answer: 35 Explanation: Spirometry is required for smokers over 35 years of age. A driver with congestive heart failure (CHF) recently had an echocardiogram demonstrating an ejection fraction of 44%. The driver may be certified for __________ if the driver meets all other qualifications for CHF. One year. Two years. Six months. The driver should not be certified. - Answer One year. Explanation: The minimum left ventricular ejection fraction (LVEF) for certification with any cardiovascular condition is 40%. The maximum certification interval for drivers with CHF is one year. documentation requirement with schizophrenia - Answer for a driver with progressive schizophrenia cannot be certified, document: Medical Examiner observations and examination. Medical Examiner rationale not to certify. Which of the following is true regarding why regulation is needed to protect public safety? There is little environmental risk from crashes involving hazardous materials. There is greater risk of injury and fatalities to individuals in smaller vehicles from crashes involving commercial motor vehicles. The economic cost of crashes involving commercial vehicles is relatively low. Commercial vehicles do not carry members of the public. - Answer There is greater risk of injury and fatalities to individuals in smaller vehicles from crashes involving commercial motor vehicles. Explanation: There is significant environmental risk from crashes involving hazardous materials. The economic cost of CMV crashes is very high compared with crashed involving personal and private vehicles. Some CMV's do carry members of the public. Levodopa/carbidopa may cause the driver to be disqualified because it is used for the treatment of what condition? Parkinson's disease. Peripheral neuropathy. Isaac's disease or Stiff Man Syndrome. Epilepsy. - Answer Correct Answer: Parkinson's disease. Explanation: Although all of the conditions listed are disqualifying, levodopa/carbidopa is used to treat Parkinson's disease. If glucose is detected on urinalysis in a driver with no history of diabetes, an appropriate next step is __________. Endocrinology consultation. One year clearance and recommendation to see personal physician. Fingerstick or blood glucose determination. Temporary disqualification. - Answer Correct Answer: Fingerstick or blood glucose determination. Explanation: The medical examiner should first determine blood glucose, make an appropriate certification determination, and consider appropriate referral to the driver's personal physician. The maximum certification interval for a driver with a Skill Performance Evaluation (SPE) certificate is __________. Three months. Six months. One year. Two years. - Answer Correct Answer: Two years. Explanation: A Skill Performance Evaluation (SPE) certificate may be issued for up to two years. It must be renewed within 30 days of expiration. A three-month medical certificate is recommended in two cases of elevated BP: - Answer Where the driver has a BP that is equivalent to Stage 2 hypertension, or A driver that was certified with Stage 1 hypertension for one year and has not achieved a BP less than or equal to 140/90 at recertification. The purpose of the three-month certificate is to allow the driver with high blood pressure that is an absolute indication for antihypertensive drug therapy to continue to drive while taking steps to lower elevated blood pressure. When certified three months, the driver is to seek evaluation and initiation of drug therapy to lower BP to equal to or less than 140/90. Medical guidelines for the driver with diabetes mellitus include: - Answer Annual medical examination. Annual ophthalmologist or optometrist eye evaluation. Disqualification for a diagnosis of unstable proliferative retinopathy. Can Medical Examiner perform alcohol and drug testing as part of the driver examination using any alcohol or drug testing methodology? - Answer yes, and ME may consider such results in assessing driver fitness for duty. If such testing is performed based on the Medical Examiners assessment, and is not conducted in compliance with FMCSA drug and alcohol testing rules, the Medical Examiner must be sure to advise the driver of this circumstance - that the testing is being performed based on the Medical Examiner's assessment, not on the basis of FMCSA regulation. A driver with an impairment of an arm, leg, hand, or foot who is otherwise medically qualified, may be certified if the driver does what? - Answer gets an SPE certificate. Driver must apply for the SPE certificate from the FMCSA and the FMCSA determines if driver is qualified for the SPE certificate. Driver examination 6/18/2011. Driver disqualified due to benign positional vertigo with last symptoms noted 5/15/2011. Driver advised to return after a __________ symptom free interval for a maximum __________ certification interval. One month, one year. Two month, one year. Two month, two year. Three month, one year. - Answer Correct Answer: Two month, two year. Explanation: The waiting period for benign positional vertigo, as well as dizziness and acute or chronic vestibulopathy, is two months symptom free, with a maximum certification interval of two years. Suicide attempt affect on certification - Answer loss of certification and create the start of a minimum one-year waiting period for consideration of certification. FMCSA content sources rules and regulations include __________. 49 CFR Part 16 DOT Procedures for Drug and Alcohol Testing. 49 CFR 391.41 Physical Qualifications for Drivers. 49 CFR 391.82 Medical examination; certificate of physical qualification. 49 CFR Part 73: Medical Review Board procedures. - Answer 49 CFR 391.41 Physical Qualifications for Drivers. Explanation: Drug and alcohol testing regulations described in 49 CFR Part 40. 49 CFR 391.43 describes medical examiner responsibilities for driver examination. 49 Part CFR Part 391.41 describes physical qualifications for drivers. Medical Review Board procedures are described in internal FMCSA documents. Drivers with Stage 2 hypertension should be advised that: - Answer a limited certification interval of three months will be provided and that medication treatment is indicated and must be initiated prior to reconsideration of certification beyond the three-month interval. also, the risk for gradual or sudden incapacitation is higher with Stage 2 hypertension than with Stage 1 hypertension. Drivers with Stage 1 or Stage 2 hypertension should be advised of the risk that hypertension could progress to Stage 3 hypertension, which would be disqualifying. Which of the following is true? For drivers on Coumadin, INR should be measured every 3 months and records should be provided by the driver to the medical examiner. On exercise tolerance testing (ETT), a driver should exercise to greater than a 10 MET capacity. Left ventricular ejection fraction (LVEF) of at least 40% is required for certification. The waiting period for pacemaker implantation for cardiogenic syncope is two months. - Answer Left ventricular ejection fraction (LVEF) of at least 40% is required for certification. Explanation: For patients on warfarin (Coumadin), INR should be checked monthly and records provided to the medical examiner. Exercise tolerance testing (ETT) should be performed to at least 6 METS. The waiting period for pacemaker implantation for cardiogenic syncope is three months. Which of the following is disqualifying? PaCO2 less than 45 mm Hg. PaO2 less than 70 mm Hg at altitudes less than 5000 feet. PaO2 less than 65 mm Hg at altitudes above 5000 feet. PaCO2 greater than 45 mm Hg. - Answer Correct Answer: PaCO2 greater than 45 mm Hg. Explanation: PaCO2 of less than 45 mm Hg is not disqualifying, but PaCO2 of greater than 45 mm Hg is disqualifying. An PaO2 saturation of less than 65 mm Hg is disqualifying at altitudes below 5,000 feet and an PaO2 saturation of less than 60 mm Hg is disqualifying at altitudes above 5,000 feet. Drug and Alcohol Testing Who must be tested? - Answer All drivers, including part-time drivers, holding a commercial driver's license (CDL) and operating CMVs (greater than 26,000 combined gross vehicle weight rating, or transporting more than 16 passengers, or carrying placarded hazardous materials) on public roadways must be subject to testing according to U.S. Department of Transportation (DOT) drug and alcohol regulations. This means any driver required to possess a CDL, including drivers employed by Federal, State, and local government agencies and owner operators. Equivalently licensed drivers from foreign countries are also subject to these rules. NOTE: Drivers who only operate CMVs on private property not open to the public are not subject to testing. Which of the following is not a criteria that the FMCSA uses to define a severe hypoglycemic reaction? Seizure. Dizziness. Need of assistance from another person. Coma - Answer Correct Answer: Dizziness. Explanation: The FMCSA defines severe hypoglycemia as a reaction that results in seizure, loss of consciousness, need of assistance from another person, or coma. When is Drug and/or Alcohol Testing Required? - Answer Pre-employment: Drug testing is required. However, a driver may be exempted from testing if the driver was in a testing program within the last 30 days and tested within the last six months or in a testing program for the previous 12 months. Pre-employment alcohol testing is not required; however, the employer may require alcohol testing before the driver can perform safety-sensitive functions. The employer may make job offers contingent upon passing an alcohol test. Post-accident drug and/or alcohol testing is required for all fatal crashes, when the driver is cited for a moving traffic violation, and when crashes meet specific criteria related to the cost of vehicular damage or personal injury. Random drug and/or alcohol testing is conducted on a random, unannounced basis just before, during, or just after performance of safety-sensitive functions. Reasonable suspicion testing is conducted when a trained supervisor or company official observes behavior that is characteristic of drug and/or alcohol misuse. Return-to-duty and follow-up testing is conducted when an individual who has violated the prohibited drug and/or alcohol conduct standards returns to performing safety-sensitive duties. Skill Performance Evaluation (SPE) can be applied for what impairment? - Answer The requirements for a Skill Performance Evaluation (SPE) certificate cited in 49 CFR 391.49 are an alternate standard for 391.41(b)(1) and (2) and can be applied only in cases of fixed deficits of the extremities. The impairment must be fixed and stable, not the result of a progressive disease (e.g., multiple sclerosis). The impairment must affect an extremity and may not involve the neck or torso. The Medical Examiner: Determines if the driver is eligible for a SPE certificate. Determines that the driver is otherwise medically qualified. Directs the driver to obtain a SPE certificate. Completes documentation necessary for the SPE certificate process. The SPE certificate: Issued by FMCSA, not Medical Examiner. Issued up to two years; may be renewed. To legally operate a CMV, the driver must carry a SPE certificate and a valid Medical Examiner's certificate. The driver is responsible for ensuring that both certificates are renewed prior to expiration. The SPE application and renewal application must include a medical evaluation summary completed by a board-certified orthopedist or physiatrist. Examinations must document that the driver is eligible for a SPE certificate. Follow-up examinations must document that there has been no change in the driver's condition that would affect the driver's eligibility for a SPE certificate (determination that the deficit remains fixed and stable). The Medical Examiner determines, on a case-by-case basis, that a Skill Performance Evaluation (SPE) is required when the severity of the limb loss or impairment is less than the whole hand or foot. If the driver is otherwise qualified, the Medical Examiner should check the SPE certificate box on both the Medical Examination Report and the Medical Examiner's certificate that indicates the driver is qualified when accompanied by a SPE certificate. Employer Responsibilities related to drug and alcohol testing and violations and counseling - Answer Employer responsibilities include: Implementing and conducting drug and alcohol testing programs. Providing a list of substance abuse professionals (SAPs) for drivers who violate drug and alcohol regulations. Ensuring that the driver who is returning to a safety- sensitive position has complied with SAP recommendations. Conducting follow-up testing to monitor that the driver is compliant with DOT alcohol conduct guidelines and abstaining from unauthorized drug use. Employer responsibilities do not include: Providing SAP evaluations. Paying for driver SAP evaluation, education, or treatment. The Medical Examiner should obtain additional evaluation by appropriate mental health professionals, which may include: - Answer Breath alcohol technicians (BATs). Designated employer representatives (DERs). Medical review officers (MROs). Substance Abuse Professionals (SAPs). Additional medical assessment may include referral to substance abuse specialists (in addition to a SAP) and/or drug and/or alcohol testing. FMCSA guidelines require evaluation by a Substance Abuse Professional (SAP) even if the driver has seen other mental health professionals, and requires that the driver complete any rehabilitation program recommended by the SAP prior to return to duty. A current clinical diagnosis of drug abuse or alcoholism cert period? - Answer disqualifying. When INR is required, it should be monitored how often? - Answer monthly and the driver should provide monthly records to the Medical Examiner. Which of the following is true? By May 21, 2015, medical providers that perform medical examinations for commercial motor vehicle drivers must have completed an approved training program and passed a national certification examination. The Medical Examiner may request that an appropriate specialist provider make the driver certification determination. The purpose of the commercial motor vehicle driver examination is for treatment of driver medical conditions. FMCSA guidance recommendations may or may not be followed by the Medical Examiner. - Answer FMCSA guidance recommendations may or may not be followed by the Medical Examiner. Explanation: The deadline for training and certification of medical examiners was May 21, 2014. Only the medical examiner may make a certification determination; the medical examiner cannot cede the certification decision to any other medical provider. The purpose of the CMV driver examination is a medical fitness for duty determination, not for the treatment of driver medical conditions. Do Not Certify for BP of: - Answer The driver with Stage 3 hypertension - a BP greater than or equal to 180/110 - as the driver is at risk for an acute hypertensive event that could occur while operating a CMV thus endangering the driver and public safety. The driver who had Stage 2 hypertension on initial examination, and on reexamination three months later still has Stage 2 hypertension. The driver with disqualifying side effects from medication use - e.g., the driver who reports that after starting a beta blocker for hypertension treatment the driver has noted extreme fatigue and occasional dizziness and weakness one to two hours after taking the medication. Disqualify the driver when a condition exists that will interfere with the safe operation of a commercial motor vehicle. Document the rationale for disqualification. At least two BP readings should be taken and documented. Which of the following is a common symptom of congestive heart failure (CHF)? Chest pain. Swelling in the legs, ankles, or other parts of the body. Irregular pulse. Slow pulse rate. - Answer Swelling in the legs, ankles, or other parts of the body. Explanation: Although chest pain is common to many cardiovascular conditions, it is not common with CHF. A driver with chest pain should be evaluated for coronary heart disease including angina or myocardial infarction. An irregular pulse is not a common finding with CHF. CHF is associated with a rapid, not slow, pulse rate. Health History questions that specifically address respiratory conditions include: - Answer Shortness of breath Lung disease Emphysema Asthma Chronic bronchitis Fainting, dizziness Sleep disorders Pauses in breathing while asleep Daytime sleepiness Loud snoring The driver must indicate onset date, diagnosis, treating provider's name and address, and any current limitations related to respiratory (pulmonary) disease. Which of the following conditions are disqualifying? Myotonia. Stiffman Syndrome. Isaac's Syndrome. Amyotrophic lateral sclerosis (ALS). All of the above. - Answer Correct Answer: All of the above. Explanation: All of these conditions are disqualifying. Which of the following is true of nephropathy? Nephropathy is a disqualifying condition. The maximum certification interval for nephropathy is two years. A driver with 3+ proteinuria should not be certified. A renal specialist should make the certification determination for a driver with nephropathy. - Answer Correct Answer: The maximum certification interval for nephropathy is two years. Explanation: Certification of drivers with nephropathy should be considered on a case-by-case basis. The medical examiner determines what evaluation or monitoring is necessary for a driver with 3+ proteinuria, and may qualify or disqualify the driver. The certification determination is always made by the medical examiner and cannot be deferred to a specialist. Recommend not to certify if driver has following musculoskeletal impairment: - Answer An impairment that affects the torso. Not provided proof of compliance with skill performance evaluation (SPE) certification requirements. A disqualifying limb impairment caused by a progressive disease (e.g., multiple sclerosis). The maximum period for which a driver with a history of a psychological disorder should be certified is - Answer one year. disqualifying drugs - Answer Do not certify a driver who uses methadone. Even though other narcotic drugs may have similar effects and dependence and abuse potential, methadone is the only narcotic specified by the FMCSA as disqualifying. Schedule I drugs, including marijuana, are disqualifying. This also includes "medical marijuana" or marijuana for "medicinal use." Schedule I drugs currently have no accepted medical use in the United States, have a high abuse potential, and are not considered safe, even under medical supervision. A driver should be disqualified if the driver uses a controlled substance, including a narcotic, an amphetamine, or another habit-forming drug, without a prescription from the treating physician. Even with a prescription, the Medical Examiner should obtain certification from the prescribing provider that the driver is safe to driver a CMV while using the medication as prescribed. The prescribing provider should be familiar with the driving duties of a CMV driver. If such certification from the prescribing provider is not obtained, the driver using such medications should be disqualified. Drivers with which of the following conditions should be disqualified? Cancer requiring chemotherapy treatment. Umbilical hernia not surgically repaired. Renal failure on peritoneal dialysis. Hemochromatosis. - Answer Correct Answer: Renal failure on peritoneal dialysis. Explanation: Dialysis of any type is disqualifying. A driver with history of moderate traumatic brain injury with early seizures, stroke with risk for seizures, or intracerebral or subarachnoid hemorrhage with risk for seizures requires a waiting period of __________ seizure free and off anticonvulsant medications. One year. Two years. Five years. Ten years. - Answer Correct Answer: Five years. Explanation: Each of these conditions requires a symptom-free waiting period of five years. Drivers with a history of alcoholism or alcohol or drug misuse or abuse may be certified for a maximum of - Answer two years. Skill performance evaluation (SPE) initial and renewal applications require a medical evaluation summary completed by - Answer either a board qualified or certified physiatrist or orthopedic surgeon. Do not certify for following mental conditions - Answer If an active psychosis is present. If prominent negative symptoms are present, including: Substantially compromised judgment. Attention difficulties. Suicidal behavior or ideation. If side effects from medications interfere with safe driving. Guidelines for supraventricular tachycardias include: 1. Certification should be granted only after adequate anticoagulation is demonstrated for three months. 2. Certification for atrial flutter may be considered if the driver is one month following isthmus ablation. 1 only. 2 only. Both 1 and 2. Neither 1 nor 2. - Answer 2 only. Explanation: The minimum waiting period for anticoagulation for a cardiovascular condition is one month. Cert period for Stage 1 hypertension who is not on treatment - Answer One-year certification. What are the differences between the medical standards and the medical guidelines? - Answer Regulations are laws and are mandatory. The medical examiner must use the standards found in 49 CFR 391.41 to determine interstate CMV driver medical fitness for duty. Medical guidelines are not regulatory; the medical examiner may choose not to follow the medical guidance. They are based on expert review and intended to assist the medical examiner in determining driver certification. before return to duty, The driver disqualified for alcohol or drug abuse must: - Answer Have an evaluation by a Substance Abuse Professional (SAP) and complete any rehabilitation program required by the SAP. Have a negative return to duty drug and/or alcohol test result. Be subject to follow up random drug and/or alcohol testing. NOTE: drivers who violate FMCSA drug and alcohol testing regulations are not required to undergo a return to duty medical examination. A driver with a history of recent drug abuse must - Answer be evaluated by a substance abuse professional (SAP) and must complete a rehabilitation program as recommended by the SAP. A driver with a history of recent drug abuse must pass a DOT return-to-work drug test and is then subject to follow-up random drug testing at a frequency determined by the SAP. Refer a driver with limitations in extremity movement for an - Answer on-road performance evaluation and/or skill performance evaluation. many Medical Examiners routinely include sleep apnea screening questionnaires, such as - Answer the Epworth Sleepiness Scale or the Berlin Questionnaire, on every driver examination waiting period for myocardial infarction - Answer two-month waiting period for myocardial infarction and three-month waiting period for coronary artery bypass graft (CABG) operation. The longer of the two waiting periods should apply. If a driver has had a myocardial infarction and then subsequently has a CABG operation, the waiting period should be three months from the date of the CABG operation. FMCSA medical guidance recommends that diagnosis and evaluation of neuromuscular conditions be performed by an appropriate specialist, usually a - Answer neurologist or neurosurgeon. For musculoskeletal conditions, appropriate specialists are usually a - Answer physiatrist or orthopedist. if driver has a diagnosis of a neuromuscular disorder - Answer Recommend not to certify by guidance not regulatory tricyclic antidepressants - Answer Amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine. Antidepressants which interfere with safe driving - Answer First-generation antidepressants have consistently been shown to interfere with safe driving. First-generation antidepressants include amitriptyline and imipramine. Second-generation antidepressants have fewer side effects and are generally safe; however, these medications can still interfere with safe driving and require case-by-case evaluation. Second-generation antidepressants include selective serotonin reuptake inhibitors such as fluoxetine, Celexa (citalopram), and sertraline; and norepinephrine reuptake modulators such as venlafaxine; and unicyclic aminoketones such as bupropion. Which of the following conditions is not disqualifying? Multiple sclerosis. Congenital myopathies. Metabolic muscle diseases. Muscular dystrophies. - Answer Correct Answer: Multiple sclerosis. Explanation: Multiple sclerosis may or may not be disqualifying, depending on whether the driver has symptoms that interfere with safe driving. Congenital myopathies, metabolic muscle diseases, and muscular dystrophies are all disqualifying. Guidelines for reconsideration of the decision not to certify a driver with a diagnosis of a neuromuscular disorder include: - Answer Evaluation by a neurologist or physiatrist who understands the demands of commercial motor vehicle driving. Specialist may recommend a simulated driving skills test or equivalent functional test. Annual recertification that repeats specialist evaluation and driving test may be performed when indicated. These conditions include: Congenital myopathies Central core disease. Centronuclear myopathy. Congenital muscular dystrophy. Rod (nemaline) myopathy. Inflammatory myopathies Dermatomyositis. Inclusion body myositis. Polymyositis. Motor neuron diseases and muscular dystrophies Spinal muscular dystrophies Amyotrophic lateral sclerosis (ALS - Lou Gehrig's Disease) Neuromuscular junction disorders - myathenia gravis Note: guidelines Recommend not to certify if driver has a diagnosis of a neuromuscular disorder. Which of the following is true? Regulations are advisory and are not mandatory. Driver qualification standards are found in 49 CFR 391.43. Medical guidelines are regulatory and must always be followed by the medical examiner. Medical guidelines are based on expert review and intended to assist the medical examiner in determining driver certification. - Answer Medical guidelines are based on expert review and intended to assist the medical examiner in determining driver certification. Driver qualification standards are found in 49 CFR Part 391.41. 49 CFR Part 391.43 contains the instructions to medical examiners for performing the driver certification examination. Regulations are mandatory and must be followed. Guidance is not regulatory and the medical examiner may choose whether or not to follow guidance recommendations. Cert period for Stage 1 hypertension who is on treatment. - Answer Three-month certification. The waiting period for hypertrophic cardiomyopathy is __________. One month. Two months. Three months. There is no waiting period. Hypertrophic cardiomyopathy is a disqualifying condition. - Answer There is no waiting period. Hypertrophic cardiomyopathy is a disqualifying condition. Explanation: Hypertrophic cardiomyopathy is a disqualifying condition. If a significant abnormal finding for urinalysis specific gravity, protein, or blood is found, the medical examiner should __________. Disqualify the driver. Request that a renal specialist determine if the driver is medically qualified. Use clinical expertise to determine if additional evaluation is required and request or recommend primary care provider follow-up. Obtain blood chemistries for renal function. - Answer Correct Answer: Use clinical expertise to determine if the driver is medically qualified. Explanation: Use clinical expertise to determine if additional evaluation is required and request or recommend primary care provider follow-up. Abnormalities on urinalysis may indicate the presence of serious medical conditions that can affect driving safety, but also occur in the context of normal conditions (e.g., female driver currently menstruating). visual acuity test - Answer standard eye examination to determine the smallest letters a person can read on a Snellen chart, or E chart, at a distance of 20 feet Cert period Stage 2 hypertension who is not on treatment. - Answer Three-month certification. When a driver tests positive for alcohol or controlled substances under Part 382, the driver is not required to be medically re-examined or to obtain a new Medical Examiner's certificate provided the driver is seen by - Answer a substance abuse professional (SAP) and the driver completes any rehabilitation recommended by the SAP. The SAP provides the driver with documentation allowing the driver to return to work after the SAP evaluation and the completion of any required rehabilitation. If the SAP determines that alcoholism exists, the driver is not qualified to drive a commercial motor vehicle in interstate commerce until the driver completes any recommended rehabilitation and is determined to no longer have a current clinical diagnosis of alcoholism. The SAP determines that recommended treatment for drug abuse has been completed, and specifies requirements for return to work and follow-up testing. The ultimate responsibility rests with the motor carrier to ensure the driver is medically qualified and to determine whether a new medical examination should be completed. regulatory standard requirements include: - Answer Vision requirements: including distant visual acuity, horizontal vision, and color vision. Drivers who do not meet standards cannot be certified unless accompanied by a vision exemption/waiver. Diabetes requirements: drivers using insulin cannot be certified unless special procedures for evaluation and certification of such drivers are followed. Epilepsy: drivers with a diagnosis of epilepsy cannot be certified unless accompanied by an epilepsy waiver/exemption. Hearing: drivers who cannot meet whisper test or audiometric test requirements cannot be certified unless accompanied by a hearing waiver/exemption. Stage 2 hypertension who is on treatment cert period? - Answer Three-month certification. Cert period for driver with a three-month certificate and continued Stage 1 hypertension. - Answer Driver certified to maximum three-month certificate date; if driver has not achieved blood pressure equal to or less than 140/90 by the end of the three-month certificate date, the driver is disqualified until blood pressure equal to or less than 140/90 is achieved. peripheral neuropathy guidelines - Answer The FMCSA lists peripheral neuropathy as a disqualifying condition. However, this is a guidance, not regulatory, listing. Thus, peripheral neuropathy is usually disqualifying, but the Medical Examiner may consider certifying a driver with peripheral neuropathy. Guidelines for reconsideration of the decision not to certify include evaluation by a neurologist or physiatrist who understands demands of commercial motor vehicle driving. The specialist or the Medical