DOT Medical Examiner Review Questions and Complete Solutions Graded A+

  To promote the safety of America's roadways through the promulgation and implementation of medical regulations, guidelines and policies that ensure commercial motor vehicle drivers engaged in interstate commerce are physically qualified to do so. Whose mission is this? - Answer: The mission of the Office of Medical Programs To improve highway safety by producing trained, certified medical examiners who can effectively determine if a commercial motor vehicle driver's health meets Federal Motor Carrier Safety Administration Standards. Whose mission is this? - Answer: National Registry of Certified Medical Examiners Who can be a medical examiner? - Answer: PAs, NPs, physicians and chiropractors. T/F...When a driver returns from an illness or injury that interferes with driving ability, the driver must undergo a medical examination if the medical examiner's certificate has not expired - Answer: True What is title 49? - Answer: Transportation What is part 391? - Answer: Qualifications of Drivers and Longer Combination Vehicle What is subpart E of Part 391? - Answer: Physical Qualifications and Examninations What are the four non-discretionary (disqualifying) standards? - Answer: 1. Vision 2. Hearing 3. Epilepsy 4. Diabetes Mellitus What is 49 CFR 391.41? - Answer: Describes the physical qualification requirements for drivers. The 13 standards are used to determine medical fitness for duty. (9 discretionary and 4 non-discretionary) What is 49 CFR 391.49? - Answer: Describes the skill performance evaluation certification program, which is an alternative physical qualification standard for the driver with a fixed musculoskeletal deficit of an extremity who cannot physically qualify to drive under 391.41 (b)(1) or (b)(2). What is 49 CFR 391.62? - Answer: Describes limited exemptions for intra-city zone drivers. What is 49 CFR 391.64? - Answer: Describes grandfathering for certain drivers who participated in vision and diabetes waiver study programs. What is an exemption? - Answer: An exemption provides temporary relief from one or more of the FMCSRs for commercial drivers. Relief from a regulation is for 2 years and may be renewed. Currently the FMSCA has two medical Driver Exemption Programs. What are they? - Answer: 1. Federal Vision Exemption Program (1998) 2. Diabetes Exemption Program (September 2003) T/F The medical examiner cannot issue an exemption - Answer: True T/F Both federal exemptions require the driver to have an annual medical examination for maintenance and renewal of the exemption. - Answer: True What is 49 CFR 391.43? - Answer: Certificate of physical examination. Describes your responsibilities as a FMCSA medical examiner. What is the purpose of Interstate Commercial Driver Physical Examination? - Answer: As a medical examiner, your fundamental obligation is to establish whether a driver has a disease, disorder, or injury resulting in a higher than acceptable likelihood for gradual or sudden incapacitation or sudden death, thus endangering public safety. When conducting a physical examination to determine if the driver is medically fit to perform the job of commercial driving, you must consider what 3 things? - Answer: 1. Physical condition 2. Mental condition 3. Medical treatment How do you distinguish between medical standards (49 CFR 391.41) and medical guidelines? - Answer: Regulations/standards are laws and must be followed. Whereas guidelines, such as advisory criteria and medical conference reports are recommendations. T/F A complete physical examination is required for new certification and recertification - Answer: True If a driver is on dialysis can they be certified? - Answer: No What is the maximum amount of time you can certify a driver? - Answer: 2 years How long do you retain the driver medical records for? - Answer: 3 years What is 49 CFR 391.41 (b) (10)? - Answer: Vision What qualifies for vision? - Answer: Has distant visual acuity of at least 20/40 (Snellen) in each eye without corrective lenses or visual acuity separately corrected to 20/40 (Snellen) or better with corrective lenses, distant binocular acuity of at least 20/40 (Snellen) in both eyes with or without corrective lenses, field of vision of at least 70 degrees in the horizontal median in each eye, and the ability to recognize the colors of traffic signals and devices showing standard red, green, and amber. T/F Monocular vision is disqualifying - Answer: True What is the requirement for central distant visual acuity and distant binocular visual acuity? - Answer: At least 20/40 in each eye What is the requirement for peripheral vision? - Answer: At least 70 degrees in the horizontal meridian for each eye What is the color vision requirement? - Answer: Ability to recognize and distinguish among red, amber and green. *True color perception is not required* What eye conditions should you refer? - Answer: 1. Cataracts 2. Glaucoma 3. Macular degeneration 4. Retinopathy What is a early symptom of cataracts? - Answer: Glare, particularly during night driving in the face of oncoming headlights. Glare, diminished overall acuity, contrast, and color resolution are compounded by the light scattering effect of the cataracts. T/F Glaucoma can cause deficits in peripheral vison - Answer: True.....Snellen acuity test results may not be affected, but peripheral field test results may show deficits T/F Visual loss caused by glaucoma cannot be restored - Answer: True T/F Antiglaucoma agents may have side effects that impact vision and interfere with safe driving. - Answer: True What condition is a leading cause of untreatable legal blindness in the US? - Answer: Macular degeneration How is vision affected in Macular degeneration? - Answer: May cause rapid loss of central vision. Peripheral vision is generally spared. Medical guidelines for the driver with diabetes mellitus - Answer: 1. Annual medical examination 2. Annual ophthalmologist or optometrist eye evaluation 3. Disqualification for a diagnosis of unstable proliferative retinopathy. The driver with monocular vision who is otherwise qualified may want to apply for a Federal vision exemption. - Answer: IF a driver presents a valid vision exemption and a copy of the specialist eye examination report, how long can you certify for? - Answer: 1 year What are the provisions included in the vision exemption? - Answer: 1. Annual medical examination 2. Eye exam by an ophthalmologist or an optometrist What are the hearing requirements? - Answer: 1. Perceive a forced whispered voice, in one ear, at not less than five feet. 2. Have an average hearing loss, in one ear, less than or equal to 40 decibels. *Disqualify when both the forced whisper test AND the audiometric test are failed T/F Uncontrolled vertigo is disqualifying - Answer: True....The driver may be certified after completing at least 2 months symptom free with a diagnosis of: BPPV, acute and chronic peripheral vestibulopathy T/F Insulin is a disqualifier - Answer: True T/F FMCSA believes that 1 year maximum certification time is reasonable when the driver has a diagnosis of diabetes - Answer: True T/F Incretin mimetics such as exenatide (Byetta) are not insulin and can be used without an exemption - Answer: True Maximum certification with incretins? - Answer: 1 year T/F The driver with a diabetes exemption must carry a source of rapidly absorbable glucose while driving - Answer: True Waiting period for a driver with diabetes that was previously diagnosed and on treatment that did not include the use of insulin - Answer: 1 month Waiting period for a driver with diabetes that is newly diagnosed and was not on prior treatment - Answer: 2 months What blood glucose level is generally considered safe for commercial driving? - Answer: 100 mg/dl-400mg/dl Maximum certification for oral hypoglycemics - Answer: 1 year T/F The driver with a diabetes exemption must carry a source of rapidly absorbable glucose while driving - Answer: True What is 49 CFR 391.43? - Answer: Blood Pressure An individual diagnosed with Stage 1 HTN (140/90-159/99) maybe certified for how long? - Answer: 1 year A driver with Stage 1 HTN at recertification has a BP equal to or less than 140/90 maybe certified for how long? If there BP is >140/90 but <160/100 how long can you certify? - Answer: 1 year and 3 months An individual diagnosed with Stage 2 HTN (160/100-179/109) should be certified for how long? - Answer: one-time certificate for 3-months. *Once the driver has reduced their BP to equal to or less than 140/90, he or she may be recertified annually thereafter. An individual with Stage 3 HTN (>180/100) should be certified for how long? - Answer: Should not be certified until his or her BP is reduced to 140/90 or less, and may be recertified every 6 months. Waiting period for secondary HTN post-surgical correction? - Answer: 3 months....Maximum certification period 1 year What workload capacity should a driver have? - Answer: >6 METs on exercise tolerance test Heavy and very heavy work requires greater than 6 METs and includes carrying heavy objects and climbing stairs rapidly - Answer: Maximum certification for AAA - Answer: 1 year Waiting period for driver started on anti-coagulation? - Answer: 1 month stabilized Intermittent claudication waiting period for post-surgical repair? - Answer: 3 months........*Maximum certification 1 year* If the driver has intermittent claudication with pain at rest should they be certified? - Answer: No Driver has active PE can they be certified? - Answer: NO...they have to wait 3 months with no PE and then can be certified for 1 year If the driver has an ICD can they be certified? - Answer: Recommend not to certify If the driver has a newly placed pacemaker is there a waiting period to certify them? - Answer: Yes...they have to wait one month post-implantation if underlying disease is sinus node dysfunction and AV Block....3 months if it is due to neurocardiogenic syncope and hypersensitive carotid sinus with syncope Post-CABG surgery waiting period - Answer: Minimum - 3 months regardless of type of CABG surgery performed Post-CABG maximum certification period - Answer: 1 year T/F The driver who is post-CABG must have stress test annually after 5 years of CABG - Answer: True Post-percutaneous coronary intervention waiting period - Answer: Minimum 1 week Initial certification of Post-percutaneous coronary intervention - Answer: Up to 6 months...Recertify up to 1 year if ETT results are satisfactory T/F A driver with post-PCI should have a ETT 3-6 months post PCI following initial certification and bring results to a 6 month follow-up examination - Answer: True Minimum waiting period post heart transplant - Answer: 1 year post transplant.....*max certification period is 6 months* Can you certify a driver with hypertrophic cardiomyopathy? - Answer: Recommend not to certify Maximum certification period for driver with mild aortic regurgitation - Answer: 1 year Waiting period of certification for sleep apnea - Answer: 1. 1 month after starting CPAP 2. 3 months symptom free after surgical treatment Maximum certification for OSA - Answer: 1 year T/F Medications used to treat respiratory tract congestion, such as prescriptions and/or over-the-counter antihistamines or narcotic antitussives, can cause drowsiness and loss of attention. You should educate the driver to refrain from operating a vehicle for at least 12 hours after taking a medication with sedating side effects. - Answer: True T/F If FEV1 < 65% of that predicted, ABG measurements should be evaluated - Answer: True What four specific urinalysis tests results are required for driver physical examination? - Answer: 1. Specific gravity 2. Protein 3. Blood 4. Glucose Can a driver with epilepsy be certified? - Answer: No..Disqualify When can someone with epilepsy be certified? - Answer: If they are off ant-seizure medication and seizure free for 10 years T/F The use of either benzodiazepines or phenothiazines for the treatment of vertigo would render the driver medically unqualified - Answer: True Recommend not to certify if driver has a diagnosis of dementia - Answer: T/F Recommend not certifying driver if they use a first generation antidepressant - Answer: True Waiting period for a driver following a severe depressive episode, a suicide attempt, or a manic episode - Answer: 1 year Waiting period for a driver following a nonpsychotic major depression unaccompanied by suicidal behavior - Answer: 6 months Can a driver be certified with a diagnosis of schizophrenia - Answer: No Before qualifying a driver with ADHD who is using a CNS stimulant what must you consider? - Answer: 1. Request evaluation from the treating provider 2. Verify the diagnosis of adult ADHD 3. Use caution when determining the side effects of medication If a driver undergoes ECT for depression how long should they be symptom free before obtaining certification? - Answer: 6 months