DOT exam - NRCME Training Institute
Material
A BP of 140/90 should be confirmed with a second reading during the exam. What certification
would you give if:
1. Repeat reading is less than 140/90
2. Repeat reading is greater than 140/90
3. Repeat reading is exactly 140/90 - ANS-1. Can certify for 2 years if patient is not taking HTN
medications. If pt is taking meds, 1 year is the max.
2. Follow stage 1 HTN guidelines, 1 year certification
3. Repeat reading or use clinical judgement to make decision on certification.
A driver presents for clearance to return to driving a CMV four weeks after arthroscopic carpal
tunnel repair to his left hand. The surgical incision is healed and the range of motion and
strength in the affected extremity is normal. The certification decision should be __________.
Yes, for a maximum of one year, as long as all other qualification standards are met.
No, there is a three-month waiting period following carpal tunnel surgery.
Yes, for a maximum of two years, as long as all other qualification standards are met.
No, there is a six-month waiting period following carpal tunnel surgery. - ANS-Yes, for a
maximum of two years, as long as all other qualification standards are met.
A driver presents for clearance to return to driving a CMV six weeks after arthroscopic carpal
tunnel repair on his right hand. Can he be re-certified, if so, for how long? - ANS-The ME will
use professional judgement to ensure patient can meet standards by testing to determine if grip
strength, prehension (grasping), sensation, and range of motion are sufficient to control steering
wheel, shift gears, and other tasks. Certification can be up to two years.
A driver presents with history of depression taking an SSRI, but appears depressed. - ANS-The
ME should have the patient referred to the appropriate medical health professional who would
treat and monitor the driver. Before certification, the driver would have to complete a
symptom-free waiting period and have an effective, well-tolerated treatment plan, with no side
effects that impair the ability of the driver to operate a CMV safely.
A driver takes Diphenhydramine 25mg BID/TID PRN nasal congestion. What concerns should
be discussed? - ANS-Antihistamines should be avoided 12 hours prior to driving. ME should
discuss side effects, such as decreased alertness, reaction time, and memory.
Inform driver of risks associated with taking antihistamines 12 hours before driving, advise driver
to consult with PCP to evaluate the need for chronic use of antihistamines and obtain treatment
that will not interfere with driving abilities.
,A driver treated for hypertension presents on September 8, 2012 with a blood pressure of
142/96. The driver is given a three month certification until December 8, 2012. On blood
pressure check 1 month later, on October 14, 2012, the driver's blood pressure is 144/72. The
driver should be certified for __________.
Do not certify.
Three months to January 14, 2013.
One year to September 8, 2013.
The driver remains certified for the three month interval until December 8, 2012 . - ANS-The
driver remains certified for the three month interval until December 8, 2012 .
A driver with adult attention deficit hyperactivity disorder (ADHD) must meet all of the following
requirements EXCEPT:
Tolerates treatment without disqualifying side effects.
Complies with treatment program.
Has a comprehensive evaluation from an appropriate mental health professional who
understands the functions and demands of commercial driving.
Passes a urine drug test. - ANS-Passes a urine drug test.
A driver with bipolar disorder must meet a waiting period of __________ following a
nonpsychotic episode of major depression unaccompanied by suicidal behavior or a waiting
period of __________ following a nonpsychotic episode of major depression with by suicidal
behavior.
One year, two years.
Six months, one year.
Three months, six months.
Three months, one year. - ANS-must wait 6 months after a nonpsychotic episode of major
depression or a waiting period of one year if any suicidal behavior
A driver with which of the following conditions should not be certified?
PaCO2 greater than 45 mmHg.
Diagnosis of asthma.
Smoking history of more than 2 packs per day.
FEV1 < 70%. - ANS-PaCO2 greater than 45 mmHg.
A patient has exercised-induced asthma, controlled with albuterol inhaler before any aerobic
activity. Her PFTs must have a forced expiratory volume (FEV1) above what % to be qualified? -
ANS-FEV1 must be above 65% predicted to qualify.
A patient marks asthma in his medical history. He uses albuterol inhaler several times per day.
He hasn't seen his PCP in several years. He has been hospitalized 2x in the past 6 months, was
on a ventilator during his last visit. Should you certify? - ANS-Do not certify. Pt needs to follow
up with PCP or pulmonologist for better control of asthma. He is a great risk for respiratory
compromise and dysfunction during driving.
, A patient on Bentyl 20 mg QID for IBS-D, is this okay for certification? - ANS-Yes, as long as
patient is tolerating medication well. An uncontrolled case of IBS-D is potentially more
dangerous.
Individualize each decision
A patient on insulin: - ANS-Must complete the evaluation required by 49 CFR 391.46, which
includes evaluation from treating clinician, completion of form MCSA-5870, the Insulin-Treated
Diabetes Mellitus Assessment Form.
A patient presents who had a pneumothorax 1 month ago. His forced vital capacity (FVC) was
58%. There are no follow up studies. - ANS-Do not certify. The ME needs to verify the recovery
is completely with x-rays, PFTS and FVC greater than 65%.
A patient presents who had a pneumothorax 3 months ago. This is his second pneumothorax on
the same side. His last FVC was 68%. - ANS-Do not certify. Pt needs intervention to prevent
recurrence due to being the second time this has happened.
A patient provides the ME with a copy of records from cardiologist, indicating a diagnosis of
CHF and EF of 38%. Can he be certified? - ANS-No, EF% must be greater than 40% to be
certified.
A patient with MS: what symptoms would indicate further disease progression and would
possibly disqualify patient? - ANS-Signs of progression that interfere with ability to operate a
CMV safely.
Neurologist identifies functionally significant neurologic signs and symptoms
Abnormal MRI and triple-evoked potential studies revealing new lesions, compared to prior
MRI/eval made at least one year apart.
History of excessive fatigability or periodic fluctuations in motor performance, especially in
relation to heat, physical and emotional stress, and infections.
A Skill Performance Evaluation (SPE) certificate __________.
Is valid for one year from the date of issuance.
May be renewed 60 days prior to expiration.
Is required when the severity of a fixed deficit of an extremity includes the loss or impairment of
a hand, arm, foot, or leg.
Is issued by the medical examiner. - ANS-Is required when the severity of a fixed deficit of an
extremity includes the loss or impairment of a hand, arm, foot, or leg.
According to regulation, only ______ can grant drivers a SPE certificate. - ANS-FMCSA
Arterial blood gas (ABG) and/or pulse oximetry testing should be performed on drivers with a
FEV1 of less than __________ on spirometry testing.
60% predicted.
Material
A BP of 140/90 should be confirmed with a second reading during the exam. What certification
would you give if:
1. Repeat reading is less than 140/90
2. Repeat reading is greater than 140/90
3. Repeat reading is exactly 140/90 - ANS-1. Can certify for 2 years if patient is not taking HTN
medications. If pt is taking meds, 1 year is the max.
2. Follow stage 1 HTN guidelines, 1 year certification
3. Repeat reading or use clinical judgement to make decision on certification.
A driver presents for clearance to return to driving a CMV four weeks after arthroscopic carpal
tunnel repair to his left hand. The surgical incision is healed and the range of motion and
strength in the affected extremity is normal. The certification decision should be __________.
Yes, for a maximum of one year, as long as all other qualification standards are met.
No, there is a three-month waiting period following carpal tunnel surgery.
Yes, for a maximum of two years, as long as all other qualification standards are met.
No, there is a six-month waiting period following carpal tunnel surgery. - ANS-Yes, for a
maximum of two years, as long as all other qualification standards are met.
A driver presents for clearance to return to driving a CMV six weeks after arthroscopic carpal
tunnel repair on his right hand. Can he be re-certified, if so, for how long? - ANS-The ME will
use professional judgement to ensure patient can meet standards by testing to determine if grip
strength, prehension (grasping), sensation, and range of motion are sufficient to control steering
wheel, shift gears, and other tasks. Certification can be up to two years.
A driver presents with history of depression taking an SSRI, but appears depressed. - ANS-The
ME should have the patient referred to the appropriate medical health professional who would
treat and monitor the driver. Before certification, the driver would have to complete a
symptom-free waiting period and have an effective, well-tolerated treatment plan, with no side
effects that impair the ability of the driver to operate a CMV safely.
A driver takes Diphenhydramine 25mg BID/TID PRN nasal congestion. What concerns should
be discussed? - ANS-Antihistamines should be avoided 12 hours prior to driving. ME should
discuss side effects, such as decreased alertness, reaction time, and memory.
Inform driver of risks associated with taking antihistamines 12 hours before driving, advise driver
to consult with PCP to evaluate the need for chronic use of antihistamines and obtain treatment
that will not interfere with driving abilities.
,A driver treated for hypertension presents on September 8, 2012 with a blood pressure of
142/96. The driver is given a three month certification until December 8, 2012. On blood
pressure check 1 month later, on October 14, 2012, the driver's blood pressure is 144/72. The
driver should be certified for __________.
Do not certify.
Three months to January 14, 2013.
One year to September 8, 2013.
The driver remains certified for the three month interval until December 8, 2012 . - ANS-The
driver remains certified for the three month interval until December 8, 2012 .
A driver with adult attention deficit hyperactivity disorder (ADHD) must meet all of the following
requirements EXCEPT:
Tolerates treatment without disqualifying side effects.
Complies with treatment program.
Has a comprehensive evaluation from an appropriate mental health professional who
understands the functions and demands of commercial driving.
Passes a urine drug test. - ANS-Passes a urine drug test.
A driver with bipolar disorder must meet a waiting period of __________ following a
nonpsychotic episode of major depression unaccompanied by suicidal behavior or a waiting
period of __________ following a nonpsychotic episode of major depression with by suicidal
behavior.
One year, two years.
Six months, one year.
Three months, six months.
Three months, one year. - ANS-must wait 6 months after a nonpsychotic episode of major
depression or a waiting period of one year if any suicidal behavior
A driver with which of the following conditions should not be certified?
PaCO2 greater than 45 mmHg.
Diagnosis of asthma.
Smoking history of more than 2 packs per day.
FEV1 < 70%. - ANS-PaCO2 greater than 45 mmHg.
A patient has exercised-induced asthma, controlled with albuterol inhaler before any aerobic
activity. Her PFTs must have a forced expiratory volume (FEV1) above what % to be qualified? -
ANS-FEV1 must be above 65% predicted to qualify.
A patient marks asthma in his medical history. He uses albuterol inhaler several times per day.
He hasn't seen his PCP in several years. He has been hospitalized 2x in the past 6 months, was
on a ventilator during his last visit. Should you certify? - ANS-Do not certify. Pt needs to follow
up with PCP or pulmonologist for better control of asthma. He is a great risk for respiratory
compromise and dysfunction during driving.
, A patient on Bentyl 20 mg QID for IBS-D, is this okay for certification? - ANS-Yes, as long as
patient is tolerating medication well. An uncontrolled case of IBS-D is potentially more
dangerous.
Individualize each decision
A patient on insulin: - ANS-Must complete the evaluation required by 49 CFR 391.46, which
includes evaluation from treating clinician, completion of form MCSA-5870, the Insulin-Treated
Diabetes Mellitus Assessment Form.
A patient presents who had a pneumothorax 1 month ago. His forced vital capacity (FVC) was
58%. There are no follow up studies. - ANS-Do not certify. The ME needs to verify the recovery
is completely with x-rays, PFTS and FVC greater than 65%.
A patient presents who had a pneumothorax 3 months ago. This is his second pneumothorax on
the same side. His last FVC was 68%. - ANS-Do not certify. Pt needs intervention to prevent
recurrence due to being the second time this has happened.
A patient provides the ME with a copy of records from cardiologist, indicating a diagnosis of
CHF and EF of 38%. Can he be certified? - ANS-No, EF% must be greater than 40% to be
certified.
A patient with MS: what symptoms would indicate further disease progression and would
possibly disqualify patient? - ANS-Signs of progression that interfere with ability to operate a
CMV safely.
Neurologist identifies functionally significant neurologic signs and symptoms
Abnormal MRI and triple-evoked potential studies revealing new lesions, compared to prior
MRI/eval made at least one year apart.
History of excessive fatigability or periodic fluctuations in motor performance, especially in
relation to heat, physical and emotional stress, and infections.
A Skill Performance Evaluation (SPE) certificate __________.
Is valid for one year from the date of issuance.
May be renewed 60 days prior to expiration.
Is required when the severity of a fixed deficit of an extremity includes the loss or impairment of
a hand, arm, foot, or leg.
Is issued by the medical examiner. - ANS-Is required when the severity of a fixed deficit of an
extremity includes the loss or impairment of a hand, arm, foot, or leg.
According to regulation, only ______ can grant drivers a SPE certificate. - ANS-FMCSA
Arterial blood gas (ABG) and/or pulse oximetry testing should be performed on drivers with a
FEV1 of less than __________ on spirometry testing.
60% predicted.
