FMCSA DOT Physical Medical Examiner Test with Complete Solution

FMCSA DOT Physical Medical Examiner Test with Complete Solution Interstate commerce definition? - Any material transported from 1 state to another state, even if the individual driver never leaves 1 state, that: a) weighs >10,001 lbs (if >26,001 lbs, they also need a drug test) b) 9-15 passengers for compensation c) 16+ passengers regardless of compensation d) that requires placarding for hazardous materials Does interstate commerce refer to the cargo or to the driver? - It refers to the cargo, tools, vehicle, NOT to the driver. When is a 12 month (or shorter) certification required? - a) intracity zone exempt drivers b) waiver program drivers c) insulin d) any driver whose job duties have been impaired by mental/physical injury Does the driver need a new exam after sustaining an injury? - That is up to the employer. Can an examiner write schedule/MSK restrictions? - No. Document every abnormality? - Yes, and then just write in comments, "not likely to interfere." Whisper test okay for hearing? - Yes Need to fill out both state and federal? - No, one or the other Is determination pending okay on both state and federal? - No, only permissible on federal When to fill out state form? - If truly intrastate. Need to know the state variances for the state in which the driver operates. How short a period can you put on the card? - As short as you want. Eg. 30 days, 45 days, 3 months, etc. 2 reasons for not medically qualified? - 1) Disease/condition that temporarily or permanently DQs them OR 2) Haven't fulfilled appropriate waiting period, eg. 1 year What do you document if driver stops exam? - "Incomplete exam" If you do determination pending, what do you put as the expiration date? - The date they come back with whatever documentation you needed. Is the medical certification limited to their current employer? - No. They are allowed to switch employers that might require more strenuous tasks/different schedule, etc. What is "acceptable risk?" - 1% annual risk of sudden incapacitation. If the driver is at increased risk compared to the general population, than they shouldn't be operating a CMV. When to certify for less than 2 years? - If their condition requires more frequent monitoring by specialist/PCP, etc. What do you put in the "medical record" box? - Can be blank, employee ID, etc. Up to you. Okay to examine drivers from Canada and Mexico? - Yes Driver ID requirements? - You must see some sort of government issued ID to make sure they're not having a friend/family member take the medical exam for them. If they leave blank, check yes, or not sure under "medical certificate issued for less than 2 years," then what? - Ask why and address. Review old exams done in your clinic!!! If driver wrote "not sure" to any answer... - Ask about and address. Never cross out what driver wrote but you can put additional comments below. Does determination pending require a new exam? - No. A short medical certificate does, but a DP does not. What to do if current med certificate expires tomorrow, but you need their HgbA1C, etc? - 1) You can issue a short term certificate AND do determination pending but will need to repeat exam 2) DQ and do determination pending if you do not think driver is safe to be on the road in the meantime before you get the info How long do you have to submit driver determination online after doing exam? - Close of next calendar business day. Whose responsibility is it to address driver's age and language? - Employer What do you do after you make your determination? - Required to discuss with the driver and what they need to do. Must be clear that you are making your decision based on best practice/guidelines and NOT on regulation. What if a driver from another country has a variance/waiver? - They are not qualified in the US. What are the 13 physical qualifications for drivers? - 1 + 2. No loss/impairment of foot/leg/hand/arm. 3. No IDDM (new waiver) 4. No dx of heart dz that might cause syncope, SOB, collapse, or CHF 5. No respiratory dysfunction likely to interfere 6. No HTN likely to interfere 7. No hx or dx of MSK dz likely to interfere 8. No hx of epilepsy or dz causing LOC 9. No mental/psych dz likely to interfere 10. Distance vision of 20/40 in each eye and together, 70 degrees horizontal field, and ability to recognize red/green/yellow 11. Whisper at 5 feet in BETTER ear or no average HL in better ear>40 DBs at 500,1000,and 2000 hz 12. No schedule 1, amphetamine, narcotic, habit forming drugs except when prescribed by someone who says it will not affect ability to operate CMV 13. No dx of alcoholism Can a medical examiner grant a waiver? - No. They have to go through the online FMCSA processes. Don't certify until etiology is _______, and _____ is shown to be _____, ______, and _____. - Confirmed, treatment, safe, effective, stable. What if multiple waiting periods for multiple comorbidities? - Wait until longest one is done. When to get additional tests/consults? - Case by case basis to adequately address fitness for duty. No required to accept the consult/testing. What are the only required regulations? - Vision, hearing, epilepsy, IDDM. What to do if choose not to follow a guideline? - Document extensively why you did not. What testing MUST be done for the exam? - Height, weight, vision, hearing, BP, pulse, urinalysis. What optional testing may be done? - BMI, audiometry, PFTs, ECHO, EKG, sleep study, CT scan, etc, based on H&P and your determination. CAUTION: If you require these, you CANNOT be the one ordering or paying. Must be employer or driver's private health insurance or private pay. 4 possible options for determinations for medical exam? - 1) Qualified 2) Not qualified 3) Determination pending 4) Incomplete What is the date for the certificate expiration? - The date of determination, NOT necessarily of the exam. Is dialysis disqualifying? - Yes Is monocular vision okay? - No. Need to have 20/40 in BOTH eyes. No corrective contacts that make one eye see far/one near. No telescopic lenses. Meniere's disease - DQ? - Yes, if active dx due to risk of incapacitation from vertigo spells. If in remission, no episodes for 10 years, probably fine. What to do if proteinuria? - Nephrologist consult Nitroglycerine use - DQ? - No, but need cardiologist letter certifying angina is stable. Sustained V-tach > 15 seconds? - Disqualifying Narcolepsy? - DQ Provigil (modafinil)? - Not DQ but be cautious.