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DOT Exam Questions

Good questions Part I

When should a driver who is prescribed anticoagulation therapy be disqualified? When taking medication for treatment post cerebrovascular accident (CVA)
How long should a driver status-post permanent pacemaker (PPM) insertion secondary to sinus node dysfunction wait before certification/recertification for duty can be considered? 1 month
A CMV driver who has an implantable cardioverter-defibrillator (ICD) can be certified for how long when he or she has clearance from a cardiologist indicating that the driver is fit for duty? Uh, no. Disqualify.
The medical examiner should refer a driver for pulmonary function testing (PFT) when they present with..... History of any specific lung disease Symptoms of shortness of breath, cough, chest tightness, or wheezing Cigarette smoking in drivers 35 years of age or older
True or false....With polysomnogram, diagnosis of obstructive sleep apnea (OSA) is based on the apnea/hypopnea index with over 30 episodes per hour. Very true!
Comorbid conditions common in bipolar disorder include.... Substance abuse Anxiety Binge eating
A 30 y/o driver presents to the ME's office for recert. The driver notes he had 3 episodes of benign positional vertigo 6 months ago but has been asx since this time. with clearance from neurologist. All other hx and exam is benign. Should you cert? Yes! BPPV recommendations are that they are asymptomatic for at least 2 months and you can certify for two years.
The driver candidate with a history of transient ischemic attack (TIA) is subject to a ___ symptom free waiting period prior to certification. 1 year waiting period.
A driver with a history of TIA is in your office for examination. He was waited two years without any symptoms. The driver has a normal physical exam and received clearance from a neurologist for driving. What would disqualify this driver? If they are on anti-coagulant medications.
True or false....Use of muscle relaxants such as Skelaxin, Soma, or Flexeril in the CMV driver is disqualifying. FALSE
The risk of an acute incapacitating event for a CMV driver with Hypertension is more likely to be caused by? Sudden acute coronary event
A driver presents for medical examination with two blood pressure readings >140/80. The driver claims no previous history of HTN. How long should the driver be certified for? One year, carefully advising driver to follow up with his primary care provider for blood pressure management.
A driver comes in for his initial DOT examination. His blood pressure readings are 166/92 and 159/104 mmHg (stage 2 HTN which indicate medications are needed!). How long should this driver be certified for? Certify the driver for a one time 3 month certificate, advising the driver that blood pressure must be equal to or less than 140/90 mmHg during follow up
A driver who has previously tested positive on a drug test would like to be considered for recertification. When can this driver be re-certified? Must have a negative result on a return to duty drug test and evaluation by substance abuse professional.
Employers must randomly test what percentage of drivers unannounced yearly for alcohol use? 35%
A driver with DM has had two hypoglycemic episodes within the past 12 months. Should this driver be qualified to drive? NO! Disqualification includes a hypoglycemic episode within the past 12 months that resulted in a seizure, LOC, required assistance, or a period of impaired cognitive function. OR in the past 5 yrs had two or more hypoglycemic episodes.
True or false: A Federal Diabetes Exemption/Waiver is no longer required in order for the insulin-treated CMV driver to operate a commercial vehicle. True
According to FMCSA regulation 49 CFR 391.45 (e), what is the maximum certification period for the driver who requires insulin for glucose control? 1 year
Discuss the AAA guidelines for driver qualification.
Discuss the AAA guidelines for driver DISQUALIFICATION *Sx regardless of size *There has been recommendation for surgical repair regardless of AAA size from a CV specialist *The AAA is 4 to <5 cm and the driver does not have clearance. * Is greater ≥5 cm *Has increased >0.5 cm in a 6 month period.
When a CMV driver completes an exercise tolerance test (ETT), successful results are: Attain a workload capacity greater than 6 metabolic expenditure (METs), no ST depression or elevation, and no ventricular arrhythmias
A CMV driver who is post heart transplant that is able to tolerate medications well can be certified for a period of? The driver can be certified every 6 months, if he or she is asymptomatic, tolerates medications, and has completed a minimum waiting period of one year
The FMCSA medical examiner should certify which CMV driver 3 months post Coronary Artery Bypass Graft (CABG)? Driver with a LVEF of 45%, is asymptomatic, sternum incision is completely healed, and has clearance from a cardiologist
The CMV driver post MI must meet which of the following criteria before he or she can be certified for duty? Completes a minimum 2 month waiting period post MI, has a LVEF of 40% or greater, able to tolerate medications, and has clearance from a cardiologist
A CMV driver has been diagnosed with severe Aortic Stenosis (AS) but he denies symptoms of dyspnea, chest pain, dizziness, or syncope. The FMCSA medical examiner should certify the driver for how long? The driver with severe AS should be disqualified regardless of symptoms!!
A driver presents to the ME's office for a new certification. The driver's hx indicates a diagnosis of bipolar mood disorder. The minimum symptom free waiting period following a nonpsychotic major depression unaccompanied by suicidal behavior is: 6 months NOTE: if driver has had a severe depressive episode, a suicide attempt, or a manic episode, they have to wait 1 year.
A letter of application for a skill performance evaluation (SPE) must be accompanied by... ●A copy of the medical certificate completed ●A copy of the results of the medical examination performed ●A medical evaluation summary completed by r a board qualified or board certified physiatrist (doctor of physical medicine) or orthopedic surgeon
True or False. The physical qualifications standards include a maximum and minimum height and weight requirement. False
For a driver candidate with a history of syncope the maximum certification period is: 1 year
What is the minimum certification waiting period for a CMV driver status post permanent pacemaker insertion secondary to Neurocardiogenic Syncope? 3 months
According to FMCSA regulations, which of the following must the medical examiner evaluate when examining a driver's eyes? Pupil reactivity.
Discuss vision test results and what would be a passing score. Distant visual acuity of 20/40 in each eye (with/without corrective lens) and distant binocular acuity of at least 20/40. Must also have a field of vision of at least 70 degrees in the horizontal meridian in each eye.
Discuss the hearing test requirements for passing certification. ●Pass the forced whisper test (no less than 5 feet!) ●Have an average hearing loss, in one ear, less than or equal to 40 decibels ●Driver must be disqualified when both the forced whisper test and the audiometric test are failed.
Should a driver with Lewy Body dementia be certified to drive? No! Recommended not to certify the driver.
Discuss the ETT and what a driver should be able to achieve during the testing. •Exercise to a workload capacity greater than 6 METs •Attain a heart rate greater than or equal to 85% of predicted maximum (unless on BB) •Have a rise in SBP greater than or equal to 20 mm Hg without angina. •Have no significant ST segment depression.
True or False: A driver presents to the medical examiner for initial evaluation. On the health history form the driver indicates he takes methadone for treatment of chronic back pain. The medical examiner may qualify this patient. No! Recommended NOT to qualify this driver, regardless of Rx indication.
A driver presents to the medical examiner for recertification. The driver reports deteriorating peripheral vision and decreased night vision over the past 2 years. The medical examiner suspects these may be symptoms of: Glaucoma
A 35 year old female presents for a recertification evaluation. During the exam the patient notes a recent history of increased heart rate, diarrhea, intolerance to heat, tremor, and insomnia. The medical examiner should refer the patient out for: Thyroid panel
A commercial motor vehicle driver is taking coumadin. What is the minimum interval at which their International Normalized Ratio (INR) must be checked? 30 day interval
A new patient presents to your office for an initial certification. Examination of the patient’s fundus reveals the presence of cotton wool spots and microaneurysms. The most likely cause of this abnormality is? Diabetes Mellitus
According to FMCSA regulations, which of the following must a medical examiner evaluate when examining a driver’s ear? Scarring of the TM. Scarring of the tympanic membrane may indicate prior perforation, infection or inflammation and directly lead to hearing loss.
A driver's urine must be tested for.... •Specific gravity. •Protein (proteinuria). •Blood (hematuria). •Glucose (glycosuria).
In a patient with glaucoma the greatest clinical concern would be? Deficits in peripheral vision
A common visual complaint in patients with cataracts is that of? Glare, especially at night. Note: glare is an early symptoms of cataract formation!
In a driver with COPD, when would you NOT certify them drive? The driver has: •Hypoxemia at rest. •Chronic respiratory failure. •History of continuing cough with cough syncope.
Discuss the federal exemption program and provisions. •Program is for monocular vision •The vision exemption is granted for a maximum of two years •The driver must be otherwise qualified under 49 CFR 391.41(b)(1-13) •The driver must have an annual medical examination and an eye examination by an eye spc.
A driver should have an annual echocardiogram in the presence of? Systolic heart murmur.
A 66 year old female driver presents for certification. She has a history of exposure to silica dust. She is without sxs and PE is benign. Chest-x ray reveals bilateral interstitial infiltrates. Which of the following should the medical examiner do next? Consult with a pulmonologist.
According to FMCSA guidelines, which of the following is included in their definition of a severe hypoglycemic reaction in a driver with diabetes? •Seizure. •Loss of consciousness. •Need of assistance from another person. •Period of impaired cognitive function that occurred without warning.
The medical examiner must include the following information on the medical examination report form: The medical examiner's license number and expiration date.
The CMV driver post-myocardial infarction (MI) must have a left ventricular ejection fraction (LVEF) of: 40% or higher
The certified medical examiner understands that patients with a history of CABG (5 years or more) are at risk for re-occlusion of bypass graft, therefore this driver should obtain: An ETT every year.
The minimum waiting period for a CMV driver who is status-post elective Percutaneous Coronary Intervention (PCI) is: One week
A driver with a history of hypertension can be certified for a maximum period of one year as long as the driver’s blood pressure is equal to or less than: 140/90
Mr. Taylor has a 3 month certificate for Hypertension. He has been started on antihypertensive drugs and his blood pressure is now 116/78 during follow-up. How long should the medical examiner certify Mr. Taylor for? One year. Starting the date of the initial examination.
According to the FMCSA regulations, the driver utilizing insulin for glucose control with a diagnosis of severe proliferative retinopathy can be qualified for a period of: None! Disqualified.
What should you obtain from the driver who uses Insulin for glucose control? An electronic copy of blood sugar readings from the preceding past 3 months. If the driver is unable to do so, you may initiate a 3 month certificate until the driver can do so.
A driver states that he takes Methadone for chronic pain and provides you with a note indicating that he is cleared to drive. According to FMCSA regulations, this driver may be certified for: Nope. Methadone is disqualifying.
Mr. Ingram has a history of drug abuse. He tells you that he has been clean for 12 months and attends Narcotics Anonymous regularly. Physical exam is unremarkable. What should the medical examiner ask Mr. Ingram for before issuing a driver’s certificate? A urine specimen!
Who is responsible for implementing and conducting drug and alcohol testing programs? The driver's employer.
The minimum waiting period for the driver who is status-post Thoracic Aneurysm repair is: Three months.
According to FMCSA guidelines, the CMV driver with multiple coronary heart disease (CHD) risk factors should only be certified for a maximum period of one year, why? To closely monitor the driver for signs and/or symptoms of a medical condition that can affect safe driving
The driver with severe aortic regurgitation who is asymptomatic can be certified for a maximum period of: 6 months.
Commercial motor vehicle (CMV) drivers must be able to sustain vigilance and attention for extended periods in all types of traffic, road, and weather conditions. Neurological demands of driving include: Cognitive demands: o Sustained vigilance and attention. o Quick reactions. o Communication skills. o Appropriate behavior. Physical demands: o Coordination.
Recommend not to certify the driver when ABG measurement reveals: Partial pressure of arterial oxygen (PaO2) less than: o 65 (mm Hg) at altitudes below 5,000 feet. o 60 mm Hg at altitudes above 5,000 feet. Partial pressure of arterial carbon dioxide (PaCO2) greater than 45 mm Hg at any altitude.
Exercise Tolerance Test (ETT) is the most common test used to evaluate workload capacity and detect cardiac abnormalities. Discuss what the driver should be able to do. •Exercise to a workload capacity greater than 6 (METs) •Attain a HR greater than or equal to 85% of predicted maximum (unless on BB). •Have a rise in SBP > or = to 20 mm Hg without angina. •Have no significant ST segment depression.
A driver suffering from Angina pectoris may be certified to drive a commercial vehicle if: •Driver must wait 3 months without any symptoms of rest angina or change in anginal patterns. •Must have clearance from CV specialist •Satisfactory ETT •Patient is able to tolerate medications without any side effects
What does the insulin treated CMV driver need to have done before being examined by the DOT ME? The driver needs to have their treating clinician fill out MCSA-5870 (ITDM) to certify that their insulin treatment is adequate and stable. The form is only valid for 45 days after issue, so the driver needs to be examined before the form expires!
How often does the driver with a major mood disorder need to be evaluated by a mental health specialist? Every 2 years
What would be reasons why a driver with MVP should NOT be certified? •Symptoms or reduced effort tolerance due to mitral valve prolapse or mitral regurgitation. •Ruptured chordae or flail leaflet. •Systemic emboli. •Atrial fibrillation. •Syncope or documented VTACH •Severe mitral regurgitation or LV dysfunction.
A driver diagnosed with a blood pressure equal to or greater than 180/110 can be certified for how long? NEVER! They are disqualified. This is stage 3 HTN and needs prompt treatment.
A 57 year old male driver presents for certification. He has a BP of 170/100. He is given a one time three month certification for BP management. On follow-up, His blood pressure is now 145/95. What should the ME do next? This driver is disqualified for not having BP below 140/90. For the driver with a first time episode of Stage 2 HTN, a one-time three month certificate
A 45 yo male presents for certification. He has a hx of asthma & is currently using Albuterol and Qvar. The driver appears somewhat breathless with exertion. PE reveals a RR of 22 & wheezes in lung fields. What should the medical examiner do next? Obtain pulmonary function tests and an arterial blood gas
A 72 year old male driver presents for certification. He mentions in his history that he had a heart attack 18 months ago. What would lead to a recommendation to not to certify the driver? Recurrent angina symptoms, post-MI ejection fraction of <40%, abnormal ETT, ischemic changes on ECG, poor tolerance to medications. Note, driver must also wait 2 months after MI before evaluation.
In a driver with angina pectoris, what are the recommendations for what a driver should obtain for evaluation? Annual certification Biennial ETT at minimum (If test positive or inconclusive, imaging stress test may be indicated). Cardiologist examination recommended.
A driver presents with pectus excavatum of long standing duration. She takes no medications and states that she does not suffer from SOB or dyspnea on exertion. Her physical examination is otherwise unremarkable. What would be reasons to NOT certify them? The driver has: •Hypoxemia at rest. •Chronic respiratory failure. •History of continuing cough with cough syncope. If driver appears to have difficulty breathing on exam, there is the need for further testing! (PFT)
A CMV driver who has suffered a deep venous thrombosis (DVT) is not eligible for certification if: Obvious symptoms are present! And if driver is on Coumadin, they need to be regulated monthly.
A 67 yo male driver presents for certification. He states that he has a pacemaker implanted in his chest 2 months ago. Patient is unsure why it was inserted.He is asymptomatic and his physical examination is normal. What should the ME do next? Obtain documentation from the drivers cardiologist explaining why the pacemaker was inserted. Note: if the patient had the pacemaker inserted for a specific cause, this changes the waiting period.
An incretin mimetic, such as exenatide (Byetta), is used to improve glycemic control in people with Type 2 diabetes by reducing fasting and postprandial glucose concentrations. FMCSA recommends that a driver taking an incretin mimetic must also: These medications (incretin mimetic) can be used without exemption. The driver should also have a note from their HCP describing their tolerance to the medication, efficacy, and how frequent their blood glucose is checked.
Why would you NOT certify a driver that is taking Lithium? The driver has: •Disqualifying underlying condition. •Disqualifying symptoms. •Lithium levels that are not in the therapeutic range.
A 56 year old male driver presents for recertification. He has a past history of alcohol abuse. The driver can be recommended for certification if: He has successfully completed counseling and/or treatment with a substance abuse professional
The minimum waiting period for the driver with a history of bacterial meningitis with early seizures is? 5 years
What is the waiting period for a driver with the diagnosis of vertigo 2/2 BPPV? 2 months!
How often does the driver with a history of an AMI need to have an ETT? Biennial ETT (every 2 years)
The minimum waiting period for the CMV driver with a past medical history of stable angina is: Must wait 3 months! Max certification is for 1 year
Mr. Charleston has a history of heart disease and gives you the results of his ETT performed 4 months ago. The test results were inconclusive and the driver denies having any sxs. His PE findings are normal. What should the medical examiner do next? Refer the driver to his cardiologist for a nuclear stress test before certifying.
The driver with a history of Coronary Artery Bypass Graft (CABG) surgery should have an annual exercise tolerance test 5 years post-CABG surgery. Why? A significant risk associated with CABG surgery is the high long-term reocclusion rate of the bypass graft.
Mr. Webster’s forced whispered voice test results are as follows: 3 feet in the right ear and 5 feet in the left ear. Based on these findings, the certified medical examiner should certify the driver for: Do not certify! With the forced whisper test, they need to be able to hear at no less than 5 feet!
The CMV driver with a medical history of Labyrinthine Fistula can be certified for a period of: NO! The are disqualified.
What is the waiting period for the driver with a-fib? Minimum — 1 month anticoagulated adequately Patient needs to have INR monitored monthly!
According to FMCSA guidelines, a driver with stage I HTN (140/90 to 159/99) being seen for initial examination can be certified for a period of? One year initially
A driver with intermittent claudication who is status-post femoral bypass graft surgery of the left lower extremity must complete a minimal waiting period of? Must wait 3 months post-surgical repair!
What is the minimum waiting period for a driver newly diagnosed with diabetes mellitus who requires insulin for blood glucose control and was not on any prior oral hypoglycemic agents/treatment? There is no minimum waiting period for the CMV driver who requires insulin for glycemic control. The insulin dependent CMV driver can obtain a medical certificate if the driver meets all the requirements outlined in CFR 391.46.
FMCSA recommends not to certify a driver when his or her ABG measurements reveal: PaCO2 greater than 45 mm Hg at any altitude
Mr. Charles is a 55 year old male with COPD. He provides you with a copy of his pulmonary function test results performed 2 weeks ago which indicate that his FEV1 is 58% and FEV1/FVC ratio is 60%. What should the medical examiner do next? The medical examiner should first perform a thorough physical examination and pulse-ox screening in his or her office before sending the driver for ABG’s, chest x-ray, or to a pulmonologist for further work-up.
True or False: when evaluating a driver for vision qualifications, the FMSCA certified medical examiner is required to test the driver for VA, peripheral horizontal visual fields, and color. TRUE
The CMV driver with monocular vision should be disqualified unless the driver has a current federal vision exemption. True
The driver who meets hearing and vision requirements can be certified for the same interval. What is this interval? 2 years
What is the recommended maximum certification period for the driver with a diagnosis of Syncope? 1 year
The ME can certify a driver for 1 year post-MI after they have waited the appropriate 2 months and the driver is (list five things!) 1. Asx 2. Tolerate medications 3. Has a satisfactory ETT (able to achieve a workload of 6 METs or more) 4. LVEF 40% or greater 5. No ECG ischemic changes
How often should the driver who has had an MI obtain an ETT? Bienniel
The driver post-CABG surgery must complete a minimum waiting period of at least __________ before certification can be considered. 3 months
The FMSCA ME may certify a driver post-CABG for a period of one year if (list 5 things): 1. Asx 2. Tolerates medications without side effects 3. LVEF greater than or = to 40% 4. Healed sternum 5. Cleared by cardiologist
The CMV driver post heart transplant must wait a period of ______ and can be certified for a period of ________. 1 year & 6 months
Which heart conditions (cardiomyopathy) are considered disqualifying? HCM and Restrictive
The minimum waiting period for a driver status-post Commissurotomy is_________________. 3 months
The CMV driver who has had an implanter inserted for sinus node dysfunction must complete a minimum waiting period of________ 1 month
The CMV driver status-post AAA repair must complete a waiting period of _____________. 3 months
The CMV driver on Anti-coagulant therapy for the management of an underlying CV condition, can be certified for a maximum of one year if the driver (list 3 conditions driver must meet)..... 1. Is stabilized on medications for at least one month 2. Provides a copy of his/her INR results at examination 3. Has INR checked and monitored at least on a monthly basis.
What are the recommendations to NOT certify the driver with a AAA (cannot list symptomatic. Give 3 other reasons why). •Is greater than 4 cm but less than 5 cm and driver does not have medical clearance for driving from a Cardiologist. •Is greater than or equal to 5 cm. •Has increased more than 0.5 cm during a 6 month period, regardless of size.
The ME should not certify the driver with a thoracic aneurysm greater than _____________. 3.5 cm
Created by: kbaranowski27
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