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FMCSA
Flashcards for DOT Certification exams.
| Question | Answer |
|---|---|
| Define interstate commerce. | 1. Between a place in a state and a place outside a state. 2. Between two places in a state, through another state, or a place outside of the United States. 3. Between two places in the state as originating or terminating outside the state or the US. |
| Define intrastate commerce. | Any trade, traffic or transportation in any state which is not described in the term "interstate commerce." |
| Define a "commercial vehicle." | Has combined/gross weight of >/=10k#. Designed/used to transport >8 passengers including driver for pay or >15 passengers. Transports hazardous materials in quantities that require placards under hazmat regs. |
| What is the Medical Expert Panel? What does it do? | Appointed subject matter experts in a particular area. They review evidence reports and issues recommendations to the FMCSA for certifying CMV drivers with specific conditions. |
| What is the Medical Review Board? What does it do? | They meet 3-4 times each year to review and discuss specific topics. They independently review the evidence report, MEP opinion and related info. They propose recs to the FMCSA. They decide guidelines. |
| What is the Office of Analysis, Research and Technology? What do they do? | They are within the FMCSA. They provide the transportation industry and the public with analytical reports on trends, costs, fatalities and injuries in large truck and bus crashes. They prepare economic/environmental analyses for FMCSA rulemakings. |
| What is the SAFETEA-LU? When and why did it start? | Safe, Accountable, Flexible and Efficient Transportation Equity Act - A Legacy for Users. Signed August 2005 in response to the 1999 New Orleans Bus Crash that killed 22 and injured 15. Requires the Sec of Trans to establish FMCSA. |
| What is the NRCME? When did it start? | National Registry of Certified Medical Examiners. A national registry of certified medical examiners who are the only group able to legally certify CMV drivers. Started 10 April 2012 by the FMCSA. |
| Who can be a Certified Medical Examiner? | MD, DO, DC, PA, NP |
| What does a CME do? | Determine medical fitness for duty, if CMV driver has condition that may cause sudden death/incapacitation or a fixed deficit that would be unsafe. Is aware of demands of drivers. Knows FMCSA standards, medical guidelines and medical advisory criteria. |
| What does a CME NOT do? | Determine treatment. Act as driver's physician. Provide specific medical advice. |
| What are the requirements to maintain certification? | Document current licensure. FMCSA refresher training at least 5 years and take recert test every 10 years. |
| How much time does a CME have to report changes or provide medical examiner reports? | Within 48 hours of request. |
| How long does a CME maintain all medical exam report forms and certificates? | At least 3 years from the date of examination. |
| What info must be on Form MCSA-5850? What does it do? | It maintains certification. CMV driver's name, DOB, driver's license number and state, date of exam, indication of exam outcome, whether intrastate driver only. |
| What is the deadline to report to FMCSA of a driver disqualification? | By midnight local time of the next calendar day following the examination. This goes for any CDL/CLP or nonCDL/CLP who must be medically certified to operate in interstate commerce. |
| How can a CME be removed from the National Registry? | Failing to meet/maintain the regulatory requirement. Errors, omissions, or other indications of improper CMV driver cert. Failure to comply with exam reqs or falsification of training. Failing to produce records requested by FMCSA. |
| What are the driver's 3 distinct responsibilities? | Pre-trip inspection, post-trip inspection, drive. |
| Driver Job Requirements (non-medical) | Sustained alertness and endurance not compromised by fatigue or sudden sx. Problem solving, communication, judgement and appropriate behavior in normal/emergency situations. |
| Driver Job Requirements (medical) | Fit for: inspecting operating condition or tractor/trailer. coupling/uncoupling trailer/tractor, loading/unloading. lifting, installing and removing heavy tire chains. Lifting heavy tarpaulins. |
| 49 CFR 391.41 | Describes CMV driver qualifications |
| 49 CFR 391.43 | Describes medical examiner responsibilities |
| 49 CFR 391.45 | Criteria for who must have CMV driver physical examination |
| 49 CFR 391.47 | Process for conflict resolution, re: driver qualifications |
| 49 CFR 391.49 | Skill performance evaluation (SPE) certification program. For drivers with msk deficit or amputation. |
| 49 CF4 391.62 | Limited exemptions for intra-city zone drivers. Seldom used. Cannot transport placarded hazmats. Certified annually. |
| 49 CFR 391.64 | Grandfathering for participation in vision and diabetes waiver study programs |
| 49 CFR 390 | General information and definitions |
| 49 CFR 40 | Regulations for medical review officers and testing procedures |
| What are the 13 standards for medical certification u nder 49 CFR 391.41? | 9 standards are discretionary. 4 are not (hearing, vision, epilepsy and insulin-treated diabetes). |
| Describe the guidelines for deciding certification | Issued by FMCSA. Based on expert review. Not legally binding. "best practices" and can be considered standards of care. Minimize variation among examiners. |
| Which guidelines are older and do not reflect current treatment or technology? | Neurology (1988), Pulmonary (1991), psychiatry (1991), Vision (1991/1998), Hearing (1993), Anticoagulation (1996), cardiovascular (2002) |
| Which guideline is not in agreement with the FMCSA? | Sleep disorder and dementia. |
| What important conditions are not addressed by the guidelines? | renal disease, musculoskeletal disease, transplants |
| True or False: FMCSA Medical Advisory Criteria under 391.41 are recommendations. | True. |
| What should the examiner do if the certification decision does not conform to the FMCSA recommendations or advisory criteria? | Reasons why should be documented. |
| True or False: BP readings outside of the DOT certification can be used. | False. |
| True or False: A driver must provide a urine specimen to be certified. | True. |
| What conditions warrant a maximum one-year certification interval per FMCSA? | Hypertension and Heart Disease |
| What conditions warrant disqualification? | Those affecting vision, hearing, epilepsy and insulin taking (as of 19 Nov 2018). |
| What does it mean to disqualify under 392.3? | Driver is ill or fatigued. |
| True or False: The medical examiner can issue exemptions to standards. | False, only the FMCSA can. |
| If a driver is applying for an exemption, they must present ____ at a recert exam. The examiner issues a card for ____. | 1. Exemption or waiver letter. 2. Six-months. |
| Can the medical examination report be given to the driver's employer? | Yes, but only with the driver's written consent. |
| What tests are necessary for a certification exam? | Tests are completed for vision, hearing, urinalysis dip, blood pressure, pulse and height and weight |
| What are the vision qualifications? | Distant visual acuity of at least 20/40 in each eye and binocular w or w/o corrective lenses. Field of vision of at least 70dege in horizontal meridian in each eye. Ability to recognize stoplight traffic signals (red, green, amber). |
| What should the examiner check for in the patient's eyes? | Pupillary equality • Reaction to light and accommodation • Ocular motility • Ocular muscle imbalance • Extraocular movements • Nystagmus • Exophthalmos |
| True or false: Monocular vision is disqualifying. | True. |
| What is the maximum certification for a driver with corrective lenses? | 2 years |
| How often must drivers grandfathered in the 49 CFR 391.64 program be certified? How long are they certified? | They must have an eye exam by an optho/opto every year, then see an medical examiner. The driver will be certified for one year? |
| What side effects can VEGF inhibitors cause? | Increased risk of stroke with predisposing health conditions. Long-term cv effects not determined |
| Opthalmic side effects of oral and topical anti-histamines | Corneal staining. First gen orals can cause drowsiness and fatigue. |
| Opthalmic side effects of mast cell stabilizers | Headache, dizziness, drowsiness, blurred vision, dry eyes |
| Opthalmic side effects of Topical nonsteroidal anti-inflammatory Agents | Transient burning and stinging upon instillation, lacrimation, abnormal vision, acute elevated IOP, corneal changes, superficial punctate keratitis, development of persistent epithelial defects, iritis. hepatic side effects. chills, facial edema, an |
| Opthalmic side effects of Glucocorticoid drops | Cataract formation, elevated intraocular pressure (IOP), glaucoma, secondary infections; steroids should be used under supervision of an ophthalmologist. Blindness is a risk associated with unsupervised glucocorticoid therapy |
| What are the hearing standards per 49 CFR 391.41(b) (11)? | Either perceives a whispered voice in the better ear at least 5ft w or w/o hearing aids or if tested w audiometry, no more hearing loss greater than 40db at 500Hz, 1kHz, and 2kHz w or w/o hearing aids. |
| On the Medical Examination Report form, what hx questions regarding hearing/inner ear are included? | ear disorders, loss of hearing, loss of balance, dizziness |
| True or False: both hearing tests must be administered. | MAYBE BOTH. If the driver fails the whisper test, administer the audiometery. |
| What are the passing criteria for audiometry? | Average hearing loss in one ear </= 40dB at 500Hz, 1kHz, 2kHz. |
| How do you correct ISO audiometric test results to ANSI? | Subtract 14dB from ISO for 500Hz, 10 from ISO for 1kHz, 8.5 from ISO for 2kHz. |
| True or False: audiometers for non-specialty practices can be used to test on patients who wear hearing aids. | False: refer to an audiologist or a hearing aid center. |
| The maximum certification period for a driver that meets hearing standards is _____. | 2 years |
| The hearing exemption does not apply to _____. | Bus drivers |
| Dizziness with ______ should warrant the decision to not certify the driver. | Cognitive abilities, judgement, attention, concentration and sensory or motor function. |
| Vertigo: a waiting period for ______ is recommended for a driver with a diagnosis of ______. | 1. two-month 2. Acute or chronic peripheral vestibulopathy or benign positional vertigo. |
| Vertigo: a driver should not be certified if they have _____ | 1. Uncontrolled vertigo 2. Meniere's Disease of sufficient severity and unpredictability 3. Labrynthine Fistula 4. Nonfunctioning Labrynths |
| What are the Safety standards for Cardiovascular Disease outlined by 49 CFR 391.41 (b)(4)? | No current dx of MI, angina pectoris, coronary insufficency, thrombosis or any other CVD with sx of syncope, dyspnea, collapse, or congestive cardiac failure. |
| What is a failing Exercise Treadmill Test for CMV drivers? | 1. Failing to exceed 6 Metabolic Equivalents 2. The presence of Ischemic ST-T changes 3. Angina 4. Inappropriate BP (systolic increase <20mmHg) or heart rate response (failure to reach 85% predicted if not on Beta Blockers). |
| True or False: An ETT is recommended for asymptomatic drivers with risk factors (per 2002 and 2007 FMCSA CV Advisory Panels). | FALSE. The sensitivity and specificity are too low. |
| What are the age and gender risks for CAD? | In men, risk increases after age 45. Among women, risk increases faster after age 55. |
| What family hx increases the risk of CAD? | Pt's father or brother dx with CAD before age 55. Mother or sistre dx with CAD before age 65. |
| What are the controllable risk factors for CAD? | High LDL's, low HDL's, lack of exercise, DM, HTN, Obesity, Sedentary lifestyle, smoking. |
| True or False: The presence of risk factors in an asymptomatic driver is not sufficient reason to deny certification. | True |
| What is the major prognostic indicator for a CAD pt in determining certifcation? | Ejection fraction of 40% or more |
| What are other prognostic indicators for a CAD pt? | Severeity of coronary disease, arrhythmias, general health, age, angina pectoris, associated vascular disease |
| What is the workload capacity for certification? (tested via ETT) | Greater than 6 METS |
| What are the general CAD certification recommendations? | Pt should be cleared by CV specialist, tolerate CVD meds, comply with tx, have annual exam. |
| What is the minimum/maximum waiting period for a Post Acute MI pt? | 2 months to 1 year |
| Certification is recommended for the post-acute MI driver if: | they meet general CAD cert recommendations, is asymptomatic, has satisfactory ETT post MI and biennial ETT after, has resting LVEF >/= 40% |
| What is the waiting period and max certification period for a driver with stable angina pectoris? | No waiting period if no changes in sx, max cert for one year. |
| Certification is recommended for the stable angina pectoris pt if the driver: | Meets general CAD certification recommendations, has stable angina, has as a satisfactory binennial ETT. If ETT inconclusive, an imaging test may be indicated. |
| True or False: a driver with angina pectoris should have an annual medical exam. | True |
| What is the recommendation for a pt with unstable angina? | Do not certify in the 3 months prior to the examination. |
| What are the certification criteria for a post-CABG pt? What is the certification period? | Meets general CAD cert recommendations. Waiting period at least 3 months post-surgery to allow sternum to heal. Ejection fraction > 40% ETT (not required) Cert period 1 year. Should have annual med exam. |
| When should the post-CABG pt have annual ETT/Imaging stress test? | Five years post-CABG |
| When should a driver NOT heal a post-CABG pt? | Non-healed sternum Symptomatic Orthostatic side effects from CV meds Has LVEF <40% Does not have cardios approval for driving |
| What is the waiting period for a post-PCI pt? | Minimum of one week. |
| What are the certification criteria for a post-PCI pt? | Meets general CAD cert recs Asymptomatic No injry at vascular accesss site No ischemic EKG changes |
| When should a PCI pt perform an ETT? | 6-9 months post PCI if symptomatic |
| What is the certification period for a pt post PCI? | Annually |
| How often should a post PCI pt have an ETT? | Every other year |
| What are the certification recommendations for a pt with CHF? | Asymptomatic (class I) Tolerates medication Exercise tolerance > 6 MET's LVEF =/> 40% using echo to get EF |
| When is a driver with CHF NOT certified? | EF<40% Sustained VT (30s or more or requires intervention) Symptomatic (NYHA class II or higher) |
| What are the waiting periods for post-isthmus ablation for atrial flutter? | Minimum 1 month |
| What is the minimum waiting period for AV nodal reentrant tach, WPW or ATrial Tach? | Minimum 1 month asx/tx |
| What is the max cert for SVT's? | 1 year. Driver should have annual med exam |
| Recommend to certify the driver with SVT if: | HR is controlled Comply with anticoagulant tx guidelines (if applicable) No disqualifying underlying disease Clearance from CV specialist |
| Recommend NOT certifying the driver with SVT if: | LOC Compromised cerebral function Sudden death resuscitated |
| What is the minimum waiting period for a pt with Atrial Fibrillation? | 1 month |
| Certify the pt with Atrial Fibrillation if: | Anticoagulated adequately The heart rate is controlled No disqualifying underlying disease Cleared by CV specialist |
| Recommend NOT certifying the driver if: | Symptomatic Sustained VT Occurs with an EF <40% Hypertrophic cardiomyopathy, long QT interval syndrome or Brugada syndrome |
| What is the minimum wait period for a pt post Pacemaker implantation? Max cert period? | One month. Max certification is one year if compliant with scheduled function checks. |
| What is the minimum waiting period for a pt with syncope? | At least 3 months. |
| What is the max cert period for a pt with syncope? | 1 year if cause can be prevented or the driver is not at risk while driver or if the driver is syncope-free for 3 months and no underlying heart or neurological disease. |
| True or False: Certify a pt with a pacemaker that treats neurocardiogenic syncope. | False |
| No evaluation for a murmur if: | Midystolic and grade 2 or less No symptoms No clinical findings venous hum |
| Evaluation for a murmur is recommended if it is: | Early Systolic Midsystolic garde 3 or more late systolic holosystolic midsystolic murmur grade 2 or less with sx or other signs diastolic continuous murmor systolic grade 1 or 2 with signs/sx of heart disease |
| How often is a driver with aortic stenosis certified? | Annually |
| True or false: You should not certify a driver with aortic stenosis if it is severe, regardless of symptoms or left ventricular function. | True |
| Do not certify a driver with moderate or severe aortic stenosis if they have one or more of the following: | Angina heart failure atrial fibrillation left ventricular dysfunction with EG < 50% Thromboembolism |
| What is the certification frequency for a pt with mild aortic regurgitation? For Moderate aortic regurgitation? | For Mild/Mod: Annually if the driver is asymptomatic. Echo q 2-3 years |
| What is the certification frequency for a pt with mild aortic regurgitation? | For Severe: Cert every 6 months if: asymptomatic, normal LV function, EF>/= 50%, LV end diastolic dimension <60mm, LV end systolic dimesnion <50mm, Cardiologist exam q 6-12 months, echo q 6-12 months. |
| Do not certify a pt with aortic regurgitation if: | Symptomatic. Unable to complete stage 2 Bruce Protocol, LV dysfunction/dilatation, EF<50%, LV dilatation, LV end diastolic dimension > 70mm, LV end systolic dimension > 55mm. |
| What categorizes Mild Mitral Stenosis? How often should it be monitored? | Valve area greater than 1.5cm2, mean gradient less than 5mmHg OR pulmonary artery systolic pressure < 30mmHg. Echo q 3-5 years. |
| What categorizes Moderate Mitral Stenosis? How often should it be monitored? | Valve area 1.0 to 1.5cm2, mean gradient 5-10 mmHG, or pulmonary artery systolic pressure 30-50mmHg. Echo q 1-2 years. |
| What categorizes Severe Mitral Stenosis? How often should it be monitored? | Valve area less than 1.0cm2, mean gradient greater than 10mmHg, or pulmoary artery systolic pressure greater than 50mmHg. Echo q year |
| You can certify a pt with mild or moderate mitral stenosis if the pt is symptomatic, True or False | True |
| Do not certify a patient with mitral stenosis if: | Symptomatic, NYHA class 2 or >, Afib, severe Pulmonary HTN (>60mmHg), < 6 METS with exercise |
| When do you certify mitral stenosis post-procedures? | 4 weeks post percutaneous balloon valvotomy or 3 months post-surgical commissurotomy |
| True or False: a mitral stenosis patient must be cleared by a cardiovascular specialist. | True |
| A mitral stenosis patient is certified: | annually |
| 1. Certify Mild Mitral Regurgitation if: 2. How often do you certify? 3. Is a yearly echo necessary? | asymptomatic, no evidence of LV enlargement, no LV dysfunction and no pulmonary hypertension. 2. Annually. 3. Only if there is evidence it has worsened. |
| How often do you evaluate moderate mitral regurgitation? What is the max certification period? | Evaluate q year with echo or sooner with symptoms occur. Maximum certification period is one year. |
| True or False: can patients with severe mitral regurgitation be certified? | True, if asymptomatic |
| How often do severe mitral regurgitation patients need to be examined? | q 6 to 12 months to assess symptoms with Hx, PE, and echo. ETT can be done q six to 12 months. |
| Do not certify a patient with severe mitral regurgitation if: | Symptomatic with dyspnea, fatigue, orthopnea or paroxysmal nocturnal dyspnea. <6 METS on Bruce protocol. Ruptured chordae or flail leaflets. Afib. LV dysfrunction. Thromboembolism. Pulmonary hypertension. |
| What is the waiting period post mitral valve repair for mitral regurgitation? When do you certify? How long? | Minimum 3 months. Certify based on whether condition is mild, moderate or severe, asymptomatic, no thromboembolic complications, no pulmonary htn,. Max certification is one year. |
| How often is certification for Mitral Valve Prolapse? | q 2 years if asymptomatic and stable |
| What is the waiting period s/p mechanical valve implantation? When do you certify? | Waiting period is 3 months. Certify if asymptomatic and cleared by cardiologist. Recommend certification q year with cardio exam. |
| When do you not certify a patient with mechanical valves? | Do not certify if symptomatic, LV dysfunction with EF <40%, thrombembolic complications post procedure, pulmonary hypertension and unable to maintain adequate antiocoagulatio. |
| True or False: Biologic prosthesis certification criteria are the same as mechanical valves. | True |
| How long does a biologic prosthesis require anticoagulation? | 3 months post implantation |
| How often do you certify a patient with pulmonary valve stenosis? | Annually |
| When do you disqualify a patient with pulmonary valve stenosis? | Sx of dyspnea, palpitations or syncope are present. Pulmonary valve peak gradient > 50mmHg with normal cardiac output. Right ventricular pressure >50% systemic pressure. > mild right ventricular hypertrophy or by echo. Pulm art diameter >5cm. |
| What is the waiting period for s/p repair of pulmonary valve stenosis? | At least 3 months following surgical valvotomy or 1 month post-balloon valvuloplasty. |
| When do you certify a driver with Ebstein anomaly? | Asymptomatic, mild tricuspid anomaly, mild cardiac enlargement, mild right ventricular dysfunction. |
| When do you disqualify a patient with Ebstein anomaly? | Sx of dyspnea, palpitations or paradoxical embolism. > than mild cardiac enlargement. Associated intracardiac lesions. > than mild right ventricular dysfunction. > moderate tricuspid valve regurg. Sx arrhythmia or accessory conduction pathway. Shunt. |
| True or False: a pt with restrictive cardiomyopathy should be disqualified. | True |
| True or False: certify a patient with idiopathic hypertrophic subaortic stenosis. | False |
| True or False: Do not certify a driver with a diagnosis of hypertrophic cardiomyopathy. | True |
| What is the maximum certification period for a patient with AAA? | 1 year |
| True or False: FMCSA recommends DQ for a driver with an AAA larger than 5.0cm | True. Also, if it is fast-growing (>0.5cm q month) or Sx |
| Post-AAA repair, how long is the waiting period? What is needed to clear the driver? How frequently can they be certified? | 3 months, cleared by CV specialist. Recert is q year. |
| When do you DQ a pt with a thoracic aneurysm? When do you certify post repair? | If it is > 3.5cm. 3 months post repair. |
| How frequent should you certify a pt with intermittent claudication? How often? Post surgical waiting period? | 1 year for both. Waiting period post surgery is 3 months. |
| When do you cert/DQ a driver with DVT? Max cert period? With anticoag? | If there is no acute DVT? Do not cert if not tx effectively. Max cert 1 year. With anticoag, after 1 month on anticoag, 3 months if PE (current guidelines rec 6 months). |
| What is the waiting period post heart transplant? Max cert period. Criteria for cert? | 1 year. 6 months. Cert if ASx, tolerates meds, no signs of rejection, meets other qual reqs, clearance from CV specialist. |
| What is the waiting period for when a pt starts coumadin tx? What is the max cert period? When do you or do not certify? | 1 month minimum. Max cert if 1 year. Cert if stabilized for at least a month, has INR records and monitors INR q month. DQ if INR not being monitored, therapeutic or underlying dz is DQ'ing. |
| True or False: You can qualify a driver over 75 years old on coumadin with ischemic cerebrovascular disease. | False |
| What is the certification for a BP reading of 140-159/90-99? How long? When do you recert? | 1 year. 1 year if </= 140/90. One-time cert for 3 months if BP 141-159/91-99 |
| What is the certification for a BP reading of 160-179/100-109? How long? When do you recert? | One-time certificate for 3 months. Recert 1 year from date of exam if BP </= 140/90 |
| What is the certification for a BP reading of >/= 180/110? How long? When do you recert? | 6 months from date of exam if BP is </= 140/90. DQ if BP over/equal 180/110. Certify q 6 months if BP <= 140/90. Cert date is date of full cert of exam. |
| What are the guidelines for evaluating pulmonary function per FMCSA? | FEV1 < 65% predicted; FEV1/FC ratio < 65% OR PFT shows FVC < 60% (restrictive), THEN obtain pulse ox. If Pulse Ox < 92% (PO2 = 64), Get ABG. DO NOT CERTIFY IF PaO2 < 65mmHg at altitude below 5k feet or 60mmHg below 5k feet; OR PaCO2 > 45mmHg. |
| What is the Max cert time for a driver with pulmonary disease? | 2 years |
| Do not certify a driver with a chest wall or lung deformity if: Max cert time is ____ | Hypoxemia at rest, chronic respiratory failure, hx of continuing cough w cough syncope. Max cert time is 2 years. |
| Can you certify a driver with cystic fibrosis? Max cert period is 1 year. | If they do not show: hypoxemia at rest, chronic resp failure, hx of continuing cough w syncope, does not meet spirometry criteria, is in a unstable condition. Max cert period is 1 year. |
| Do not certify a driver with Interstitial Lung Disease if ____. Max certification period is ____ | 1. Hypoxemia at rest, chronic respiratory failure, hx of continuing cough with cough syncope. 2. Two years |
| When do you certify/disqualify a driver with pneumothorax? What is the max period? | Cert if: asymptomatic wo chest pain, SOB, no dq'ing lung dz, confirmed resolution of 1 spont PTX, successful pleurodesis. DQ if: hx of >/=2 spont PTX on one side, no surgery to prevent, hypoxemia at rest, chronic resp fail, cough with syncope. 2 years. |
| How long can a driver return to duty after taking sedating medications? | 12 hours |
| True or False: you can certify a driver who is color blind due to TB meds. | False |
| Do not certify a driver with atypical TB if they have: max cert is | Severe pulm dysfunction, weakness, fatigue, adverse reaction to medical tx. Max cert is 2 years |
| What is the waiting period for pulmonary embolism? What is the max cert? When do you DQ? | 3 months. Max cert 1 year. Do not certify if Sx. |
| When do you cert a driver with Cor Pulmonale? | Acute: q 3 to 6 months. Chronic: DQ |
| When do you or do not cert a driver with Pulm HTN? For how long? | If not a danger to public health. DQ if at risk of sudden death, dyspnea at rest, dizziness, or hypotension, PaO2 </= 65mmHg. Max cert if one year. |
| What does the FMCSA recommend for a driver with obstructive sleep apnea? | Certifying for 30 days to allow time for a sleep study. Limit certification or DQ if the driver does not present with proof of compliance. DQ a driver who had a sleep study confirming OSA that needed tx and has not undergone adequate tx. |
| When does the FMCSA recommend DQ for sleep apnea? | hypoxemia at rest (<91%), dx of unTx and Sx OSA, (removed) AHI > 20, Narcolepsy, primary (idiopathic) alveolar hypoventilation syndrome, idopathic CNS hypersomnolence, RLS with EDS |
| What other recommendations for DQ for a sleep apnea pt? | Pt reports excessive sleepiness while driving, who had MVA assoc with falling asleep, Observed sleeping behind the wheel, non-compliant with tx. |
| A driver with OSA on PAP can be certified: | At least 30 consecutive days of PAP use documented, at least 4 hours per night on 70% of nights, no excessive daytime sleepiness. Driver can keep driving while collecting data. Cert for 1 year. Recert if fulfills the same criteria (mostly) |
| If driver fails to meet compliance standards for OSA tx by PAP | May provide 30 day cert to get data. After, issue 60 day cert. After, issue 90 day cert. After, 1 year cert. DQ if can't produce 30 days of data |
| True or False: oral appliances are not acceptable tx for OSA in order to qualify. | False |
| What is the waiting period min/max for TIA? | 1 year for both |
| What is the criteria for certifying a stroke pt? | Normal PE, no neuro residuals that interfere with driving. Cleared by neuro. Waiting period 1 year if no seizure risk, 5 years for seizure risk. |
| True or False: you can certify a driver with a dx of inflammatory myopathy. | False |
| True or False: you should not certify a driver with a neuromuscular junction disorder | True |
| When do you DQ neuropathy or similar diseases? How often do you recertify? | Loss of position sense. Recert is annual. |
| Can you qualify a driver with dementia? | No. |
| What type of CNS tumors are DQ'ing? | primary or metastatic malignant tumors |
| What CNS tumors require a 1 year waiting period post-surgical removal? | Infrantentorial meningiomas, acoustic neuormas, pituitary adenomas, spinal benign tumors, benign extra-axial tumors. |
| What CNS tumors require a 2-year waiting period post-surgical removal? | Benign supratentorial tumors, spinal tumors. For meningiomas, exam must show no recurrence. |
| The FMCSA defines epilepsy as: | Two or more unprovoked seizures |
| What is the certification criteria for drivers with epilepsy? How often should they be certified? | Seizure free for 10 (8) years without seizure meds. After that, annual certifications. |
| What is the minimum wait time for a single unprovoked seizure? What is required for clearance? What is the maximum certification? | 5 (4) years seizure-free. Max cert is one year. Clearance from neurologist. |
| DO not certify a driver who has had one unprovoked seizure if: | The driver has not completed the waiting period and is off anticonvulsants and who has not been cleared by a neurologist. |
| What constitutes severe head injury? Should you certify a driver who has had it? | Dural penetration with LOC > 24 hrs. Do not certify. |
| What constitutes moderate head injury? Do you certify? | Loss of consciousness > 30 minutes but < 24hrs. Waiting period is 5 years off anticonvulsant meds if early seizures, 2 years off anticonvulsant meds if no early seizures. Max cert 1 year. |
| What constitutes mild head injury? Do you certify? | LOC < 30 min, Waiting period with early seizure 2 years seizure free and off anticonvulsant meds. No waiting period if no early seizure. Max cert 1 year. |
| True or False: The waiting period for a pt with aseptic meningitis is 1 year. | False, there is no waiting period. No risk of subsequent unprovoked seizures. |
| What is the waiting period for a pt with bacterial meningitis? | Without early seizures, 1 year seizure free without meds. With early seizures, 5 year seizure free interval w/o meds. |
| True or False: there is a 1-year seizure free off med period for viral encephalitis pts. | True |
| Encephalitis: do you qualify a pt with it? | Do not qualify a pt with encephalitis with early seizures for the first 10 years. |
| How long must a driver be on anti-seizure meds to be certified? | At least 2 years. |
| What is the max cert for a pt with migraines? | 2 years, if not taking meds that interfere with safe driving, not incapacitated by headaches and no neuro complications. |
| If a pt loss a foot, leg, hand and/or arm, can they be qualified? | NO. |
| True or False: a driver can be certified if they have an impairment of the hand or finger, as long as it doesn't interfere with prehension or power grasping. | True |
| A driver with musculoskeletal disease usually needs a ____ before being certified. | Skill Performance Evaluation |
| A SPE Certificate is given by a _____ | Orthopedic surgeon or physiatrist |
| A recert with an SPE is given every | 2 years or less |
| True or False: A diabetic driver who takes insulin can be qualified. | False, unless they have the 49 CFR 391.46 exception q year |
| True or False: A diabetic driver who has a severe hypoglycemic episode can continue driving. | False, they must report to the treating clinician. This clinician will re-evaluate the pt and complete a new MCSA-5870 form. The pt must then be re-examined by a certified examiner. |
| True or False: a UA is required in driver exams. | True |
| Certify a driver with DM if: | meets physical standards, has tx plan that manages disease. Max cert is one year. |
| Do not certify a driver with DM if: | Loss of position or pedal sensation. Resting tachycardia. Orthostatic hypotension. Dx of perip neuropathy that interferes with pedal use. Dx of proliferative retinopathy or severe non-prolif retinopathy. ESRD. GI/GU autonomic neuropathy. |
| True or False: Stage 5 CKD is grounds DQ. | True |
| How soon after receiving a renal transplant can a driver return to duty? | 90 days |
| True or False: Advanced Liver Disease is not disqualifying. | False |
| True or False: Disqualify a driver with an active psychosis. | True |
| How long is the waiting period for a driver who suffered a brief reactive psychosis or schizophreniform disorder? Of any other psychotic disorder? | 6 months. 1 year. |
| When do you certify a driver taking antipsychotics? How long? | When the meds show adequate, effective, and safe and the driver is stable. 1 year. DQ if underlying condition or tx side effects interfere with safe driving. |
| What are the waiting periods with the mood disorders? | 6 months sx free following a nonpsychotic major depression without suicidal behavior. 1 year sx free following: severe depressive episode, suicide attempt or manic episode. |
| True or false: do not certify a driver whose lithium levels are not in therapeutic range. | True |
| What is the max cert period for a pt with ADHD? | 1 year |
| The max cert for a driver on stimulant therapy is: | 1 year |
| Can you cert a driver on sedative hypnotics? | Yes, if the dose is low, used for a short period of time and is short-acting. Max cert is 2 years. |
| True or False: You can certify a driver on benzodiazepenes. | False |
| What is the waiting period s/p ECT? | 6 months. But not ECT |
| How is heavy drinking defined? | Men: Consume an average of more than two drinks per day Women: Consume an average of more than one drink per day |
| How is binge drinking defined? | Alcohol consumption that brings the blood alcohol concentration to 0.08% or more. In men this is approximately five or more drinks on a single occasion. In women this is four or more drinks on a single occasion. This is usually within a 2 hour period. |
| True or False: a test for controlled substances is required as a part of the medical re-certification process. | FALSE. It is NOT required. |
| When is post-accident substance abuse testing required if there's a loss of human life? | Within 8 hours for alcohol testing and 32 hours for drug testing when the crash involves the loss of human life. |
| When is post-accident substance abuse testing required if there's no loss of life and the driver receives a citation? | Driver receives citation within 8 hours AND: bodily injury to person who directly goes to offsite care OR one or more motor vehicles must be towed. |
| A driver who has violated the prohibited substance abuse standards returns to duties after having a ________ drug test or breath alcohol test. | Directly-observed |
| How many follow-up drug/alcohol tests must a driver have after returning to duty? | 6 within the first year |
| What drugs do DOT tests for? (hint: there's 5) | Cocaine, Marijuana, PCP, Opiates, Amphetamines |
| What drugs are NOT detected by DOT drug testing? | Antidepressants, tranquilizers, benzodiazepines, synthetic THC or CBD, sleeping pills (Ambien, sonata, lunesta) |
| True or False: all Schedule 1 drugs are disqualifying. | True. Even medical marijuana. |
| True or False: Methadone is allowed to be used by CMV drivers. | False |
| At what BAC is a driver removed from the worksite, per DOT? | 0.04 |
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markcab
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