CME Content Flashcards
(293 cards)
1
Q
Glucose - sugar in the blood
A
Normal: 70-99 mg/dL
2
Q
Sodium (Na) - electrolyte
A
Normal: 135-145 mEq/L
3
Q
Chloride (Cl) electrolyte
A
Normal: 96-106 mmol/L
4
Q
Potassium (K) - electrolyte
A
Normal: 3.5-5.5 mEq/L
5
Q
Carbon Dioxide (CO2) - gaseous waste product
A
Normal: 20-29 mmol/L
6
Q
Blood Urea Nitrogen (BUN) - waste product of the liver carried to the liver and excreted through urine
A
Normal: 7-20 mg/dL
7
Q
Creatinine - chemical waste product of muscle metabolism
A
Normal: 0.8-1.4 mg/dL
can be tested in blood or urine
8
Q
Calcium (Ca) - mineral stored in the bones
A
Normal: 8.5-10.9 mg/dL
9
Q
Magnesium (Mg) - electrolyte
A
Normal: 1.8-2.6 mEq/L
10
Q
Protein (Total) - chains of amino acids essential for growth and repair of cells
A
Normal: 6.3-7.9 g/dL
11
Q
Albumin - protein that keeps fluid from leaking out of blood vessels and that nourishes tissues
A
Normal: 3.9-5.0 g/dL
12
Q
Globulin - alpha, beta, and gamma proteins
A
Normal: 2.0-3.5 g/dL
13
Q
Bilirubin - pigment in bile, a digestive fluid produced b the liver
A
Normal: 0-0.3 mg/dL
14
Q
Alkaline Phosphatase (ALP) - enzyme found in liver and bones
A
Normal: 50-160 IU/L
15
Q
Alanine Amino-transferase (ALT) - enzyme found mostly in the liver
A
Normal: 8-37 IU/L
16
Q
Aspartate Amino-transferase (AST) - enzyme found in the liver, muscles, and other tissues
A
Normal: 10-34 IU/L
17
Q
Glomerular Filtration Rate (GFR) - checks how well the kidneys are working by estimating how much blood passes through the glomeruli each minute
A
Normal: 90-120 mL/min/1.73 m2
18
Q
Body System 1
A
General
19
Q
Body System 2
A
Skin
20
Q
Body System 3
A
Eyes
21
Q
Body System 4
A
Ears
22
Q
Body System 5
A
Mouth/throat
23
Q
Body System 6
A
Cardiovascular
24
Q
Body System 7
A
Lungs/chest
25
Body System 8
Abdomen
26
Body System 9
GU (including hernias)
27
Body System 10
Back/spine
28
Body System 11
Extremities/joints
29
Body System 12
Neurological (including reflexes)
30
Body System 13
Gait
31
Body System 14
Vascular
32
DUI - alcohol (as prescribed under State law)
```
1st offense = 1 year
1st offense (hazardous materials) = 3 years
2nd offense = life
```
33
DUI - alcohol (blood concentration >= 0.04)
```
1st offense = 1 year
1st offense (hazardous materials) = 3 years
2nd offense = life (possible reinstatement after 10 years after completion of state-approved rehab program)
```
34
DUI - controlled substance
```
1st offense = 1 year
1st offense (hazardous materials) = 3 years
2nd offense = life (possible reinstatement after 10 years after completion of state-approved rehab program)
```
35
Refusing to take an alcohol test
```
1st offense = 1 year
1st offense (hazardous materials) = 3 years
2nd offense = life
```
36
Leaving the scene of an accident
```
1st offense = 1 year
1st offense (hazardous materials) = 3 years
2nd offense = life
```
37
Using CMV to commit a (non-drug-related) felony
```
1st offense = 1 year
1st offense (hazardous materials) = 3 years
2nd offense = life
```
38
Driving with a revoked, suspended, or disqualified license
```
1st offense = 1 year
1st offense (hazardous materials) = 3 years
2nd offense = life
```
39
Causing a fatality through negligent operation of a CMV
```
1st offense = 1 year
1st offense (hazardous materials) = 3 years
2nd offense = life
```
40
Using CMV in the commission of a felony involving the manufacture, distribution, or dispensing of a controlled substance (whether hauling hazardous material or not)
1st offense = life (permanent)
41
Moving violations (speeding in excess of 15 mph over the limit, reckless driving, improper lane changes, tailgating, driving without CDL in possession, driving without proper class of CDL, texting while driving)
2nd offense = 60 day suspension
| 3 or higher offense = 120 day suspension
42
Stage 1 HTN (140-159/90-99)
Certify: 1 year
Recertify: 1 year if BP < 140/90 or 3 months if not
43
Stage 2 HTN (160-179/100-109)
Certify: 3 months (refer to specialist)
Recertify: 1 year if BP < 140/90
44
Stage 3 HTN (>=180/110)
Disqualify
| Recertification: never more than 6 months and only if BP < 140/90
45
Monocular vision
Disqualify
| Certify 1 year with exemption (renew exemption q 2 years)
46
Meniere's disease
Disqualify
47
Uncontrolled vertigo
Disqualify
48
Labyrinthine fistula
Disqualify
49
Nonfunctioning labyrinth
Disqualify
50
Secondary HTN
if not treated through surgery - use guidelines for essential HTN
Waiting period: 3 months after surgical correction of underlying disorder
Certify: 1 year
Recertification: annual
51
Anticoagulant therapy
Waiting period: >= 1 month stabilized on Tx
Certify: 1 year (must provide documentation of INR results at exam with at least monthly INR testing)
Recertification: annual
52
Abdominal aortic aneurysm (< 4 cm 4-5 cm with clearance, or any size but repaired)
Waiting period: 3 months post-surgical repair
Certify: 1 year
Recertification: annual
53
Abdominal aortic aneurysm (symptomatic, recommended for repair, increased > 5 cm in size in 6 months, or > 5 cm)
Disqualify
54
Acute DVT
Waiting period: until etiology has been confirmed and Tx initiated
Certify: 1 year (if well managed, under supervision, and on prescription medications)
Recertification: annual
55
Chronic thrombotic venous disease
Certify: 2 years (if stable and asymptomatic)
Recertification: biannual
56
Intermittent claudication
Waiting period: do not certify if pain at rest
Certify: 1 year
Recertification: annual
57
Pulmonary emboli
S/S: sharp pain with cough
Waiting period: 3 months post-surgical repair OR without PE (do not certify if symptomatic - dyspnea, chest pain, SOB)
Certify: 1 year
Recertification: annual
58
Thoracic aneurysm (< 3.5 cm)
weakened and bulging area in upper part of aorta
Waiting period: 3 months post-surgical repair
Certify: 1 year
Recertification: annual
59
Varicose veins
Waiting period: do not certify until etiology confirmed and Tx effective - can be harmless but painful or sign of pulmonary/vascular disorder => refer to specialist
Certify: 2 years
Recertification: biannual
60
Implantable cardioverter-defibrillators (ICD)
Disqualify (do not certify driver with pacemaker/ICD, even if ICD not activated) - treat cardiac arrest, ventricular tachycardia, and ventricular fibrillation through delivery of rapid electrical shocks (treat, but do not prevent arrhythmias)
61
Pacemaker (sinus node dysfunction/AV block)
Waiting period: 1 month post-implantation
Certify: 1 year (documentation of regular checks)
Recertification: annual
62
Pacemaker (neurocardiogenic syncope/hypersensitive carotid sinus w/syncope)
Waiting period: 3 months post-implantation
Certify: 1 year (documentation of regular checks)
Recertification: annual
63
Atrial fibrillation
Waiting period: 1 month with adequate anticoagulation or ablation
Certify: 1 year (do not certify if symptomatic)
Recertification: annual
64
Ventricular arrhythmia
Waiting period: 1 month after Tx
Certify: 1 year (do not certify if driver has LVEF < 40%, hypertrophic cardiomyopathy, long QT interval, Brugada syndrome)
Recertification: annual
65
Acute MI
Waiting period: 2 months (LVEF >= 40%)
Certify: 1 year (do not certify if resting angina, ETT < 6 METs, ischemic change on rest ECG, intolerance to therapy)
Recertification: annual (with biennial ETT)
66
Angina pectoris
Waiting period: 3 months with no resting angina or change in pattern (satisfactory ETT with cardiovascular evaluation q 2 years)
Certify: 1 year (do not certify if driver has unstable angina within 3 months of exam)
Recertification: annual
67
Coronary Heart Disease (CHD) risk-equivalent (DM, PVD, Framingham risk 20% CHD in next 10 years, over age 45 with multiple risk factors for CHD)
Certify: 1 year
Recertification: annual
68
Coronary artery bypass grafting (CABG) surgery
Waiting period: 3 months post-surgery (or until sternum has healed)
Certify: 1 year (only if LVEF >= 40% - do not certify if driver is symptomatic, has LVEF < 40%, not cleared by cardiologist, unhealed sternum)
Recertification: Annual (annual ETT 5 yrs. Post-CABG)
69
Percutaneous coronary intervention (PCI) - angioplasty
Waiting period: 1 week
Certify: Initial certification = 6 months (driver should bring results of ETT 3-6 months post intervention) then 1 year
Recertification: annual (if ETT normal)
70
Ebstein anomaly
congenital downward displacement of the tricuspid valve
Certify: 1 year
Recertification: annual
71
Heart transplantation
Waiting period: 1 year
Certify: 6 months (evaluation should be done by cardiologist)
Recertification: 6 months
72
Hypertrophic cardiomyopathy
Disqualify - left ventricle or septum between ventricles enlarges (heart cannot relax properly between beats and fills with less blood = insufficient blood flow to body)
73
Restrictive cardiomyopathy
Disqualify
74
Syncope
loss of consciousness
Waiting period: identify and treat underlying disorder
Certify: 1 year
Recertification: annual
75
Heart murmurs
Waiting period: 3 months after valve repair
Certify: 6 mos. w/o valve repair and 1 yr. w/valve repair (ECG every 2-3 years)
Recertification: annual
76
Mitral Stenosis
Mild: mitral valve area (MVA) >= 1.6 cm (certify)
Moderate: MVA 1.0-1.6 cm
Severe: MVA < 1.0 (disqualify)
Waiting period: 4 wks. (post-percutaneous balloon valvotomy)/3 mos. (Post-surgery)
Certify: 1 year (annual CXR, ECG, 2D echocardiography with Doppler)
Recertification: annual
77
Mitral Valve Prolapse
Certify: 1 year
Recertification: annual (with Echo if mitral regurgitation)
78
Prosthetic valves
Waiting period: 3 months post-surgery
Certify: 1 year
Recertification: annual
79
Pulmonary valve stenosis
Waiting period: 1 mo. (post-balloon valvuloplasty)/3 mos (post-surgical valvotomy)
Certify: 1 year
Recertification: annual
do not certify: symptomatic, pulmonary valve peak gradient > 50 mm Hg, right ventricular pressure > 50%, > mild RV hypertrophy/dysfunction, > moderate pulmonary valve regurgitation, main pulmonary artery diameter > 5 cm
80
Antihistamine therapy use
Certify: 2 years (must wait 12 hours before operating vehicle)
Recertification: biennial
81
Asthma
Certify: 2 years (do not certify if asthma is poorly controlled)
Recertification: biennial
82
Hypersensitivity pneumonitis (immune-mediated granulomatous interstitial pneumonitis)
Certify: 2 years (CXR can reveal extent of interstitial disease)
Recertification: biennial
83
Chronic obstructive pulmonary disease (COPD)
Certify: 2 years (do not certify w/hypoxemia at rest, chronic respiratory failure, Hx of cough with syncope)
Recertification: biennial
84
Acute respiratory disease
Certify: 2 years (wait 12 hours after taking sedatives)
Recertification: biennial
85
Atypical TB
Certify: 2 years
Recertification: biennial
86
Pulmonary TB
Certify: 2 years (do not certify with chronic TB, noncompliance with therapy, incomplete streptomycin therapy)
Recertification: biennial
87
Chest wall deformity
Certify: 2 years (do not certify if hypoxemia at rest, chronic respiratory failure, Hx of cough with syncope, < spirometry, unstable)
Recertification: biennial
88
Interstitial lung diseases (ILDs)
Certify: 2 years (do not certify if hypoxemia at rest, chronic respiratory failure, Hx of cough with syncope)
Recertification: biennial
89
Traumatic or Spontaneous Pneumothorax
Certify: 2 years (confirm recovery with CXR)
90
Cor pulmonale (enlargement of the right ventricle secondary to lung disease)
Certify: 2 years (do not certify if dyspnea at rest, dizziness, hypotension, PaO2 < 65 mm Hg)
Recertification: biennial
91
Pulmonary hypertension (pulmonary artery pressure greater than 50% systemic systolic blood pressure)
S/S: chest pain, swollen ankles, SOB
Certify: 1 year (do not certify if dyspnea at rest, dizziness, hypotension, PaO2 < 65 mm Hg)
Recertification: annual
92
Anticonvulsant therapy for pain
Certify: 2 years (do not certify if Tx used to prevent seizures)
Recertification: annual
93
Provoked (1 time seizure)/childhood febrile seizures
Certify: 2 years
Recertification: biennial
94
Unprovoked Seizure (mild without early seizure)
Waiting period: 1 year seizure free and off anticonvulsant medications
Certify: 1 year
Recertification: annual
95
Unprovoked Seizure (moderate without early seizure)
Waiting period: 2 years seizure free and off anticonvulsant medications
Certify: 1 year
Recertification: annual
96
Unprovoked Seizure (moderate with early seizure) or single unprovoked seizure
Waiting period: 5 years seizure free and off anticonvulsant medications
Certify: 1 year
Recertification: annual
97
Unprovoked Seizure/Hx of Epilepsy (2 or more unprovoked seizures)
Waiting period: 10 years seizure free and off anticonvulsant medications
Certify: 1 year
Recertification: annual
98
Headaches
Certify: 2 years
Recertification: biennial
99
Benign positional vertigo/Acute and chronic peripheral vestibulopathy
Waiting period: 2 months asymptomatic
Certify: 2 years
Recertification: biennial
do not certify: use of benzodiazepines/phenothiazines for treatment
100
Aseptic meningitis
Certify: 2 years
Recertification: biennial
101
Bacterial meningitis or Viral encephalitis without early seizures
Waiting period: 1 year seizure free and off anticonvulsant medications
Certify: 2 years
Recertification: annual
102
Bacterial meningitis with early seizures
Waiting period: 5 years seizure free and off anticonvulsant medications
Certify: 2 years
Recertification: annual
103
Viral encephalitis with early seizures
Waiting period: 10 years seizure free and off anticonvulsant medications
Certify: 2 years
Recertification: annual
104
Autonomic neuropathy (affects the nerves that regulate vital functions)
Certify: 2 years (do not certify with resting tachycardia or orthostatic BP)
Recertification: biennial
105
Myotonia
Disqualify
106
Isaac's syndrome (rare neuromuscular disorder that is characterized by progressive muscle stiffness; continuously contracting or twitching muscles [myokymia]; and diminished reflexes)
Disqualify
107
Stiff-man syndrome
Disqualify
108
Congenital myopathies
Disqualify
109
Metabolic muscle diseases (conditions affecting the energy metabolism of muscle)
Disqualify
110
Motor neuron disease (spinal muscular atrophy, amyotrophic lateral sclerosis)
Disqualify
111
Muscular dystrophy
Disqualify
112
Neuromuscular junction disorders (myasthenia gravis, myastenic syndrome)
Disqualify (easy fatigability)
113
Peripheral neuropathy
Disqualify (interferes with sensation) - protein in the urine is often the first sign
114
Brain tumors (infratentorial meningiomas, acoustic neuromas, pituitary adenomas, spinal benign tumors)
Waiting period: 1 year post-surgical removal
Certify: 1 year (with no evidence of new tumors)
Recertification: annual
115
CNS tumors (benign supratentorial tumors, spinal tumors)
Waiting period: 2-4 years post-surgical removal
Certify: 1 year (with no evidence of new tumors)
Recertification: annual
116
Dementia (Alzheimer's/Pick's disease)
Disqualify
117
Stroke/intracerebral and subarachnoid hemorrhage/TIA
Waiting period: 1 yr. (no risk for seizure)/5 yrs. (risk for seizure)
Certify: 1 year (no risk for seizure - cerebellum or brainstem vascular lesions/risk for seizure - cortical or subcortical deficits)
Recertification: annual
118
Mild TBI without early seizures
Certify: 2 years
Recertification: biennial
119
Mild TBI w/early seizure or Moderate TBI w/out early seizures
Waiting period: 4 years seizure free and off anticonvulsant medications
Certify: 1 year
Recertification: annual
120
Moderate TBI w/early seizures
Waiting period: 5 years seizure free and off anticonvulsant medications
Certify: 1 year
Recertification: annual
121
Severe TBI (penetrates dura - with or without early seizures)
Disqualify
122
Fixed deficit on extremity and SPE issued
Waiting period: driver otherwise qualified to drive; SPE renewed every 2 years (do not certify if impairment affects torso)
Certify: 2 years
Recertification: biennial
123
Diabetes Mellitus (without insulin use)
Certify: 2 years (assess with urinalysis and A1c - greater than 10% = poor glucose control)
Recertification: biennial
124
Insulin-dependent diabetes
Waiting period: 1 mo. (previous Dx and not on insulin), 2 mos. (newly diagnosed)
Certify: 1 year (driver should present with MCSA-5870 form and should carry 20 g glucose tablets)
Recertification: annual (by endocrinologist)
Drivers certified in Canada or Mexico cannot be certified in the USA
125
Incretin mimetic (exenatide/Byetta - reduces fasting and postprandial glucose concentrations) use
Certify: 1 year (Incretin mimetics are not insulin and can be used without an exemption)
Recertification: annual
126
Hernia
can affect driver's ability to load, unload, couple, and uncouple vehicle
Certify: 2 years
Recertification: biennial
127
Nephropathy (diabetic-related)
Certify: 2 years (check for proteinuria with urinalysis)
Recertification: biennial
128
ESRD (on hemodialysis)
Disqualify
129
Antidepressant use
Waiting period: as necessary until medication use is adequate and stable
Certify: 1 year (do not certify if driver using 1st general antidepressant - amitriptyline/Elavil or imipramine/Tofranil)
Recertification: annual
130
Hypnotic medications
Certify: 2 years (only if short acting - 1/2 life < 5 hrs., lowest effective dose, and used < 2 weeks)
Recertification: annual
Example: Ambien lowest dosage is 5 mg
131
Non-sedating anxiolytic
Certify: 2 years
Recertification: annual
132
Sedating anxiolytics (Benzodiazepines: Ativan, Halcion, Librium, Valium, Xanax, Rohypnol)
Disqualify
133
Central nervous system (CNS) stimulants (e.g., dextroamphetamine, methylphenidate, pemoline)
Certify: 1 year (only if used to treat ADHD - disqualify if used to treat narcolepsy)
Recertification: annual
134
Narcolepsy
Disqualify
135
Electroconvulsive therapy (ECT)
Waiting period: 6 months symptom free following last course of ECT
Certify: 1 year (do not certify if driver receiving maintenance ECT)
Recertification: annual
136
Lithium (Eskalith)
Certify: 1 year (do not certify if driver is symptomatic or lithium is not in therapeutic range)
137
ADHD
Waiting period: as necessary until cause is confirmed and treatment deemed adequate
Certify: 1 year - do not certify if active psychosis, prominent negative symptoms, or side effects of medications interfere with driving
Recertification: annual
138
Nonpsychotic major depression unaccompanied by suicidal behavior
Waiting period: 6 months
Certify: 1 year
Recertification: annual
139
Severe depressive episode/suicide attempt/manic episode
Waiting period: 1 year
Certify: 1 year (evaluation every 2 years by mental health professional)
Recertification: annual
140
Personality disorder
Certify: 1 year
Recertification: annual
141
Schizophrenia
Waiting period: 6 mos. (brief reactive psychosis or schizophreniform disorder); 1 yr. (any other psychotic disorder)
Certify: 1 year
Recertification: annual
142
Alcohol use
Certify: 2 years (If SAP finds that driver does not have alcoholism; attendance at 12 step groups is not disqualifying)
Recertification: annual
143
Alcoholism
Disqualify (can be reinstated following completion of SAP) - S/S: hand shaking, memory loss, anxiety, insomnia, mood swings, smell of alcohol
144
History of drug abuse
Certify: 2 years (SAP must provide clearance; free of active use)
Recertification: biennial
145
Schedule I drug use /amphetamines/narcotics/methadone/marijuana
Disqualify (methadone/marijuana - even if State allows legal use or use is prescribe by medical profession)
146
Seizure Exemption - Hx of Epilepsy
Seizure-free for 8 years, on or off medication (if on medications, 8 years since the date the medication was discontinued)
If taking anti-seizure medications - plan for medication should be stable for 2 years (no changes in medication, dosage, or frequency)
Certify: 1 year
Recertification: annual
147
Seizure Exemption - Single unprovoked seizure (no known trigger for the seizure)
Seizure-free for 4 years, on or off medication
If taking anti-seizure medications - plan for medication should be stable for 2 years (no changes in medication, dosage, or frequency)
Certify: 2 years
Recertification: annual
148
Seizure Exemption - Single provoked seizure (known trigger for the seizure)
Low risk for recurrence (cleared by neurologist)
Moderate to high risk factors for recurrence should be seizure-free for 8 years, on or off medication
Certify: 1 year
Recertification: annual
149
Acute seizure with acute structural CNS insult (stable)
Waiting period: 4 years
Certify: 1 year
Recertification: annual
150
Topics for Driver Education
Medication side effects, Rx warning labels, seeking care for conditions that do not affect driving safety
151
CDL Classes
A - any combination of vehicles with gross weight >= 26,001
B - single vehicle >= 26,001 or any vehicle towing another vehicle weighing up to 10,000 pounds
C - doesn't meet A or B and transports >= 16 passengers (including the driver) or hazardous materials
152
FMCSA requirements for CDL
(1) no use of Schedule I drugs
(2) visual acuity >= 20/40 in each eye, >= 20/40 distant visual acuity, field of vision >= 70 degrees in each eye, able to recognize colors of traffic signals (red, amber, green)
(3) force whispered test >= 5 feet in better ear OR does not have average hearing loss > 40 decibels at 500, 1,000, and 2,000 Hz
(4) no loss of foot, leg, hand, or arm OR has been granted a skill performance evaluation
(5) insulin-treated diabetes is stable and diabetes controlled
(6) no current diagnosis of epilepsy OR has epilepsy exemption
(7) no current diagnosis of alcoholism
153
4 absolutes
vision, hearing, insulin-treated diabetes, and epilepsy
154
Mental/physical work demands of CDL drivers
attention/concentration/memory, visual spatial function, behavior, impulse control, communication/calculations
155
Types of routes
(1) Turn around/short relay - driver returns home each evening
(2) Long relay - drives 9 to 11 hours, followed by >= 10 hours off-duty
(3) Straight through haul/cross country - driver may spend a month on the road, sleeps in truck, returns home for 4 to 5 days (team operation - drivers share driving: 5 hours on/off)
156
Hours of service limits
70 hours/week
Passenger-carrying: 10 hours
Property-carrying: 14 hours
157
Hearing measures
Pitch: Hz (500 to 2,000)
Loudness: decibels (dB)
158
Disqualifying visual conditions
Monocular vision (can apply for exemption but ophthalmologist must provide approval)
Contact lenses when 1 corrects for distant visual acuity and the other for near visual acuity
Use of telescopic lenses
Failure to meet vision test in 1 or both eyes
159
Field of vision
Normal (full binocular): 180 degrees
Normal (monocular): 160 degrees
Requirement: >= 70 degrees in both eyes
160
Retina
Back of eyeball, sensitive to light
Rods: work in dim light
Cones: work in brighter light
161
Diplopia
double vision - needs specialist assessment
162
Cardiovascular disease disqualifications
```
ECG: ischemic changes at rest
Echo: EF < 40%
Exercise tolerance test: cannot pass at >= 6 METs
Symptomatic disease
Resting angina
Poor medication tolerance
```
163
Exercise tolerance test (ETT)
>= 6 METs (through Bruce Stage II or equivalent)
Attain HR > 85% predicted maximum (adjust for use of beta blockers)
Rise in SBP >= 20 mmHg without angina
No significant ST segment depression
164
Idiopathic cardiomyopathy
Certify: 1 year (asymptomatic, LVEF > 40%, no ventricular arrhythmia)
Recertification: annual (with cardiology evaluation that includes Echo and Holter monitor)
165
Left ventricular ejection fraction (LVEF)
```
< 40% - disqualify
>= 40% and asymptomatic:
Waiting period: 1 month
Certify: 1 year
Recertification: annual (by cardiologist)
```
166
Aortic stenosis
Mild: certify if asymptomatic (Echo q 5 years)
Moderate: wait 3 months after surgery (Echo annually)
Severe: disqualify unless 3 months post-surgery
167
Severe aortic regurgitation
Do not certify if symptomatic, fails ETT, EF < 50%, or LVEDD >50/LVESD > 55 mm
EF >= 50%, LVEDD < 60/LVESD < 50 mm
Certify: 6 months (Echo q 6-12 months)
LVEDD = 60/LVESD = 50 mm
Certify: 4-6 months (Echo q 4 months)
168
Mitral regurgitation
Do not certify if symptomatic
Mild: certify 1 year
Moderate: certify 1 year if normal LV
Severe: certify 1 year if asymptomatic (Echo q 6-12 months)
169
MCSA-5870
Form that must be completed by treating clinician for insulin-dependent diabetes exemption (driver must provide electronic glucose records for at least 3 months)
170
severe non-proliferative diabetic retinopathy/proliferative diabetic retinopathy
permanent disqualification
171
Cervical range of motion
Flexion: 50 degrees
Extension: 60 degrees
L/R lateral extension: 45 degrees
L/R rotation: 80 degrees
172
lumbar spine range of motion
Flexion: 60 degrees
Extension: 25 degrees
L/R lateral extension: 25 degrees
173
Use of oxygen
Not permitted while driving
174
Mallampati Score
Used to assess risk of sleep apnea:
I - soft palate, uvula, fauces, and pillars visible
II - soft palate, part of uvula, and fauces visible
III - soft palate and base of uvula visible
IV - only hard palate visible
175
Spirometry
perform on all smokers > 35 years old, Hx of lung cancer, symptomatic (SOB, cough, chest tightness, wheezing)
176
Spirometry findings
Low Forced Expiratory Volume in 1 second (FEV1) = air expelled in 1 second => obstructive diseases (emphysema, asthma, COPD)
Low Forced Vital Capacity (FVC) = total air expelled => restrictive diseases (asbestosis, sarcoidosis, pulmonary fibrosis)
177
Pulmonary function findings
Pulse ox >= 92%
FEV1 > 65%
FVC > 60%
FEV1/FVC > 60%
178
Arterial Blood Gases (ABGs)
```
Order if pulse ox < 92%
Do not certify if:
PaO2 < 65 at altitude < 5,000 feet
PaO2 < 60 at altitude >= 5,000 feet
PaCO2 > 45 at any altitude
```
179
Obstructive sleep apnea (OSA)
Mild = 5-14 episodes/hour
Moderate = 15-29 episodes/hour
Severe >= 30 episodes/hour
Moderate-to-severe OSA = apnea-hypopnea index >= 15
Waiting period: 1 month after starting CPAP treatment/3 months after surgical repair
Certify: 1 year (annual sleep study required, need to provide evidence of >= 70% adherence to CPAP use for >= 4 hours/night)
Recertification: annual
180
Sleep apnea - definition
pause in breathing of >= 10 seconds
181
Hypopnea
>= 50% airflow reduction for >= 10 seconds
182
Abdominal Aortic Aneurysm (AAA)
do not certify if symptomatic, driver has recommendation for repair, 4-5 cm without clearance, OR > 0.5 cm increase over a 6-month period, regardless of original size
< 4.0 cm - certify 1 year with annual recertification (if asymptomatic)
4.0-5.0 cm - certify 1 year with annual recertification (if cleared by cardiologist)
> 5.0 cm - case-by-case (generally disqualify)
183
Reinstatement following DUI conviction
Evaluation by substance abuse professional (SAP)
Documentation of SAP program
Negative drug/alcohol tests
184
Traumatic brain injury (TBI)
Mild: does not penetrate dura and loss of consciousness (LOC) < 30 minutes - if seizure free and not taking anticonvulsants (certify 1 year with annual recertification)
Moderate: does not penetrate dura but LOC 30 min. to 24 hrs. - waiting period of 4 years
Severe: penetrates dura and LOC > 24 hrs. - permanent disability
185
Headaches
not disqualifying except chronic migraine OR unless accompanied by neurological deficits
headaches with atypical facial pain and vision loss could be a CNS tumor - refer to specialist to rule out
186
Mental health disorders
Refer for additional evaluation: bipolar disorder, major depressive disorder, obsessive compulsive disorder, antisocial personality disorder
187
Driver qualifications (federal standards)
```
>= 21 years of age
read and speak English
safely operate vehicle
physically qualified (ME decision)
current/valid CDL/CLP
has provided employer a list of violations
is not disqualified to drive
has passed road test
```
188
Waivers vs. exemptions
Only the FMCSA can grant waivers or exemptions - not the ME
Waivers - provide relief from regulations for up to 3 months
Exemptions - provide relief up to 2 years
189
Aortic valve repair
Waiting period: 3 months after surgery
Certify: 1 year (asymptomatic, LVEF > 50%, no blood clots, ECG q 5 years, 2D ECG with Doppler prior to hospital discharge)
Recertification: annual (by cardiologist)
190
Urinalysis - reference ranges
* Required component of exam - reference ranges:
- color: yellow (light to amber)
- clarity: clear
- pH: 4.5-8
- specific gravity: 1.005-1.025*
- glucose: <= 130*
- blood: <= 3 RBCs*
- protein: <= 150*
- bilirubin: negative
191
Blepharitis
Anterior: affects outer edge of eyelid
Posterior: affects inner edge (part that touches the eyeball)
192
Hearing loss
if identified by ME, should be referred to specialist before final determination
193
Levels of hearing loss
dBs: 0-25 normal hearing
dBs: 26-40 mild hearing loss (difficulty with distance speech)
dBs: 41-55 moderate hearing loss (difficulty with conversational speech)
dBs: 56-70 moderately severe hearing loss (difficulty with group conversations)
dBs: 71-90 severe hearing loss (difficulty with loud speech)
dBs: >= 91 profound hearing loss
194
Auditory brain stem response
place electrodes on each earlobe and scalp, headphones worn, clicking noises generated - tests each ear separately
195
Stress tests - intake restrictions
- Do not eat or drink anything with caffeine for 12 hours prior
- Do not eat or drink anything but water 4 hours prior
196
Phosphorus
Normal: 3-4.5 mg/dL
197
Chemistry screen
type of blood test
198
Types of blood thinners
(1) anticoagulants: work on chemical reactions in the body to increase the time it takes for blood clots to form
(2) antiplatelets: prevent blood cells from clumping together
199
Recommendations for shift work
Get >= 6 hours of consecutive sleep (try different sleep times)
Avoid permanent night shifts
Have planned time off
Avoid quick shift changes
Minimize number of consecutive overnight shifts
Take a nap beforehand (no more than 20-30 minutes)
200
Types of ejection fraction
Normal: 50-70%
EF < 40% is too low (41-49% is borderline) = HF
EF > 70% = hypertrophic cardiomyopathy
(1) preserved (diastolic HF due to increased ventricular filling pressure - ventricles contract normally but do not relax and muscle becomes stiff)
(2) reduced (systolic heart failure/cardiomyopathy - heart muscle does not contract effectively, decreasing the force of blood flow)
201
Medical certification required
- combined vehicle weight >= 10,001 pounds
- vehicle used to transport 9-15 passengers (including the driver) for compensation
- vehicle used to transport >= 16 passengers (whether for compensation or not)
- transporting hazardous materials in quantity requiring a placard
202
Code of Federal Regulations (49CFR391.41)
Title 49 = Transportation
Part 391 = Driver Qualifications
Section 41 = physical qualifications of driver
203
Part 391 sections
40 - alcohol/drug testing procedures
41 - physical qualifications of drivers
43 - responsibilities of ME
45 - who must have a CMV medical exam
47 - conflict resolution
49 - Skills Performance Evaluation program
62 - limited exemptions for intra-city zone drivers
64 - grandfathering: vision and DM waivers
204
Cataracts
opacification of lens
S/S: glare with night driving, decreased acuity/contrast/color resolution
Tx: surgery
205
Glaucoma
abnormal regulation of intraocular pressure (IOP)
Types:
(1) normal/low tension - optic nerve damage (refer to specialist)
(2) open-angle (most common) - slow clogging of drainage canals leads to increased IOP
*(3) angle-closure (most dangerous) - closing of angle leads to sudden increase in IOP
S/S: deficits in peripheral vision, seeing halos around lights, hazy looking eyes, nausea, tunnel vision, redness in eyes
Tx: eye drops - vision lost cannot be restored
206
Macular degeneration
damage to the macula
Types:
(1) dry (85-90% of cases) - deterioration of retina due to deposit of drusen under macula
*(2) wet (most dangerous) - abnormal blood vessels grow under retina and macula (bleed and leak fluid)
S/S: loss of central vision, scotoma (dark spots) in direction of attempted gaze
Tx: none - vision lost cannot be restored
207
Retinopathy
damage to the small blood vessels in the eye
Types:
(1) non-proliferative (blood vessels not growing)
*(2) proliferative (abnormal blood vessels growing in size)
S/S: partial scotoma, spots, hemorrhages, exudates (white spots due to fatty deposits), cotton wool spots (microstrokes), abnormal blood vessels, aneurysms
208
Pulmonary HTN
pulmonary artery pressure > 50% of systemic SBP
209
6 METs
workload requirements for heavy and very heavy work
210
Sudden death
individual goes from usual state of health to death within 1 hour
211
Pre-syncope
lightheadedness, dizziness
212
Respiratory assessment - when to send to specialist
send to pulmonologist if clubbing, cyanosis, tachypnea at rest, or friction rub
213
Heart murmur grades
```
I strain to hear
II faint without straining
III loud
IV loud with thrill
V heart with stethoscope on skin
VI heard with stethoscope off skin
```
214
Aortic regurgitation - left ventricular dimensions
Left ventricular end-diastolic dimension: <= 60 mm
| Left ventricular end-systolic dimension: <= 50 mm
215
3 peripheral nervous systems
(1) vestibular - balance
(2) visual - vision
(3) proprioception - positional awareness
216
Hernias
Check abdomen, viscera, and GU system - refer for specialist evaluation
217
Drug testing (urinalysis)
tests for: marijuana, cocaine, amphetamines, opiates, phencyclidine (PCP)
218
Becker's muscular dystrophy
onset as late as 25, causes heart problems, allows normal walk
219
Myotonic/Steinert's muscular dystrophy
most common - causes muscle weakness
220
Duchene's muscular dystrophy
disqualifying - more common in boys, onset in childhood
221
Limb-girdle muscular dystrophy
affects men and women, causes weakness in hips that moves to limbs, becomes difficult to walk after 20 years
222
Pericardial effusion
fluid in the sac around the heart
223
Venous thromboembolism
blood clots that form in a vein
224
Intracerebral hematoma
hematoma found in brain tissue
225
Reporting head injuries
any head injury that occured in the past 5 years - any severe TBI must be reported regardless of when it occurred
226
Clubbing edema
signs of vascular, lung, or heart disease
227
Middle ear infection
inflammation in middle ear - treat prior to certification (problems with inner ear require specialty consult, even if hearing test passed)
228
Nitrogylcerine
not a disqualifying indication
229
Abnormal Babinski reflex
splaying of toes - sign of brain or spinal chord disorder
230
Pulse ox
measures O2 concentration in the blood - tested using oximeter (photoelectric device)
231
Pure tone audiometry
uses pitch and loudness to test hearing - vibrating device is placed on the bone behind the ear and driver listens to tones through headphones (tests each ear separately)
232
Amaylase
Normal: 53-123 (can be elevated in pancreatitis and alcoholism)
233
Toxicology exams
Blood, urine, or saliva
can test for 30 drugs at once
can test for illicit drugs, prescription medications, vitamins, and alcohol
234
Multiple sclerosis - S/S
visual disturbances, muscle weakness, memory problems, numbness
235
S/S of CHF
```
SOB on exertion (or at rest)/wheezing
need to urinate at night
edema (ankles/abdomen)
JVD/prominent neck veins
bluish discoloration of face
abnormal heart sounds
weight gain/fatigue
```
236
Hx of TIA on anticoagulants
disqualify
237
Oculopharyngeal muscular dystrophy
affects individuals aged 40-60, affects eyes and throat, progresses slowly
238
Conjuntivitis
inflammation, gritty feeling in eyes, swollen eyelids, excessive tearing
239
Health Hx
ME must discuss any "Yes" answers and document the discussion (Hx, Dx, Tx, and response to Tx; etiology; tests/consultations ordered)
failure to fill out fully and honestly can invalidate the exam - must include any condition under treatment for or any illness, condition, or injury sustained in the last 5 years
240
Components of ABGs
pH: normal (7.35-7.45) - measure of acid content (H+ ions) in the blood
PaCO2: normal (35-45) - measure of CO2 level in the blood
HCO3- (bicarbonate): normal (22-26) - chemical buffer that keeps the pH from becoming too acidic/basic
PaO2: normal (> 60%) - amount of dissolved O2 in the blood (indicates how well O2 can move from airspace to the blood)
SaO2: normal (95-100%) - number of hemoglobin binding sites that have O2 attached
241
Digoxin
used for treatment of irregular HR - ideal range: 1.5-2.5 ng/dL
S/S of digoxin toxicity: confusion, dizziness, nausea, yellow tinted vision, blurred vision
242
Side effects of antipsychotic medications
weight gain, increased risk of diabetes, restlessness, tardive dyskinesia, muscle spasms, tremors
243
Exemption from medical certification exam
- driver is subject to Part 391 but company is private, non-business motor carrier of 9-15 passenger van
- school bus drivers (driving between school and home)
- transporting personal property
- transporting corpses/sick/injured people
- transporting to races/tournaments/shows, if not done for profit
- fire trucks/rescue vehicles involved in emergency operations
- transporting propane/winter heating fuel or responding to pipeline emergency
- responding to emergency in declared disaster
- driving off-road motorized construction vehicles
244
Driver fails exam but still holds unexpired medical card
card is no longer valid
245
Pending status exam
must be completed within 45 days or the exam must be redone - not an option for intrastate operations
if certification decision is made before the 45-day waiting period, expiration date of new certificate is based on the certification decision, not the date of the exam
246
Driver privacy
Carriers cannot:
- store any medical records in personnel file
- disclose any medical information to co-workers
247
Use of anti-hypertensives
driver is still considered to have HTN, even in BP controlled
248
Cardiomyopathy
heart chambers enlarge so that heart cannot beat with as much force
249
Disqualifying cardiovascular conditions
- ICD (including pacemaker/ICD)
- thoracic aneurysm > 3.5 cm
- AAA > 5 cm
- untreated aneurysms
- untreated DVT
- pain at rest from vascular disease or intermittent claudication
- unstable angina
- hypertrophic/restrictive cardiomyopathy
- heart conditions that cause fainting
250
Superficial phlebitis
inflammation of vein wall - can be certified for 2 years if no coexisting DVT
251
Supraventricular arrhythmias
irregular heart rate originating above the ventricles
(1) supraventricular tachycardia - cured through catheter ablation
(2) A-fib - wait 1 month after adequate anticoagulant treatment
252
Echocardiography (Echo)
creates an image of the heart using ultrasound - superior to ETT
253
Unstable angina
unpredictable pattern, pain at rest, change in pattern, decreased response to medications - do not certify
254
Tuberculosis - certification by type of test
+ intermediate TB skin test = previous infection (can certify)
+ purified protein derivative (PPD) skin test and normal CXR (can certify)
+ PPD with abnormal CXR (requires further evaluation)
255
Disqualifying diabetes complications
- hypoglycemic reaction in the last 12 months
- >=2 hypoglycemic reactions in the last 5 years
- loss of positional sensation
- loss of sensation in feet
- resting tachycardia
- orthostatic hypotension
- Dx of peripheral neuropathy or proliferative retinopathy
256
Keratoconus
eye disease that affects the structure of the cornea - tissue on the front of the eye (cornea) thins and bulges outward into a cone shape
S/S: increased light sensitivity, eye strain, halos around lights, excessive eye rubbing, headaches
257
Keratitis
inflammation of the cornea
| S/S: difficulty opening eyelid, redness, eye pain, blurred or reduced vision, photophobia, tearing
258
Hyperopia
farsightedness - can see distant objects clearly but near objects are blurry
259
Facioscapulohumeral muscular dystrophy
affects men and women; progresses slowly; affects face, upper arm, shoulder; causes difficulty swallowing and walking
260
Amblyopia
lazy eye - decreased vision in one eye (lazy eye wanders inward or outward)
S/S: favoring one eye, bumping into objects on one side
not automatically disqualifying
261
Distal muscular dystrophy
affects forearms, hands, lower legs, and feet; affects muscles farthest from the center of the affected area; progresses slowly
262
Dermatological and GI conditions
if they do not affect driving, driver does not necessarily have to report but must report drugs used to treat
Certify for 1 year
263
Distended neck veins
indicative of a vascular or heart disorder - refer to specialist
264
Carpal tunnel syndrome
type of peripheral neuropathy - disqualify
265
Contact lenses
Certify if well tolerated - disqualify if excessive tearing
266
Speech and word recognition test
hearing test of ability to hear and understand normal conversation - driver asked to repeat simple words spoken at different degrees of loudness
267
Cholesterol
Total: < 200 (borderline: 201-240; high > 240)
LDL: < 160 (optimal < 100)
HDL: 45-70 (men); 50-90 (women)
Triglycerides: < 150 (borderline 150-199; high > 200)
268
Severe side effects of antiplateletes
blood in urine, chest pain, SOB, difficulty swallowing, severe stomach pain
269
Side effects of anti-anxiety medications
drowsiness, sleep disturbance, blurred vision, nightmares
270
Tarps
- use all eyelets to tie down
- blue with UVV protection and 12 mm thickness (can last > 10 years)
- 6 mm thick (can last 3-5 years)
- water collected on tarp can strain eyelets and lead to tears
271
5th wheel
must be tilted up prior to coupling
272
Steps to Certification for Insulin-dependent DM
1. follow treatment plan developed with clinician (keep at least 3 months of electronic glucose readings)
2. schedule appointment with treating clinician and bring glucose records
3. treating clinician completes and signs MCSA-5870
4. have medical exam within 45 days of the MCSA-5870 being completed
5. repeat steps 1-4 annually
273
Medical Certification under ITDM program
do NOT mark "Accompanied by a ____ waiver/exemption" under Section 391.46 (section does not involve a waiver or exemption program)
274
Three categories of risk associated with psychological disorders
mental disorder itself, lingering symptoms, medications
275
Bipolar disorder/major depression
Waiting period: 6 months (non-psychotic major depression that is not accompanied by suicidal behavior); 1 year (severe depressive episode, suicide attempt, manic episode)
Certify: 1 year (report any manic or severe depressive episode within 30 days)
Recertification: annual (clearance by mental health professional every 2 years)
276
Personality disorders
Waiting period: as necessary until the cause is confirmed and treatment is adequate
Certify: 1 year
Recertification: annual
277
Schizophrenia
Disqualify for chronic schizophrenia
Waiting period: at least 6 months symptom free (if brief reactive psychosis or schizophreniform disorder); 1 year (any other psychotic disorder)
Certify: 1 year
Recertification: annual (evaluation every 2 years by mental health specialist)
278
Drug abuse
drivers may never use Schedule I drugs, amphetamines, narcotics, methadone, or marijuana - even if prescribed by treating clinicians
279
MCSA-5895
391.41 CMV Driver Medication Form - can be requested by ME from the treating clinician in cases of suspected substance misuse
280
Suspected alcohol use
contact driver's employer for information on reasonable suspicion drug and alcohol testing - examiner cannot order a test but can perform a non-DOT test using a non-DOT form - driver is not required to obtain a new physical exam after completing SAP program
281
Drug abuse
Waiting period: driver must be evaluated by SAP, comply with recommended rehabilitation program, and have a negative result on a return to duty drug test
Certify: 2 years (use of 12 step programs is insufficient as SAP program, but is not disqualifying)
Recertification: biennial
282
Scheduled drugs
I - have no currently accepted medical use, cannot be legally prescribed, have high abuse potential, not considered safe (heroin and marijuana)
II - have accepted medical uses but high abuse potential (methadone)
III-V decreasing risk for abuse (III includes tranquilizers, IV includes chlorhydrol and phenobarbital, V includes narcotic compounds)
283
Resolving conflicts (2 MEs disagree on driver qualifications)
driver must see an impartial medical specialist in the field in which the conflict arose
driver or employer submits a written application to the FMCSA (driver remains disqualified until the FMCSA makes a decision)
284
Medical certification requirements
ME is responsible for making medical determinations on fitness for duty
Employer is responsible for informing ME of minimum physical requirements and characteristics of work being performed
285
Drug urine testing
60 ml of urine required to perform testing - any remaining urine can be used to test for glucose or protein levels
286
Medical exam requirements after an illness
a new test is not required unless the illness impaired the driver's ability to perform normal duties
287
Geographic setting of medical exams
ME can be located in a different state than the one in which the driver is licensed or lives
288
Inaccurate Health Hx section
deliberate omission of falsification may invalidate exam - civic penalty may be issued against the driver for making a false statement of - or concealing - a disqualifying medical condition
289
Driver performing a road test
requires a valid medical card and driver's license or permit
290
Short-term medical card
requires a new medical exam prior to expiration (card expires on stated date - 30 days, 6 months, etc.)
291
Determination Pending status
Driver is still eligible to drive but requires a determining within 45 days or else the certification expires (only if the driver currently holds a valid medical certificate)
292
Disqualifying exam with valid medical certification
new exam invalidates prior exam (old card is invalid if driver fails a medical exam, even if prior card had not expired)
293
Provigil (Modafinil)
Used to treat excessive sleepiness (narcolepsy, OSA, shift work disorders)
Waiting period: 6 weeks
Certify: 1 year (disqualifying if being used to treat narcolepsy)
Recertification: annual
