DOT Flashcards
(156 cards)
1
Q
DOT regulates what types of vehicles/passengers?
A
Gross vehicles weight >10,0001 lbs
Transport 8 passengers for profit
Transport 15 passengers
Carries HAZMAT
2
Q
Which dept. operates within the DOT and oversees the medical cert of drivers?
A
FMCSA
3
Q
Hearing test(s) absolutely required
A
Whisper and audiogram
4
Q
Vision test(s) absolutely required
A
Distant, peripheral, color
5
Q
Urinalysis components
A
Specific gravity, protein, blood, glucose
6
Q
If the driver requires an exemption when do they see the ME?
A
The driver must see ME first. If eligible to drive except for exemption, driver certified at least 6 months
7
Q
Components of a satisfactory ETT (exercise tolerance test)
A
Capacity of 6 METS
Resting HR>85% predicted
Rise systolic BP >20mm Hg w/o angina
No significant ST depression or elevation
Driver should not experience orthostatic symptoms upon standing
8
Q
Myocardial infarction (MI) waiting period
A
2 months post MI. Must have satisfactory ETT prior to recert
9
Q
Angina pectoris reasons to DQ
A
Resting/unstable angina
Abnormal ETT
Ischemic changes on ECG
Medication intolerance
10
Q
Percutaneous coronary intervention (PCI, stents, balloons) waiting period
A
1 week
11
Q
Reasons to disqualify individuals with PCI (percutaneous coronary intervention)
A
Incomplete healing at access site
Resting angina
Ischemic changes on ECG
12
Q
Monitoring after PCI
A
Wait 1 week
ETT 3-6 months post PCI
Then every 2 years
Certify for 1 year
13
Q
Waiting period for CABG
A
3 months
Certify- 1 year
14
Q
Post CABG requirements for certification
A
Complete 3 month period
LVEF >= 40%
Asymptomatic
Card clearance
15
Q
Post CABG monitoring
A
ETT every 2 years for 5 years the annual
16
Q
Stage 1 HTN
A
140-159/90-99
17
Q
If driver has no history of hypertension and has blood pressure 140-156/90-99
A
No hx of HTN and no on trx certify for 1 year card
18
Q
If driver’s BP is 140-159/90-99 with hx of HTN, on trx, or continues with stage 1 HTN after 1 year certificate how long do you certify?
A
One time 3 month certification
19
Q
If patient returns after 3 month certification for stage 1 with BP > 140/90 how long to qualify?
A
Disqualify- must show BP control
20
Q
Stage 2 HTN
A
160-179/100-109
21
Q
Stage 2 HTN certification no hx of HTN or trx
A
3 months one time. At recheck must have BP <140/90 or disqualification until provides evidence of control
22
Q
Stage 3 HTN
A
> =180/110
23
Q
If driver presents with BP >180/110 how long to certify?
A
Disqualification until evidence of control < 190/90 the certify for 6 month. ME decides at recheck on case by case if longer recert is appropriate
24
Q
General valvular hearts disease criteria
A
ECHO to determine severity
Symptoms
Pulmonary HTN (pressure >=50% systemic systolic BP)
ETT > 6 METS
Frequency and symptoms associated with arrhythmia
25
Hypertrophic cardiomyopathy
Disqualify, ECHO required for diagnosis
26
Restrictive cardiomyopathy
Disqualify
27
Cert requirements for Idiopathic dilated cardiomyopathy and CHF
Asymptomatic, no ventricular arrhythmia, LVEF 40% to 50%
Cert for 1 year- must have cardiology clearance, echocardiography and holster monitoring
28
CHF DQ
Symptomatic or
Ventricular arrhythmia with LVEF <50% or
LVEF <40%
29
AFib waiting period
1 month
30
AFib cert requirements
Tolerating meds with no SEs
Card clearance
RR controlled
No underlying disease
31
AFib monitoring
None unless on anticoagulant then required monthly INRs
32
Ventricular arrhythmia should be evaluated for what?
Underlying disease
33
Qualifying requirements for drivers with ventricular arrhythmias or coronary heart disease
Non sustained Vtach with LVEF>=40%
No symptoms
Card clearance
One month wait after successful drug therapy
34
Implantable cardiac defibrillator certification
Disqualify
35
Pacemaker monitoring
Documenting of pacemaker checks
DQ if no documentation of function
36
Neurocardiogenic syncope certification requirements
3 months after pacemaker implantation
Documented correct function by pacemaker center
Asymptomatic
Do not qualify if symptomatic
37
Congenital heart disease requirement
Annual should have evaluation by cardiologist knowledgeable in adult congenital heart disease
38
Congenital heart disease-post surgical waiting period
Should have testing to evaluate cardiac fxn and note rhythm disturbances
39
Pulmonary HTN certification
DQ
40
Definition of pulmonary HTN
Pulmonary artery mean -
25mm Hg at rest
30mm HG with exercise
41
AAA 4.0-5.0cm certification standards
recommend yearly US
Not certified if surgical repair recommended.
42
AAA <4.0 cm certification standards
1 year certification if asymptomatic
43
What size thoracic aneurysm is disqualifying?
>3.5cm
Can certify if at least 3 months after surgical repair and cleared by cardiovascular specialist.
44
Peripheral vascular disease (lower extremity pain) certification
DQ
45
Waiting period after peripheral vascular surgery
3 months
No claudication
Annual certification
46
DVT certification standards
No waiting period
If anticoagulant therapy needs to meet monitoring guidelines
1 year certification
47
Intracerebral hemorrhage and subarachnoid hemorrhage requirements
If ruptured aneurysm or AVM not surgically repaired- medically disqualified
48
waiting period cerebellar or brain stem strokes
1 year
49
Stroke disqualifiers
Incomplete waiting period
Residual impairment interferes with driving
Anticoagulants
Seizure medications
Hx of Seizures
50
Motor neuron disease certification requirements
Permanent DQ
51
Malignant tumors of the CNS
Permanent DQ
52
Huntington's disease
Permanent DQ
53
Which neurological conditions are likely to be disqualifying but possible certification depending on disease state and course?
MS
Peripheral neuropathies
Myopathies
Neuromuscular junction deficits
Benign brain tumors
Dyskinesias
Treatable dementias
Cerebellar ataxias
54
Symptom free waiting period for benign positional vertigo
2 months symptoms free
55
Benign positional vertigo
DQ
56
Meniere's disease
DQ- very unpredictable
57
Acute and chronic peripheral vestibulopathy
Driver may be certified if symptom free for 2 months
58
Surgical repaired intracerebral hemorrhage and subarachnoid hemorrhage waiting period
1 year after event
Cleared by neurology
No recurrent symptoms
No CNS meds
59
Waiting period cerebellar or brain stem strokes
1 year
60
waiting period cortical/subcortical stroke
5 years
61
Dementia certification
Permanent DQ
62
Wilson's disease
Permanent DQ
63
Labyrinthine Fistula
DQ
64
Epilepsy
Permanently DQ
65
Hx of epilepsy, seizure free and off meds for 10 years under doctor's supervision
can be medically certified
66
Single unprovoked seizure
Can be certified if seizure free and off anticonvulsant meds for at least 5 years
67
Symptomatic seizure in presence of acute structural insult to CNS
Certify if seizure free for 2 years and off anti-seizure medication
68
Driver is actively psychotic
DQ
69
Amitriptyline use
DQ- drug is sedating- antidepressant and nerve pain SRI
70
Methadone use
DQ- narcotic
71
Opioids
Usually disqualifying
Exception:
Prescribed by PCP familiar with driver's medical hx and has advised drug will not adversely affect machine operation
72
Alcohol consumption waiting period before driving
4 hours
73
Schedule 1 drug use- Cocaine, marijuana, meth etc
DQ
74
Marijuana
DQ even if legal in states
75
Alcoholism waiting period
None
Certify if:
Normal exam
Clearance from HCP
Completed treatment program
76
Fixed minimal defects that don't interfere with ability to operate vehicle documentation
Document exact physical findings
Lack of interference with vehicle operation
Refer to SPE
Check box on long form and card
Certify for 2 years
77
Fixed deficit examples
Missing arm, leg, foot, hand, thumb and index fingers on the same hand.
Marked limitation ROM major joints, neck or spine
78
Suspicion of substance abuse
DQ and refer to appropriate psychologist, psychiatrist or SAP
Do not preform drug or alcohol test
79
Drivers are responsible for what types of duties?
Pre and post trip safety checks
Making sure the vehicle is properly loaded
Securing the load
Driving
80
Non fixed deficit
If they are not able to meet standards then DQ. No eligible for SPE
81
Stage 1 and 2 CKD
Certify for 2 years
82
Stage 3 CKD
Certify annually
83
Stage 4 CKD
With normal BP and EKG - Certify for 6 months
Elevated BP, Stage 1 or 2- Certify for 3 months
Stage 3 HTN- DQ
84
Hemodialysis and peroneal dialysis
DQ
85
General appearance check
Marked overweight
Tremor
Signs of alcoholism or drug use
86
Eyes check
PERRLA
Motility
Ocular muscle imbalance
EOM
Nystagmus
Exopthalmos
87
Eyes- ask patient about
Retinopathy
Cataracts
Aphakia
Glaucoma
Macular degeneration
88
Ears check
Scarring TM
Occlusion of external canal
Perforated eardrum
89
Mouth and throat check
Irremediable deformities likely to interfere with breathing or swallowing
90
Heart check
Murmurs
Extra sounds
Enlarged heart
Pacemaker
ICD
91
Lungs and chest check
Abnormal wall expansion
Abnormal respiratory rate
Abnormal breath sounds
Dyspnea
Cyanosis
Abnormal findings may require further testing
92
Abdome and viscera
Enlarged liver
Enlarged spleen
Masses
Bruits
Hernia
Significant abdominal muscle weakness
93
Vascular check
Abnormal pulses
carotid or arterial bruits
varicose veins
94
Gentiourinary check
Hernias
95
Pulmonary embolism waiting period
3 months after embolus
96
PE documentation
Symptoms
Oxygen use
Medications
If on anticoagulants - INR and frequency
97
DQ post PE
Hypoxemia at rest
Symptomatic
Insufficiently anti-coagulated
Severe abnormal lung function
98
Visual acuity
Must have at least 20/40 in both eyes
99
What id the driver can't tell the difference between red, green, yellow?
DQ no exemptions
100
Monocular vision
Obtain monocular vision exemption
101
Telescopic lenses
DQ- not allowed
102
Monocular vision
DQ
103
Requirements for FMCSA vision exemption
Driving with visual deficit for at least 3 years
Excellent safe driving record
CMV driving as the primary vocation
Yearly full examination by ophthalmology/optometrist who attest vision in better eye meets the standard
Must have annual exam. Vision exemption good for 2 years
104
Acceptable levels of glucose control
FBG: <200
2 hour postprandial <235
hgba1c <10%
105
Insulin use
Requires exemption
106
Hypoglycemic episodes DQ
Seizures
LOC
Assistance from another person
Impaired cognitive deficit without warning
2 or more hypoglycemic episodes in the last 5 years
107
Loss of pedal or positional sensation
DQ
108
DM and resting tachycardia
DQ
109
DM and orthostatic HTN
DQ
110
What level of FEV1 requires additional testing?
FEV1 <65% normal
111
What are the next steps after an abnormal FEV1?
Pulse Ox (must be >92%)
ABG
Arterial PO2 <65 below 5,000 ft or 60mm above 500 feet
OR
PCO2 45 mm HG = DQ
112
Temporary disqualification advised in patient with asthma who:
Status asthmaticus
Severe coughing spells
FEV1 <65%
pO2 <65mmHg
Frequent hospitalizations
113
Cor Pulmonale
DQ until lung disease is resolved/successfully treated
114
Pulmonary HTN
DQ
115
What is the next step if driver has experienced excessive sleepiness driving
DQ and require sleep study/review compliance
116
What is the next step if driver has experienced crash associated with falling asleep?
DQ and require sleep study/review compliance
117
What is the next step if driver has had ENT surgery and the findings of a post op sleep eval are pending
DQ or review compliance
118
What BMI does the expert panel recommend for sleep study?
33
119
What neck circumference is a referral for obstructive sleep apnea?
Males:17
Females: 15
120
Minimally acceptable use of CPAP for certification?
4 hours per night, 70% nights
121
ENT surgical post op waiting period (OSA)
1 month
Individuals should have no excessive daytime sleepiness and should have a post op sleep study with an AHI <= 10 at 30 days or more after procedure
122
After ENT surgical procedure for OSA what is needed for recertification?
Yearly sleep study with AHI <= 10 or negative maintenance of wakefulness test
123
Bariatric surgery for OSA waiting period
Certification without use of CPAP = 6 month
May still be certified if they are complaint with CPAP
124
Oral appliances for OSA
DQ
125
TIA waiting period
1 year
126
TIA requirements for certification
Completion waiting period
Clearance from neurology
No seizures during waiting period
DQ if using anticoagulant or anti seizure meds
Same for thrombotic and embolic infarction
127
Myocardial infarction waiting period
2 months
128
Requirements for initial post MI certification
Asymptomatic
Card clearance
ETT 85% predicted HR OR Echo LVEF >= 40%
No ischemia on ECG
129
Post MI recertification requirements
Asymptomatic
Card clearance
ETT every other year
130
Pneumothorax waiting period
None- must have documented XR showing recovery
131
documentation needed for pneumothorax
Onset and number of pneumos
Which side
Spontaneous or traumatic
Symptoms at rest or with exertion
Lack of oxygen use
Meds
providers name and location
132
How long to certify a driver with hx of pneumothorax who is stable and asymptomatic?
Up to 2 years
133
If a driver has a history of pneumothorax and has hypoxemia at rest
DQ
134
If a driver has a hx of pneumothorax and has cough syncope
DQ
135
If a driver has a history of a pneumothorax and uses oxygen
DQ
136
If a driver has a hx of a pneumothorax and has abnormal lung function
DQ
137
What happens if a driver has had 2 or more pneumothoraces on the same side without pleurodesis?
DQ until procedure is done and driver has recovered
138
Waiting period non psychotic major depression without suicide attempt
6 months
139
Waiting period severe depression, manic episode, suicide attempt
1 year
140
Waiting period brief reactive psychosis
6 months
141
Waiting period brief reactive psychosis
6 months
142
Waiting period following ECT
6 months symptom free
143
waiting period anxiety disorder
One year with caution depending on medications
144
Waiting period for schizophrenia
DQ
145
Waiting period for bipolar disorder
1 year
146
Abnormal PFT
FEV1 <65%
FEV1/FVC <65%
FVC <60%
147
Abnormal ABG
PaO2 <65mm HG
PCO2 45mmHg
148
Aortic Regurgitation monitoring
Echo every 2-3 years. Certify for 1 year
149
Aortic regurgitation guidelines
Certify if:
Mild or moderate with normal LV function
No LV dilation
Asymptomatic
150
Aortic Stenosis Monitoring
Echo every 5 years if mild
Echo every 1-2 years if moderate
Do not certify if- Angina, HF, Syncope, AFib EF<50%, Thromboembolism
151
Severe aortic stenosis
DQ
152
Mitral regurgitation monitoring
Mild- none
Moderate- Annual echo
Severe- Echo every 6-12 months
Do not certify if
Symptomatic
can't achieve >6METs
AFib
LV disfunction
Thromboembolism
Ruptured chorade
Flail leaflet
Pulmonary HTN
153
Mitral regurgitation monitoring
Mild- none
Moderate- Annual echo
Severe- Echo every 6-12 months
Do not certify if
Symptomatic
can't achieve >6METs
AFib
LV disfunction
Thromboembolism
Ruptured chorade
Flail leaflet
Pulmonary HTN
154
Mitral stenosis monitoring
Mild- none
Moderate- Annual Echo
Must be asymptomatic
155
Severe mitral stenosis
DQ
156
Waiting period for repair valvular disease
3 months
Must get card clearance
