NRCME Exam Questions Flashcards
(554 cards)
1
Q
Which point of contact is NOT required when entering and exiting the cab? A. Elbows B. Hands C. Arms D. Legs
A
CORRECT ANSWER: A»Explanation: Hands, arms, and legs are required points of contacts to enter or exit a cab
2
Q
A driver needs a minimum grip strength of \_\_\_ pounds (\_\_\_ kilograms) to be certified when a dynamometer is used. A. 58 pounds (26.3 kilograms) B. 80 pounds (36.3 kilograms) C. 42 pounds (19.1 kilograms) D. 36 pounds (16.4 kilograms)
A
CORRECT ANSWER: A»Explanation: A minimum grip strength of 58 pounds (26.3 kilograms) of force is recommended for both men and women if a dynamometer is used.
3
Q
A driver comes in with a diagnosis of peripheral neuropathy. You should:
A. Certify for 6 months
B. Not certify the driver
C. Send the driver for evaluation by a neurologist and certify based on the neurologist’s recommendation
D. Certify for 3 months
A
CORRECT ANSWER: B»Explanation: A driver with peripheral neuropathy should not be certified, but may file for an appeal, which includes evaluation by a neurologist or physiatrist. However, if the driver chooses not to appeal he does not require a neurologist or physiatrist. You should disqualify the patient
4
Q
A driver presents with autonomic neuropathy. Which of the following is NOT affected by this disorder? A. Control of lower extremities B. Blood pressure C. Bowel and bladder function D. Digestion
A
CORRECT ANSWER: A»Explanation: Autonomic neuropathy affects the autonomic system, which regulates vital functions such as blood pressure, heart rate, bowel and bladder control, and digestion. Control of the lower extremities would be affected by the peripheral neuropathies.
5
Q
A driver presents with autonomic neuropathy with resting tachycardia. You should:
A. Certify the driver for 6 months
B. Certify the driver for any length of time you feel is safe
C. Not certify the driver
D. Certify the driver for 1 year
A
CORRECT ANSWER: C»Explanation: A driver with autonomic neuropathy can be certified for up to 2 years once etiology is confirmed and treatment has been shown to be safe and effective. A driver with autonomic neuropathy cannot be certified when the neuropathy is accompanied by resting tachycardia, orthostatic drop in blood pressure, or other organ autonomic neuropathy that interferes with driving ability.
6
Q
A driver is prescribed nitroglycerin. In what situation can the driver be certified?
A. The driver may be certified if the nitroglycerin has not been used in the past month
B. A driver on nitroglycerin can be certified regardless of the type of angina being experienced
C. The driver may be certified if the angina is stable
D. Nitroglycerin is always disqualifying
A
CORRECT ANSWER: C»Explanation: Nitroglycerine use is not disqualifying. The medical examiner may require an evaluation by the treating cardiologist to make sure that the driver’s angina is stable.
7
Q
A driver presents with severe and unpredictable bouts of dizziness (vertigo). As the medical examiner, you suspectMénière'sdisease. You should: A. Certify the driver for 2 years B. Certify the driver for 1 year C. Not certify the driver D. Certify the driver
A
CORRECT ANSWER: C»Explanation:Ménière’sdisease, a condition associated with severe and unpredictable bouts of dizziness (vertigo), is disqualifying. This recommendation can be found in the Conference on Neurological Disorders and Commercial Drivers.
8
Q
Which of the following conditions is NOT automatically disqualifying for certification? A. Autonomic neuropathy B. Myotonia C. Isaac's syndrome D. Stiff person syndrome
A
CORRECT ANSWER: A»Explanation: Autonomic neuropathy is only disqualifying under certain conditions. Myotonia, Isaac’s syndrome, and stiff person syndrome are always disqualifying.
9
Q
Which of the following is NOT a risk category addressed by the panel for the Conference on Psychiatric Disorders and Commercial Drivers? A. Psychopharmacology B. Counseling C. Mental disorders D. Residual symptoms
A
CORRECT ANSWER: B»Explanation: The 3 categories addressed by the panel for the Conference on Psychiatric Disorders and Commercial Drivers are mental disorders, residual symptoms, and psychopharmacology. They did not address treatment by counseling.
10
Q
What blood alcohol level is used as a guideline when assessing the effect of psychotropic medications? A. 0.06 B. 0.08 C. 0.05 D. 0.04
A
CORRECT ANSWER: D»Explanation: When assessing the effects of psychotropic medications, the guidelines suggest comparing the effects to behavior and effects of having a blood alcohol level of 0.04.
11
Q
Which mental disorder has the highest risk to public safety and is most likely to be disqualifying? A. Major depression B. Anxiety C. Personality disorder D. Schizophrenia
A
CORRECT ANSWER: D»Explanation: The more serious the diagnosis, the more likely there will be risk to public safety. Schizophrenia is the most serious mental disorder and, therefore, is more likely to be disqualifying.
12
Q
Cyclothymia is a mild form of: A. Schizophrenia B. Depression C. Anxiety D. Bipolar mood disorder
A
CORRECT ANSWER: D»Explanation: Cyclothymia is a mild form of bipolar mood disorder and is rarely disqualifying.
13
Q
Which of the following is NOT true of major depression?
A. Major depression may relapse within 5 years
B. The highest risk of suicide is in the first few years after onset
C. There is no relation between major depression and stressful events
D. Most cases of major depression will recover
A
CORRECT ANSWER: C»Explanation: Stressful events commonly occur in the 6 months previous to depression.
14
Q
Which one is NOT a question associated with the CAGE assessment.
A. Have you ever felt bad or guilty about your drinking?
B. Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (eye-opener)?
C. Have people annoyed you by drinking in your presence?
D. Have you ever felt like you should cut down on your drinking?
A
CORRECT ANSWER: C»Explanation: The correct question for A-annoyance is, ““Have people annoyed you by criticizing your drinking?”“
15
Q
A driver shows up for the medical exam disheveled with bloodshot eyes and alcohol on his breath. You should:
A. Directly contact FMCSA or the driver’s employer for information on controlled substances and alcohol testing under Part 382 of the Federal Motor Carrier Safety Regulations
B. Tell the driver to come back tomorrow when he is sober
C. Certify the driver if all other conditions are met since a blood alcohol test is not part of the certification
D. Do a blood alcohol test
A
CORRECT ANSWER: A»Explanation: A blood alcohol test is not part of the certification process, although one could be done in conjunction with the test if the driver is required by another regulation or the employer to have one. So you wouldn’t do one at this time unless specifically directed to do so. You should not certify a driver you suspect of being an alcoholic even if he meets other conditions. The guidelines suggest contacting the FMCSA or the employer.
16
Q
A driver voluntarily attending a 12-step program for maintenance of recovery is:
A. Eligible for certification 1 month after completing the program
B. Not disqualified
C. Automatically disqualified
D. Eligible for certification 3 months after completing the program
A
CORRECT ANSWER: B»Explanation: Ongoing voluntary attendance at self-help groups (eg, 12-step programs) for maintenance of recovery is not disqualifying.
17
Q
Drug testing:
A. Must be done at the beginning of the exam
B. Must be done at the end of the exam
C. Can be done anytime during the exam
D. Is not a required part of the certification exam
A
CORRECT ANSWER: D»Explanation: Drug testing is not part of the certification process, although, one could be done in conjunction with the test if the driver is required by another regulation or the employer to have one.
18
Q
What is typically the first sign in the development of diabetic nephropathy? A. Persistent proteinuria B. Hematuria C. Glucosuria D. Increased specific gravity
A
CORRECT ANSWER: A»Explanation: The first sign of nephropathy commonly is the development of persistent proteinuria. End-stage renal disease follows some time later.
19
Q
What is the maximum certification time frame for a driver with diabetic nephropathy?
A. Two years as long as hematuria is not present
B. Two years when etiology is confirmed and treatment has been shown to be adequate/effective, safe, and stable
C. One year when etiology is confirmed and treatment has been shown to be adequate/effective, safe, and stable
D. Six months when etiology is confirmed and treatment has been shown to be adequate/effective, safe, and stable
A
CORRECT ANSWER: B»Explanation: The guidelines state that a driver with diabetic nephropathy can be certified for up to 2 years when etiology is confirmed, and treatment has been shown to be adequate/effective, safe, and stable. The presence of hematuria is not considered in the diabetic nephropathy guidelines.
20
Q
How often should a driver with a hernia have follow-up? A. Biennially B. Biannually C. Annually D. Every 5 years
A
CORRECT ANSWER: A»Explanation: The driver must have at least biennial medical examinations.
21
Q
Which location is not specifically identified in the guidelines as a place to check for hernias? A. Viscera B. Genitourinary C. Lumbar region D. Abdomen
A
CORRECT ANSWER: C»Explanation: The guidelines specifically state to assess for hernias in ““hernia for both the abdomen and viscera body system and the genitourinary system.”” Lumbar hernias are not specifically mentioned.
22
Q
A driver with a hernia that causes pain: A. Should receive a 1-year certification B. Needs further evaluation C. Is automatically disqualified D. Will see no effect on driving ability
A
CORRECT ANSWER: B»Explanation: A driver with a hernia that causes pain needs further evaluation to determine the effect on driving ability and certification status. If, after further evaluation, it is determined that there is no or minimal effect on driving ability, the driver may be certified for up to 2 years.
23
Q
What should you do in the case of an abnormal urinalysis?
A. Refer the driver for evaluation and treatment when indicated
B. Certify the driver; getting a urinalysis is a mere formality
C. Treat the driver
D. Have the driver come back the next day to repeat the test
A
CORRECT ANSWER: A»Explanation: You should advise the driver of any abnormal findings, and when indicated, encourage the driver to seek primary care provider evaluation, particularly if an abnormal urinalysis could indicate the presence of a medical condition that if left untreated could result in a serious illness that might affect driving. When acting as a medical examiner, you should not prescribe treatment.
24
Q
What do the guidelines say about the use of medical marijuana?
A. The use of medical marijuana is disqualifying
B. A driver using medical marijuana can be certified after 3 months of monitoring to assess the effects
C. A driver using medical marijuana can be certified for up to 2 years if the marijuana was prescribed by a clinician familiar with the driver’s medical history and assigned duties
D. The use of medical marijuana is never disqualifying
A
CORRECT ANSWER: A»Explanation: The use of medical marijuana is disqualifying.
25
Which of the following is NOT true when medical clearance to drive from the prescribing clinician is received?
A. You may certify for a time period of ≤2 years
B. Schedule I drugs are never certifiable, even with the prescribing clinician's endorsement
C. You must approve certification
D. The decision to certify or not certify is always up to the medical examiner
CORRECT ANSWER: C>> Explanation: Some medications on the disqualification list can still be qualified when approved by the prescribing provider. The decision is left to the medical examiner, and the prescribing clinician's opinion does not have to be followed. You may choose to certify for any time period of ≤2 years based on perceived risk. Schedule 1 drugs, however, can never be qualified.
26
Which of the following is not true about Schedule III to V medications?
A. Use of Schedule III to V drugs can be certified for a time frame of <2 years based on the risk to public safety.
B. Use of Schedule III to V medications does not need to be evaluated because they pose little risk to safety.
C. Use of Schedule III to V medications may be disqualifying based on side effects.
D. Use of Schedule III to V medications is automatically disqualifying due to the possibility of habit formation or addiction.
CORRECT ANSWER: B>> Explanation: Schedule III to V drugs have decreasing potential for abuse than preceding schedules. Abuse may lead to moderate or low physical dependence or high psychological dependence. Schedule III drugs include tranquilizers. Schedule IV drugs include drugs such as chlorhydrol and phenobarbital. Schedule V drugs have the lowest potential for abuse and include narcotic compounds or mixtures. Side effects are not part of the DEA schedule rating criteria. Therefore, a substance can have little risk for addiction and abuse but still have side effects that interfere with driving ability. Side effects and risk to public safety should always be considered in the certification process.
27
Which of the following conditions must a driver under anticoagulant treatment meet in order to be certified?
A. Monthly partial thromboplastin time (PTT)
B. Monthly international normalized ratios (INRs)
C. Quarterly international normalized ratios (INRs)
D. Weekly international normalized ratios (INRs)
CORRECT ANSWER: B>> Explanation: A patient on anticoagulants must have monthly international normalized ratios to monitor risk of bleeding in order to maintain certification.
28
A driver is prescribed beta-blockers to treat migraine headaches. The proper action is to:
A. Qualify the driver for the time period indicated by the severity of the condition
B. Disqualify the driver as migraines are disqualifying
C. Disqualify the driver since the use of beta-blockers is disqualifying.
D. Qualify the driver for 1 year
CORRECT ANSWER: A>> Explanation: The use of beta-blockers when used to treat migraines allows a driver to be qualified. Follow the recommendations for migraines. You may certify the driver for up to 2 years based on severity of symptoms, accompanying symptoms (such as visual disturbance), frequency of headaches, and side effects of treatment.
29
A driver taking antacids:
A. Should be certified as long as the medication is tolerated well and there are no acute incapacitating events caused by the underlying disease
B. Can always be certified without limitations
C. Should never be certified
D. Should be certified as long as the driver also drinks lots of milk
CORRECT ANSWER: A>> Explanation: A patient taking antacids should be certified as long as the medication is tolerated well and there are no acute incapacitating events caused by the underlying disease such as those that accompany ulcerative colitis and Crohn disease.
30
A driver taking anticonvulsants for seizures:
A. Is disqualified
B. Can be certified for 2 years
C. Can be certified for 1 year
D. Can be certified accompanied by evidence that the seizures have stopped
CORRECT ANSWER: A>> Explanation: A driver on anticonvulsants for the treatment of seizures is disqualified. A driver taking anticonvulsants to treat a condition other than seizures may be certified based on the underlying condition.
31
A driver taking Provigil can be certified for:
A. One year after a 6-week waiting period for monitoring
B. One year with no waiting period for monitoring
C. Two years after a 6-week waiting period for monitoring
D. Two years with no waiting period for monitoring
CORRECT ANSWER: A>> Explanation: Drivers being prescribed Provigil should not be qualified until they have been monitored closely for at least 6 weeks while taking Provigil. The treating physician and the medical examiner should agree that the Provigil is effective in preventing daytime somnolence and document that no untoward side effects are present. Commercial motor vehicle drivers taking Provigil should be recertified annually.
32
The main goal of the cardiovascular exam is to:
A. Determine which stressors the driver is under that may affect his/her cardiovascular health
B. Determine whether the driver has a cardiovascular abnormality that increases the risk for sudden death or incapacitation
C. Prescribe treatment for cardiac abnormalities
D. Refer the driver with a cardiac abnormality to a cardiovascular specialist
CORRECT ANSWER: B>> Explanation: The medical examiner should never prescribe treatment. The medical examiner may provide a referral to a specialist as part of the exam, but this is not the main purpose of the exam. The medical examiner should be knowledgeable about the stressors drivers experience and how those stressors affect the health of the driver. However, assessment of these stressors is not the main purpose of the exam. The main purpose of the exam is to determine whether the driver has a cardiovascular abnormality that increases the risk for sudden death or incapacitation and, therefore, risk to the driver and public safety.
33
Environmental factors affecting the health of drivers may include:
A. Whole-body vibration, temperature extremes, and excessive noise
B. Pollution, bad weather, and extreme loneliness
C. Whole-body vibration, bad smells, and bad weather
D. Excessive noise, too much pizza, and pollution
CORRECT ANSWER: A>> Explanation: The following environmental stressors affect a driver's health: excessive noise, temperature extremes, pollution, whole-body vibration, and bad weather.
34
What is one reason to use imaging studies instead of an exercise tolerance test?
A. An imaging study is less expensive than an exercise tolerance test.
B. There is no reason since the tests are equivalent.
C. Imaging studies have superior sensitivity and specificity compared to a standard stress test.
D. An exercise stress test has superior sensitivity and specificity compared to a standard stress test.
CORRECT ANSWER: C>> Explanation: Imaging studies have superior sensitivity and specificity compared to a standard stress test.
35
Which result of an exercise tolerance test allows certification?
A. A workload capacity >6 METs, a heart rate >85% predicted maximum rate unless on beta-blockers, a systolic blood pressure rise ≥20 mm Hg without angina, and no significant ECG findings
B. A workload capacity >4 METs, a heart rate >85% predicted maximum rate unless on beta-blockers, a systolic blood pressure rise ≥20 mm Hg without angina, and no significant ECG findings
C. A workload capacity >6 METs, a heart rate >90% predicted maximum rate unless on beta-blockers, a systolic blood pressure rise ≥20 mm Hg without angina, and no significant ECG findings
D. A workload capacity >4 METs, a heart rate >85% predicted maximum rate unless on beta-blockers, a systolic blood pressure rise ≥10 mm Hg without angina, and no significant ECG findings
CORRECT ANSWER: A>> Explanation: A workload capacity >6 METs, a heart rate >85% predicted maximum rate unless on beta-blockers, a systolic blood pressure rise ≥20 mm Hg without angina, and no significant ECG findings.
36
Pulmonary hypertension is defined as:
A. Pulmonary artery pressure <50% of systemic systolic blood as determined by echocardiography or cardiac catheterization
B. Pulmonary artery pressure >60% of systemic systolic blood as determined by echocardiography or cardiac catheterization
C. Pulmonary artery pressure <60% of systemic systolic blood as determined by echocardiography or cardiac catheterization
D. Pulmonary artery pressure >50% of systemic systolic blood as determined by echocardiography or cardiac catheterization
CORRECT ANSWER: D>> Explanation: Pulmonary artery pressure >50% of systemic systolic blood as determined by echocardiography or cardiac catheterization.
37
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Which is NOT a modifiable risk factor for coronary heart disease?
A. Hypertension
B. Sedentary lifestyle
C. Age
D. Smoking
```
CORRECT ANSWER: C>> Explanation: Age cannot be changed.
38
Why should you educate a driver about the warning signs of an impending cardiovascular event?
A. Once symptoms are present, sudden death is imminent
B. There is no reason to educate a driver about cardiovascular symptoms
C. You only need to educate drivers with a current cardiovascular issue
D. The driver may only have a short time to safely stop the vehicle and call for medical assistance
CORRECT ANSWER: D>> Explanation: All drivers should be educated about the warning signs of an impending cardiovascular event because the driver may only have a short time to safely stop the vehicle and call for medical assistance once symptoms present.
39
A driver describes chest pressure at rest accompanied by slight nausea and sweating. The best course of action is:
A. Refer the driver for evaluation by a specialist. Do not certify the driver at this time.
B. Refer the driver for evaluation by a specialist. Certify the driver for 3 months.
C. Certify the driver for 1 year
D. Prescribe nitroglycerin sublingual PRN for chest pain and certify the driver
CORRECT ANSWER: A>> Explanation: The driver most likely has unstable angina. A driver with unstable angina cannot be certified and should be referred to a specialist for treatment. The driver may be certified after 3 months without unstable angina. If the driver has stable angina, he/she may be certified for 1 year if he/she is asymptomatic, tolerates medication, and has a satisfactory exercise tolerance test.
40
An examiner should inquire about risk factors of coronary heart disease, in addition to active coronary disease, because:
A. Having risk factors for coronary heart disease indicates an increased risk for a cardiovascular episode
B. Once risk factors are present, a cardiovascular event is imminent
C. The presence of cardiovascular risk factors does not indicate an increased risk for an event, so there is no reason to ask
D. If there are no risk factors, an event will not occur
CORRECT ANSWER: A>> Explanation: Although risk factors play an important role in the risk of developing coronary heart disease (CHD), the presence of risk factors does not mean the driver will develop CHD, only that there is an increased risk. Conversely, the absence of risk factors does not mean that the driver will not have a CHD event.
41
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Which is the major predictor for prognosis of coronary heart disease?
A. Associated vascular disease
B. Presence of angina
C. Left ventricular function
D. Presence of arrhythmias
```
CORRECT ANSWER: C>> Explanation: The major predictor of coronary heart disease (CHD) is left ventricular function. Other indicators to be considered include general health, age, arrhythmias, angina pectoris, associated vascular disease, and severity of CHD.
42
The prognosis for a patient with an arrhythmia is generally determined by:
A. The length of an arrhythmic episode
B. The age at which the arrhythmia first presented
C. The underlying heart disease
D. The frequency with which the arrhythmia occurs
CORRECT ANSWER: C>> Explanation: Risk determination is difficult because of the number of variables that must be considered. The prognosis is generally determined by the underlying heart disease. While defibrillation may restore a normal rhythm, there remains a high risk of recurrence.
43
Which condition does NOT disqualify a driver with arrhythmias?
A. When the underlying condition is disqualifying
B. When the arrhythmia puts the driver at risk for sudden death
C. When the dysrhythmia does not increase the risk for hypoperfusion and/or impaired consciousness
D. When the arrhythmia increases the risk for cerebral hypoperfusion and/or impaired consciousness
CORRECT ANSWER: C>> Explanation: Per Cardiac Conference Guidelines. Since this is a discretionary issue, a dysrhythmia alone does not disqualify as long as hypoperfusion or altered or lack of consciousness is not involved.
44
The major risk factor associated with atrial fibrillation is:
A. Bleeding caused by anticoagulant therapy
B. There is no reason to be concerned about atrial fibrillation
C. Syncope
D. Formation of a blood clot, which could travel to the cerebral vascular system and cause a stroke
CORRECT ANSWER: D>> Explanation: The major risk associated with atrial fibrillation is the presence of an embolus, which can cause a stroke. Anticoagulant therapy decreases the risk of peripheral embolization in individuals with risk factors for stroke.
45
When is the use of anticoagulant therapy disqualifying?
A. Use of anticoagulants is never disqualifying
B. Use of anticoagulants is always disqualifying
C. When used to treat a neurovascular condition
D. When used to treat a cardiovascular condition
CORRECT ANSWER: C>> Explanation: Use of anticoagulants for neurovascular disorders is always disqualifying because of the high rate of complications associated with bleeding that can incapacitate the driver while operating a vehicle. Under certain conditions, a driver can be certified when the anticoagulants are used for cardiovascular disorders. If a driver is on anticoagulants for both neurovascular and cardiovascular disorders, use the stricter guideline for neurovascular and do not certify.
46
Supraventricular tachycardia is a(n):
A. Common arrhythmia that is usually not considered a risk for sudden death
B. Common arrhythmia that is considered a risk for sudden death
C. Uncommon arrhythmia that is usually not considered a risk for sudden death
D. Uncommon arrhythmia that is considered a risk for sudden death
CORRECT ANSWER: A>> Explanation: Supraventricular tachycardia (SVT) is a common arrhythmia that is usually not considered a risk for sudden death. On occasion, SVT can cause loss of consciousness or compromise cerebral function. Treatment by catheter ablation is usually curative and allows drug therapy to be withdrawn.
47
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Ebstein anomaly is frequently accompanied by a(n):
A. Aortic stenosis
B. Coarctation of the aorta
C. Atrial septal defect
D. Patent ductus arteriosus
```
CORRECT ANSWER: C>> Explanation: Ebstein anomaly is frequently accompanied by an atrial septal defect.
48
A driver with an Ebstein anomaly should have a(n):
A. Annual cardiovascular re-evaluation
B. Annual exam by any provider
C. Annual cardiovascular re-evaluation that should include echocardiography and evaluation by a cardiologist knowledgeable in adult congenital heart disease and who understands the functions and demands of commercial driving
D. Cardiovascular re-evaluation every 2 years that should include echocardiography and evaluation by a cardiologist knowledgeable in adult congenital heart disease and who understands the functions and demands of commercial driving
CORRECT ANSWER: C>> Explanation: An annual cardiovascular re-evaluation that should include echocardiography and evaluation by a cardiologist knowledgeable in adult congenital heart disease and who understands the functions and demands of commercial driving.
49
Which of the following should be used to decide certification status for a driver with a congenital heart disease?
A. Severity of the defect, age at diagnosis, and anatomic diagnosis
B. Severity of the defect, age at diagnosis, and risk of sudden death or incapacitation
C. Severity of the defect, results of treatment, and risk of sudden death or incapacitation
D. Severity of the defect, age at diagnosis, and risk of sudden death or incapacitation
CORRECT ANSWER: C>> Explanation: The factors to be considered for a congenital heart defect are anatomic diagnosis, severity of the congenital defect, results of treatment, present fitness status, and risk of sudden death or incapacitation.
50
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A medical examiner is most likely to see the following congenital heart diseases:
A. Coarctation of the aorta
B. Ebstein anomaly
C. Tetralogy of Fallot
D. Transposition of the great vessels
```
CORRECT ANSWER: B>> Explanation: Ebstein anomaly is the most likely congenital heart disease to be encountered and is the only one addressed in the medical examiner's handbook. The other congenital heart diseases listed are only addressed in the FMCSA medical reports.
51
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You may certify a driver with pulmonary hypertension, accompanied by dyspnea at rest, for:
A. Do not certify
B. 2 years
C. 6 months
D. 1 year
```
CORRECT ANSWER: A>> Explanation: A driver with pulmonary hypertension cannot be certified if the pulmonary hypertension is accompanied by dizziness, hypotension, dyspnea at rest, or partial pressure of arterial oxygen (PaO2) <65 mm Hg.
52
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Which one of the following is not a type of valvular heart disease?
A. Aortic stenosis
B. Mitral regurgitation
C. Aortic coarctation
D. Aortic regurgitation
```
CORRECT ANSWER: C>> Explanation: Aortic coarctation is a narrowing of the aorta.
53
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What grade of murmur is described as, ""can hear the murmur with the stethoscope close to the skin; it does not have to be in contact with the skin to detect the murmur""?
A. Grade II
B. Grade VI
C. Grade I
D. Grade VII
```
CORRECT ANSWER: B>> Explanation: There are 6 grades of murmur with being able to hear the murmur without a stethoscope in contact with the skin being the most severe at grade VI. A grade I murmur is described as ""must strain to hear a murmur."
54
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In which case do the guidelines for aortic regurgitation NOT apply?
A. Congenital aortic regurgitation
B. Severe aortic regurgitation
C. Acute aortic regurgitation
D. Chronic aortic regurgitation
```
CORRECT ANSWER: C>> Explanation: The guidelines for aortic regurgitation do not apply when the cause is due to an acute condition such as infective endocarditis.
55
Under which condition should a driver with a history of aortic valve repair NOT be certified?
A. Thromboembolic complications
B. At least 3 month postoperative
C. Meets asymptomatic guidelines for underlying cause
D. Clearance from a cardiovascular specialist
CORRECT ANSWER: A>> Explanation: Do not certify a driver who has had an aortic valve repaired with thromboembolic complications.
56
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What is the recommended certification time for a driver with a heart transplant?
A. 18 months
B. 6 months
C. 3 months
D. 1 year
```
CORRECT ANSWER: B>> Explanation: The recommended time for certification for heart transplant is 6 months.
57
A driver with a heart transplant has a fever and dyspnea. This driver may be certified for:
A. The driver cannot be certified
B. 6 months
C. 3 months
D. 6 months if cleared by a cardiac specialist
CORRECT ANSWER: A>> Explanation: Fever and dyspnea are signs of transplant rejection, so the driver cannot be certified until rejection is ruled out.
58
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Which of the following is NOT a sign of heart failure?
A. Hair loss
B. Edema of the abdomen
C. Weight gain
D. Palpitations
```
CORRECT ANSWER: A>> Explanation: The signs of heart failure include edema of the abdomen, weight gain, palpitations, dyspnea, cough, edema of feet and ankles, irregular or rapid pulse, difficulty sleeping, fatigue, weakness, faintness, loss of appetite, and indigestion.
59
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Which one does not indicate poor prognosis for a driver with mitral regurgitation?
A. Fatigue
B. Orthopnea
C. Tachycardia
D. Dyspnea
```
CORRECT ANSWER: C>> Explanation: The following indicate a poor prognosis for a driver with mitral regurgitation: fatigue, dyspnea, orthopnea, paroxysmal nocturnal dyspnea.
60
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A driver with mitral regurgitation can be certified if the driver also has:
A. Atrial fibrillation
B. Thromboembolism
C. Ruptured chordae or flail leaflet
D. Tachycardia
```
CORRECT ANSWER: D>> Explanation: Do not certify a driver with mitral regurgitation who also as any of the following: symptoms,<6 METs on Bruce protocol, ruptured chordae or flail leaflet, atrial fibrillation, LV dysfunction, thromboembolism, or pulmonary hypertension.
61
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Which is not always a congenital heart disease?
A. Aortic regurgitation
B. Ebstein anomaly
C. Tetralogy of Fallot
D. Transposition of the great vessels
```
CORRECT ANSWER: A>> Explanation: Aortic regurgitation can be developed or acquired.
62
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Drivers are at high risk for acute deep vein thrombosis because of:
A. Long hours of sitting
B. Long hours of driving
C. Obesity
D. Loud noises
```
CORRECT ANSWER: A>> Explanation: Long hours of sitting is a risk factor for the formation of deep vein thrombosis.
63
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Risk of recurrent thrombosis is decreased by ___% with adequate anticoagulant therapy.
A. 0.8
B. 0.75
C. 0.78
D. 0.9
```
CORRECT ANSWER: A>> Explanation: Risk of recurrent thrombosis is decreased by 80% with adequate anticoagulant therapy.
64
A driver with superficial phlebitis and deep vein thrombosis (DVT) can be certified:
A. Never
B. If the guidelines for DVT are met
C. When the DVT is resolved
D. As long as the driver is not using anticoagulants
CORRECT ANSWER: B>> Explanation: A driver with superficial phlebitis and deep vein thrombosis can be certified if the guidelines for DVT are met. The guidelines for DVT are: do not certify the driver until etiology is confirmed, and treatment has been shown to be adequate/effective, safe, and stable.
65
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The maximum certification for a driver with superficial phlebitis is:
A. 3 years
B. 18 months
C. 2 years
D. 1 year
```
CORRECT ANSWER: C>> Explanation: The maximum certification for a driver with superficial phlebitis is 2 years.
66
```
A driver who has had surgical repair for peripheral vascular disease should have a waiting period of how long?
A. 3 months
B. 2 weeks
C. 6 months
D. 1 month
```
CORRECT ANSWER: A>> Explanation: A driver who has had surgical repair for peripheral vascular disease should have a 3-month waiting period.
67
```
A driver who has had surgical repair of a thoracic aneurysm should have a waiting period of how long?
A. 2 weeks
B. 6 months
C. 1 month
D. 3 months
```
CORRECT ANSWER: D>> Explanation: A driver who has had surgical repair of a thoracic aneurysm should have a 3-month waiting period.
68
A driver with a thoracic aneurysm cannot be certified if:
A. The size of the aneurysm is <=3.5 cm
B. The driver is at least 3 months post-surgery and has been cleared by a cardiovascular specialist
C. There is no reason not to certify a driver with a thoracic aneurysm
D. The size of the aneurysm is > 3.5 cm
CORRECT ANSWER: D>> Explanation: Size is the major risk factor for dissection or rupture of a thoracic aneurysm. The larger the aneurysm, the greater the risk for rupture. Do not certify a driver with a thoracic aneurysm >3.5 cm.
69
A driver with dilated cardiomyopathy can be certified if the driver has:
A. Sustained V-tach with any left ventricular ejection fraction
B. Syncope/near syncope and any left ventricular ejection fraction
C. Non-sustained V-tach and left ventricular ejection fraction ≥40%
D. Non-sustained V-tach and left ventricular ejection fraction <40%
CORRECT ANSWER: C>> Explanation: A driver with dilated cardiomyopathy can be certified if he/she has nonsustained V-tach and left ventricular ejection fraction ≥40%.
70
When can you certify a driver with restrictive cardiomyopathy?
A. When the restrictive cardiomyopathy is not accompanied by dyspnea
B. When a METS measurement is >6
C. If the oxygen saturation is >90%
D. Never
CORRECT ANSWER: D>> Explanation: The Clinical Profile and Outcome of Idiopathic Restrictive Cardiomyopathy report done at the Mayo Clinic indicated a 5-year survival rate of only 64%, compared with an expected survival rate of 85%. Because of this, a driver with restrictive cardiomyopathy is disqualified.
71
What is the most serious complication of an aneurysm?
A. Pain
B. There is no reason to be concerned about an aneurysm
C. Rupture
D. Leakage
CORRECT ANSWER: C>> Explanation: Rupture is the most serious complication of an aneurysm and is related to the size of the aneurysm.
72
```
Which drug is NOT commonly used to treat tuberculosis?
A. Vancomycin
B. Ethambutol
C. Rifampin
D. Pyrazinamide
```
CORRECT ANSWER: A>> Explanation: The following medications are commonly used to treat tuberculosis: ethambutol, isoniazid, pyrazinamide, streptomycin, rifampin.
73
Treatment of tuberculosis may cause:
A. Eighth cranial nerve damage and subsequently vision abnormalities
B. Ninth cranial nerve damage and subsequently vision abnormalities
C. Eighth cranial nerve damage and subsequently hearing and balance deficiencies
D. Ninth cranial nerve damage and subsequently hearing and balance deficiencies
CORRECT ANSWER: C>> Explanation: Treatment of tuberculosis may cause residual eighth cranial nerve damage that affects balance and/or hearing to an extent that interferes with safe driving.
74
```
Bronchiectasis is:
A. Destruction and widening of the large airways
B. Infection of the large airways
C. Bleeding in the large airways
D. Collapsed alveoli
```
CORRECT ANSWER: A>> Explanation: Bronchiectasis is destruction and widening of the large airways.
75
The following are types of chronic obstructive pulmonary disease (COPD):
A. Chronic bronchitis, emphysema, and asthma
B. Chronic bronchitis and emphysema
C. Chronic bronchitis and asthma
D. Emphysema and asthma
CORRECT ANSWER: B>> Explanation: Chronic bronchitis and emphysema are types of COPD. Asthma is an inflammatory disorder and not considered as COPD.
76
```
Which is NOT one of the cardinal symptoms of chronic obstructive pulmonary disease (COPD)?
A. Dyspnea on exertion
B. Circumoral cyanosis
C. Chronic cough
D. Large amounts of sputum production
```
CORRECT ANSWER: B>> Explanation: Chronic cough, large amounts of sputum production, and dyspnea on exertion are cardinal symptoms of COPD. Circumoral cyanosis may be present in COPD, but is not considered one of the cardinal signs.
77
To improve highway safety by producing trained certified medical examiners who can effectively determine if a commercial motor vehicle driver's health meets Federal Motor Carrier Safety Administration Standards is the mission statement of :
A. The American Medical Association
B. The National Registry of Certified Medical Examiners
C. The Federal Motor Carrier Safety Administration
D. The Office of Medical Programs
CORRECT ANSWER: B>> Explanation: The primary mission of the National Registry of Certified Medical Examiners is to improve highway safety by producing trained, certified medical examiners who can effectively determine if a commercial motor vehicle driver's health meets Federal Motor Carrier Safety Administration standards.
78
Which of the following serves as the lead federal agency for the regulation of commercial motor vehicle driver's health and safety and conducts relevant research?
A. The American Medical Association
B. The Office of Medical Programs
C. The Federal Motor Carrier Safety Administration
D. The National Registry of Certified Medical Examiners
CORRECT ANSWER: B>> Explanation: To promote safety, the Office of Medical Programs serves as the lead federal agency for the regulation of commercial motor vehicle driver's health and safety and conducts relevant medical research.
79
The FMCSA identifies a person who can be a medical examiner by the following 2 criteria:
A. Professional licensure and scope of practice that include performing physical examinations
B. Current DEA registration and board certification in internal medicine
C. Medical Doctorate and current state licensure
D. Graduate of accredited school of medicine and board certification in a medical specialty
CORRECT ANSWER: A>> Explanation: The Federal Motor Carrier Safety Regulations identify a person who can be a medical examiner by 2 criteria: professional licensure and scope of practice that includes performing physical examinations.
80
Medical certification in accordance with Federal Motor Carrier Safety Administration physical qualification standards is required when a driver is operating a commercial vehicle (in interstate commerce) for all of the following EXCEPT:
A. Has >4 wheels and a sleeping compartment
B. Transports hazardous materials in quantities that require placarding under the hazardous materials regulations
C. Is designed or used to transport 9 to 15 passengers (including the driver) for compensation
D. Has a combined gross vehicle weight or weight rating of ≥ 10,000 pounds
CORRECT ANSWER: A>> Explanation: Medical certification in accordance with FMCSA physical qualification standards is required when the driver is operating a commercial motor vehicle in interstate commerce that: has a combined gross vehicle weight or weight rating of ≥10,000 lbs; is designed or used to transport 9 to 15 passengers (including the driver) for compensation; is designed or used to transport ≥16 passengers (including the driver) whether for compensation or not; or transports hazardous materials in quantities that require placarding under the hazardous materials regulations.
81
Which of the following statements is NOT true?
A. The medical examiner is responsible for certifying only drivers who meet the physical qualification standards.
B. The medical examiner's certificate expires at midnight on the day, month, and year written on the certificate.
C. Certification of a Federal Motor Carrier Safety Administration qualified driver can be extended beyond 2 years only at the discretion of a certified medical examiner.
D. When a driver returns from an illness or injury that interferes with driving ability, the driver must undergo a medical examination even if the medical examiner's certificate has not expired.
CORRECT ANSWER: C>> Explanation: The medical examiner is responsible for certifying only drivers who meet the physical qualification standards. Certification cannot exceed 2 years, and at the discretion of the FMCSA medical examiner, may be <2 years.
82
Interstate commerce means trade, traffic, or transportation in the United States for all of the following EXCEPT:
A. Between any 2 commercial properties separated by >100 nautical miles
B. Between a place in a state and a place outside of such state (including a place outside of the United States)
C. Between 2 places in a state through another state or a place outside of the United States
D. Between 2 places in a state as part of trade, traffic, or transportation originating or terminating outside the state or the United States
CORRECT ANSWER: A>> Explanation: Interstate commerce means trade, traffic, or transportation in the United States between a place in a state and a place outside of such state (including a place outside of the United States), between 2 places in a state through another state or a place outside of the United States or between 2 places in a state as part of trade, traffic, or transportation originating or terminating outside the state or the United States.
83
Select the statement that is NOT true.
A. The Department of Transportation publishes rules on who must conduct drug and alcohol tests.
B. Safety-sensitive transportation employees in aviation, trucking, railroads, mass transit, pipelines, and other transportation industries are included in the Omnibus Transportation Employee Testing Act (1991).
C. Interaction between the medical examiner and the health-care professionals who perform services in the drug and alcohol testing program is prohibited by HIPAA regulations.
D. The Omnibus Transportation Employee Testing Act (1991) requires drug and alcohol testing of safety-sensitive transportation employees.
CORRECT ANSWER: C>> Explanation: The Department of Transportation publishes rules on who must conduct drug and alcohol tests, how to conduct those tests, and what procedures to use when testing. There are times when a medical examiner may have interactions with health-care professionals who perform services in the drug and alcohol testing program.
84
Choose the correct statement.
A. The Drug Enforcement Administration formulates rules regarding procedure to be followed for drug and alcohol testing.
B. The Department of Transportation publishes rules on how to conduct drug and alcohol tests.
C. A medical review officer (MRO) is a licensed MD, DO, DC, PA, or APN who is responsible for receiving and reviewing laboratory results generated by an employer drug testing program and for evaluating medical explanations for certain drug test results.
D. A substance abuse professional is responsible for evaluating employees who have violated Department of Transportation drug and alcohol regulations, but may not make recommendations concerning treatment and follow up.
CORRECT ANSWER: B>> Explanation: The Department of Transportation publishes rules on who must conduct drug and alcohol tests, how to conduct those tests, and what procedures to use when testing.
85
Choose the correct statement.
A. A release form signed by the driver is not recommended if the employer wishes to obtain a copy of the medical examination report form.
B. Employer compliance with applicable state laws regarding the privacy and maintenance of employee medical information is not required.
C. Regulatory requirements take precedence over the Health Insurance Portability and Accountability Act.
D. The Federal Motor Carrier Safety Regulations require the medical examiner to give a copy of the medical examination report form to the employer.
CORRECT ANSWER: C>> Explanation: Regulatory requirements take precedence over the Health Insurance Portability and Accountability Act of 1996. There are potential subtle interpretations that can cause significant problems for the medical examiner. What information must or can be turned over to the carrier is a legal issue, and if in doubt, the examiner should obtain a legal opinion.
86
All of the following are true EXCEPT:
A. The motor carrier is required to keep a copy of the medical examiner's certificate in the driver qualification file.
B. The medical examiner should keep a copy of the medical examiner's certificate on file.
C. A release form is required to release the medical examiner's certificate to the motor carrier that employs the driver.
D. A copy of the completed medical examiner's certificate is provided to the driver and to the motor carrier (employer).
CORRECT ANSWER: C>> Explanation: If the medical examiner finds that the driver is physically qualified to drive a commercial motor vehicle in accordance with 391.41 (b), the medical examiner shall complete a medical examiner's certificate and furnish 1 copy to the driver and 1 copy to the motor carrier that employs the driver. A release form is not required.
87
Choose the incorrect statement.
A. The Code of Federal Regulations (CFR) is a compilation of the discretionary rules for medical examiners.
B. Regulations are laws and must be followed.
C. Standards or Federal Motor Carrier Safety Regulations (FMCSRs) are legal requirements for interstate commercial vehicles, drivers, and motor carriers.
D. The medical examiner may or may not choose to use the FMCSA-recommended medical guidelines.
CORRECT ANSWER: A>> Explanation: The Code of Federal Regulations (CFR) is the codification of the general and permanent rules published in the Federal Register by the executive departments and agencies of the federal government.
88
```
Which of the following covers regulations for physical qualifications for drivers?
A. FMCSA Medical Guidelines
B. 49 CFR 391.43
C. 49 CFR 391.41
D. 49 CFR 391.45
```
CORRECT ANSWER: C>> Explanation: 49 CFR 391.41 describes the physical qualification requirements for drivers.
89
The Skill Performance Evaluation (SPE) Certification Program:
A. Requires that the driver be otherwise qualified to drive a commercial motor vehicle and meet the provisions of the alternate (SPE) standard
B. Is available to drivers with a progressive musculoskeletal deficit of an extremity
C. Can be completed at a follow-up visit with the medical examiner
D. Requires renewal every 5 years
CORRECT ANSWER: A>> Explanation: The Skill Performance Evaluation Certification Program is an alternative physical qualification standard for the driver with a fixed musculoskeletal deficit of an extremity who cannot physically qualify to drive under 49 CFR 391.41(b)(1)or (b)(2). The driver must be otherwise qualified to drive a commercial motor vehicle and meet the provisions of the alternate standard.
90
Currently, the FMCSA has the following 2 Medical Exemption Programs:
A. Federal Vision Exemption Program and Diabetes Exemption Program
B. Federal Vision Exemption Program and Auditory Assistance Exemption Program
C. Auditory Assistance Exemption Program and Automatic Internal Cardiac Defibrillator Exemption Program
D. Respiratory Disorders Requiring Oxygen Exemption Program and Auditory Assistance Exemption Program
CORRECT ANSWER: A>> Explanation: Currently, the Federal Motor Carrier and Safety Administration has 2 medical driver exemption programs. These include the Federal Vision Exemption Program (1998) and the Diabetes Exemption Program (September 2003).
91
Which statement is incorrect?
A. Only the Diabetes Exemption Program requires the driver to have an annual medical examination for maintenance and renewal of the exemption.
B. The medical examiner cannot issue an exemption.
C. The role of the medical examiner is to determine if the driver is "otherwise qualified."
D. There are currently no Federal Motor Carrier and Safety Administration medical waiver programs.
CORRECT ANSWER: A>> Explanation: Both federal exemptions (vision and diabetes) require the driver to have an annual medical examination for maintenance and renewal of the exemption.
92
```
In addition to medical fitness for duty certification, other regulations affecting the commercial motor vehicle driver include all of the following EXCEPT:
A. Use of safety restraints
B. Drug and alcohol testing
C. Record keeping
D. Hours of service
```
CORRECT ANSWER: A>> Explanation: In addition to medical fitness for duty certification other regulations affecting the commercial motor vehicle driver include drug and alcohol testing, record keeping, hours of service, and more.
93
Motor carriers are responsible for ensuring that a driver is able to speak and read English well enough for all of the following EXCEPT:
A. Making legible entries on reports
B. Successfully completing a high school equivalency exam
C. Conversing with the general public
D. Responding to official questions
CORRECT ANSWER: B>> Explanation: Successful completion of a high school equivalency exam is not a requirement for a commercial motor vehicle driver.
94
Motor carriers are responsible for ensuring that the driver is compliant with all the following EXCEPT:
A. Be capable of safely operating a commercial motor vehicle
B. Have provided the motor carrier with required background and violations information
C. Be at least 25 years of age
D. Have a current medical examiner's certificate on file
CORRECT ANSWER: C>> Explanation: The age requirement for a commercial motor vehicle driver is 21 years of age.
95
State regulations:
A. May not have additional, different, or more stringent requirements to federal regulations
B. Are not the responsibility of the medical examiners performing the physical exam
C. Do not regulate commercial drivers NOT subject to federal regulations
D. Regulate intrastate commerce
CORRECT ANSWER: D>> Explanation: States regulate intrastate commerce and commercial drivers who are not subject to federal regulations. They are required, at a minimum, to adopt federal physical qualification requirements and may even have additional, different, or more stringent requirements.
96
All of the following statements regarding a medical examiner are true EXCEPT:
A. Is responsible for ensuring that only the driver who meets the federal physical qualification requirements is issued a medical examiner's certificate
B. May certify a driver for <2 years when the medical examination indicates
C. Certifies that the driver is fit for duty and can perform the driver role described in the medical examination form
D. May certify a driver for a minimum of 2 years
>> CORRECT ANSWER: D>> Explanation: The medical examiner is responsible for ensuring that only the driver who meets the federal physical qualification requirements is issued a medical examiner certificate (certifying the driver is medically fit for duty and can perform the driver role described in the medical examination form). Maximum duration is 2 years; a driver may be certified for <2 years when the medical examination indicates.
97
```
The profile of the average truck or bus driver includes all the following EXCEPT:
A. Sedentary, overweight
B. Poor eating habits
C. Age < 25 years
D. Male, smoker
```
CORRECT ANSWER: C>> Explanation: The profile of the average truck or bus driver includes the following: male; >40 years of age; sedentary; overweight; smoker; and poor eating habits.
98
The medical profile of the average truck or bus driver includes:
A. Equally as healthy as the average person
B. Less risk for gradual or sudden incapacitation
C. Prevalence of cardiovascular disease
D. Rarely >1 medical condition
CORRECT ANSWER: C>> Explanation: The medical profile of the average truck or bus driver includes being less healthy than the average person, having >2 medical conditions, and a prevalence for cardiovascular disease.
99
All of the following factors contribute to making commercial driving a stressful occupation EXCEPT:
A. Short-relay routes
B. All of these factors contribute to making commercial driving a stressful occupation
C. Cross-country routes
D. Abrupt schedule changes
CORRECT ANSWER: B>> Explanation: Factors that contribute to making commercial driving a stressful occupation include types of routes (turn-around or short-relay, long-relay, straight-through haul and cross-country routes), schedules, environment, and types of cargo
100
Safe driving includes all the following EXCEPT:
A. Appropriate behavior in both normal and emergency situations
B. 3 rest stops in a 12-hour period
C. Sustained mental alertness and physical endurance
D. Cognitive skills including problem-solving, communication, and judgment
CORRECT ANSWER: B>> Explanation: Safe driving demands sustained mental alertness and physical endurance not compromised by fatigue or sudden incapacitating symptoms, problem-solving, communication, and judgment skills, appropriate behavior in normal and emergency situations, and the ability to judge the maximum speed at which vehicle control can be maintained under changing traffic, road, and weather conditions.
101
Manipulation of dashboard switches and controls requires:
A. Adequate reach, prehension, and touch sensation in hands and fingers
B. Familiarity with English and metric measurements
C. Appropriate, complete visual color perception
D. ≤3 gauges in operation at any given time
CORRECT ANSWER: A>> Explanation: Manipulation of dashboard switches and controls requires adequate reach, prehension, and touch sensation in hands and fingers.
102
The job of commercial driving requires:
A. Smaller than ordinary steering wheel for ease of maneuvering
B. Entering and exiting the vehicle in a manner similar to that of private vehicles
C. The driver to repeatedly perform reciprocal movements of both legs coordinated with right arm and hand movements
D. Use of side mirrors to inspect cargo
CORRECT ANSWER: C>> Explanation: Shifting gears requires the driver to repeatedly perform reciprocal movements of both legs coordinated with right arm and hand movements. Side mirrors are used to monitor traffic and in backing up to loading areas. Steering wheels of large trucks/buses are oversized, and entering/exiting a commercial motor vehicle is similar to climbing a ladder.
103
```
Physical demands involved in coupling and uncoupling trailers include all the following EXCEPT:
A. Balance
B. Flexibility
C. Grip strength ≤35 pounds
D. Upper body strength
```
CORRECT ANSWER: C>> Explanation: Physical demands for coupling and uncoupling trailers include grip strength, upper body strength, range of motion, balance, and flexibility.
104
Loading, securing, and unloading cargo:
A. Is not a component of commercial driving
B. Is listed by the Centers for Disease Control and Prevention as an example of a vigorous activity
C. Federal Motor Carrier Safety Administration guidelines specify that a driver must be able to lift 75 pounds from the ground to waist level
D. Requires ≤4.8 metabolic equivalents (METs) to perform
CORRECT ANSWER: B>> Explanation: FMCSA guidelines do not specify the number of pounds a driver must be able to lift. However, the Centers for Disease Control and Prevention's table of General Physical Activities Defined by Level of Intensity lists ""loading and unloading a truck"" as an example of a vigorous activity that requires the individual to exert >6.0 metabolic equivalents in performance of the activity.
105
Results of the Federal Motor Carrier Safety Administration (FMCSA) Office of Analysis, Research, and Technology studies are used to:
A. Justify the need for highway safety patrol officers
B. Develop effective countermeasures that will reduce the occurrence and severity of crashes involving commercial vehicles
C. Provide the transportation industry and public with reports on trends in fuel consumption by commercial vehicles
D. Examine the public utilization of commercial transportation versus private transportation
CORRECT ANSWER: B>> Explanation: The FMCSA Office of Analysis, Research, and Technology (ART) provides the transportation industry with reports of trends, costs, fatalities, and injuries in large truck and bus crashes, which helps to identify factors contributing to crashes. This facilitates development of effective countermeasures designed to reduce the occurrence and severity of crashes.
106
The purpose of an interstate commercial driver physical exam is to:
A. Identify, diagnose, and treat conditions that may result in a sudden incapacitating event
B. To establish an information base of driver demographics in the continental United States
C. (In part) Fund medical assistance programs for drivers disabled in crashes while on duty
D. Detect the presence of any physical, mental, or organic conditions of such character and extent as to affect a driver's ability to operate a commercial motor vehicle safely
CORRECT ANSWER: D>> Explanation: The purpose of interstate commercial driver physical examinations is to detect the presence of any physical, mental, or organic conditions of such character and extent as to affect the ability of the driver to operate a commercial motor vehicle safely.
107
As a medical examiner, a ""Yes"" answer to which question should be followed by a driver's disqualification from driving?
A. Does a benign underlying prognosis have symptoms that interfere with the driver's ability to drive?
B. Can the driver stop the vehicle safely before becoming incapacitated?
C. Can the driver process environmental cues rapidly, make appropriate responses, independently solve problems, and function in a dynamic environment?
D. Are the driver's interactions appropriate, responsible, and nonviolent?
CORRECT ANSWER: A>> Explanation: As you conduct the physical examination, you must consider whether a benign underlying condition with an excellent prognosis has symptoms that interfere with the ability to drive. If the answer is ""yes"", the driver must be disqualified. An example of this would be a benign supraventricular arrhythmia that causes syncope.
108
A medical examiner's responsibilities include all of the following EXCEPT:
A. Promotion of public safety by education of drivers regarding medication use
B. Seeking further testing/evaluation for those medical conditions of which the medical examiner is unsure
C. Strict adherence to Federal Motor Carrier Safety Administration-recommended medical guidelines
D. Education and referral of drivers for further evaluation of an undiagnosed or worsening medical problem
CORRECT ANSWER: C>> Explanation: The medical examiner must comply with FMCSA regulations, but may deviate from FMCSA-recommended medical guidelines. Reasons for a decision to deviate from guidelines should be appropriately documented.
109
Choose the incorrect statement. The medical examiner:
A. Is responsible for reviewing the driver information field of the medical examination report form for legibility
B. Is not responsible for ensuring that a driver meets the commercial driver's license requirements before driving an interstate commercial motor vehicle
C. Is responsible for ensuring that a driver meets the 21 years of age requirement before driving an interstate commercial motor vehicle
D. May administer a driver physical to anyone who requests the exam
CORRECT ANSWER: C>> Explanation: The employer is responsible for verifying age requirements for interstate drivers, as in some states a driver may qualify intrastate at the age of 18.
110
```
For any ""Yes"" response on his health history, a driver must include all of the following EXCEPT:
A. Treating provider's name and address
B. Family history
C. Onset date
D. Diagnosis
```
CORRECT ANSWER: B>> Explanation: For each ""Yes"" answer, the examiner must: ask about history, diagnosis, treatment/response to treatment; explore underlying cause, precipitating events, and other pertinent facts; obtain additional tests/consults as necessary to assess fitness; review response to treatment and medications, including side effects and interactions, and document all.
111
By signing the medical examination report form, a driver affirms all of the following EXCEPT:
A. Acknowledges that providing inaccurate or false information or omitting information could result in the levy of a civil penalty against the driver under 49 U.S.C. 521 (b) (2) (B)
B. Forfeiture of right to sue examiner if job is denied him based on exam findings
C. Certification that information is complete and true
D. Acknowledges that providing inaccurate or false information or omitting information could invalidate the examination and any certificate issued based on it
CORRECT ANSWER: B>> Explanation: By signing the medical examination report form, the driver certifies that information the is complete and true and acknowledges that providing inaccurate or false information or omitting information could invalidate the examination and any certificate issued based on it and/or result in the levy of a civil penalty against the driver under 49 U.S.C 521b(2)(B).
112
Federal Motor Carrier Safety Administration regulations dictate that a medical examiner must:
A. Review and discuss with the driver any "Yes" response in the health history section of the medical examination report form
B. Obtain a written statement from the driver's treating provider for any condition listed
C. Issue a temporary disqualification if ≥2 conditions treated by medication are listed
D. Require the driver's pharmacist to provide a list of current medications
CORRECT ANSWER: A>> Explanation: Federal regulations require the medical examiner to review and discuss with the driver any ""Yes"" answers.
113
Which statement is incorrect?
A. A medical examiner should obtain documentation of heart surgery information and related testing as needed to adequately assess a driver's medical fitness for duty.
B. If a driver reports current cardiovascular disease, consultation with and documentation from the driver's health-care provider should be obtained prior to certification.
C. An automated implanted cardiac defibrillator (ICD) is disqualifying; however, dual pacemaker/ICD units may be qualified with supporting cardiologist's clearance.
D. A driver reporting symptoms consistent with undiagnosed cardiovascular disease should be referred to a specialist for further evaluation prior to certification.
CORRECT ANSWER: C>> Explanation: Federal Motor Carrier Safety Administration medical guidelines recommend not to certify the driver who has an ICD. This includes a dual pacemaker/ICD, even if the ICD has not been activated.
114
High blood pressure:
A. Is likely to cause a sudden incapacitating event
B. Accompanied by suspected target organ damage requires recommendation of specific therapy by the medical examiner
C. Is unlikely to target the cerebral vasculature
D. Treatment may produce side effects that impair job performance
CORRECT ANSWER: D>> Explanation: Treatment of high blood pressure may produce side effects that impair job performance. Hypertension alone is unlikely to cause sudden collapse, but target organ damage increases the likelihood.
115
Which driver response to ""shortness of breath"" questioning should trigger a more detailed evaluation of the driver, possibly including a consult with an appropriate medical specialist?
A. I become short of breath while walking fast and carrying 50 pounds up a steep incline
B. My shortness of breath resolves after brief (<20 minutes) rest
C. I become short of breath while driving
D. Loading and unloading my cargo results in shortness of breath
CORRECT ANSWER: C>> Explanation: According to guidelines, many drivers may experience shortness of breath (SOB) while performing the nondriving aspects of their work. However, most commercial drivers are not SOB while driving their vehicles. SOB while driving should trigger a more detailed evaluation of the driver.
116
A driver states he was hospitalized 6 months ago for 3 days following an exacerbation of his chronic lung disease. His medications were adjusted and continuous oxygen at 2 liters per minute was added to his treatment regimen. The driver has purchased an oxygen concentrator (portable) and brings a statement from his pulmonologist stating he may return to commercial driving. The examiner should
A. Speak directly to the pulmonologist, then issue certification at 6-month intervals based upon pulmonologist's report from each 6-month follow-up visits
B. Attach copies of the pulmonologist's documentation to the medical examination report form and issue a 1-year certification
C. Disqualify driver since the use of oxygen while driving is prohibited
D. Issue a 1-month certification and request documentation of pulmonary function tests with and without bronchodilators; if acceptable, a 1-year certification may be issued
CORRECT ANSWER: C>> Explanation: Since a driver must be alert at all times, any change in mental state is in direct conflict with highway safety. Even the slightest impairment in respiratory function under emergency conditions (when greater oxygen supply is necessary for performance) may be detrimental to safe driving, and the driver should be disqualified.
117
A driver presents for recertification. Included in the driver's health history is the fact that he/she is receiving dialysis 3 times a week. The driver is compliant with same and with monthly nephrologist follow-ups. The driver is accompanied by documentation from his/her nephrologist that he/she may return to commercial driving without restriction. The examiner should:
A. Issue 6-month certification intervals dependent upon acceptable (laboratory) renal function parameters
B. Attach a copy of the nephrologist's documentation to medical examination report form and issue a 1-year certification
C. Disqualify the driver; if a driver is on dialysis, the driver cannot drive
D. Issue certification at 3-month intervals, to be based on written documentation from the nephrologist at each interval
CORRECT ANSWER: C>> Explanation: If a driver is on dialysis, he/she cannot drive.
118
A driver presents for new certification. Included on the driver's health history is the fact that he had 2 unprovoked seizures 7 years ago. He has been off medication and seizure-free for 3 years. The driver's neurologist has provided him with a statement allowing him to return to commercial driving. The medical examiner should:
A. Temporarily disqualify the driver until laboratory results affirm that the driver is not on an anticonvulsant; if negative, certify for 1 year
B. Disqualify; a driver with epilepsy cannot be certified until/unless the driver has been off medications and seizure-free for at least 10 years
C. Complete the medical exam and provide forms to apply for Seizure Disorder Exemption
D. Attach the neurologist's documentation to the medical examination report form and issue a 1-year certification
CORRECT ANSWER: B>> Explanation: According to regulations, a driver with an established medical history or clinical diagnosis of epilepsy (2 or more unprovoked seizures) does not meet qualification standards and cannot be certified. Current advisory criteria allow that some ""drivers with a history of epilepsy/seizures off antiseizure medication and seizure-free for 10 years may be qualified to drive a commercial motor vehicle in interstate commerce."
119
An Insulin Treated Diabetic driver may be certified for one year if ONLY an endocrinologist completes form MCSA-5870.
A. True
B. False
CORRECT ANSWER: B>> Explanation: The treating clinician, which may include but is not limited to an endocrinologist, may fill out form MCSA-5870 and forward to the FMCSA medical examiner to be determined for certification.
120
Report of a missing or impaired hand, arm, foot, leg, finger, or toe:
A. May require a Skill Performance Evaluation (SPE) prior to certification
B. Is automatically disqualifying
C. Will not affect normal driving tasks
D. Does not require further history-taking or exam findings prior to certification
CORRECT ANSWER: A>> Explanation: A missing or impaired hand, arm, foot, leg, finger, toe (fixed deficit) may require a Skilled Performance Evaluation (SPE) to determine whether the driver still maintains the ability to safely perform normal commercial driving tasks.
121
All of the following questions would appropriately be asked of a driver who reports chronic back pain EXCEPT:
A. Has the driver attempted relief from Dr. Jones, DC (ie, local chiropractor)?
B. How does the pain affect the driver's ability to perform driving and non-driving tasks?
C. What does the driver do to alleviate the pain?
D. Does treatment for the pain interfere with safe driving?
CORRECT ANSWER: A>> Explanation: Recommendation of treatments or treating providers is not included in the role of a medical examiner.
122
A driver has reported regular, frequent, alcohol use on the driver's heath history. The examiner should NOT:
A. Administer the CAGE questionnaire to screen for potential dependency
B. Refer the driver who shows signs of a current alcoholic illness to a specialist
C. Disqualify since drinking and driving don't mix
D. Inquire about quantity and frequency of alcoholic beverages
CORRECT ANSWER: C>> Explanation: If a driver reports regular, frequent alcohol use, the medical examiner should ask about quantity and frequency, or use such tools as the CAGE questionnaire to screen for possible alcohol use problems. The medical examiner should refer the driver who shows signs of a current alcoholic illness to a specialist.
123
A driver states that she has occasional back pain for which she uses oxycodone prescribed to her by her primary care physician, whom the driver sees on an annual basis. The medical examiner should:
A. Disqualify the driver if the medical examiner believes the medication adversely impacts the driver's ability to safely operate a commercial motor vehicle.
B. Issue certification based upon physical exam findings alone, since the medication is legally prescribed.
C. Stop the encounter, request a urine specimen for drug test, and resume examination at a later date if the results are negative.
D. Contact the company designated employee representative to obtain authorization for drug and alcohol testing.
CORRECT ANSWER: A>> Explanation: The medical examiner has the authority to disqualify a driver if he believes that the medication the driver is taking adversely impacts the ability to safely operate a commercial motor vehicle.
124
The vision standard includes all of the following EXCEPT:
A. Depth perception of 40 arc seconds on standard DOT butterfly
B. Distant visual acuity of at least 20/40 (Snellen) in each eye and both eyes with or without corrective lenses
C. Field of vision of at least 70 degrees in the horizontal meridian in each eye
D. Ability to distinguish among the colors of traffic signals and devices showing the standard red, amber, and green
CORRECT ANSWER: A>> Explanation: Vision regulation- Driver must have distant visual acuity of at least 20/40 (Snellen) in each eye, with or without corrective lenses, distant binocular visual acuity of at least 20/40 (Snellen) in both eyes, with or without corrective lenses, field of vision of at least 70 degrees in the horizontal meridian in each eye, and the ability to recognize and distinguish among the colors of traffic signals and devices showing the standard red, amber, and green.
125
Select the true statement:
A. Vision examination by a specialist (ophthalmologist or optometrist) is required for a driver whose peripheral vision is 85 degrees bilaterally
B. A driver may not test without glasses if the glasses are required for reading
C. Trained assistive personnel may perform vision screening tests and record results; however, the medical examiner must sign the medical examination report form, taking responsibility for and attesting to the validity of all documented test results
D. Drivers must remove contact lenses for vision testing during recertification exams only
CORRECT ANSWER: C>> Explanation: Trained assistive personnel may perform vision screening tests and record results. However, the medical examiner must sign the Medical Examination Report form taking responsibility for and attesting to the validity of all documented test results.
126
Which of the following are not disqualifying?
A. Visual acuity of 20/40 in the left eye, 20/25 in the right eye, and 20/30 in both eyes with glasses
B. Use of 1 contact lens to correct distant vision - right eye and use of contact lens correcting near vision - left eye
C. Monocular vision
D. Use of telescopic lenses
CORRECT ANSWER: A>> Explanation: Vision disqualifiers include: monocular vision; use of contact lenses when one lens corrects distant visual acuity and the other lens corrects near visual acuity; use of telescopic lenses; failure to meet any part of the vision testing criteria with one eye or both eyes.
127
Which of the following statements is not true?
A. Vision testing and certification may be completed by an optician
B. Some drivers with monocular vision may be able to be certified if otherwise medically fit for duty and are granted a federal vision exemption certificate
C. If the vision test is performed by a specialist, that provider must complete name, date, telephone number, license number, and state of issue, and must sign the examination form in the appropriate areas
D. A specialist's vision examination may be necessary to obtain adequate evaluation of vision with specialized diagnostic equipment
CORRECT ANSWER: A>> Explanation: Vision testing and certification may be completed by an ophthamologist or optometrist. That provider must fill in the date, name, telephone number, license number with state of issue, and sign the examination form. Vision is the only portion of the driver physical examination that can be performed and certified by a provider other than a medical examiner.
128
A driver presents for new certification. The driver is able to hear a forced whisper at 6.0 feet in the left ear and at 4.5 feet in the right ear. The examiner should:
A. Determine that the driver has satisfactorily met the federal regulation for hearing
B. Proceed to an audiometric test to determine certification
C. Disqualify the driver until a hearing aid for the left ear can be obtained
D. Provide the driver with forms for hearing exemption
CORRECT ANSWER: A>> Explanation: Hearing regulation-A driver must first perceive a forced, whispered voice IN ONE EAR at not less than five feet, OR not have an average hearing loss IN ONE EAR greater than 40 decibels at 500 hertz (Hz), 1,000 Hz and 2,000 Hz.
129
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The results of an audiometric exam are as follows - right ear: 500 Hz=42, 1000 Hz=38, 2000 Hz=36, 4000 Hz=60; left ear: 500 Hz=40, 1000 Hz=50, 2000 Hz=48, 4000 Hz=20. The average decibel loss in the left ear for purposes of the Department of Transportation medical examination is:
A. 46
B. 36.6
C. 39.5
D. 39.3
```
CORRECT ANSWER: A>> Explanation: LEFT EAR: 500 Hz=40; 1,000 Hz=50; 2,000 Hz=48--40+50+48=138/3=46
130
Which statement is incorrect regarding a hearing aid?
A. Required use of a hearing aid must be documented on the medical examination report form
B. A driver may not use a hearing aid to meet the standard
C. A driver requiring a hearing aid usually must go to an audiologist or hearing aid center for (hearing) testing
D. A driver who must use a hearing aid to qualify is required to use a hearing aid while driving a commercial motor vehicle
CORRECT ANSWER: B>> Explanation: A driver may use a hearing aid to meet the standard.
131
A driver states that he ""never (has) high blood pressure in (his) doctor's office,"" and brings documentation from his medical provider of blood pressure readings at 3 different visits of 126/84, 128/78, and 130/80. The examiner should:
A. Explain that only blood pressure readings taken during the driver physical or follow-up examinations may be used for certification decisions, and obtain his own reading(s)
B. Accept the most recently-obtained blood pressure reading as valid, but issue only a 6-month certification
C. Average the 3 readings and document the result on the medical examination report form
D. Disqualify the driver since none of the readings are acceptable
CORRECT ANSWER: A>> Explanation: Only blood pressure readings taken during the driver physical or follow-up examinations may be used for certification decisions.
132
Which statement is not true? A 1-time, 3-month certificate:
A. Is only issued once during a commercial driver's driving career
B. Is granted to a driver whose blood pressure was previously normal, but is now at Stage 2
C. Is granted to a re-certifying driver who had previously received a 1-year certification for stage 1 hypertension who has not achieved a blood pressure ≤140/90
D. May be issued by an examiner using the examiner's clinical expertise and the results of the individual driver's examination
CORRECT ANSWER: A>> Explanation: The issuance of a 1-time, 3-month certificate is a one-time issuance for the recertification period and is not intended to mean once in the driver's lifetime.
133
When a blood pressure reading is a value where the individual systolic and diastolic readings are in different stages:
A. The examiner should classify the reading by the higher stage
B. A second blood pressure reading should be obtained and the average recorded
C. Stage classification should be based on the lowest systolic and lowest diastolic reading obtained in a series of 3 automatic device readings
D. The examiner should classify the reading by the lower stage
CORRECT ANSWER: A>> Explanation: When a blood pressure reading is a value where the individual systolic and diastolic readings are in different stages, the medical examiner should classify the reading by the higher stage.
134
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Which of the following is not a required parameter for a Department of Transportation dip urinalysis.
A. Protein
B. Specific gravity
C. pH
D. Blood
```
CORRECT ANSWER: C>> Explanation: The medical examiner must perform a urinalysis (dipstick test) and test for specific gravity, protein (proteinuria), blood (hematuria), and glucose (glycosuria).
135
Which of the following is a true statement?
A. Trained assistive personnel who obtain urine specimens and record test results must sign the medical examination report form.
B. Urine testing for controlled substances is included in the physical qualifications for the driver examination process.
C. Checking for hematuria is not a required parameter for the driver examination process.
D. The medical examiner must perform a dipstick urinalysis during a Department of Transportation medical examination.
CORRECT ANSWER: D>> Explanation: The medical examiner must perform a urinalysis (dipstick test) and test for specific gravity, protein (proteinuria), blood (hematuria), and glucose (glycosuria).
136
Regarding documentation of the physical exam, which statement is incorrect?
A. A body mass index (BMI) >32 requires testing for sleep apnea
B. Height must be recorded in inches and weight in pounds
C. "No" is checked if the body system is normal
D. "Yes" responses require documentation in detail, including the finding's impact on driving
CORRECT ANSWER: A>> Explanation: The medical examiner must measure and record driver height (inches) and weight (pounds). The physical qualification standards do not include any maximum or minimum height and weight requirements. Height and weight factors should be considered as part of the overall driver medical fitness for duty.
137
Which is the correct statement?
A. Documentation of abnormal findings that are not disqualifying is not required
B. Defer documentation of abnormal findings until additional evaluation results are available
C. Discussion with a driver, including advice to seek additional evaluation of a condition that is not disqualifying, is private and should not be included on the medical examination report form
D. A copy of any supplementary medical evaluation obtained to adequately assess a driver's health should be included with the medical examination report form
CORRECT ANSWER: D>> Explanation: Medical examiner comments should include a copy of any supplementary medical evaluation(s) obtained to adequately assess driver health.
138
At minimum, when examining the eyes, you must check for:
A. Aphakia, nystagmus, and glaucoma
B. Pupillary equality, reaction to light and accommodation, ocular motility, ocular muscle imbalance, extraocular movement, nystagmus, and exophthalmos
C. Retinopathy, extraocular movements, and pupillary response to light
D. Cataracts, macular degeneration, and exophthalmos
CORRECT ANSWER: B>> Explanation: The eye exam must, at a minimum, include checking for pupillary equality, reaction to light and accommodation, ocular motility, ocular muscle imbalance, extraocular movement, nystagmus, and exophthalmos.
139
When examining the heart, evaluation for all of the following must be included EXCEPT:
A. Pitting edema of the lower extremities
B. 12-lead electrocardiogram
C. Murmurs, extra sounds, enlargement
D. Presence of pacemaker and/or automatic defibrillator
CORRECT ANSWER: B>> Explanation: The medical examiner must examine the heart for murmurs, extra sounds, enlargement, and a pacemaker or implantable cardioverter defibrillator and check the lower extremities for pitting edema and other signs of cardiac disease.
140
Further considerations after finding an abnormality indicating that the driver may have a current cardiovascular disease include all of the following EXCEPT:
A. Will the driver be capable of driving if specifically prescribed work restrictions are in place?
B. Is the disease likely to cause symptoms of syncope, dyspnea, collapse, or congestive heart failure?
C. Is the disease progressive?
D. Can the condition be corrected surgically or managed by pharmacologic measures?
CORRECT ANSWER: A>> Explanation: There are no work restrictions permitted. The commercial driver must be able to perform all job-related tasks, including lifting, to be certified.
141
When examining the lungs and chest, determination for the presence of all of the following must be considered EXCEPT:
A. Abnormal chest wall expansion or deformity
B. Presence of abnormal breath sounds
C. Accompanying cyanosis; clubbing of fingers
D. Presence of breast masses and/or nipple discharge
CORRECT ANSWER: D>> Explanation: Breast examination is not part of the commercial driver fitness for duty medical examination
142
The medical examiner, when conducting an exam of the abdomen and viscera, should include all the following EXCEPT:
A. Determining the presence of bruits or masses
B. Determining the presence of enlarged liver and spleen
C. Bedside ultrasonography
D. Determining the presence of significant abdominal wall muscle weakness
CORRECT ANSWER: C>> Explanation: Examination of the abdomen and viscera includes checking for enlarged liver and spleen, masses, bruits, hernia, and significant abdominal wall muscle weakness, as well as checking for tenderness and auscultation of bowel sounds.
143
Which of the following statements is not true?
A. The diagnosis of arterial disease should prompt the examiner to evaluate for the presence of other cardiovascular diseases
B. A driver who has not provided a urine specimen for dipstick urinalysis cannot be certified
C. The driver must be checked for hernias
D. Calf circumference must be documented when evaluating the vasculature of the lower extremities
CORRECT ANSWER: D>> Explanation: Documentation of calf circumference is not a required component of completion of the medical examination report form.
144
Which of the following statements is not true?
A. Presence of sufficient mobility and strength to operate pedals properly must be determined
B. Presence of clubbing or edema must be noted and the presence of an underlying heart, lung, or vascular condition considered
C. Drivers with documented progressive disease of the upper or lower extremities must obtain a Skill Performance Evaluation (SPE) certificate before being certified to drive
D. Presence of sufficient prehension to maintain steering wheel grip must be determined
CORRECT ANSWER: C>> Explanation: Skilled Performance Evaluation certificates are issued only for fixed deficits, not progressive disease deficits.
145
An exam finding that would direct the examiner to further evaluate a driver for decreased sensation, muscle weakness, and/or chronic pain would be:
A. Mid-line longitudinal well-healed surgical scar from L3-5 levels
B. Stretch marks present on anterior thighs
C. Varicosities of bilateral popliteal areas, without inflammation
D. Bounding posterior tibialis pulse on left with dependent rubor
CORRECT ANSWER: A>> Explanation: Physical evidence of previous back surgery would require the examiner to further evaluate for changes in sensation, muscle strength, and/or history of chronic pain and treatment thereof.
146
All of the following should be included in the neurological exam EXCEPT:
A. Evaluation of equilibrium, coordination, and speech pattern
B. Babinski reflex
C. Evaluation for Grey-Turner sign
D. Deep tendon reflexes
CORRECT ANSWER: C>> Explanation: The neurological exam requires examination of the driver for impaired equilibrium, coordination, speech pattern, reflexes, and sensory or positional abnormalities.
147
Discussion with a driver whom the examiner has chosen to certify may include all the following EXCEPT:
A. Expiration information - occurs at midnight on the expiration date listed on the driver's medical examiner's certificate
B. Requirements for 2-week grace period following the expiration date on the driver's medical examiner's certificate
C. Additional requirements associated with certification
D. Reason for periodic monitoring and shortened examination interval
CORRECT ANSWER: B>> Explanation: Discussion with a driver who has been certified may include: reason for periodic monitoring and shortened examination interval; additional requirements associated with certification; and expiration information including its occurrence at midnight on the expiration date and that it has NO grace period.
148
Discussion with a driver whom the examiner has chosen to disqualify or temporarily disqualify may include all of the following EXCEPT:
A. Requirement of a driver to submit the driver's license to the Department of Motor Vehicles as it is currently suspended
B. Steps that can be taken to meet certification standards
C. List of documentation driver must provide to examiner
D. Reason for disqualification
CORRECT ANSWER: A>> Explanation: Discussion with a driver who has NOT been certified may include reason for disqualification and steps that can be taken to meet certification standards. Temporary disqualification reasons include length of waiting period, conditions that could restart the waiting period, and a list of any documentation the driver is to provide to the medical examiner.
149
A medical examiner's recordkeeping requirements include all of the following EXCEPT:
A. Must retain a driver's medical records for a minimum of 3 years
B. Provide a copy of the medical examination report form to the driver who is applying for or renewing a diabetes or vision exemption certificate
C. Provide a copy of the medical examination report form to the driver who is applying for or renewing a Skill Performance Evaluation certificate
D. Provide a copy of the medical examination report form to the Department of Motor Vehicles
CORRECT ANSWER: D>> Explanation: Results of driver physical examination must be documented in accordance with the medical examination report form and the instructions cited in 49 CFR 391.43. Driver medical records must be retained for a minimum of 3 years, and a copy provided to the driver who is applying for, or renewing, a Skill Performance Evaluation certificate, a diabetes exemption certificate or a vision exemption certificate. A copy of the medical examiner's certificate may be provided to a prospective or current employer upon request.
150
All of the following statements regarding the medical examiner's certificate are true EXCEPT:
A. The original medical examiner's certificate must be provided to the driver who the medical examiner examined and found medically fit for duty.
B. A copy of the medical examiner's certificate must be retained by the medical examiner for a minimum of 3 years.
C. The driver must carry an original, copied, or reduced-size copy of the medical examiner's certificate while operating a commercial motor vehicle.
D. A copy of the medical examiner's certificate may be provided to a prospective or current employer upon request only after the driver signs a release.
CORRECT ANSWER: D>> Explanation: Release from a driver is not required when providing a copy of the medical examiner's certificate to a prospective or current employer.
151
The medical examination report form must document all of the following information related to certification status EXCEPT:
A. Length of (shortened) interval and reason for required periodic monitoring
B. Special requirements, eg, corrective lenses, hearing aid
C. Expiration date of Skill Performance Evaluation (SPE) certificate when the SPE certificate is required
D. Certification status maximum of 2 years
CORRECT ANSWER: C>> Explanation: Indication of the required Skill Performance Evaluation (SPE) certificate is sufficient; date of its expiration is not required. The medical examiner's evaluation should have included confirmation that SPE certificate is valid.
152
The treating clinician has a maximum of 45 days to fill out form MCSA-5870 and forward to the Medical Examiner.
A. True
B. False
CORRECT ANSWER: A>> Explanation: Per FMSCA regulations
153
Which of the following statements is not true?
A. Driving within an exempt intracity zone guarantees the driver police protection while driving through areas noted for high crime rates.
B. A medical examiner starts the exemption program application process by first determining if a driver is otherwise qualified except for monocular vision or the use of insulin.
C. Operation of 49 CFR 391.64 applies to a small number of individuals who participated in the FMCSA studies conducted prior to implementation of the medical exemptions program.
D. A medical examiner must disqualify a driver who fails to meet a physical qualification requirement cited in the standards or whom the examiner believes has a medical condition that endangers the health and safety of the driver and the public.
CORRECT ANSWER: A>> Explanation: By checking the ""Driving Within an Exempt Intracity Zone"" option, the examiner certifies that the driver is otherwise medically fit for duty except for the exempted condition, that the exempted condition remains stable, and that the driver remains in medical compliance with the requirements of section 391.62.
154
When a driver is temporarily disqualified due to a condition having a clinical course likely to restore the driver's medical fitness for duty:
A. A medical examiner's certificate reflecting the disqualification and follow-up date should be issued.
B. The follow-up date should be greater than or equal to the waiting period when a recommended waiting period is applicable.
C. The reason for temporary disqualification and treatment to be implemented should be documented.
D. The follow-up date documented should reflect the shortest waiting period if the driver has multiple medical conditions and a waiting period is applicable.
CORRECT ANSWER: B>> Explanation: When the (temporarily) disqualifying condition or treatment has a clinical course likely to restore a driver's medical fitness for duty and a recommended waiting period is applicable, the date should be greater than or equal to the waiting period, or if multiple medical conditions exist, greater than or equal to the longest waiting period-no medical examiner's certificate should be issued.
155
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A driver is taking a medication typically used for hypertension for the driver's anxiety. For what length of time can the driver's certificate be issued?
A. 1 year
B. No certificate can be issued
C. 2 years
D. 6 months
```
CORRECT ANSWER: C>> Explanation: If the driver was taking these medications for hypertension, then only a 1-year certificate could be granted even if his blood pressure was ≤140/90. But, because he is taking them for anxiety, a 2-year certificate could be granted.
156
A driver is taking verapamil for anxiety and states that her condition is well controlled. All of the following are true EXCEPT:
A. The driver may be issued a 1-year certificate
B. The driver must pass all other components of the physical exam in order to be qualified for certification
C. The driver is automatically disqualified
D. The medical examiner must have a letter from the cardiologist stating that the driver is able to drive a commercial vehicle before issuing a certification
CORRECT ANSWER: C>> Explanation: The key here is that you must have something signed from the cardiologist or primary care physician releasing the driver to drive a commercial vehicle.
157
When using Sudafed or other drugs for allergies, a driver may operate a commercial vehicle unless:
A. The medications contain codeine
B. The driver is driving alone without a companion
C. The driver has been taking the medications for < 3 months
D. The medication is in the form of a nasal spray
CORRECT ANSWER: A>> Explanation: As long as the medication does not contain codeine, the driver may be qualified to operate a commercial vehicle.
158
Antibiotics as a class are not a reason to disqualify a driver unless:
A. The antibiotic is being taken for a respiratory infection
B. The driver is on the second round of antibiotic for the same infection
C. The driver experiences dizziness, nausea, or other side effects that may interfere with their driving ability
D. The driver has been on the antibiotic for >6 weeks
CORRECT ANSWER: C>> Explanation: Antibiotics as a classification, have no restrictions. However, the patient may have an infection that causes dizziness, nausea and other side effects that may lead you to give a temporary limited license.
159
All of the following are true about a driver on Coumadin EXCEPT:
A. A driver may be taking Coumadin due to an increased risk of a stroke
B. A thorough history as to any limitations set by the driver's primary care physician should be used as a guide in making your determination
C. A 2-year certificate can be issued
D. Coumadin can be prescribed for a driver who has an increased risk of blood clot in the legs
CORRECT ANSWER: C>> Explanation: A patient on this medication must have at least a 1-month history of well regulated Coumadin. Many times it is prescribed for conditions that could lead to an incapacitating event. You should discuss the reasons for the medication with the primary care physician when making your decision.
160
In order to evaluate a driver's risk of having an incapacitating event when taking medications for asthma or chronic obstructive pulmonary disease, a medical examiner must know all of the following EXCEPT:
A. The length of time the driver has been using an inhaler
B. How often the driver must use an inhaler
C. If it is an inhaled or ingested medication
D. If the driver is stable
CORRECT ANSWER: C>> Explanation: Evaluation with the driver's primary care physician is key. If you are not satisfied that the condition is under control (eg, seasonal asthma), then a limitation until the condition is stable may be necessary.
161
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If a driver on medication for asthma/chronic obstructive pulmonary disease has a statement from a pulmonologist indicating that the driver is stable, what length of certification may the driver receive?
A. 2 years
B. 1 year
C. 3 months
D. 6 months
```
CORRECT ANSWER: B>> Explanation: When evaluating these drivers, you must be careful to question them to confirm that the medications are being used correctly. If they are not used as prescribed, an incapacitating event could occur while driving.
162
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During the physical exam, the medical examiner notes the driver's blood pressure (BP) to be 135/65. The examiner tests the BP 2 times. The driver is taking a beta-blocker to lower the blood pressure. The pressure has been stable for 2 years. What is the length of certificate the driver is qualified to receive?
A. 3 months
B. 6 months
C. 2 years
D. 1 year
```
CORRECT ANSWER: D>> Explanation: If the blood pressure is ≤140/90, even if is stable at this pressure, they can only qualify for a 1-year certificate.
163
```
When a driver has been taking Prilosec for ulcers, the limitation on the license is:
A. 1 year
B. No limitation
C. 3 months
D. 6 months
```
CORRECT ANSWER: B>> Explanation: Medications taken for ulcers have no limitations.
164
A driver comes to a medical examiner for recertification. The driver is in his early 40s and is taking an antiseizure medication for his migraines. All the rest of the physical exam is within the normal ranges. The driver qualifies for:
A. No restrictions
B. Is automatically disqualified until the examiner sees a letter from the driver's primary care physician or neurologist stating that the antiseizure medication is only for migraines; antiseizure medications automatically disqualify
C. 6 months
D. 1 year
CORRECT ANSWER: B>> Explanation: Antiseizure medications automatically disqualify until you see a letter from his primary care physician or neurologist stating that the antiseizure medication is only for migraines.
165
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A driver that the medical examiner saw 1 year ago is here for recertification. Over the past year, the driver quit smoking and is taking ChantixTM. The medical examiner should:
A. Certify the driver for 6 months
B. Certify the driver for 1 year
C. Certify the driver for 2 year
D. Temporarily disqualify the driver
```
CORRECT ANSWER: D>> Explanation: Understanding the side effects of all drugs is important as we make clinical decisions about certification of a driver. The side effects of some medications such as Chantix could be seizures, dizziness and heart arrhythmias. Until the primary care doctor who prescribed the Chantix provides written documentation that driver is no longer taking it, the driver should be temporarily disqualified.
166
A driver is coming for a first time certificate. The driver is middle-aged and has a pacemaker. He brings with him a letter from his cardiologist stating that all cardiac functions are within normal limits. For what length of time can the driver be qualified?
A. A 1-year certificate can be issued
B. Only a 3-month certificate can be issued
C. A 2-year certificate can be issued
D. The driver must be disqualified because of cardiac reasons
CORRECT ANSWER: A>> Explanation: As long as a driver has a written letter from his cardiologist stating that all cardiac function test are within normal limits and that the pacemaker is functioning properly they may be qualified for a 1-year certificate.
167
If the above patient with a pacemaker is taking Coumadin, what would the limitations be?
A. The driver must be on Coumadin for a period of at least 1 month and it must be regulated in order to qualify for a certificate
B. No driver taking Coumadin can be qualified to drive
C. A driver on Coumadin must have at least a 6-month history of well-regulated Coumadin levels
D. Coumadin is not on the list of medications that are regulated
CORRECT ANSWER: A>> Explanation: As long as a patient is regulated on Coumadin for at least 1 month, and has a letter from his primary care physician, it will not disqualify him from a driving certificate.
168
All of the following statements about blood pressure medications are true EXCEPT:
A. There are no limitations as long at the blood pressure is stable
B. The medications can be used to lower blood pressure
C. Some of the medications can be used for anxiety disorders
D. When used for hypertension, a 1-year certificate is the most that can be issued
CORRECT ANSWER: A>> Explanation: Automatically, if a driver is taking any of these medications for hypertension or maintenance of hypertension, then only a 1-year certificate can be granted.
169
All of the following statements about Humulin, Lantus, Novolin, and Humalog are true except:
A. These medications are only limiting if the blood sugars are not controlled
B. These are insulin-containing preparations
C. Drivers admitting to taking these drugs are immediately disqualified
D. These medications are often used when other medications used to control blood sugars have failed
CORRECT ANSWER: A>> Explanation: Some medications used to control blood sugars contain insulin and others do not. Medications that DO NOT contain insulin DO NOT disqualify a driver. Those that DO contain insulin are an automatic disqualifier.
170
A driver presenting for recertification tells the medical examiner that he has cancer and has been treated with chemotherapy and radiation. All of the following are true in this case except:
A. The examiner must consider the driver's ability to function safely when making the examiner's certification recommendations
B. The use of chemotherapy and radiation do not automatically disqualify a driver
C. A driver with cancer who is currently undergoing cancer treatment of any kind is automatically disqualified
D. Cancer is not a disqualifier
CORRECT ANSWER: C>> Explanation: The key here is to qualify the driver based on their ability to function safely. You should look at the side effects of any treatment or drugs the driver is undergoing and possibly issue a shorter certification time.
171
A driver underwent coronary artery bypass graft surgery 4 months ago. All of the following conditions must be met for the driver to be certified except:
A. The driver must be off all medications
B. The CABG procedure must have been at least 3 months ago
C. The left ventricular ejection fraction must be ≥40%
D. The driver must have approval by the their cardiologist
CORRECT ANSWER: A>> Explanation: The 3-month delay in returning to work is to allow the sternal incision to heal. The driver must also be asymptomatic and be tolerating all medications.
172
A medical examiner is temporarily disqualifying a driver due to multiple medical conditions. Which of the following statements are true about selecting the appropriate waiting period?
A. The examiner should select the most recent condition for which the driver has started treatment and use that as the examiner's guide when selecting the waiting period.
B. Whenever the examiner is temporarily disqualifying a driver, the examiner must use the 3-month waiting period.
C. The examiner should select the waiting period that is equal to the longest waiting period when there are multiple conditions or medications involved.
D. Before issuing a certification, the examiner must have a letter from the cardiologist stating that the driver is able to drive a commercial vehicle.
CORRECT ANSWER: C>> Explanation: Many times we will be evaluating drivers with multiple conditions or medications. For the safety of the driver and the public, we must choose the condition or medication that has the longest waiting period and use that as our guide.
173
When discussing the health history with the driver, the medical examiner must:
A. Give the examiner's opinion about the profession of commercial vehicle drivers
B. Be careful to not ask questions about pregnancy if the driver is a woman
C. Document the examiner's discussion
D. Limit the discussion to how the driver operates the truck or bus that they will be driving
CORRECT ANSWER: C>> Explanation: Regulations state you must document your discussion with the driver about their medical fitness for driving, which would cover all of these questions.
174
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Of the 4 things the examiner is testing for on the urinalysis, which of them will have actual numbers that the examiner must write in on the physical exam form?
A. Glucose
B. Specific gravity
C. Protein
D. Blood
```
CORRECT ANSWER: B>> Explanation: When comparing the testing strip to the guide found on the container, specific gravity will have numbers to choose from, and you must write down the number that most correctly responds to the color of the test strip.
175
```
All of the following are complications associated with varicose veins except:
A. Decrease in leg circumference
B. Chronic venous insufficiency
C. Leg ulcerations
D. Recurrent deep vein thrombosis
```
CORRECT ANSWER: A>> Explanation: Varicose veins are an indication that there may be a vascular problem. They tend to get worse over time, and can become swollen or inflamed (thrombophlebitis).
176
```
The vision test includes tests for all of the following except:
A. Night vision acuity
B. Central visual acuity
C. Peripheral vision
D. Color vision
```
CORRECT ANSWER: A>> Explanation: The Snellen chart measures static central vision acuity. The peripheral vision requirement is 70 degrees in the horizontal meridian for each eye, and the color vision requires recognizing and distinguishing among red, amber and green.
177
All of the following are true statements about monocular vision except that it:
A. Occurs when the vision requirements are met in only 1 eye
B. Is not automatically disqualifying
C. Causes deficiencies in contrast recognition
D. Causes deficiencies in depth perception compared to binocular vision
CORRECT ANSWER: B>> Explanation: Monocular vision is disqualifying. If the driver is otherwise qualified, they may want to apply for a federal vision exemption.
178
All of the following can alter how a medication may affect a driver except:
A. The size of the tablet or capsule
B. Sleep deprivation or poor quality of sleep
C. Long and irregular work hours
D. Long periods of time without food
CORRECT ANSWER: A>> Explanation: Medications have instructions that must be followed. Some are to be taken with food, others without. Most require a constant steady dose to be in the patients system. If the patient misses a dose and then ""doubles"" up, they can have serious side effects. Sticking to a schedule can be difficult and you must question any driver on medications about this.
179
During the physical exam, a medical examiner finds that a driver has an undiagnosed medical condition that does not disqualify the driver from driving. The examiner should:
A. Refer the driver to a primary care physician for diagnosis and treatment
B. Make a diagnosis for that condition
C. Treat the driver for that condition before the examiner certifies the driver
D. Just ignore it as it is not part of the Department of Transportation physical exam requirements
CORRECT ANSWER: A>> Explanation: The purpose of the Department of Transportation physical exam is to examine the drivers medical fitness for duty, not diagnosing and treating personal medical conditions.
180
```
Which of the following is not included in the medical profile of an average truck or bus driver?
A. Less healthy than the average person
B. More than 2 medical conditions
C. Cardiovascular disease prevalence
D. More active than the average person
```
CORRECT ANSWER: D>> Explanation: The profile of the average driver is similar to the general population; however, the medical profile shows them to be less active, have >2 medical conditions, and be cardiovascular disease prevalent.
181
When a driver is on any medications, a medical examiner is responsible for educating the driver for all of the following EXCEPT:
A. How to read the medication warning labels
B. Monitoring and not neglecting conditions that could result in serious illnesses or a disqualification in the future
C. Whether the driver should continue to take their medications
D. The side effects of all drugs, including prescriptions and over-the-counter medications
CORRECT ANSWER: C>> Explanation: As a medical examiner, you are obligated to determine if the driver can safely operate a commercial vehicle. You are responsible to help promote public safety by educating the driver in these areas.
182
```
Complications from hypoglycemia or hyperglycemia can include all the following EXCEPT:
A. Drowsiness
B. Hyperactivity
C. Semi-consciousness
D. Diabetic coma or insulin shock
```
CORRECT ANSWER: B>> Explanation: Drivers using medications containing insulin have the risk of using too much or too little medication. This can lead to an incapacitating event such as those listed.
183
All of the following statements in relation to anti-inflammatory and/or arthritis medications are true EXCEPT:
A. A driver can only be issued a 1-year certificate if he/she is taking anti-inflammatory and/or arthritis medications due to potential side effects
B. These medications have the potential side effect of sleepiness/fatigue
C. There is no limitation on issuing a certification as long as the side effects do not interfere with safe driving
D. These medications are prescribed to alleviate inflammation
CORRECT ANSWER: A>> Explanation: Some of these drugs include the corticosteroids, hyaluronic acid products (used in knee injections) and nonsteroidal anti-inflammatory drugs to name a few. As long as the side effects do not interfere with safe driving, there are no limitations.
184
```
All of the following conditions may interfere with oxygen exchange and result in some type of incapacitating event EXCEPT:
A. Hypertension
B. Emphysema
C. Chronic asthma
D. Carcinoma
```
CORRECT ANSWER: A>> Explanation: If during the history and physical exam you detect a medical condition such as these and feel it may interfere with the driver's ability to safely drive, you should refer the driver to a specialist for further evaluation.
185
To confirm that a driver has an elevated blood pressure, the medical examiner should:
A. Test the driver sitting down and then re-test the driver standing up
B. Test the driver at the beginning and then again at the end of the physical exam
C. Test the driver on at least 2 subsequent measurements and on different days
D. Test the driver during the physical exam, 2 times on each arm
CORRECT ANSWER: C>> Explanation: To confirm that a driver has an elevated blood pressure you should take the blood pressure more than once during a visit, then ask them to come back for additional testing on a different day. A 1-time reading of an elevated blood pressure does qualify for a diagnosis of hypertenstion.
186
All of the following statements on performing the hearing test are true EXCEPT:
A. The driver must be able to hear a forced whisper at a distance of ≥7 feet
B. The medical examiner should not use only sibilants ("s" sounds)
C. The ear NOT being tested should be covered
D. If the driver fails the whispered voice test, the driver should be tested using the audiometric test
CORRECT ANSWER: A>> Explanation: A driver must be able to hear a forced whisper in the testing ear at not <5 feet in order to qualify for certification. If they do not, you should refer them for testing using the audiometric device.
187
Medical guidelines are established for use in clinical settings. All of the following about these guidelines are accurate EXCEPT:
A. They are laws and must be followed
B. The guidelines have recommendations for examiners to follow in order to help make "best practice" decisions
C. They use advisory criteria and medical conference reports to help make recommendations
D. Guidelines are not laws that must be followed like the "medical standards" are
CORRECT ANSWER: A>> Explanation: It is important to distinguish between ""medical standards,"" which are laws that must be followed and ""Guidelines,"" which are NOT law, but are intended as best practice for the examining doctor.
188
If a medical examiner disqualifies a driver, the examiner should do all of the following except:
A. Discuss the reason the driver is being disqualified, including what steps the driver can take to meet the federal qualification requirements
B. Recertify only when the examiner determines that the driver can now meet the federal requirement for certification
C. Issue the driver a certificate with multiple limitations
D. Do not issue a medical examiner's certificate
CORRECT ANSWER: C>> Explanation: There are only 2 options: either the driver is issued a medical certificate or the driver is disqualified. If they are disqualified, they are not to be issued a certificate. It is important for them to understand why you made that decision and then make referrals to the appropriate physician for evaluation and treatment.
189
```
Of the 13 medical standards for commercial vehicle drivers, how many are nondiscretionary?
A. 9
B. 11
C. 4
D. 6
```
CORRECT ANSWER: C>> Explanation: The 4 nondiscretionary medical standards are diabetes mellitus, epilepsy, vision, and hearing.
190
If a driver wearing a hearing aid fails the forced whisper test, the driver can be certified for:
A. The driver must be sent for an audiometry test to determine certification
B. Cannot be certified
C. 1 year
D. 2 years
CORRECT ANSWER: A>> Explanation: A driver is certified until they fail the audiometry test, and then, they would be disqualified.
191
```
A driver's hearing was tested using International Organization for Standardization (ISO) with the following results: 31 at 500 Hz, 32 at 1000 Hz, and 27 at 2000 Hz. What would the driver's readings be using the American National Standards Institute (ANSI) standard?
A. 22.5, 22.0, 13.0
B. 17.0, 22.0, 18.5
C. 21.0, 18.0, 18.5
D. 17.0, 23.5, 17.0
```
CORRECT ANSWER: B>> Explanation: When switching from ISO to ANSI, at 500 Hz, subtract 14, at 1000 Hz, subtract 10, and at 2000 Hz, subtract 8.5.
192
```
Which of the following is not used to treat benign positional vertigo?
A. Anticholinergics
B. Steroids
C. Benzodiazepines
D. Sympathomimetics
```
CORRECT ANSWER: B>> Explanation: Steroids are used to treat infections/inflammation.
193
```
The most common cause of retinopathy is which of the following?
A. Sickle cell disease
B. Systemic lupus
C. Diabetes mellitus
D. Carcinoma
```
CORRECT ANSWER: C>> Explanation: All are causes of retinopathy, but diabetes mellitus is the most common cause.
194
A driver has a vision exemption due to monocular vision. How often must the driver renew the exemption?
A. It is always good as long as the driver passes the vision requirements with the good eye
B. Every 2 years
C. Every year
D. Every 3 years
CORRECT ANSWER: B>> Explanation: The exemption is good for a maximum of 2 years.
195
Which of the following is a classification for type 2 diabetes?
A. Glucose control counter regulatory mechanisms are often severely compromised
B. May preserve glucose control counter mechanism for many years with lifestyle changes and oral hypoglycemic medications
C. No insulin produced
D. Insulin replacement therapy required
CORRECT ANSWER: B>> Explanation: The other options are classifications of type 1 diabetes.
196
Which of the following is not a condition caused by hypoglycemia as defined by the FMCSA?
A. Loss of consciousness
B. Period of impaired cognitive function that appears without warning
C. Rapid heart rate
D. Seizure
CORRECT ANSWER: C>> Explanation: Rapid heart rate is a condition caused by mild hypoglycemia.
197
A driver comes in for a Department of Transportation physical exam and is taking Byetta to control her diabetes. The driver can be certified for how long?
A. Cannot be certified
B. Certified for a year after the driver shows a diabetes exemption form
C. 1 year
D. 2 years
CORRECT ANSWER: C>> Explanation: It is not considered insulin and approved by the FMCSA.
198
```
A driver presents for a physical and has a blood pressure reading of 143/88. The driver is classified as:
A. Stage 1 hypertension
B. Borderline hypertension
C. Stage 2 hypertension
D. Normal
```
CORRECT ANSWER: A>> Explanation: Always use the guideline for the higher number.
199
A driver with stage 2 hypertension has a 1-time 3-month certificate that is expiring. Currently the driver's blood pressure is 140/90. For how long can the driver now be certified?
A. Cannot be certified
B. 1-year certificate from original physical
C. 1 year from date of recheck
D. 2 years
CORRECT ANSWER: A>> Explanation: One year based on ≤140/90 blood pressure, from date of original exam when the 1-time 3-month certification was given.
200
```
For which of the following is hypertension not a risk factor?
A. Diabetes mellitus
B. Cardiovascular disease
C. Peripheral vascular disease
D. Chronic renal insufficiency
```
CORRECT ANSWER: A>> Explanation: The other options are risk factors, while diabetes is not.
201
```
A driver is taking heparin for treatment after experiencing a stroke. For how long can the driver be certified?
A. 2 years
B. 6 months
C. Cannot be certified
D. 1 year
```
CORRECT ANSWER: C>> Explanation: Cardiac Conference Guidelines. If an anticoagulant is being taken to prevent cerebrovascular accident or post CVA, driver cannot be certified. However if driver is taking this medication to prevent cardiovascular issues, with specialists note of approval and monthly INR results, the driver may be certified.
202
Which of the following locations are at the greatest risk for post-stroke seizures?
A. Cortical
B. Cerebellum
C. Brainstem
D. All strokes are at great risk of seizures
CORRECT ANSWER: A>> Explanation: Cortical deficits are at the highest risk for seizure while cerebellum and brainstem deficits are the least likely to cause seizure.
203
```
A driver with dementia can be certified for how long?
A. 1 year with an appeal
B. Cannot be certified
C. 1 year
D. 2 years
```
CORRECT ANSWER: B>> Explanation: Due to the variation in progression.
204
For which of the following may a driver with multiple sclerosis (MS) appeal disqualification?
A. Course of MS is benign with minimum dysfunction at least 3 years post-diagnosis
B. There has been a new lesion on 2 studies within 1 year
C. Neurological signs are functionally insignificant
D. There has been a small amount of progression of disease
CORRECT ANSWER: C>> Explanation: If signs are small or are nonexistent, they can apply for appeal.
205
```
Which congenital myopathy can be treated?
A. Nemaline myopathy
B. Centronuclear myopathy
C. Myotubular myopathy
D. Central core disease
```
CORRECT ANSWER: B>> Explanation: Centronuclear myopathy is the only one that has effective treatment.
206
```
Which of the following medications is not immediately disqualifying when it comes to treating headaches?
A. Antihistamines
B. Propoxyphene
C. Benzodiazepine
D. Analgesics that combine sedatives
```
CORRECT ANSWER: A>> Explanation: Antihistamines use a case-by-case disqualification and are not automatically disqualified.
207
When can a driver be certified after having seizures?
A. Seizure free and on anticonvulsants for 5 years
B. Seizure free and off anticonvulsants for 2 years
C. Seizure free and on anticonvulsants for 2 years
D. Seizure free and off anticonvulsants for 5 years
CORRECT ANSWER: D>> Explanation: The recommendation is to be seizure free and off anticonvulsants for 5 years to be qualified.
208
```
A driver presenting into the office for a physical recently had surgery done that penetrated the dura, so for how long can the driver be certified?
A. 6 months
B. Cannot be certified
C. 1 year
D. 2 years
```
CORRECT ANSWER: B>> Explanation: The risk of seizure following surgery that penetrates the dura is the same as that of severe head trauma. Therefore, the driver is disqualified.
209
```
How many different exemption programs are there for drivers?
A. 1
B. 3
C. 2
D. None
```
CORRECT ANSWER: C>> Explanation: There are 2 exemption programs, the diabetes exemption and the vision exemption.
210
```
As a medical examiner, how many of 49 CFR 391.41 qualification standards can a driver not meet before the driver is disqualified?
A. Does not meet ≥1
B. Does not meet ≥2
C. Does not meet ≥3
D. Does not meet ≥4
```
CORRECT ANSWER: A>> Explanation: The driver is disqualified if they do not meet one or more.
211
When a driver is disqualified and does not meet standards, what should the medical examiner do with the medical examiner's certificate?
A. The examiner never issues a certificate to the driver.
B. The examiner does not issue the certificate
C. The examiner gives the driver the certificate marking that the driver is disqualified
D. The examiner issues a certificate for the employer to keep for their records.
CORRECT ANSWER: B>> Explanation: Because the driver is disqualified and therefore does not need a certificate, the examiner would not issue one.
212
Which of the following would not be passing the vision standard?
A. Distant binocular visual acuity of at least 20/40 in both eyes with or without corrective lenses
B. Field of vision of at least 60 degrees in horizontal meridian in each eye
C. Ability to recognize the colors of the traffic signals
D. Distant visual acuity of at least 20/40 in each eye with or without corrective lenses
CORRECT ANSWER: B>> Explanation: Fields of vision must be at least 70 degrees in each eye.
213
Which of the following agents is used to treat glaucoma?
A. Topical cyclosporine
B. Mast cell stabilizers
C. Vascular endothelial growth factor inhibitors
D. Carbonic anhydrase
CORRECT ANSWER: D>> Explanation: The only one to treat glaucoma is carbonic anhydrase. The others are used to treat either dry eyes, allergic conjunctivitis, or macular degeneration.
214
```
The Snellen chart should be how many feet away from the driver?
A. 20 feet
B. 15 feet
C. 25 feet
D. 30 feet
```
CORRECT ANSWER: A>> Explanation: The Snellen chart should be 20 feet away, as represented by the numerator.
215
If a driver is tested with an audiometric device, what does the driver need to pass?
A. Have an average hearing loss in 1 ear ≤40 decibels
B. Have an average hearing loss in 1 ear ≥40 decibels
C. Have an average hearing loss in 1 ear ≤30 decibels
D. Have an average hearing loss in 1 ear ≥30 decibels
CORRECT ANSWER: A>> Explanation: To pass the test, a driver needs to have an average hearing loss ≤40 decibels. The test is done at 500, 1000, and 2000 Hz.
216
A driver fails the forced whisper test during his physical. What is the next step that the medical examiner should take?
A. An audiometry test should be the next test performed
B. The driver fails the physical exam and it should be marked on the form
C. The driver should be referred out for hearing aids
D. The driver would pass the physical exam
CORRECT ANSWER: A>> Explanation: If the driver fails one of the two tests, the medical examiner would administer the next to determine if the driver passes the exam.
217
```
Which of the following medications is not used to treat anti-acute benign positional vertigo?
A. Benzodiazepines
B. Anticholinergics
C. Sympathomimetics
D. Steroids
```
CORRECT ANSWER: D>> Explanation: Steroids are used to treat infection and inflammation.
218
Which of the following is a symptom of cataracts?
A. Deficits in peripheral vision
B. Atrophy of the optic nerve
C. Interference with detailed central vision
D. Diminished visual acuity
CORRECT ANSWER: D>> Explanation: The slow, progressive opacification of the crystalline lens of the eye distorts the optical passage of light to the retina resulting in diminished visual acuity.
219
```
How long does a driver need to be symptom free when the driver has a diagnosis of chronic peripheral vestibulopathy?
A. Symptom free for 6 months
B. Symptom free for 2 months
C. Symptom free for 3 months
D. Automatic disqualification
```
CORRECT ANSWER: B>> Explanation: The Conference on Neurological Disorders and Commercial Drivers report recommends that the driver may be certified after being symptom free for 2 months.
220
```
A driver has been diagnosed with Ménière's disease. For how long can the driver be certified?
A. Cannot be certified
B. 1 year
C. 2 years
D. 6 months
```
CORRECT ANSWER: A>> Explanation: The Conference on Neurological Disorders and Commercial Drivers report recommends disqualification when there is a diagnosis of Ménière's disease.
221
```
A driver presents to the clinic for a physical. The driver's blood pressure is 181/110. For how long can the driver be certified?
A. 6 months
B. 1 year with an appeal
C. Cannot be certified
D. 3 months
```
CORRECT ANSWER: C>> Explanation: An individual diagnosed with stage 3 hypertension (blood pressure [BP] ≥180/110) should not be certified until his/her BP is reduced to ≤140/90, and may be recertified every 6 months.
222
```
A driver who is taking antihypertensive therapy reduces his/her risk of all of the following diseases EXCEPT:
A. Heart failure
B. Diabetes mellitus
C. Stroke
D. Myocardial infarction
```
CORRECT ANSWER: B>> Explanation: The Chicago Heart Association Detection Project in Industry found that antihypertensive therapy reduces the incidence of stroke, myocardial infarction, and heart failure.
223
A driver presents to the clinic for a physical, and while the examiner is performing the exam, the driver's blood pressure is 142/93. What is the examiner's next step?
A. Retake the blood pressure later in the exam
B. Give the driver a 1-year certificate
C. Give the driver a 3-month certificate
D. Refer the driver out to see a medical doctor about antihypertensive therapy
CORRECT ANSWER: A>> Explanation: For every certification and recertification examination you must confirm blood pressure >139/89 with a second measurement taken later during the examination.
224
```
A new driver presents to the clinic for a new Department of Transportation physical with a blood pressure of 142/91. What would the driver get for certification?
A. 3 months
B. Cannot be certified
C. 1 year
D. 2 years
```
CORRECT ANSWER: C>> Explanation: Recommend to certify for 1 year if it is the first examination at which the driver has blood pressure equivalent to stage 1 hypertension.
225
```
A driver presents to the examiner's office with a 3-month certification that is expiring. The driver's blood pressure is 145/94. What is recommended in regard to certification?
A. 6-month certificate
B. Cannot be certified
C. 1-year certificate
D. 2-year certificate
```
CORRECT ANSWER: B>> Explanation: It is recommended not to certify a driver that has had a 1-time 3-month certificate for elevated BP or hypertension and BP >140/90.
226
A driver, whose 3-month certificate is about to expire, comes into the clinic with a blood pressure <140/90. For how long can the driver be certified?
A. 6 months
B. 1 year from the initial exam
C. 1 year from the end of the 3-month certificate
D. 2 years
CORRECT ANSWER: B>> Explanation: If the driver at follow-up qualifies, a 1-year certificate will be issued from the date of the initial examination, not the expiration date of the 1-time, 3-month certificate.
227
```
Which of the following is not a cognitive demand for drivers?
A. Quick reactions
B. Appropriate behavior
C. Coordination
D. Communication skills
```
CORRECT ANSWER: C>> Explanation: Coordination is a physical demand for drivers.
228
```
A driver is taking Coumadin for 1 year and has a copy of his international normalized ratio results at the examination. For how long can the driver be certified?
A. Maximum 1 year
B. Maximum 2 years
C. Cannot be certified
D. Maximum 6 months
```
CORRECT ANSWER: A>> Explanation: As long as the medication is stabilized and they have monthly international normalized ratio testing, the driver can be certified for 1 year.
229
```
A driver is taking an anticonvulsant for seizures. For how long can the driver be certified?
A. Cannot be certified
B. 1 year
C. 2 years
D. 6 months
```
CORRECT ANSWER: A>> Explanation: The driver should be disqualified when anticonvulsant therapy is used to control or prevent seizures. Even with effective therapy, there is still a risk for a seizure should the medication be missed inadvertently.
230
```
In general, the risk for subsequent unprovoked seizures is greatest in what following acute insult?
A. First 2 years
B. First 5 years
C. First 2 months
D. First 3 months
```
CORRECT ANSWER: A>> Explanation: In general, the risk for subsequent unprovoked seizures is greatest in the first 2 years following the acute insult.
231
```
A driver had a subarachnoid hemorrhage without risk of seizure. How long can the driver be certified?
A. 6 months
B. Cannot be certified
C. 1 year
D. 2 years
```
CORRECT ANSWER: C>> Explanation: A driver can be certified a minimum of 1 year after a subarachhoid hemorrhage as long as they are seizure free and off anticonvulsant medication.
232
```
A driver has suffered from childhood febrile seizures. What is the maximum time for which the driver can be certified?
A. Cannot be certified
B. 6 months
C. 2 years
D. 1 year
```
CORRECT ANSWER: C>> Explanation: If the history of seizures is limited to childhood febrile seizures, the driver can be certified for a maximum of 2 years.
233
Using the forced whisper test, which of the following is not a step when checking hearing in the right ear?
A. Have the driver cover the right ear
B. Ask the driver to repeat the whispered sequence
C. Stand to the side or behind the driver to eliminate visual cues
D. From the measured 5-foot distance from the right ear, exhale fully and then whisper a sequence of words, numbers, or letters
CORRECT ANSWER: A>> Explanation: When testing the right ear, the driver would cover the left ear.
234
```
For how long can a driver diagnosed with nonfunctioning labyrinth be certified?
A. 1 year
B. 2 years
C. 6 months
D. Cannot be certified
```
CORRECT ANSWER: D>> Explanation: The Conference on Neurological Disorders and Commercial Drivers report recommends disqualification when there is a diagnosis of nonfunctioning labyrinth.
235
```
A driver who has come in for a physical was previously diagnosed with stage 3 hypertension. The driver's current blood pressure is <140/90, and he is on medication. For how long can the driver be certified?
A. 6 months
B. 1 year
C. 2 years
D. Cannot be certified
```
CORRECT ANSWER: A>> Explanation: As long as the driver is on medication and it is well tolerated and the blood pressure is under 140/90, they can be certified for a maximum of 6 months.
236
A driver who previously had high blood pressure related to pheochromocytoma had surgery to correct the pheochromocytoma. How long must the driver wait before she can be certified?
A. 6 months
B. 1 month
C. There is no wait, and the driver can be certified immediately
D. 3 months
CORRECT ANSWER: D>> Explanation: There is a minimum 3-month wait after post-surgical correction.
237
```
What is the frequency of abdominal aortic aneurysms?
A. 2:1 females to males
B. 3:1 males to females
C. 3:1 females to males
D. 2:1 males to females
```
CORRECT ANSWER: B>> Explanation: The majority of abdominal aortic aneurysms (AAAs) occur in the sixth and seventh decades of life and occur more frequently in males than in females by a 3:1 ratio.
238
```
A driver presents to the office post-surgery for correction of an abdominal aortic aneurysm. How long does the driver need to wait before being certified?
A. 3 months
B. 1 month
C. 6 months
D. 1 year
```
CORRECT ANSWER: A>> Explanation: The minimum wait is 3 months for post-surgical repair of an aneurysm.
239
```
A driver is on anticoagulant therapy. For how long can the driver be certified?
A. Cannot be certified
B. Maximum of 6 months
C. Maximum of 1 year
D. Maximum of 2 years
```
CORRECT ANSWER: C>> Explanation: A driver that is taking anticoagulation therapy can be certified for a maximum of 1 year as long as the medication is tolerated.
240
```
Which of the following is not a side effect of anticonvulsant medications?
A. Increased reflex
B. Cognitive deficits
C. Unsteadiness
D. Sedation
```
CORRECT ANSWER: A>> Explanation: Anticonvulsants cause a decrease in reflex responses and not an increase.
241
```
What is the maximum time a driver can be certified if the driver is taking anticonvulsants?
A. 1 year
B. 6 months
C. Cannot be certified
D. 2 years
```
CORRECT ANSWER: D>> Explanation: The driver can be certified for 2 years as long as the medication is well tolerated and not used to prevent seizures.
242
```
A driver had a mild insult with early seizures. How long is the wait for the driver before being certified?
A. Minimum of 5 years
B. Cannot be certified
C. Minimum of 2 years
D. Minimum of 1 year
```
CORRECT ANSWER: C>> Explanation: There is a minimum wait of 2 years seizure free and off anticonvulsant medication following mild insult with early seizures.
243
```
A driver who had a stroke 1 month ago presents to your office for a physical. This driver is at risk for seizures. How long is the wait before this driver can be certified?
A. 2 years
B. Cannot be certified
C. 5 years
D. 1 year
```
CORRECT ANSWER: C>> Explanation: There is a minimum wait of 5 years seizure free and off anticonvulsant medication following stroke with risk of seizures.
244
```
A driver presents to the office for a Department of Transportation physical. A month ago, the driver had surgery to repair an abdominal aortic aneurysm. The following week, the driver suffered a stroke. The driver is not at risk for seizures following the stroke. How long does the driver have to wait to be certified?
A. 1 year
B. 2 years
C. 3 months
D. 6 months
```
CORRECT ANSWER: A>> Explanation: If >1 waiting period applies (because of multiple conditions or other comorbid diseases), examine the driver for certification after the completion of the longest waiting period.
245
```
A driver has been diagnosed with epilepsy. For how long can the driver be certified?
A. 6 months
B. Cannot be certified
C. 1 year
D. 2 years
```
CORRECT ANSWER: B>> Explanation: A driver who has a current clinical diagnosis of epilepsy cannot be certified due to epilepsy resulting in loss of voluntary control, which may lead to loss of consciousness and/or seizures.
246
Which of the following is the exception for a driver with epilepsy to be certified?
A. 5 years off anticonvulsant medication and seizure free
B. The medication is well tolerated
C. 10 years off anticonvulsant medication and seizure free
D. The driver fills out an exemption form
CORRECT ANSWER: C>> Explanation: The driver has completed a waiting period of 10 years off anticonvulsant medication and is seizure free. If you, as the medical examiner, believe that the nature and severity of the medical condition of the driver does not endanger the health and safety of the driver and the public, the driver can be certified.
247
```
Which of the following headaches may not interfere with a driver's ability to drive a commercial motor vehicle?
A. Tension
B. Cluster
C. Sinus
D. Migraine
```
CORRECT ANSWER: C>> Explanation: The following types of headaches may interfere with the ability to drive a commercial motor vehicle safely: migraines, tension-type headaches, cluster headaches, and post-traumatic head injury syndrome.
248
```
A driver who experiences migraine headaches presents to the office for a physical examination. What is the maximum time for which the driver can be certified?
A. 6 months
B. 2 years
C. 1 year
D. 3 months
```
CORRECT ANSWER: B>> Explanation: If you, as the medical examiner, believe that the nature and severity of the medical condition of the driver does not endanger the health and safety of the driver and the public, then the driver can be certified for a maximum of 2 years.
249
```
A driver has 1 unprovoked seizure. What is the timeframe between the first and second unprovoked seizure before the driver would receive a diagnosis with epilepsy?
A. 2 seizures within 5 years
B. 2 seizures within 10 years
C. The time frame doesn't matter
D. 2 seizures in 1 year
```
CORRECT ANSWER: C>> Explanation: A second unprovoked seizure, regardless of the elapsed time between seizures, would constitute a medical history of epilepsy, and the driver would no longer meet the physical requirements.
250
```
Which of the following is not one of the most common medications to treat vertigo?
A. Anti-inflammatory medications
B. Benzodiazepines
C. Antihistamines
D. Phenothiazines
```
CORRECT ANSWER: A>> Explanation: The most common medications used to treat vertigo are antihistamines, benzodiazepines, and phenothiazines.
251
```
A driver has been diagnosed with benign positional vertigo. How long does the driver need to be asymptomatic before he/she can be certified?
A. 2 months
B. 1 month
C. 3 months
D. 6 months
```
CORRECT ANSWER: A>> Explanation: The minimum wait is 2 months for a driver who has been diagnosed with benign positional vertigo.
252
```
A driver who experiences cluster headaches comes into the examiner's office for a Department of Transportation physical. How often should the driver be recertified?
A. Cannot be recertified
B. Semi-annually
C. Biennially
D. Annually
```
CORRECT ANSWER: C>> Explanation: The driver should have at least biennial medical examinations.
253
Which of the following health-care professionals are able to perform vision tests?
A. Only a medical examiner
B. Medical examiner, ophthalmologist, and optometrist
C. Medical examiner and optometrist
D. Ophthalmologist and optometrist
CORRECT ANSWER: B>> Explanation: A medical examiner, ophthalmologist, or optometrist may perform and certify vision test results.
254
```
A driver presents for a physical. When having vision tested using the Snellen chart, the driver can see 20/20 in the right eye, 20/50 in the left eye, and both eyes vision is 20/25. For how long can the driver be certified?
A. 1 year
B. 2 years
C. 6 months
D. Cannot be certified
```
CORRECT ANSWER: D>> Explanation: Monocular vision occurs when the vision requirements are met in only one eye, with or without the aid of corrective lenses, regardless of cause or degree of vision loss in the other eye. Therefore, this driver would be disqualified since they did not pass the test in the left eye.
255
Which of the following is not used to treat macular degeneration?
A. Mast cell stabilizers
B. Antioxidants
C. Zinc
D, Vascular endothelial growth factor inhibitors
CORRECT ANSWER: A>> Explanation: Mast cell stabilizers are used to treat allergic conjunctivitis.
256
A driver who wears a hearing aid fails the forced whisper test. What is the examiner's next step?
A. To use the examiner's discretion on determining the amount of time for the driver's certificate
B. Refer to an audiologist, otolaryngologist, or hearing aid center
C. Cannot be certified
D. Have the driver fill out an exemption form so he/she is able to drive
CORRECT ANSWER: B>> Explanation: When a driver who wears a hearing aid is unable to pass a forced whisper test, referral to an audiologist, otolaryngologist, or hearing aid center is required.
257
What is the maximum time that a driver who passes the hearing test but wears hearing aids can be certified?
A. Cannot be certified
B. The driver must have an exemption to be certified
C. 2 years
D. 1 year
CORRECT ANSWER: C>> Explanation: The driver who uses a hearing aid to qualify must wear a hearing aid while driving, but they can be certified for a maximum of 2 years.
258
```
A driver who has blood pressure of 162/101 is classified as having what stage of hypertension?
A. Normal blood pressure
B. Stage 2 hypertension
C. Stage 1 hypertension
D. Stage 3 hypertension
```
CORRECT ANSWER: B>> Explanation: An individual diagnosed with stage 2 blood pressure would have a reading between 160/100 and 179/109.
259
```
What is the most common cause of retinopathy?
A. Excessive alcohol
B. Diabetes mellitus
C. High cholesterol
D. Hypertension
```
CORRECT ANSWER: B>> Explanation: The most common cause of retinopathy is diabetes mellitus.
260
```
Which of the following diseases is the abnormal regulation of intraocular pressure that can result in gradual progressive atrophy of optic nerve cells?
A. Macular degeneration
B. Cataracts
C. Glaucoma
D. Retinopathy
```
CORRECT ANSWER: C>> Explanation: Glaucoma is the abnormal regulation of intraocular pressure that can result in gradual progressive atrophy of optic nerve cells. The development of chronic elevated intraocular pressure is generally painless, and the gradual loss of peripheral visual fields can progress significantly before symptoms are noticed.
261
```
Which of the following is not a condition causing secondary hypertension?
A. Renovascular disease
B. Pheochromocytoma
C. Primary aldosteronism
D. Glaucoma
```
CORRECT ANSWER: D>> Explanation: Examples of primary conditions that may lead to secondary hypertension include pheochromocytoma, primary aldosteronism, renovascular disease, and unilateral renal parenchymal disease.
262
```
A driver who is taking hypertensive medication to lower blood pressure has a blood pressure reading of 132/76. For how long can the driver be certified?
A. 1 year
B. 2 years
C. 3 months
D. 6 months
```
CORRECT ANSWER: A>> Explanation: A driver who is taking hypertension medication can be certified for 1 year even if blood pressure is under 140/90.
263
```
A driver presents to the examiner's office for a physical examination. The driver was just given a prescription for Coumadin. For how long must the driver wait to be certified?
A. 1 year
B. 1 month
C. 2 months
D. 6 months
```
CORRECT ANSWER: B>> Explanation: A person who is taking Coumadin has to wait a minimum of 1 month and be stabilized before they can be certified.
264
```
Which drug is immediately disqualifying for a Department of Transportation driver?
A. Zoloft
B. Lyrica
C. Methadone
D. Oxycontin
```
CORRECT ANSWER: C>> Explanation: Methadone use or its derivatives or substitutes mandates immediate disqualification for the drug use and the underlying addiction.
265
```
A driver has an abdominal aortic aneurysm that is 3 cm and notes insidious onset of low back pain. For how long can the driver be certified?
A. 1 year
B. 6 months
C. 2 years
D. Cannot be certified
```
CORRECT ANSWER: A>> Explanation: Insidious onset of lower back pain does not guarantee abdominal aorta aneurysm is associated; 3-cm dilatation requires watchful waiting and a reduced certification time.
266
A driver should be disqualified if the driver has a blood pressure of 164/90.
A. FALSE
B. TRUE
CORRECT ANSWER: A>> Explanation: This driver would be given a 1-time certification for 3 months.
267
When checking the urinalysis during the physical exam, which of the following carries the greatest concern?
A. Glycosuria
B. Hematuria
C. Proteinuria
D. Urine temperature between 90 and 100 degrees Fahrenheit
CORRECT ANSWER: A>> Explanation: Glucosuria carries most concern because of undetected or uncontrolled NIDDM.
268
A pre-employment commercial motor vehicle physical examination requires both a drug and alcohol test.
A. FALSE
B. TRUE
CORRECT ANSWER: A>> Explanation: Alcohol evaluation on a pre-employment examination is employer optional.
269
```
A new driver with a blood pressure of 142/92 can be certified for how long?
A. 2 years
B. Cannot be certified
C. 1 year
D. 6 months
```
CORRECT ANSWER: C>> Explanation: One-year per recommendations
270
```
A driver who has recently had a myocardial infarction should wait how long before he/she can be certified?
A. 1 year
B. 2 months
C. 1 month
D. 6 months
```
CORRECT ANSWER: B>> Explanation: A 2-month wait is minimum before returning to safety sensitive duties.
271
Joining and disjoining trailers requires:
A. Prehension and power grasp
B. Body mass index no greater than 34
C. Driver weight to be within FMCSA standards
D. Neck circumference <18 inches
CORRECT ANSWER: A>> Explanation: Prehension and power grasp are mandatory in FMCSA drivers.
272
A driver who is taking insulin for diabetes, accompanied by an MCSA-4240 form, from the treating physician, can drive for one year, pending ME approval.
A. True
B. False
CORRECT ANSWER: B>> Explanation: A driver may drive a commercial motor vehicle while taking Insulin as long as they are stable; the treating clinician properly certifies the driver with form MCSA-5870; and the medical examiner certifies the driver is otherwise qualified.
273
A driver with a stable angina pectoris who is taking nitroglycerin cannot be certified.
A. FALSE
B. TRUE
CORRECT ANSWER: A>> Explanation: If the angina pectoris is stable and medications are well tolerated, and if a cardiologist has certified the driver's condition via letter, then it is OK to drive a commercial motor vehicle.
274
```
A non-discretionary (no examiner laterality) standard is:
A. Vision
B. Deep vein thrombosis
C. Symptomatic psychological depression
D. Grade 2 hypertension
```
CORRECT ANSWER: A>> Explanation: One of the 4 non-discretionary standards providing no laterality for certification at time of examination.
275
During the examination, a driver has a blood pressure (BP) level of 148/94 while taking BP medication for 2 years. The examiner's recommendation is:
A. Pend the certification and refer back to the driver's primary care physician until the examiner gets more information
B. Give a 1-time certification for 3 months
C. Can't be certified
D. Provide a 1-year certification
CORRECT ANSWER: B>> Explanation: The driver is currently taking hypertension medications. Minimum standard is 140/90 to receive a 1-year certification. He does not meet that. He can be given only a 1-time certification for 3 months.
276
```
What is the waiting period for someone who has had a moderate traumatic brain injury without early seizure?
A. 1 year
B. 6 months
C. 2 years
D. 5 years
```
CORRECT ANSWER: A>> Explanation: Per Neurological Conference Guidelines.
277
A driver with an implantable cardioverter-defibrillator can be certified for 1 year as long as the driver gets a checkup with a cardiologist yearly, has a letter from the cardiologist, and is tolerating medication.
A. TRUE
B. FALSE
CORRECT ANSWER: B>> Explanation: Implantable defibrillators are non-certifiable.
278
```
A driver with a pacemaker can be certified for how long?
A. 2 years
B. Can't be certified
C. 1 year
D. 6 months
```
CORRECT ANSWER: C>> Explanation: Single function pacemakers are certifiable for 1 year.
279
```
A qualified driver should have an exercise stress test at least every 2 years after what condition?
A. Angioplasty
B. Stroke
C. Significant ST elevation
D. ≥2 cardiac risk factors
```
CORRECT ANSWER: A>> Explanation: Per Cardiac Conference Guidelines.
280
Most drivers who undergo coronary artery bypass graft (CABG) are not able to return to work once the sternum is completely healed due to restriction of shoulder mobility.
A. FALSE
B. TRUE
CORRECT ANSWER: A>> Explanation: Shoulder mobility is of concern and should be evaluated, but it is typically not an issue.
281
```
When considering the safety implications of a driver's medical condition, what does the examiner need to consider?
A. Mental condition
B. Road condition
C. Axle weights
D. Number of passengers
```
CORRECT ANSWER: A>> Explanation: Mental stability is an important safety-sensitive concern. Examiners do not certify based on axle weights, road conditions, or number of passengers.
282
```
One of the non-discretionary test result requirements for the vision standard is?
A. Nystagmus
B. Color vision
C. Intraocular pressure
D. Ophthalmoscopic evaluation
```
CORRECT ANSWER: B>> Explanation: Color blindness is part of the non-discretionary vision exam.
283
If a driver has loss of a foot, leg, arm, or hand, for how long can the driver be certified?
A. Can't be certified
B. The driver must obtain a Skill Performance Evaluation (SPE) before becoming certified
C. 1 year
D. 2 years
CORRECT ANSWER: B>> Explanation: No certification can be issued until an SPE is obtained. The driver must be otherwise certifiable, so the exam would be completed.
284
A driver who has >40 decibels of hearing loss in 1 ear--but the other ear is normal--must be referred for audiologist evaluation and cannot return until a hearing aid is in use and an alternate battery supply is readily available.
A. TRUE
B. FALSE
CORRECT ANSWER: B>> Explanation: The hearing loss of >40 decibels in both ears requires further evaluation.
285
The FMCSA is a division of the Federal Department of Transportation (DOT), and is one of many entities the Federal DOT administers. The requirements of the physical examination for an FMCSA-regulated driver are the same as:
A. It is up to the examiner to determine if he/she is qualified to perform an exam on a non-FMCSA entity, because the entities are all different
B. An engineer for the Federal Railroad Administration
C. A pilot for the Federal Aviation Administration and an air traffic controller
D. All DOT entities have the same exam requirements
CORRECT ANSWER: A>> Explanation: Per FMCSA Regulations.
286
The FMCSA's primary goal in the Office of Medical Programs is to:
A. Provide rules, regulations, and guidance to assist the examiner in preventing an incapacitating event in a driver
B. Protect and serve the drivers of the United States
C. Prevent injury
D. Establish best practices as the primary tool in evaluating drivers for medical fitness
CORRECT ANSWER: A>> Explanation: Per FMCSA Regulations.
287
The FMCSA's Office of Medical Programs' functions include:
A. Eliminating unfit drivers and examiners
B. Evaluating drivers when they fail a physical examination
C. Overseeing the medical exemption program
D. Establishing guidelines for the Federal Aviation Administration, the U.S. Coast Guard, the FMCSA, the Federal Railway Administration, the Federal Transit Administration, and the pipeline industry
CORRECT ANSWER: C>> Explanation: Per FMCSA Regulations.
288
Who is the responsible determinant of driver certification?
A. The FMCSA has final determination of a driver's fitness
B. The NRCME examiner
C. The cardiologist
D. The driver's primary care physician
CORRECT ANSWER: B>> Explanation: The NRCME examiner is the primary determinant of certification status; however, the examiner may call upon any specialist for driver status.
289
```
Which CFR lists the physical qualification requirements for a driver to be medically fit for duty?
A. FAA CFR 445.10
B. 49 CFR 391.41
C. 49 CFR 391.43
D. 49 CFR 359
```
CORRECT ANSWER: B>> Explanation: Per FMCSA Regulations.
290
```
One of the 4 non-discretionary standards is:
A. Hearing
B. Hypertension
C. Drug use
D. Loss of limb
```
CORRECT ANSWER: A>> Explanation: The 4 non-discretionary standards are vision, hearing, insulin-dependent diabetes mellitus, and epilepsy.
291
One of the responsibilities of an FMCSA/NRCME medical examiner is to:
A. Know dispatcher schedules of deployment
B. Know emergency procedures in a school bus accident
C. Anticipate the possibility of an incapacitating event
D. Know axle distribution weights and horsepower ratios
CORRECT ANSWER: C>> Explanation: The NRCME examiner is the primary determinant of certification status; however, the examiner may call upon any specialist for driver status.
292
Even though the FMCSA does not regulate intrastate commerce, it does regulate intrastate drivers who:
A. Have state exemptions
B. Operate a vehicle that is weighted >10,001 pounds
C. Drive a vehicle used or designed to carry ≥14 people
D. Transport non-hazardous materials that require a placard
CORRECT ANSWER: B>> Explanation: Per FMCSA Regulations.
293
Standards are not legal requirements for interstate commercial vehicles, drivers, and motor carriers.
A. FALSE
B. TRUE
CORRECT ANSWER: A>> Explanation: Standards are rules set forth by the FMCSA and must be adhered to.
294
```
Which regulation explains the responsibilities of the medical examiner?
A. 40 CFR 396.5
B. 49 CFR 391.43
C. 49 CFR 391.41
D. 48 CFR 391.41
```
CORRECT ANSWER: B>> Explanation: Per FMCSA Regulations.
295
```
Trade, traffic, or transportation in the United States between 2 places in a state through another state or a place outside of the United States is called:
A. Interstate commerce
B. Intrastate commerce
C. Intercontinental commerce
D. Intracontinental commerce
```
CORRECT ANSWER: A>> Explanation: Per FMCSA Regulations.
296
```
The federal regulation that describes driver qualification requirements is:
A. 48 CFR 391.41
B. 40 CFR 396.5
C. 49 CFR 391.41
D. 49 CFR 391.43
```
CORRECT ANSWER: C>> Explanation: Per FMCSA Regulations.
297
```
Which of the following is a not a job-related stress factor for drivers?
A. Diet
B. Type of route
C. Type of cargo
D. Financial worries
```
CORRECT ANSWER: A>> Explanation: Diet is a large part of the problem in the health of drivers. This carries on past their workday.
298
FMCSA medical examiners should always protect public safety.
A. TRUE
B. FALSE
CORRECT ANSWER: A>> Explanation: A major testing point on the NRCME written examination.
299
```
When considering safety implications of the medical condition of the driver, the examiner would consider the lowest priority to safety considerations as being:
A. Daily schedule
B. Current physical condition
C. Current mental condition
D. Current medical treatment
```
CORRECT ANSWER: A>> Explanation: The medical examiner is concerned with the daily schedule of the driver, as it can lead to fatigue, but the prioritization would put it lower than direct health issues.
300
```
The average truck driver is:
A. Of a normal weight
B. A healthy eater
C. Aged >40 years
D. Female
```
CORRECT ANSWER: C>> Explanation: Per FMCSA Statistics.
301
```
The average truck driver usually:
A. Is known for taking stimulants
B. Has thrombophlebitis
C. Has ≥2 medical conditions
D. Is more healthy than the normal population
```
CORRECT ANSWER: C>> Explanation: Due to lifestyle and stressors, drivers are more likely to have ≥2 comorbidities.
302
Transitional age groups (30 to 50 years) are more likely to present with problems that have been previously undetected or misdiagnosed.
A. TRUE
B. FALSE
CORRECT ANSWER: A>> Explanation: Due to generally good health in youth and few regular checkups, the transitional age group will be the likely catch of early health conditions.
303
Examiners have no discretion in applying the diabetes mellitus standard for a driver certification with non-insulin-dependent diabetes mellitus (NIDDM).
A. FALSE
B. TRUE
CORRECT ANSWER: A>> Explanation: The laterality in this standard is indeed variable for NIDDM, multiple factors to include glycosuria, HbA1c, symptoms, and tolerance of medications allow for variable certification wait periods and certification times.
304
A driver taking insulin may be certified for a period of 2 years.
True
False
CORRECT ANSWER: B>> Explanation: Upon being certified via form MCSA-5870 and a physical exam performed by the FMCSA medical examiner, the driver may be certified for one-year.
305
If a driver is required to start insulin, they should have a wait period of 2 months of starting insulin therapy if:
A. He keeps a glucose log
B. He is newly diagnosed and not on prior treatment
C. He was previously diagnosed and treated with oral agents
D. He should not be certified
CORRECT ANSWER: B>> Explanation: Stability and predictability are of utmost concern with insulin use.
306
```
A driver taking hypoglycemics or using diet and exercise to control diabetes mellitus can be certified.
A. Can't be certified
B. On a case-by-case basis
C. For 1 year
D. For 2 years
```
CORRECT ANSWER: C>> Explanation: A hypoglycemic driver can be certified for 1 year, as long as he is stable and is tolerating medications with no side effects.
307
A driver has a mild to moderate amount of sugar present in his urine, as proved by the urinalysis. He should be qualified for:
A. 2 years
B. Can't be certified
C. Additional testing, and a limited driver's certificate can be issued until an etiology is determined
D. 1 year
CORRECT ANSWER: C>> Explanation: A mild to moderate amount of sugar could be due to a number of sources on a urine dip stick. Limited driving time until the etiology is established would be appropriate.
308
When a driver wants to drive a commercial motor vehicle and is taking Insulin, he/she may do so only after being approved by the FMCSA medical examiner.
A. True
B. False
CORRECT ANSWER: A>> Explanation: After the medical examiner receives the MCSA-5870, he/she determines if the driver is qualified to drive.
309
Preventing hypoglycemia is the most critical and challenging safety issue for any driver with diabetes.
A. TRUE
B. FALSE
CORRECT ANSWER: A>> Explanation: Hypoglycemia can promote an incapacitating event very quickly.
310
Annual physical examination of a driver with diabetes mellitus is recommended due to the progressive nature of the disease and potential complications.
A. TRUE
B. FALSE
CORRECT ANSWER: A>> Explanation: A watchful eye to include regular HbA1c testing is required.
311
As of November 19, 2018, the FMCSA Diabetes Exemption program is eliminated.
A. True
B. False
CORRECT ANSWER: A>> Explanation: The FMCSA has eliminated the provision for a waiver/exemption for Insulin Dependent Diabetes Mellitus.
312
A driver comes in for a physical examination. Upon performing the physical, the examiner determines that the driver is experiencing ""hypoglycemia unawareness."" For how long should the driver be certified?
A. 2 years
B. The driver must have a diabetic exemption
C. Can't be certified
D. 1 year
CORRECT ANSWER: C>> Explanation: The driver should be disqualified, and emergency treatment should be sought.
313
Examiners have discretion when applying the hearing standard.
A. FALSE
B. TRUE
CORRECT ANSWER: A>> Explanation: This is a non-discretionary standard, and the examiner has no laterality.
314
```
When administering the audiometric test, the examiner should check the driver's hearing at which frequencies?
A. 500 Hz, 1000 Hz, and 2000 Hz
B. 500 Hz and 1000 Hz
C. 600 Hz and 2500 Hz
D. 600 Hz, 1500 Hz, and 2500 Hz
```
CORRECT ANSWER: A>> Explanation: Per FMCSA Regulations.
315
```
A driver with benign positional vertigo must be symptom free for how long before he can be certified?
A. 1 month
B. 3 months
C. Can't be certified
D. 2 months
```
CORRECT ANSWER: D>> Explanation: Per FMCSA Regulations
316
A driver who uses a hearing aid to pass the hearing test must use the hearing aid when driving.
A. TRUE
B. FALSE
CORRECT ANSWER: A>> Explanation: Per FMCSA Regulations.
317
The second hearing test must be administered no matter what when doing a physical.
A. FALSE
B. TRUE
CORRECT ANSWER: A>> Explanation: Either the forced whisper test is passed first or the audiometer is passed first, one or the other is not used to confirm a pass on the first try.
318
```
When administering the audiometric test, the driver must not have hearing loss:
A. ≥60 decibels
B. ≥40 decibels
C. ≤40 decibels
D. ≤60 decibels
```
CORRECT ANSWER: B>> Explanation: Per FMCSA Regulations.
319
```
When using the forced whisper test, the driver must perceive a forced whisper in 1 ear at what distance?
A. Not <4 feet
B. Not <5 feet
C. Not <6 feet
D. Not <7 feet
```
CORRECT ANSWER: B>> Explanation: Per FMCSA Regulations.
320
```
While performing the forced whisper test, a driver can hear with the left ear at 5 feet. With the right ear, the driver hears at 4 feet. For how long can he be certified?
A. 2 years
B. 1 year
C. 6 months
D. Can't be certified
```
CORRECT ANSWER: A>> Explanation: Recertification for 2 years if the 5-foot forced whisper test is performed at ≥5 feet in the better ear.
321
When testing a driver using the audiometric test, the driver hears at 32 decibels at 500 Hz, 41 decibels at 1000 Hz, and 43 decibels at 2000 Hz. For how long can the driver be certified?
A. The driver will need further testing before certification
B. Can't be certified
C. 2 years
D. 1 year
CORRECT ANSWER: C>> Explanation: Recertification at 2 years if the hearing loss is no greater than 40 decibels in the better ear.
322
```
Which of the following auditory pathologies is not disqualifying?
A. Menière disease
B. Labyrinthine fistula
C. Non-functioning labyrinths
D. Acute infection
```
CORRECT ANSWER: D>> Explanation: Caution should be observed in certification of an acute ear condition due to temporary issues with pain, fever, dizziness, antibiotic side effects.
323
The failure of the forced whisper test results in non-issuance of a driver certificate.
A. FALSE
B. TRUE
CORRECT ANSWER: A>> Explanation: The forced whisper test is a ""field evaluation"" and, if failed, must be followed up with audiometric testing.
324
A medical examiner has discretion when applying the vision standard to determine if a driver can be physically qualified.
A. FALSE
B. TRUE
CORRECT ANSWER: A>> Explanation: The vision standard is non-discretionary and, if failed, the driver cannot be issued a certification card.
325
```
Which of the following is not one of the minimum test result requirements for the vision standard?
A. Peripheral horizontal visual fields
B. Monocular vision
C. Orange-brown color vision deficit
D. Visual acuity
```
CORRECT ANSWER: C>> Explanation: The color blindness test is not based on Ishihara plates. It is based on being able to discern between red, green, and amber colors.
326
```
Which of the following health care professionals cannot perform a vision test for a physical examination?
A. Optometrist
B. Medical examiner
C. Physical therapist
D. Ophthalmologist
```
CORRECT ANSWER: C>> Explanation: There is no provision for physical therapists in the FMCSA's NRCME program.
327
```
An examiner measures static central visual acuity with all of the following EXCEPT:
A. Ishihara plates
B. Snellen chart
C. Titmus vision tester
D. An eye cover
```
CORRECT ANSWER: A>> Explanation: Ishihara plates are used for color blindness evaluation in detail.
328
For a driver to pass the central visual acuity test:
A. Each and both eyes together must be at least 20/40
B. Each eye must be at least 20/40
C. Both eyes together must be at least 20/40
D. Each and both eyes together must be at least 20/50
CORRECT ANSWER: A>> Explanation: Per FMCSA Regulations.
329
```
When checking peripheral field of vision, the driver must have, at a minimum, what degree in each eye?
A. 70 degrees
B. 65 degrees
C. 75 degrees
D. 80 degrees
```
CORRECT ANSWER: A>> Explanation: Per FMCSA Regulations.
330
When checking for color vision, the driver needs only to distinguish between green, amber, and red.
A. TRUE
B. FALSE
CORRECT ANSWER: A>> Explanation: Per FMCSA Regulations.
331
Glaucoma can interfere with safe driving by causing what?
A. Interference with detailed central vision
B. Cloudy vision
C. Loss of accommodation and hyperopia
D. Loss of peripheral vision
CORRECT ANSWER: D>> Explanation: Peripheral vision is essential in safety-sensitive functions.
332
Monocular vision causes a decrease in peripheral vision and in the depth of the field of vision.
A. TRUE
B. FALSE
CORRECT ANSWER: A>> Explanation: Monocular vision is not certifiable without a vision waiver.
333
A driver with monocular vision can apply for the federal vision exemption. Which of the following is not a requirement for the exemption?
A. The driver must carry an exemption certificate while driving
B. Corrective eyewear cannot be worn while driving
C. The driver must have an annual medical examination
D. The better eye must meet visual requirements
CORRECT ANSWER: B>> Explanation: There is no prohibition on corrective eyewear.
334
When the systolic and diastolic readings indicate conflicting stages, use the medical guidelines for the higher stage.
A. TRUE
B. FALSE
CORRECT ANSWER: A>> Explanation: Per FMCSA Recommendations.
335
A driver taking antihypertensive medication should meet all of the following qualification standards EXCEPT:
A. Maintaining a log of regularly self-monitored blood pressure readings.
B. A blood pressure level <140/90
C. Knowledge of and compliance with the treatment plan
D. Tolerating medication without side effects that interfere with driving
CORRECT ANSWER: A>> Explanation: No maintenance log is a mandatory requirement for hypertension.
336
```
A driver has no history of hypertension and comes in for an initial physical exam. His blood pressure reading shows 162/105. He should be certified for:
A. A 1-time certificate for 3 months
B. 1 year
C. 2 years
D. Can't be certified
```
CORRECT ANSWER: A>> Explanation: Per FMCSA Recommendations.
337
```
A driver has a diagnosis of hypertension and tolerates treatment with no side effects. His blood pressure reading is <140/90. He can be certified for:
A. 1 year
B. 2 years
C. A 1-time certificate for 3 months
D. Can't be certified
```
CORRECT ANSWER: A>> Explanation: Medical treatment and a blood pressure reading below 140/90 can justify a 1-year certification.
338
Hypertension is considered a non-discretionary qualification.
A. FALSE
B. TRUE
CORRECT ANSWER: A>> Explanation: Hypertension is discretionary, but established guidelines should be strictly adhered.
339
If a driver is receiving treatment for hypertension, whether pharmacological or non-pharmacological, then he should be diagnosed with hypertension.
A. TRUE
B. FALSE
CORRECT ANSWER: A>> Explanation: Per FMCSA Recommendations.
340
```
A driver is disqualified for hypertension if his blood pressure reading is:
A. 162/105
B. 139/89
C. 182/115
D. 141/93
```
CORRECT ANSWER: C>> Explanation: Per FMCSA Recommendations.
341
```
Hypertension is a risk factor for development of all of the following EXCEPT:
A. Cerebrovascular disease
B. Cardiovascular disease
C. Thrombophlebitis
D. Chronic renal insufficiency
```
CORRECT ANSWER: C>> Explanation: Generally, thrombophlebitis is not associated with hypertension.
342
```
A driver comes in for a recertification physical and his blood pressure reading is 130/80. Previously, he had a blood pressure reading of 142/92. He is not taking medication for hypertension. For how long can he be certified?
A. 6 months
B. 1 year
C. Can't be certified
D. 2 years
```
CORRECT ANSWER: D>> Explanation: He meets criteria for a 2-year certification.
343
Causes of hypertension include all of the following EXCEPT:
A. Increased body weight
B. Excess sodium intake
C. Excess calcium from genetic predisposition
D. Low potassium intake
CORRECT ANSWER: C>> Explanation: Excess calcium has no bearing on hypertension.
344
```
Which of the following would fall into the neurological standard category?
A. Arthritic disorders
B. Mental disorder
C. Epilepsy
D. Rheumatic disorders
```
CORRECT ANSWER: C>> Explanation: Per Neurological Conference Guidelines.
345
```
A driver who has seizures can be certified for:
A. 2 years
B. 3 months
C. Can't be certified
D. 1 year
```
CORRECT ANSWER: C>> Explanation: This is a non-discretionary standard, and the examiner has no laterality.
346
```
If a driver is taking anticoagulant therapy for cerebrovascular and cardiovascular disorders, for how long can he be certified?
A. Can't be certified
B. 1 year
C. 2 years
D. 6 months
```
CORRECT ANSWER: A>> Explanation: Anticoagulant therapy for cerebrovascular treatment in any form is not certifiable.
347
Even when not disqualifying, a medical examiner should not discuss abnormal findings with the driver.
A. FALSE
B. TRUE
CORRECT ANSWER: A>> Explanation: Good communication with both the driver and employer is mandatory.
348
```
An event happens and has residual, long-lasting effects. The risk that the event will recur is:
A. Static
B. Progressive
C. Episodic
D. Intermittent
```
CORRECT ANSWER: A>> Explanation: Per Neurological Conference Guidelines.
349
```
A driver has experienced a transient ischemic attack. How long is the waiting period before the driver can be certified?
A. 3 months
B. 6 months
C. 5 years
D. 1 year
```
CORRECT ANSWER: D>> Explanation: This 1-year waiting period is to ensure that the driver is stable and not subject to an incapacitating event.
350
Strokes involving the cerebellum and brainstem are most likely to cause post-stroke seizures.
A. FALSE
B. TRUE
CORRECT ANSWER: A>> Explanation: Cerebellum and brainstem strokes are more likely to not cause seizure.
351
```
A driver has had a post-stroke seizure. How long is the waiting period before the driver can be certified?
A. 6 months
B. 1 year
C. 5 years
D. 3 months
```
CORRECT ANSWER: C>> Explanation: Per FMCSA Recommendations.
352
```
A driver has had a severe head injury that penetrated the dura and caused a loss of consciousness that lasted >24 hours. For how long can the driver be certified?
A. 1 year
B. 2 years
C. Can't be certified
D. 6 months
```
CORRECT ANSWER: C>> Explanation: The likelihood of recurrent seizure actually increases over time with this type of injury.
353
```
Some common symptoms of central nervous system tumors are all of the following EXCEPT:
A. Headache
B. Numbness
C. Lower extremity paresthesias
D. Seizures
```
CORRECT ANSWER: C>> Explanation: Typically, the lower extremity is not involved in central nervous system tumors.
354
```
If the driver is not certified, all of the following may be appealed EXCEPT:
A. Epilepsy
B. Multiple sclerosis
C. Myopathies
D. Parkinson disease
```
CORRECT ANSWER: A>> Explanation: Epilepsy is a non-discretionary standard and has no waiver process.
355
A diagnosis of Huntington disease is disqualifying.
A. TRUE
B. FALSE
CORRECT ANSWER: A>> Explanation: Due to unpredictable movements, this condition is disqualifying.
356
```
When a driver is diagnosed and being treated for autonomic neuropathy with orthostatic hypotension, for how long can he be certified?
A. 1 year
B. 2 years
C. Can't be certified
D. 6 months
```
CORRECT ANSWER: C>> Explanation: The combination of conditions can lead to an incapacitating event.
357
A driver who experiences headaches on a regular basis is now having headaches with some mood swings. He should be disqualified.
A. TRUE
B. FALSE
CORRECT ANSWER: A>> Explanation: The driver should be disqualified until neurologically evaluated due to concerns of incapacitating events.
358
```
A driver has a diagnosis of benign positional vertigo. The driver can be certified for:
A. Can't be certified
B. 6 months
C. 1 year
D. 2 years
```
CORRECT ANSWER: A>> Explanation: The driver cannot be certified until he has been symptom free and evaluated and has a neurologic release for driving a commercial motor vehicle.
359
A driver with a history of 1 unprovoked seizure, who is now seizure-free and has been off anticonvulsant medication for at least 3 years can be certified.
A. FALSE
B. TRUE
CORRECT ANSWER: A>> Explanation: The wait period is 5 years.
360
A driver who has had a seizure due to hypoglycemia can be certified.
A. TRUE
B. FALSE
CORRECT ANSWER: A>> Explanation: A driver who had a seizure due to hypoglycemia can be certified as long as the etiology of the seizure has been determined.
361
```
A driver who has a clinical diagnosis of epilepsy can be certified for how long?
A. Can't be certified
B. 6 months
C. 1 year
D. 2 years
```
CORRECT ANSWER: A>> Explanation: Epilepsy is a non-discretionary standard and has no waiver process.
362
The cardiovascular standard is one of the non-discretionary standards.
A. TRUE
B. FALSE
CORRECT ANSWER: B>> Explanation: Examiner laterality is allowed in the cardiovascular standard.
363
```
The following conditions are disqualifying for certification EXCEPT:
A. Thrombosis
B. Arrhythmia
C. Angina pectoris
D. Coronary insufficiency
```
CORRECT ANSWER: B>> Explanation: If arrhythmia has been stabilized and medication tolerated, certification for 1 year is allowed.
364
A driver who is experiencing syncope must be disqualified for certification.
A. TRUE
B. FALSE
CORRECT ANSWER: A>> Explanation: Any condition that could lead to an incapacitating event is disqualifying.
365
A driver with abnormal findings is not disqualified when abnormal findings are all of the following EXCEPT:
A. Receiving timely follow-ups with a primary physician
B. They are always disqualified
C. Adequately controlled
D. Treatable
CORRECT ANSWER: B>> Explanation: As long as abnormal findings are treatable, and timely follow-ups are done, along with the condition being adequately controlled, a driver can be certified for 1 year.
366
When a driver completes an exercise tolerance test, successful results are:
A. Significant ST-segment elevation (>1 mm)
B. Ventricular dysrhythmia
C. Attainment of a workload capacity >6 metabolic expenditures (METs)
D. Significant ST-segment depression (>1 mm)
CORRECT ANSWER: C>> Explanation: Six METS is the minimum results a driver may obtain to be certified.
367
When a driver completes an echocardiogram, the results should be:
A. An ejection fraction ≤40%
B. Pulmonary artery pressure >50% systemic systolic
C. Restricted to the examiner via HIPAA regulations
D. An ejection fraction ≥40%
CORRECT ANSWER: D>> Explanation: An ejection fraction ≥40%.
368
```
An exercise tolerance test (ETT) provides information about all of the following EXCEPT:
A. Ejection fraction
B. Blood pressure
C. Heart rate
D. Arrhythmias
```
CORRECT ANSWER: A>> Explanation: Ejection fraction is measured by echocardiography, not by an ETT.
369
When indicated, an examiner may request additional testing, especially when there are concerns about the presence of undiagnosed cardiovascular disease.
A. TRUE
B. FALSE
CORRECT ANSWER: A>> Explanation: No certification should be issued until follow-up is secured.
370
```
The New York Heart Association (NYHA) symptom classification system can be used to assist in determining certification status. All of the following classes are disqualifying EXCEPT:
A. I
B. II
C. III
D. IV
```
CORRECT ANSWER: A>> Explanation: Category I is not disqualifying.
371
Transesophageal echocardiogram (TEE) may be helpful to assess structural abnormalities.
A. TRUE
B. FALSE
CORRECT ANSWER: A>> Explanation: TEE may be ordered by the primary care physician or specialist.
372
```
Which is not a modifiable risk factor for coronary heart disease?
A. Hypertension
B. Obesity
C. Genetics
D. Diabetes mellitus
```
CORRECT ANSWER: C>> Explanation: Genetics is not modifiable.
373
```
A driver who has had a percutaneous coronary intervention is showing bruising at the insertion site. The driver can be certified for:
A. 1 year
B. Can't be certified
C. 3 months
D. 6 months
```
CORRECT ANSWER: B>> Explanation: The insertion site must be fully healed in order to return to safety-sensitive functions.
374
```
A driver may be certified as long as he doesn't have a cardiovascular condition associated with any of the following EXCEPT:
A. Dyspnea
B. Tachycardia
C. Heart failure
D. Syncope
```
CORRECT ANSWER: B>> Explanation: A cardiovascular condition associated with tachycardia may lead to an unexpected incapacitating event, but the other answers take higher priority in your certification decision-making process.
375
```
For how long can a driver who had a myocardial infarction (MI) a month ago be certified?
A. 2 years
B. Can't be certified
C. 6 months
D. 1 year
```
CORRECT ANSWER: B>> Explanation: A driver who is post-MI must have a waiting period of 2 months.
376
A driver with angina pectoris can be certified for 1 year if he meets which of the following?
A. Satisfactory exercise stress test
B. He should never be certified
C. He is experiencing angina only at rest
D. He is unable to tolerate the medication
CORRECT ANSWER: A>> Explanation: An exercise tolerance test is the determinate factor of predictability for angina pectoris.
377
```
A driver who had an angioplasty 4 months ago and has had a satisfactory exercise stress test can be certified for how long?
A. 1 year
B. Can't be certified
C. 2 years
D. 6 months
```
CORRECT ANSWER: A>> Explanation: Per Cardiac Conference Guidelines.
378
Most drivers who have undergone a coronary artery bypass graft are able to return to work once the sternum has completely healed.
A. TRUE
B. FALSE
CORRECT ANSWER: A>> Explanation: In addition to exercise tolerance test, cardiography, and release from the cardiologist for driving a commercial motor vehicle, full sternal healing is suggested.
379
```
A driver has had unstable angina pectoris occurring within the last 3 months. For how long can he be certified?
A. Can't be certified
B. 1 year
C. 2 years
D. 6 months
```
CORRECT ANSWER: A>> Explanation: The driver cannot be certified until treatment is well tolerated and he is asymptomatic.
380
```
A driver who has undergone bypass can be certified if:
A. His ejection fraction ≤40%
B. His sternal wound is not healed
C. He should never be certified
D. His ejection fraction ≥40%
```
CORRECT ANSWER: D>> Explanation: An ejection fraction ≥40% is a determinate factor in recertification after myocardial infarction.
381
```
A qualified driver should have an exercise stress test at least every 2 years EXCEPT after:
A. Bradycardia
B. Myocardial infarction
C. Angioplasty
D. Stable angina pectoris
```
CORRECT ANSWER: A>> Explanation: An exercise stress test is not required for a driver with bradycardia.
382
```
A driver who is post-coronary artery bypass graft should have a yearly exercise stress test after how many years?
A. 2 years
B. 1 year
C. 7 years
D. 5 years
```
CORRECT ANSWER: D>> Explanation: Per Cardiac Conference Guidelines.
383
When evaluating driver cardiovascular fitness, non-driving tasks are not of concern compared to driving tasks.
A. FALSE
B. TRUE
CORRECT ANSWER: A>> Explanation: All factors should be considered.
384
When should a driver who is prescribed anticoagulation therapy be disqualified?
A. When taking medication for a cerebrovascular condition
B. When he is >2 months post-myocardial infarction
C. When he is on anticoagulation for >1 month
D. If his international normalized ratio is being monitored
CORRECT ANSWER: A>> Explanation: Anticoagulation therapy for cerebrovascular concerns is not certifiable.
385
```
A driver has atrial fibrillation without an accompanying disease. For how long can the driver be certified?
A. 6 months
B. 2 years
C. Can't be certified
D. 1 year
```
CORRECT ANSWER: D>> Explanation: A driver with atrial fibrillation can be certified for 1 year with his cardiologist's release for commercial driving.
386
Implantable cardioverter-defibrillators are allowed under FMCSA regulations.
A. FALSE
B. TRUE
CORRECT ANSWER: A>> Explanation: Implantable defibrillators are not allowed for commercial drivers.
387
```
How long should a pacemaker be implanted before the driver is allowed to drive?
A. 1 month
B. 2 months
C. 3 months
D. 6 months
```
CORRECT ANSWER: A>> Explanation: Per Cardiac Conference Guidelines.
388
The majority of sudden deaths are thought to be secondary to ventricular tachycardia or ventricular fibrillation.
A. TRUE
B. FALSE
CORRECT ANSWER: A>> Explanation: Per Cardiac Conference Guidelines.
389
```
When approved ""to drive a commercial motor vehicle"" by a written note from a cardiologist, a driver who has an implantable cardioverter-defibrillator can be certified for how long?
A. 1 year
B. 2 years
C. Can't be certified
D. 6 months
```
CORRECT ANSWER: C>> Explanation: Implantable defibrillators are not allowed for commercial drivers.
390
```
For how long can a driver with a bicuspid aortic valve that has been successfully repaired surgically be certified?
A. 2 years
B. Can't be certified
C. 1 year
D. 6 months
```
CORRECT ANSWER: C>> Explanation: Per Cardiac Conference Guidelines.
391
```
For how long can a driver with mild coarctation of the aorta be certified?
A. 1 year
B. 6 months
C. 2 years
D. Can't be certified
```
CORRECT ANSWER: A>> Explanation: Per Cardiac Conference Guidelines.
392
```
A driver with the Ebstein anomaly, but who is asymptomatic, can be certified for:
A. 1 year
B. 6 months
C. 2 years
D. Can't be certified
```
CORRECT ANSWER: A>> Explanation: Per Cardiac Conference Guidelines.
393
A driver who has an uncorrected Tetralogy of Fallot can be certified.
A. FALSE
B. TRUE
CORRECT ANSWER: A>> Explanation: Per Cardiac Conference Guidelines.
394
```
A driver who has been diagnosed with moderate patent ductus arteriosus is complaining of palpitations. The driver can be certified for:
A. Can't be certified
B. 3 months
C. 6 months
D. 1 year
```
CORRECT ANSWER: A>> Explanation: Per Cardiac Conference Guidelines.
395
A driver presenting with a murmur should be sent for further evaluation in all but which of the following instances?
A. When it is a diastolic murmur
B. When it is a grade 1 murmur and the driver has symptoms of heart disease
C. When the murmur is monitored in a timely fashion
D. When it is a late systolic murmur
CORRECT ANSWER: C>> Explanation: Per Cardiac Conference Guidelines.
396
```
A driver presents with mitral valve prolapse with severe mitral regurgitation. For how long can he be certified?
A. Can't be certified
B. 6 months
C. 1 year
D. 2 years
```
CORRECT ANSWER: A>> Explanation: Per Cardiac Conference Guidelines.
397
Disqualify a driver with significant pulmonary hypertension, irrespective of cause.
A. TRUE
B. FALSE
CORRECT ANSWER: A>> Explanation: Per Cardiac Conference Guidelines.
398
```
For how long can a driver with a prosthetic valve who has clearance from a cardiovascular specialist be certified?
A. Can't be certified
B. 1 year
C. 6 months
D. 2 years
```
CORRECT ANSWER: B>> Explanation: Per Cardiac Conference Guidelines.
399
```
A driver who has had a percutaneous balloon mitral valvotomy for mitral stenosis should wait how long before being certified?
A. At least 3 months
B. At least 4 weeks
C. Can't be certified
D. At least 3 weeks
```
CORRECT ANSWER: B>> Explanation: Per Cardiac Conference Guidelines.
400
```
One of the major concerns post-heart transplant is:
A. Rejection
B. Dyspnea
C. Poorly healed surgical wound
D. Staph infection
```
CORRECT ANSWER: A>> Explanation: Per Cardiac Conference Guidelines.
401
```
What is the recommended wait time for certification post-heart transplant?
A. 1 year
B. 2 years
C. 6 months
D. Can't be certified
```
CORRECT ANSWER: A>> Explanation: Per Cardiac Conference Guidelines.
402
```
Which of the following is not a symptom of heart failure?
A. Increased exercise capacity
B. Edema of the feet and ankles
C. Palpitations
D. Weight gain
```
CORRECT ANSWER: A>> Explanation: Exercise capacity will be decreased during heart failure.
403
A driver who is post-heart transplant is tolerating medication. The driver can be certified for 2 years with a cardiologist's note of approval and a normal driver's examination.
A. FALSE
B. TRUE
CORRECT ANSWER: A>> Explanation: After a heart transplant, there is a 1-year minimum waiting period with a maximum certification period of 6 months.
404
Pain and swelling in the location of the organ is a sign of transplant rejection.
A. TRUE
B. FALSE
CORRECT ANSWER: A>> Explanation: Per Cardiac Conference Guidelines.
405
A driver who has peripheral vascular disease with pain at rest is disqualifying.
A. FALSE
B. TRUE
CORRECT ANSWER: B>> Explanation: The pain can lead to distraction and thus to an incapacitating event.
406
Drivers are at an average risk of acute deep vein thrombosis (DVT).
A. FALSE
B. TRUE
CORRECT ANSWER: A>> Explanation: Due to weight, inactivity, and lack of exercise, drivers are at an increased risk for a DVT.
407
```
The following are symptoms of pulmonary emboli EXCEPT:
A. Bradycardia
B. Tachypnea
C. Shortness of breath
D. Sudden cough
```
CORRECT ANSWER: A>> Explanation: Bradycardia is not associated with pulmonary emboli.
408
```
A driver has gone 4 months with no pulmonary emboli. He can be certified for:
A. 1 year
B. 3 months
C. 6 months
D. Can't be certified
```
CORRECT ANSWER: A>> Explanation: Certification can be given for 1 year as long as the driver tolerates his medication well and the pulmonologist has released him to drive a commercial motor vehicle.
409
```
A driver with acute deep vein thrombosis who is being treated and is not having any complications can be certified for:
A. 2 years
D. Can't be certified
C. 1 year
D. 6 months
```
CORRECT ANSWER: C>> Explanation: Certification can be given for 1 year as long as the driver tolerates his medication well and the specialist or primary care physician has released him to drive a commercial motor vehicle.
410
A driver who is treated for varicose veins can have biennial recertification.
A. TRUE
B. FALSE
CORRECT ANSWER: A>> Explanation: Per Cardiac Conference Guidelines
411
```
A driver has been on anticoagulation therapy for 2 weeks and had a heart attack 1 month ago. For how long can the driver be immediately certified?
A. 2 years
B. Can't be certified
C. 6 months
D. 1 year
```
CORRECT ANSWER: B>> Explanation: A 2-month minimum wait period is required, and medications must be established and well tolerated.
412
```
A thickening of the heart muscle that makes it stiffen and difficult to pump out blood is:
A. Hypertrophic cardiomyopathy
B. Dilated cardiomyopathy
C. Restrictive cardiomyopathy
D. None of the above
```
CORRECT ANSWER: A>> Explanation: Per Cardiac Conference Guidelines.
413
```
For how long can a driver with a diagnosis of hypertrophic cardiomyopathy be certified?
A. 1 year
B. 2 years
C. Can't be certified
D. 6 months
```
CORRECT ANSWER: C>> Explanation: Per Cardiac Conference Guidelines.
414
```
Abdominal aortic aneurysms are most frequent in:
A. Women compared to men by 3:1
B. Men compared to women by 3:1
C. Men compared to women by 4:1
D. Women compared to men by 4:1
```
CORRECT ANSWER: B>> Explanation: Per Cardiac Conference Guidelines.
415
A driver with an abdominal aortic aneurysm (AAA) should be qualified when:
A. There is an increase in size >0.5 cm within 6 months
B. The driver should never be qualified
C. The AAA is <4 cm and is asymptomatic
D. The AAA is >5 cm and is symptomatic
CORRECT ANSWER: C>> Explanation: Per Cardiac Conference Guidelines.
416
Sympathomimetics are drugs that:
A. Provide for the rapid increase in blood glucose
B. Raise blood pressure by stimulating the sympathetic nervous system
C. Lower blood pressure by stimulating the sympathetic nervous system
D. Are used in anticoagulation therapy
CORRECT ANSWER: B>> Explanation: Per Cardiac Conference Guidelines.
417
Continuous use of oxygen is allowed for a driver if the system is preapproved by the FMCSA.
A. FALSE
B. TRUE
CORRECT ANSWER: A>> Explanation: Oxygen may not be used in any form by a driver of a commercial motor vehicle.
418
```
Which of the following is disqualifying for certification?
A. Chronic pulmonary tuberculosis
B. Atypical tuberculosis
C. Hemoptysis
D. Bronchiectasis
```
CORRECT ANSWER: A>> Explanation: Per Pulmonary Conference Guidelines.
419
Respiratory dysfunction is considered one of the discretionary standards.
A. TRUE
B. FALSE
CORRECT ANSWER: A>> Explanation: Pulmonary conditions are under the examiner's discretion to follow guidelines and recommendations.
420
```
A patient with chronic pulmonary tuberculosis can be qualified for:
A. 2 years
B. Can't be certified
C. 6 months
D. 1 year
```
CORRECT ANSWER: B>> Explanation: Per Pulmonary Conference Guidelines.
421
If a driver is taking sedating medications for bronchitis, he:
A. Should abstain from driving until he is no longer taking the medication
B. Should drive his normal route
C. Can't be certified
D. Should abstain from driving a vehicle for at least 12 hours after taking the medication
CORRECT ANSWER: D>> Explanation: Per Pulmonary Conference Guidelines.
422
```
All of the following are categories of respiratory disease EXCEPT:
A. Histoplasmic disorders
B. Infectious diseases
C. Allergic diseases
D. Pulmonary disorders
```
CORRECT ANSWER: A>> Explanation: Per Pulmonary Conference Guidelines.
423
A driver with pulmonary hypertension with cor pulmonale who is experiencing inadequate pulmonary function tests can be qualified.
A. FALSE
B. TRUE
CORRECT ANSWER: A>> Explanation: The possibility of an incapacitating event is elevated, and certification should be withheld.
424
In-office pulmonary function testing is required for follow-up in cases of compromised breathing ability.
A. FALSE
B. TRUE
CORRECT ANSWER: A>> Explanation: The driver should be referred to his primary care physician for specialist referral, in most cases.
425
A driver should be disqualified if which one of the following is true?
A. When the driver is missing the 5th digit on a foot
B. When the driver is missing 1 digit on each hand
C. When a musculoskeletal disease or deficit is severe enough to interfere with driving
D. When the driver is missing a digit on 1 hand
CORRECT ANSWER: C>> Explanation: When any deficit can affect safety-sensitive function, a driver should be disqualified, pending Skill Performance Evaluation results.
426
```
What is required to allow the driver to maintain steering wheel grip and to perform other required tasks?
A. Grip strength and dexterity
B. Mobility and strength
C. Dermatomal integrity
D. Prehension
```
CORRECT ANSWER: D>> Explanation: Per FMCSA Guidelines.
427
Engine and vehicle check will involve squatting, stretching, reaching, and loosening and tightening connections.
A. TRUE
B. FALSE
CORRECT ANSWER: A>> Explanation: There is no weight limit requirement; however, the driver must be able to perform evaluations, safely enter and exit the cab, and perform essential safety duties.
428
If a driver has a loss of foot, leg, arm, or hand, he can be certified for how long?
A. After obtaining a Skill Performance Evaluation (SPE)
B. 1 year
C. 2 years
D. Can't be certified
CORRECT ANSWER: A>> Explanation: An SPE should be obtained, but the exam should be completed even though no driver's medical certificate was issued.
429
If a driver is missing a finger or toe, he can be certified for how long?
A. 2 years
B. After obtaining a Skill Performance Evaluation
C. To be determined by the examiner on a case-by-case basis
D. 1 year
CORRECT ANSWER: C>> Explanation: This is a discretionary finding and provides examiner laterality in making a certification decision.
430
A driver may be qualified if he has the ability to control and operate a vehicle safely.
A. TRUE
B. FALSE
CORRECT ANSWER: A>> Explanation: Even if the driver is missing a finger, toe, or a combination thereof, he can still be qualified.
431
A driver with a physical impairment that affects his ability to safely operate a commercial motor vehicle (CMV), according to the medical examiner, or a driver with missing limbs can legally drive a CMV without a Skill Performance Evaluation (SPE) certificate.
A. FALSE
B. TRUE
CORRECT ANSWER: A>> Explanation: Once determined, an SPE is mandatory.
432
A driver with a fixed deficit may be certified for 2 years:
A. As long as the 2-year certificate is marked
B. The driver can't be certified for 2 years
C. The driver would need an exemption/waiver
D. As long as the Skill Performance Evaluation (SPE) is marked
CORRECT ANSWER: D>> Explanation: SPEs that are valid and in force must be presented to the examiner.
433
The musculoskeletal standard is a non-discretionary standard.
A. FALSE
B. TRUE
CORRECT ANSWER: A>> Explanation: Examiner laterality in making certification decisions is allowed with musculoskeletal conditions.
434
A driver with diabetic neuropathy in the lower extremities would need to undergo a Skill Performance Evaluation (SPE).
A. FALSE
B. TRUE
CORRECT ANSWER: A>> Explanation: SPEs are required only for deficits in fingers, toes, limbs, etc...not diabetic neuropathy. That would fall with the neurologist and the certified examiner.
435
```
Lack of impulse control is a characteristic of what type of mental disorder?
A. Personality
B. Psychotic
C. Manic mood disorder
D. Depressive mood disorder
```
CORRECT ANSWER: A>> Explanation: Per the Psychiatric Conference Guidelines.
436
```
A driver with schizophrenia should normally be certified for:
A. 6 months
B. Can't be certified
C. 1 year
D. 2 years
```
CORRECT ANSWER: B>> Explanation: Per the Psychiatric Conference Guidelines.
437
```
Appetite disturbance, delusions and hallucination, fatigue, loss of interest and motivation, poor concentration, and poor sleep are all symptoms of what type of disorder?
A. Depressive episode of bipolar
B. Manic episode of bipolar
C. Major depressive disorder
D. Bipolar disorder
```
CORRECT ANSWER: A>> Explanation: Per the Psychiatric Conference Guidelines.
438
Mental health is considered a non-discretionary standard.
A. TRUE
B. FALSE
CORRECT ANSWER: B>> Explanation: Per the Psychiatric Conference Guidelines.
439
```
Which of the following is not a type of benzodiazepine?
A. Diazepam (Valium)
B. Lorazepam (Ativan)
C. Fluoxetine (Prozac)
D. Clonazepam (Klonopin)
```
CORRECT ANSWER: C>> Explanation: Per the Psychiatric Conference Guidelines.
440
```
An examiner should assess a driver on a case-by-case basis when taking antidepressants, although 1 class has consistently been shown to interfere with safe driving. Which class is it?
A. Benzodiazepines
B. Amphetamines
C. First-generation antidepressants
D. Second-generation antidepressants
```
CORRECT ANSWER: C>> Explanation: First-generation antidepressant side effects include drowsiness.
441
Lithium shows strong evidence of interfering with driving skills.
A, FALSE
B. TRUE
CORRECT ANSWER: A>> Explanation: Per the Psychiatric Conference Guidelines.
442
Central nervous system (CNS) stimulants are usually disqualifying. What is the 1 disease that can be an exception to this rule?
A. Attention-deficit/hyperactivity disorder (ADHD)
B. Fatigue
C. Brain damage
D. There is no exception; CNS stimulants are always disqualifying
A>> Explanation: Medications for ADHD are assessed on a case-by-case basis, especially when impulsivity by the driver is included.
443
A driver should have a symptom-free wait period of 1 year after all of the following conditions EXCEPT:
A. Major depressive episode
B. Attention-deficit/hyperactivity disorder impulsive episode
C. Suicide attempt
D. Major manic episode
CORRECT ANSWER: B>> Explanation: Wait time for certification should be a mutual decision between the examiner and the psychiatrist.
444
A driver with a mental disorder can be certified if he meets all of the following criteria EXCEPT:
A. He met the symptom-free waiting period
B. He was cleared by a treatment provider
C. He complies with a treatment program that does not interfere with safe driving
D. He is monitored by a psychiatrist
CORRECT ANSWER: D>> Explanation: They do not have to be monitored by a psychiatrist.
445
```
When performing a pre-employment physical on a driver, what additional testing is required?
A. Drug and alcohol test
B. Hair analysis
C. Drug test
D. Alcohol test
```
CORRECT ANSWER: C>> Explanation: A pre-employment drug test is mandatory.
446
When addressing the use of alcohol and drugs, they are considered non-discretionary standards.
A. FALSE
B. TRUE
CORRECT ANSWER: A>> Explanation: Examiner laterality is allowed.
447
```
Employers must randomly test what percentage of their drivers unannounced for alcohol?
A. 0.05
B. 0.15
C. 0.2
D. 0.1
```
CORRECT ANSWER: D>> Explanation: Per FMCSA Mandate.
448
An employer may request testing for alcohol and/or drug use when the actions, appearance, behavior, and speech of a driver suggest use or withdrawal.
A. TRUE
B. FALSE
CORRECT ANSWER: A>> Explanation: Per FMCSA Mandate.
449
A return-to-duty or follow-up test is completed when a driver has violated the drug and/or alcohol conduct standards and is returning to performing safety-sensitive duties.
A. TRUE
B. FALSE
CORRECT ANSWER: A>> Explanation: Per FMCSA Mandate.
450
A driver who has previously tested positive on a drug test wants to be recertified. When can he be recertified?
A. When he has SPI documentation of successful completion of the SAP-required rehabilitation program
B. When he has a negative return-to-duty test
C. When he has a negative dilute drug test result
D. When he has had a substance abuse evaluation by his primary care physician
CORRECT ANSWER: B>> Explanation: Per FMCSA Mandate.
451
When assessing consumption patterns, ask the driver about the number of drinks per week or the number per occasion. Problem drinking may be indicated when?
A. A male consumes ≥14 drinks per week or ≥4 per occasion
B. A male consumes ≥7 drinks per week or ≥3 per occasion
C. A male consumes ≥10 drinks per week or ≥3 per occasion
D. A male consumes ≥5 drinks per week or ≥2 per occasion
CORRECT ANSWER: A>> Explanation: Per FMCSA Mandate.
452
```
A driver should be disqualified for using all of the following EXCEPT:
A. Alcohol
B. Amphetamine
C. Methadone
D. Schedule 1 controlled substances
```
CORRECT ANSWER: A>> Explanation: When not performing safety-sensitive function.
453
Self-reported sleepiness surveys are reliable in reflecting the presence of obstructive sleep apnea.
A. FALSE
B. TRUE
CORRECT ANSWER: A>> Explanation: Multiple symptoms and indications must be present to suspect OSA or excessive daytime sleepiness.
454
The 2 most common causes of excessive daytime sleepiness are narcolepsy and obstructive sleep apnea.
A. TRUE
B. FALSE
CORRECT ANSWER: A>> Explanation: Per Sleep Conference Guidelines.
455
```
Excessive daytime sleepiness (EDS) may indicate all of the following underlying conditions EXCEPT:
A. Neurological disease
B. Alcohol or drug use
C. Amphetamine use
D. Depression
```
CORRECT ANSWER: C>> Explanation: Amphetamine use or abuse would result in the opposite of EDS.
456
```
Apnea occurs when respirations cease for greater than:
A. 8 seconds
B. 10 seconds
C. 5 seconds
D. 6 seconds
```
CORRECT ANSWER: B>> Explanation: Per Sleep Conference Guidelines.
457
If a person underwent surgery to treat obstructive sleep apnea, what is the recommendation regarding certification?
A. 1-time 6-month certification
B. 3-month wait after surgery, then certified for 2 years
C. 3-month wait after surgery, then certified for 1 year
D. Certify for 2 years
CORRECT ANSWER: C>> Explanation: Per Sleep Conference Guidelines.
458
The following disorders are disqualifying regarding fatigue EXCEPT:
A. NSAID use
B. Untreated obstructive sleep apnea
C. Narcolepsy
D. Idiopathic central nervous system hypersomnolence
CORRECT ANSWER: A>> Explanation: NSAID use is not disqualifying.
459
A driver with a symptomatic hernia can be certified.
A. TRUE
B. FALSE
CORRECT ANSWER: B>> Explanation: The risk for an incapacitating event is great.
460
```
How long must a driver wait after being supplied a continuous positive airway pressure machine before returning to driving?
A. 2 months
B. Can't be certified
C. 1 month
D. 3 weeks
```
CORRECT ANSWER: C>> Explanation: Per Sleep Conference Guidelines.
461
Neck circumference and body mass index (BMI) are the standard when predicting the prevalence of obstructive sleep apnea (OSA).
A. TRUE
B. FALSE
CORRECT ANSWER: B>> Explanation: Numerous factors combined lead an examiner to order an OSA evaluation. Neck circumference and BMI are partial causes, but neither is a cause on its own.
462
An exemption may not be applied if a licensed medical practitioner prescribes the substance or drug.
A. FALSE
B. TRUE
CORRECT ANSWER: A>> Explanation: The final choice whether to certify lies with the medical examiner, not the primary or specialist.
463
Medication use is a discretionary standard except when it comes to methadone and illegal drug use.
A. TRUE
B. FALSE
CORRECT ANSWER: A>> Explanation: Methadone and illegal drugs are the only exemptions for medication use.
464
```
One side effect of Schedule I drugs is:
A. Euphoria
B. Palpitations
C. Tachycardia
D. Insomnia
```
CORRECT ANSWER: A>> Explanation: Dangerous side effects from non-recognized-as-useful drugs are of concern.
465
```
A driver who is using methadone can be certified for:
A. 2 years
B. A 1-time certificate for 6 months
C. Can't be certified
D. 1 year
```
CORRECT ANSWER: C>> Explanation: Immediate disqualification if taking methadone or suboxone, not only for the medication, but also for the underlying addiction.
466
```
Schedule I medications consist of which of the following?
A. Codeine methylbromide, heroin
B. Marijuana, Oxycontin
C. PCP, fluoxetine
D. Alcohol, Ativan
```
CORRECT ANSWER: A>> Explanation: Per drug formulary data.
467
A driver should be disqualified if the driver is taking any of the following except:
A. Narcotics
B. Prescribed narcotics with instruction and counseling from the provider
C. Amphetamine
D. Schedule I drugs
CORRECT ANSWER: B>> Explanation: Per FMCSA Guidelines.
468
If a driver is prescribed a codeine-based cough medication, which of the following is not true?
A. May drive without restriction provided the driver does not use the suppressant while driving
B. Must carry a prescription while driving
C. Must have been provided instructions on proper use and notification of side effects
D. Cannot drive until use has stopped
CORRECT ANSWER: D>> Explanation: A driver is not required to carry a prescription while driving
469
A driver is taking Allegra. What, if any, limitations does the driver have for certification?
A. Cannot use if combined with lisinopril
B. No limitations as long as it does not cause drowsiness
C. Cannot be certified
D. Can be used if accompanied with a stimulant
CORRECT ANSWER: B>> Explanation: Drowsiness is the key concern.
470
```
A driver is taking Coumadin. What should the examiner suggest for the limit on the driver's certification?
A. 6 months
B. 2 years
C. Can't be certified
D. 1 year
```
CORRECT ANSWER: D>> Explanation: Per Cardiovascular Guidelines.
471
```
If a driver with NIDDM is taking antihypertensive medication for anxiety, he can be certified for how long?
A. 1 year
B. 6 months
C. 2 years
D. Can't be certified
```
CORRECT ANSWER: C>> Explanation: Use of antihypertensive meds for anxiety can approve for 2-year certification, but it depends on the underlying condition.
472
Adrenergic alpha-antagonists (alpha-blockers) do which of the following?
A. Increase prostaglandin synthesis
B. Decrease nociceptor functioning
C. Block the actions of endogenous adrenergic agonists
D. Bind without activating the beta-adrenergic receptors
CORRECT ANSWER: C>> Explanation: Per drug formulary data.
473
Many beta-blockers are also used in liquid form as an ophthalmic solution.
A. TRUE
B. FALSE
CORRECT ANSWER: A>> Explanation: Per drug formulary data
474
```
Angiotensin II receptor antagonists are used for all of the following EXCEPT:
A. Congestive heart failure
B. Diabetic neuropathy
C. Epilepsy
D. Hypertension
```
CORRECT ANSWER: C>> Explanation: Per drug formulary data.
475
```
A driver who is taking Zetia to lower cholesterol comes in for a physical examination. The exam is essentially normal. The driver should be certified for:
A. 2 years
B. 6 months
C. 1 year
D. Can't be certified
```
CORRECT ANSWER: A>> Explanation: Zetia and statins have no limitations.
476
```
A driver is taking Lantus for diabetes. The driver can be certified for:
A. 6 months
B. 1 year
C. 2 years
D. Can't be certified
```
CORRECT ANSWER: B>> Explanation: Per FMCSA regulations
477
```
A driver is taking Zomig to treat migraines. What kind of limitation should the driver have?
A. Can't be certified
B. 6-month limitation
C. No limitation
D. 1-year limit
```
CORRECT ANSWER: C>> Explanation: Zomig has no limitations unless the underlying condition is limiting.
478
A driver taking Naprosyn for pain control never has restrictions on the driver's certification.
A. FALSE
B. TRUE
CORRECT ANSWER: A>> Explanation: There is no certainty when taking any medication, no matter how innocuous it may seem. All depends on the underlying condition.
479
A driver prescribed Byetta, an incretin mimetic, was denied driver certification on the last DOT exam 2 weeks ago. The driver presents today complaining that the other examiner was incorrect and wants your opinion. You would tell the driver that the other examiner was:
A. Incorrect, and the driver can be certified for 6-month intervals
B. Incorrect, and the driver can be certified for 1 year, as incretin mimetics are allowable
C. Indeed correct because incretin mimetics are essentially the same as insulin
D. Correct because all diabetics taking medication cannot be certified
CORRECT ANSWER: B>> Explanation: Incretin mimetics are allowed.
480
The number 1 cause of fatalities in the United States involving commercial motor vehicles is due to cell phone usage.
A. FALSE
B. TRUE
CORRECT ANSWER: A>> Explanation: Driver fatigue is the number 1 cause of accidents in the United States.
481
For a driver to be physically qualified to drive a motor vehicle, he must have all of the following EXCEPT:
A. No myocardial conditions that produce syncope
B. No issued moving violations in the last year
C. No loss of foot, leg, hand, or arm
D. No diagnosis of diabetes that requires insulin
CORRECT ANSWER: B>> Explanation: Per FMCSA Regulations.
482
It is the examiner's staff member's job to properly identify the driver that is coming in for a physical examination.
A. FALSE
B. TRUE
CORRECT ANSWER: A>> Explanation: It is the medical examiner's responsibility to properly identify the driver, but he/she may delegate that authority.
483
The visual examination is one of the discretionary standards for certification.
A. FALSE
B. TRUE
CORRECT ANSWER: A>> Explanation: Vision is a non-discretionary standard.
484
```
A driver who has had a myocardial infarction can be certified after waiting how long?
A. 2 months
B. 1 month
C. 3 months
D. 6 months
```
CORRECT ANSWER: A>> Explanation: Per Cardiac Guidelines.
485
```
When performing an examination, which of the following devices are not required to be used?
A. Reflex hammer
B. Ophthalmoscope
C. Stethoscope
D. Otoscope
```
CORRECT ANSWER: B>> Explanation: An ophthalmoscope is used only when indicated.
486
Monocular candidates are not qualified.
A. TRUE
B. FALSE
CORRECT ANSWER: A>> Explanation: Per the Vision Standard.
487
```
A driver comes in with blood pressure of 142/92. The driver can be certified for:
A. 3 months
B. 6 months
C. 2 years
D. 1 year
```
CORRECT ANSWER: D>> Explanation: Per the Hypertension Guidelines.
488
A driver with a pacemaker can be certified for how long?
A. 1 year
B. Driver must obtain a medical exemption to drive
C. 2 years
D. Can't be certified
CORRECT ANSWER: A>> Explanation: Per the Cardiac Guidelines.
489
A driver with an implantable cardioverter-defibrillator is disqualified.
A. TRUE
B. FALSE
CORRECT ANSWER: A>> Explanation: Per the Cardiac Guidelines.
490
```
A qualified driver should have an exercise stress test (EST) at least every 2 years after any of the following conditions EXCEPT:
A. Tachycardia
B. Myocardial infarction
C. Stable angina pectoris
D. Angioplasty
```
CORRECT ANSWER: A>> Explanation: Per the Cardiac Guidelines.
491
```
A driver who has recently had a myocardial infarction should wait how long before becoming certified?
A. 3 months
B. 6 months
C. 2 months
D. 1 month
```
CORRECT ANSWER: C>> Explanation: Per the Cardiac Guidelines.
492
```
What is the wait period for certification for a driver who has had a stroke?
A. 1 year
B. 1 month
C. 3 months
D. 6 months
```
CORRECT ANSWER: A>> Explanation: Per Neurological Guidelines.
493
```
A driver had a moderate head injury where he lost consciousness for 40 minutes. He has not had a seizure and is not taking any medications. He is coming in for a physical after the waiting period has expired. For how long can he be certified?
A. 2 years
B. Can't be certified
C. 1 year
D. 6 months
```
CORRECT ANSWER: C>> Explanation: Per TBI Guidelines.
494
The FMCSA defines epilepsy as ≥3 unprovoked seizures.
A. FALSE
B. TRUE
CORRECT ANSWER: A>> Explanation: Per Neurological Guidelines.
495
```
A provoked seizure includes all of the following EXCEPT:
A. Hypoglycemic seizure
B. Epileptic seizure
C. Febrile seizure
D. Anesthesia-induced seizure
```
CORRECT ANSWER: B>> Explanation: Per Neurological Guidelines.
496
```
A driver who is taking insulin for diabetes can be certified for how long?
A. Can't be certified
B. 6 months
C. 1 year
D. 2 years
```
CORRECT ANSWER: A>> Explanation: Drivers taking insulin for diabetes cannot be certified unless there is an active diabetes waiver.
497
A driver has no history of hypertension and comes in for an initial physical examination. The driver's blood pressure has a reading of 162/105.
The driver can be certified for how long?
A. Can't be certified
B. A 1-time certificate for 3 months
C. 1 year
D. 2 years
CORRECT ANSWER: B>> Explanation: Per the Hypertension Guidelines
498
A post-accident drug and alcohol test is required in all of the following except if:
A. Any person sought medical treatment away from the scene
B. The driver had passengers aged <12 years
C. The accident involves a loss of a human life
D. The driver is cited for a moving violation
CORRECT ANSWER: B>> Explanation: Per FMCSA Regulations.
499
```
A driver who has had an angioplasty 4 months ago and has had a satisfactory exercise stress test can be certified for how long?
A. 6 months
B. 2 years
C. Can't be certified
D. 1 year
```
CORRECT ANSWER: D>> Explanation: Per Cardiac Guidelines.
500
In crashes involving at least 1 large truck, the mortality rate for the occupants of the passenger vehicle is:
A. Approximately 6 times greater than that of the occupants of the truck
B. Approximately 2 times greater than that of the occupants of the truck
C. Approximately 7 times greater than that of the occupants of the truck
D. Approximately 10 times greater than that of the occupants of the truck
CORRECT ANSWER: A>> Explanation: Per FMCSA Statistics.
501
```
When considering the safety implications of the driver's medical condition, the examiner needs to consider all of the following except:
A. Road conditions
B. Physical condition
C. Driver scheduling
D. Medical treatment
```
CORRECT ANSWER: A>> Explanation: Though tonnage limits, routes, and weather may cause stress to the driver, generally, the examiner is not concerned with specific parameters of load weight. More specific interest is noted with driver scheduling because, in addition to the mental and physical condition, schedules can lead to driver fatigue.
502
Standards are legal requirements for interstate commercial vehicles, drivers, and motor carriers.
A. TRUE
B. FALSE
CORRECT ANSWER: A>> Explanation: Per FMCSA Mandate.
503
If a driver has been treated surgically for obstructive sleep apnea, what is the recommendation regarding certification?
A. 3-month wait after surgery, then certified for 1 year
B. Certify for 2 years
C. 1-time 6-month certification
D. 3-month wait after surgery, then certified for 2 years
CORRECT ANSWER: A>> Explanation: Per Sleep Study Panel.
504
The examiner finds inconclusive findings on the forced whisper test. The examiner may then:
A. Send the driver for additional testing
B. Certify the driver for 1 year
C. Certify the driver for 2 years
D. Don't certify the driver
CORRECT ANSWER: A>> Explanation: Per the Hearing Standard.
505
```
A driver who has undergone bypass can be certified if which of the following is true?
A. Ejection fraction is ≤40%
B. Sternal wound is not healed
C. Can't be certified
D. Ejection fraction is ≥40%
```
CORRECT ANSWER: D>> Explanation: Per the Cardiac Standard.
506
```
A driver has an abdominal aorta that measures 5.2 cm, and the driver's doctor recommends surgical repair. For how long can the driver be certified?
A. 1 year
B. 2 years
C. Can't be certified
D. 6 months
```
CORRECT ANSWER: C>> Explanation: Until the driver is repaired, has healed from the surgery, and has a release, he still cannot return to commercial motor vehicle driving until he takes a new exam.
507
```
Which of the following is a discretionary standard?
A. Diabetes mellitus
B. Vision
C. Hearing
D. Hypertension
```
CORRECT ANSWER: D>> Explanation: Though the recommendations are largely enforced as written on the exam form, the hypertension standard is discretionary.
508
```
A driver who has a mood disorder meets all standards except that the driver had a major manic episode in the last year. For how long can the driver be certified?
A. Can't be certified
B. 1 year
C. 6 months
D. 2 years
```
CORRECT ANSWER: B>> Explanation: As long as they are controlled, tolerate medications, and have a release from the psychiatrist, but it is up to the examiner to determine fitness.
509
```
A driver has been using electroconvulsive therapy for treatment of severe depression. What is the waiting period before the driver can be certified?
A. 3 months
B. 1 year
C. 6 months
D. 1 month
```
CORRECT ANSWER: C>> Explanation: Per FMCSA Regulations.
510
Neurological medications include all of the following EXCEPT:
A. Central nervous system stimulants
B. Non-steroidal anti-inflammatory drug (NSAID)
C. Anticoagulants
D. Anticonvulsants
CORRECT ANSWER: B>> Explanation: Per drug formulary data.
511
```
A driver who is diagnosed with Pick disease can be certified for how long?
A. 1 year
B. 2 years
C. Can't be certified
D. 6 months
```
CORRECT ANSWER: C>> Explanation: Pick disease causes a progressive destruction of brain cells, and driving would make him predisposed to an incapacitating event
512
A history of childhood seizures is not disqualifying.
A. TRUE
B. FALSE
CORRECT ANSWER: A>> Explanation: As long as there are no current seizures for the past 5 years and no medications for the past 5 years.
513
A driver with supraventricular tachycardia should be disqualified if the driver is experiencing any of the following except:
A. Loss of consciousness
B. Right shoulder pain
C. Corrective medication usage under one month
D. Compromised cerebral function
CORRECT ANSWER: B>> Explanation: Per Cardiac Conference Guidelines. Shoulder would not be disqualifying, depending on etiology.
514
A pre-employment test does not require both a drug and alcohol test.
A. TRUE
B. FALSE
CORRECT ANSWER: A>> Explanation: Drug test only is required.
515
```
Which of the following medications is not disqualifying?
A. Codeine
B. Lisinopril
C. Midazolam
D. Phenobarbital
```
CORRECT ANSWER: B>> Explanation: Lisinopril is one of the most popular prescribed medications for control of hypertension.
516
A driver has experienced a transient ischemic attack. How long is the wait period before the driver can be certified?
A. There is no wait period; the driver can't be certified
B. Seizure-free and off medication for 1 year
C. Seizure-free and off medication for 2 years
D. Seizure-free and off medication for 5 years
CORRECT ANSWER: B>> Explanation: Per the Neurological Standard.
517
```
An examiner must verify that a driver's prehension and power grasp are adequate. A dynamometer is not required but, if used, what is the minimum grip strength that is recommended?
A. 68 pounds
B. 58 pounds
C. 52 pounds
D. 62 pounds
```
CORRECT ANSWER: B>> Explanation: Per FMCSA Recommendations.
518
Use of oral hypoglycemics or diet-/exercise-controlled diabetes mellitus (DM) requires the examiner's discretion on a case-by-case basis for certification.
A. TRUE
B. FALSE
CORRECT ANSWER: A>> Explanation: Per FMCSA Recommendations.
519
Strokes involving the cerebellum and brainstem are most likely to cause post-stroke seizures.
A. FALSE
B. TRUE
CORRECT ANSWER: A>> Explanation: Per the Neurological Standard.
520
```
A driver who previously had stage 1 hypertension and was certified for 1 year comes in for recertification. Upon exam, the driver has stage 2 hypertension. For how long can the driver be certified?
A. 6 months
B. 1 year
C. Can't be certified
D. 3 months
```
CORRECT ANSWER: D>> Explanation: A 1-time certification for 3 months is in order until he has his BP under 140/90.
521
```
A Skill Performance Evaluation (SPE), once granted, is good for how long?
A. 3 years
B. 5 years
C. 2 years
D. 1 year
```
CORRECT ANSWER: C>> Explanation: An SPE is good for 2 years.
522
A 38-year-old driver presents for an initial certification exam. His history includes a diagnosis of deep vein thrombosis 3 months prior. The driver is asymptomatic. His physical exam is within normal limits and he started on Coumadin therapy just prior to hospital discharge 3 months ago. International normalized ratios performed monthly are within therapeutic range. The examiner should:
A. Issue a 1-year certification
B. Advise the driver of a required 6-month waiting period and schedule the driver for a re-evaluation at that time
C. Coumadin therapy is a disqualifying medication for commercial drivers
D. Issue 2-year certification
CORRECT ANSWER: A>> Explanation: Per FMCSA medical guidelines, criteria for certification have been met.
523
A 43-year-old driver presents for a recertification exam. The driver states that since his last exam 2 years ago, he was diagnosed with stable angina for which it was recommended that he undergo percutaneous coronary intervention (PCI) with angioplasty. The PCI was performed 2 weeks prior to this exam, without complication. The driver is asymptomatic and is tolerating the medications well. His vascular access site is without injury. The driver is accompanied by a statement from his treating cardiologist permitting return to commercial driving. The examiner should:
A. Disqualify, as a driver having undergone PCI is no longer qualified to drive commercially
B. Temporarily disqualify and schedule driver to return for examination after 6-month waiting period and post-procedure exercise tolerance testing.
C. Issue a 6-month certification and schedule the driver to return at that time, as well as to obtain a report of exercise tolerance testing 3 to 6 months post-procedure
D. Issue 1-year certification
CORRECT ANSWER: C>> Explanation: Per February 2009 Cardiovascular Recommendation tables.
524
A 57-year-old driver presents for a recertification exam. His history includes a myocardial infarction (MI) 3 months prior. The driver provides clearance from his cardiologist to continue commercial driving. In addition, he presents the results of post-MI echocardiogram showing an ejection fraction equal to only 45%. He is asymptomatic, he is tolerating the medications, and his physical exam is unremarkable. The examiner should:
A. Issue a 1-time 3-month certification
B. Cannot be certified
C. Issue a 1-year certification
D. Instruct driver that a 6-month waiting period is required after a myocardial infarction and to schedule an exam at that time
CORRECT ANSWER: C>> Explanation: Per February 2009 Cardiovascular recommendation tables
525
A 58-year-old male driver presents for a recertification exam. His history includes hypertension. The driver is a smoker and his body mass index is 42. The examiner notes that the driver's current medical examiner's certificate was of 1 year's duration, but does not expire for 2 months. The driver's blood pressure this day is 148/92 and then repeated at 144/88. The remainder of the driver's exam is normal. The examiner should:
A. Dismiss the driver from the clinic setting, with instruction to return at the time of the expiration listed on his current medical examiner card
B. Issue 1-year certification
C. Cannot be certified
D. Issue a 1-time 3-month certification
CORRECT ANSWER: D>> Explanation: Per February 2009 Cardiovascular Recommendation tables
526
A 46-year-old driver presents for a recertification exam. The driver's history includes a diagnosis of secondary hypertension, which was surgically corrected 6 weeks prior. The driver is accompanied by a document from the surgeon stating he may return to commercial driving without restriction. The driver's blood pressure today is 138/82, and he is tolerating the medications, none of which are contraindicated for commercial driving. The examiner should:
A. Issue a 1-time 3-month certification
B. Temporarily disqualify, instructing the driver to return after completing a waiting period of 3 months from the procedure
C. Issue a 1-year certification
D. Disqualify, since secondary hypertension is a disqualifying condition
CORRECT ANSWER: B>> Explanation: FMCA guidelines recommend a 3-month waiting period post-surgical correction.
527
A 47-year-old driver presents for a return-to-work physical exam after experiencing a pulmonary embolism (PE). The driver's accompanying documentation includes a statement from his treating provider stating that his last event was 10 weeks ago, he has since been regulated on Coumadin for 2 months, his monthly international normalized ratio results are within therapeutic range, and he is fit to return to commercial driving without restriction. The exam findings are within normal limits. The examiner should:
A. Temporarily disqualify the driver since the 3-month waiting period has not been met
B. Issue 3-month interval certifications until the driver has been on Coumadin for 1 year, then annual certifications
C. Disqualify; history of seizure disorder is non-discretionary
D. Cannot be certified since PE is a disqualifying medical condition
CORRECT ANSWER: A>> Explanation: FMCSA guidelines recommend a minimum of 3 months without recurrent PE waiting period.
528
A 62-year-old driver presents for recertification. The driver has a history of an abdominal aortic aneurysm (AAA) and brings a copy of an ultrasound report dated 1 week prior, revealing the aneurysm now measures 4.8 cm and is unchanged from ultrasound 3 months prior. The remainder of the history and exam are unremarkable. The examiner should:
A. Request a repeat ultrasound in 3 months and certify for 1 year if the abdominal aortic aneurysm is unchanged in size
B. Temporarily disqualify until medical clearance for commercial driving from a cardiovascular specialist can be obtained
C. Issue 6-month certification
D. Disqualify until after surgical repair and recommended a waiting period
CORRECT ANSWER: B>> Explanation: FMCSA guidelines recommend to certify if the abdominal aortic aneurysm is >4 cm, <5 cm, driver is asymptomatic, and has clearance from cardiovascular specialist.
529
A 37-year-old driver presents for a recertification exam. She has a history of hypertension and has been maintained on lisinopril. The driver's previous certification was of 1 year's duration. Her blood pressure today is 139/88. Current medications include simvastatin, methadone, and multivitamins with iron and fish oil - all prescribed by the driver's primary care physician. The driver's physical exam this day is unremarkable. The examiner should:
A. Do not certify due to methadone use
B. Issue 1-time 3-month certification due to stage 1 hypertension
C. Issue 1-year certification and educate the driver regarding cardiovascular risk factors, including hypertension and dyslipidemia
D. Issue 2-year certification
CORRECT ANSWER: A>> Explanation: FMCSA guidelines recommend not to certify if driver uses methadone regardless of reason for prescription.
530
A 39-year-old driver presents for initial certification. Her history reflects no disqualifying disorders; however, she has indicated that she has chronic low back pain and further elaborates by stating she has not lost any work (driving) time due to back pain over the past 24 months. The driver states the pain is adequately controlled by use of NSAIDs and combination acetaminophen/hydrocodone for breakthrough pain. The examiner should:
A. Proceed with exam and, if otherwise qualified, temporarily disqualify until documentation can be obtained from the prescribing provider stating that the provider is familiar with the driver's medical history and assigned duties and has advised the driver that the acetaminophen/hydrocodone combination will not adversely affect the driver's ability to safely operate a commercial motor vehicle
B. Contact the driver's motor carrier and require that the driver be placed on surveillance - unannounced random drug screens - for 6 months before issuing certification
C. Disqualify driver due to hydrocodone use
D. Issue 1-year certification
CORRECT ANSWER: A>> Explanation: FMCSA lists exception to use of habit forming drug if the drug is prescribed by a licensed practitioner who is familiar with the driver's medical history and assigned duties and has advised the driver that the drug will not adversely affect the driver's ability to safely operate a commercial motor vehicle.
531
A 56-year-old long-haul driver presents for a recertification exam. There are no affirmative responses on the history section of the medical examiner's report form. However, during the interview, the driver states he uses CPAP therapy nightly due to post-trauma nasal obstruction. He states he submitted to a sleep study that did not reveal significant sleep apnea; however, his paperwork was completed in a fashion to include sleep apnea as his diagnosis but ""only so the insurance would pay for it."" It is also learned that the driver has a history of stage 1 hypertension. His previous certification was for 1 year's duration. Physical exam findings are within normal limits, including a blood pressure of 137/80. The examiner should:
A. Call the police, since it is obvious he has intentionally falsified his history, committed insurance fraud, and will not be eligible to drive commercially from this point forward
B. Disqualify since CPAP therapy is not permitted for long-haul drivers
C. Issue 1-year certification
D. Issue 2-month certification and request documentation from the treating provider regarding sleep apnea and a compliance report from the CPAP machine
CORRECT ANSWER: D>> Explanation: FMCSA guidelines recommend to certify if objective testing is performed and compliance with continuing nonsurgical therapy is documented
532
A 37-year-old driver presents for a recertification. She states she has been taking Cephalexin for 3 days to treat an infected wound of the left (non-dominant) hand secondary to a work-related injury. She states her wound seems to be worsening - that it continues to drain thick, green-yellow fluid, and she has developed a fever. The driver's remaining history and exam are unremarkable. The examiner should:
A. Determine whether the current injury interferes with safe operation of a commercial vehicle, then certify or temporarily disqualify as indicated and refer the driver back to her treating provider
B. Obtain culture of drainage, discontinue Cephalexin, and initiate therapy with a broader-spectrum antibiotic
C. Issue 2-year certification
D. Do not certify due to draining wound
CORRECT ANSWER: A>> Explanation: Medical Examiner Handbook states that the medical examiner examines for medical fitness for duty, NOT diagnosing and treating.
533
A 61-year-old driver presents for a recertification. The driver's history includes coronary artery disease (CAD) with coronary artery bypass grafting (CABG) 8 years prior. He is asymptomatic and his exam is unremarkable. The driver is accompanied by a statement of current cardiac status, report of an exercise tolerance test with acceptable results performed 15 months ago, and recommendation by the treating cardiologist that the driver is fit to continue to drive commercially. The examiner should:
A. Advise driver that, beginning 5-years post-CABG, exercise tolerance tests (ETT) must be performed annually. Issue 1-month certification and extend, if appropriate, after receiving report of the updated ETT
B. Issue 1-year certification
C. Temporarily disqualify until report of transesophageal echocardiogram can be produced
D. Issue all certifications at 6-month intervals beginning 5 years post-CABG
CORRECT ANSWER: A>> Explanation: FMCSA guidelines recommend annual exercise tolerance testing beginning 5 years post-CABG
534
A 32-year-old driver is sent by his employer for a return-to-duty physical exam following his violation of drug/alcohol rules evidenced by random testing program. The driver carries a document from a substance abuse professional stating he has complied with treatment as outlined and recommends the driver be returned to commercial driving duty. The driver has submitted to a urine drug screen and breath alcohol testing - both with negative results. The examiner should:
A. Complete a physical exam, certify at 6-month intervals, and collaborate with the motor carrier to set up unannounced drug/alcohol screens
B. Perform exam and issue 1-year certification
C. Do not certify, as violation of drug/alcohol rules permanently disqualifies a commercial driver
D. Contact the motor carrier and advise that driver is not required to be medically re-examined until his current certification has expired
CORRECT ANSWER: D>> Explanation: FMCSA guidelines state a driver is not required to be medically re-examined until his current certification has expired
535
A 35-year-old driver presents for a return-to-driving exam. Nine months prior, the driver was involved in a motor vehicle accident and sustained a mild structural brain insult with early seizures. The injuries have healed completely without loss of function. Her seizure medication was discontinued 3 months after the occurrence and she has been seizure free and off medications since. She carries clearance from a neurologist to return to commercial driving. The examiner should:
A. Inform the driver that a 2-year seizure free/off medication waiting period is required after mild insults with early seizures; temporarily disqualify and schedule a return visit after the waiting period is completed
B. Request a copy of the most recent electroencephalogram (EEG) report and, if report is acceptable, issue 1-year certification
C. Do not certify driver, as this is a nondiscretionary issue
D. Contact the treating neurologist and confirm that driver is off anticonvulsant, then issue 1-year certification
CORRECT ANSWER: A>> Explanation: FMCSA guidelines recommend a 2-year off medication/seizure free waiting period
536
A 46-year-old driver presents for initial certification. She has been sitting comfortably in the exam room for 30 minutes. During the history-taking, you learn that the driver has a confirmed diagnosis of autonomic neuropathy. She is under treatment, and is regularly monitored. Vital signs this day are blood pressure 117/68, temperature 98.8, pulse 138, and respiration 18. The exam is otherwise unremarkable. The examiner should:
A. Not certify due to resting tachycardia
B. Issue 2-year certification
C. Issue 1-year certification
D. Request supporting documentation from a nephrologist, then issue 1-year certification
CORRECT ANSWER: A>> Explanation: FMCSA medical guidelines recommend not to certify if the driver has cardiovascular autonomic neuropathy that causes resting tachycardia or orthostatic blood pressure.
537
A 28-year-old driver presents for a recertification exam. The driver was newly diagnosed with non-insulin-dependent diabetes mellitus 9 months ago. She is seen by a treating provider every 3 months and is stable on oral medications. She denies a history of any hypoglycemic reactions resulting in seizure, loss of consciousness, requiring the assistance of another person, or a period of impaired cognitive function that occurred without warning. The physical exam is unremarkable. The examiner should:
A. Issue 1-year certification
B. Request a copy of hemoglobin A1C results prior to making a certification decision
C. Perform fingerstick glucose and issue 2-year certification if <140
D. Disqualify temporarily since FMCSA guidelines recommend 1-year waiting period
CORRECT ANSWER: A>> Explanation: Because of the progressive nature of diabetes mellitus, the FMCSA believes that 1 year maximum certification time is reasonable when the driver has a diagnosis of diabetes mellitus.
538
A 36-year-old driver presents for recertification. Since his last exam, his wife and 2 children were killed in a motor vehicle accident, resulting in severe depression, which was treated with electroconvulsive therapy (ECT). He is presenting today with an otherwise unremarkable history and exam, as well as documentation from his mental health professional explaining his diagnosis and confirming his adherence to the prescribed maintenance ECT. The examiner should:
A. Issue certification at 3-month intervals based on continued progress as documented by mental health professional
B. Issue 1-year certification
C. Issue 2-year certification
D. Disqualify due to maintenance ECT
CORRECT ANSWER: D>> Explanation: FMCSA guidelines recommend not to certify if driver has maintenance electroconvulsive therapy.
539
A 59-year-old driver presents for recertification. She has a history of an embolic stroke involving the cortical region of the brain occurring 1 year ago. The driver's exam reveals no focal deficits. She has clearance to perform commercial driving by a treating neurologist. Her medications do not interfere with safe driving. The examiner should:
A. Require serum protein electrophoresis (SPE) prior to determining certification status
B. Disqualify since cortical involvement places the driver at risk for seizures and the minimum waiting period is 5 years
C. Issue 1-year certification
D. Request a copy of discharge summary from the treating facility prior to determining certification status
CORRECT ANSWER: B>> Explanation: FMCSA guidelines recommend minimal 5-year waiting period after strokes at risk for seizures (cortical or subcortical deficits)
540
A 62-year-old driver presents for recertification 15 months after a thrombotic stroke involving the cerebellar region of the brain. He has no residual deficits. He has clearance from a treating neurologist. Monthly international normalized ratios reveal that Coumadin is within therapeutic range. His medications do not interfere with safe operation of a commercial motor vehicle. The examiner should:
A. Not certify due to Coumadin
B. Issue 1-year certification
C. Require SPE prior to determining certification status
D. Not certify since minimum waiting period is 5 years
CORRECT ANSWER: A>> Explanation: FMCSA guidelines recommend not to certify a driver on anticoagulant therapy for cerebrovascular disorder.
541
A 48-year-old driver presents for recertification. Her history includes coronary artery disease (CAD) with 3-vessel coronary artery stent placement. The driver has completed the required waiting period; she is tolerating medications, she is asymptomatic, and the exam is unremarkable. She has a clearance from the treating cardiologist to return to commercial driving, and the report of an exercise tolerance test (ETT) conducted 3 months ago reveals a heart rate equal to 75% of predicted maximum, a rise in systolic blood pressure of 24 mm Hg without angina, no ST abnormality, and workload capacity of 4 METs. The examiner should:
A. Not certify since maximum vessel disease is 2 vessels and this driver has 3-vessel involvement
B. Not certify due to suboptimal ETT results
C. Issue 1-year certification
D. Temporarily disqualify until results of follow-up angiogram are obtained
CORRECT ANSWER: B>> Explanation: FMCSA recommends ETT results as follows: >6 METS; heart rate ≥85% of predicted maximum (unless on beta blocker); rise in systolic blood pressure ≥20 mm Hg without angina; no significant ST segment depression.
542
A 37-year-old driver presents for a recertification exam. He has a fixed right lower extremity deficit with a prosthesis. His history and physical exam are otherwise unremarkable. He brings a copy of his Skill Performance Evaluation (SPE) issued 5 years ago. The examiner should:
A. Issue 2-year certification
B. Not certify - SPEs are issued ONLY for progressive disorders
C. Temporarily disqualify - SPE is not valid after 2 years
D. Issue 1-year certification
CORRECT ANSWER: C>> Explanation: Per FMCSA regulations, the SPE certificate is valid for a period not to exceed two years from the date of issue.
543
A 57-year-old driver presents for recertification. Two months ago, the driver underwent a pacemaker implantation for treatment of sick sinus syndrome. The driver brings documentation indicating the presence of a functioning pacemaker and completion of routine pacemaker checks. The driver has no disqualifying underlying disease and the physical exam was unremarkable. The driver's cardiologist has cleared the driver for commercial driving. The examiner should:
A. Issue 6-month certification
B. Issue 1-year certification
C. Temporarily disqualify driver until 3-month waiting period is complete
D. Temporarily disqualify driver until an exercise tolerance test is completed and results obtained
CORRECT ANSWER: B>> Explanation: Per FMCSA guidelines, the waiting period post-pacemaker implantation for sick sinus syndrome is 1 month.
544
A 63-year-old diabetic long-haul driver presents for recertification. The driver states he has been maintained on lithium for treatment of bipolar disorder for the past 8 months. He is asymptomatic and lithium levels are within therapeutic range. The driver has no impairment (physical or psychological) that interferes with safe driving. Consult with the mental health specialist confirms the information provided by the driver. The examiner should:
A. Issue 1-year certification
B. Issue 2-year certification
C. Not certify the driver since lithium is a disqualifying medication
D. Inform driver that he will need documentation of completion of an approved counseling program prior to certification
CORRECT ANSWER: A>> Explanation: Per FMCSA guidelines, studies suggest there is little evidence of lithium interfering with driver skill performance.
545
A 44-year-old insulin-dependent diabetic driver with a diabetes exemption presents for recertification. The physical exam is unremarkable. The examiner should:
A. Not certify - insulin use is disqualifying
B. Require the driver to provide a copy of a completed Annual Diabetes Assessment Package before determining certification
C. Issue 2-year certification
D. Issue 1-year certification
CORRECT ANSWER: B>> Explanation: Per FMCSA Federal Diabetes Exemption Program guidelines
546
A 28-year-old driver with a history of diabetes presents for recertification. In addition to oral hypoglycemic medications, the driver is using an injectable incretin mimetic. The physical exam is unremarkable. There are no medication side effects that would interfere with safe driving. The driver has no history of severe hypoglycemic reactions. The examiner should:
A. Issue 2-year certification
B. Require driver to provide federal exemption prior to determining certification status
C. Issue a 1-year certification
D. Not certify - injectable hypoglycemic agents are disqualifying
CORRECT ANSWER: C>> Explanation: Per FMCSA guidelines, incretin mimetics are not insulin and can be used without an exemption.
547
A 45-year-old driver presents for a recertification exam. The driver reports a history of ventricular arrhythmias for which an implantable cardioverter-defibrillator (ICD) was implanted. Physical findings are unremarkable. The driver brings clearance from the treating cardiologist, documentation that the device has not fired since implantation, and a negative electrocardiogram (ECG). The examiner should:
A. Issue 1-year certification
B. Require a 24-hour Holter monitor report prior to determining certification
C. Recommend that the device be removed, then certify for 1 year
D. Not certify
CORRECT ANSWER: D>> Explanation: FMCSA guidelines recommend not to certify drivers with ICD or ICD/pacemaker combination devices.
548
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A 43-year-old driver presents for an initial certification. There are no affirmative responses on the history portion of the medical examiner report form. The physical exam is unremarkable except for an initial blood pressure of 188/108, which was repeated later and recorded as 150/110. The examiner should:
A. Issue 6-month certification
B. Issue 1-year certification
C. Not certify
D. Issue 1-time 3-month certification
```
CORRECT ANSWER: C>> Explanation: Per 2002 Cardiovascular Conference Report Recommendation
549
A 50-year-old driver reports for a recertification exam. The examiner notes that the driver wears glasses to complete the history section of the medical examination report form, but removes them to read the Snellen visual acuity chart. The driver's visual acuity is OD=20/30, OS=20/40, and OU=20/30. The remainder of the exam is within normal limits. The examiner should:
A. Issue 2-year certification
B. Issue 2-year certification and check box for corrective lenses
C. Issue 1-year certification
D. Not certify the driver
CORRECT ANSWER: A>> Explanation: Per FMCSR 49 CFR 391.41 (b)(10)
550
A 63-year-old driver presents for a recertification exam. The driver's prior certification duration is 1 year. He has a history of hypertension, maintained on lisinopril and hydrochlorothiazide. Blood pressure this day is 136/78; whisper test reveals he is able to hear a forced whisper at 3 feet on the right but only able to hear a forced whisper at 10 feet on the left. The remainder of the history and exam is unremarkable. The examiner should:
A. Issue 3-month temporary certification to allow for fitting of hearing aid in left ear
B. Not certify the driver
C. Issue 1-year certification
D. Proceed to audiometric testing prior to determining certification status
CORRECT ANSWER: C>> Explanation: Per FMCSR 49 CFR 391.41 (b)(11)
551
An obese 40-year-old driver presents for a recertification exam. History includes a diagnosis of hypertension. The driver is maintained on lisinopril, and his blood pressure today is 128/76. He states he was delayed in his arrival today due to having been abducted by space aliens who are performing research in the area. He states he was able to advise them regarding their mission and will be meeting with them again for updates next week. The examiner notes that the driver's slacks are wrong side out and his shoes do not match. There is a blinking signal light on his belt buckle and an odor of cannabis on his person. The examiner should:
A. Require that the driver dress appropriately next time he presents for an exam
B. Contact security to search his person for weapons and illicit drugs
C. Contact motor carrier to report same, disqualify driver, and refer for emergency psychological evaluation
D. Issue 1-time 3-month certification
CORRECT ANSWER: C>> Explanation: per FMCSA 49 CFR 391.41 (b)(9)
552
When checking the urinalysis, what do you need to look for?
A. Specific gravity, hematuria, glycosuria
B. Hematuria, specific gravity, leukocytes
C. Glycosuria, red blood cells, bilirubin
D. Specific gravity, hematuria, bilirubin
CORRECT ANSWER: A>> Explanation: Per FMCSA Mandate.
553
A driver is responsible for providing how many months of glucose control documentation to the treating clinician.
A. 6 months
B. 1 month
C. 3 months
D. Cannot drive despite glucose control documents.
CORRECT ANSWER: C>> Explanation: Driver must provide up to 3 months of glucose control documents to the treating clinician at the time of completion of MCSA-5870.
554
If a driver cannot produce the last three months of glucose control documentation, the driver may not be certified.
A. True
B. False
CORRECT ANSWER: B>> Explanation: A driver can be provided a provisional certification for three months while the driver is gathering support documentation for the treating clinician
