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According to their mission statement, the FMCSA is focused on all except:
A. Reducing Crashes
B. Reducing Injuries
C. Reducing Fatalities involving large trucks & buses
D. Reducing the number of potential CDL candidates

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Reducing the number of potential CDL candidates

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T/F: The Fed Motor Carrier Safety Admin guidelines do not specify the number of pounds a driver must be able to lift.

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True

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The organization responsible for providing the FMSCA with data about trends, costs, fatalities, & injuries in large buss & trucks accidents is
A. NRCME
B. ART
C. FMSCA
D. DOT

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B. ART
Office of Analysis, Research & Technology - Is under the umbrella of FMSCA

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T/F: The CME may or may not choose to use the recommended guidelines.

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T: However, when the certification decision does not conform to the recommendations, the reasons for not following the medical guidelines should be included in the documentation.

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Factoid:
The profile of the average truck or bus driver:
• Male.
• More than 40 years of age.
• Sedentary.
• Overweight.
• Smoker.
• Poor eating habits.

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T

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49 CFR 391.41: Describes the physical qualification requirements for drivers. The 13 standards are used to determine driver medical fitness for duty. Four of the
standards: vision, hearing, epilepsy, and diabetes mellitus have objective disqualifiers that do not depend on medical examiner clinical interpretation. These standards are the "non-discretionary" standards. For the other nine "discretionary" standards, the medical examiner makes a
clinical judgment in accordance with the physical qualification requirements for driver certification.

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T

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49 CFR 391.43: Describes the responsibilities of the medical examiner, including general instructions for performing the medical examination, a description of driver tasks and work environment, medical advisory criteria, the sample Medical Examination Report form, and the medical examiner's certificate.

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T

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49 CFR 391.45: Identifies who must have the commercial motor vehicle (CMV) driver physical examination.

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T

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49 CFR 391.47: Describes the process for conflict resolution when there is a disagreement
between the primary care provider for the driver and the medical examiner for the motor carrier concerning driver qualifications.

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T

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49 CFR 391.49: Describes the Skill Performance Evaluation (SPE) Certification Program, which is an alternative physical qualification standard for the driver with a fixed musculoskeletal deficit of an extremity who cannot physically qualify to drive under §391.41(b)(1) or (b)(2). The driver must be
otherwise qualified to drive a CMV and meet the provisions of the alternate standard.

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T

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The first program to address fixed musculoskeletal deficits was created and administered by the Interstate Commerce Commission (ICC) in 1964
and was known as the Handicapped Driver Waiver Program. See Skill Performance Evaluation Certification Program (SPE) History.

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T

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49 CFR 391.62: Describes limited exemptions for intra-city zone drivers.

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T

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49 CFR 391.64: Describes grandfathering for certain drivers who participated in vision and
diabetes waiver study programs. These drivers may be certified as long as they continue to meet the provisions outlined in 49 CFR 391.64 and
continue to meet all other qualification standards.

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T

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49 CFR 390: Includes general information and definitions.

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T

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49 CFR 40: Includes regulations for medical review officers and substance abuse professionals, including drug and alcohol testing procedures.

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T

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Interstate Commerce:
Interstate commerce means trade, traffic, or transportation in the United States:
1. Between a place in a State and a place outside of such State (including a place outside of the United States);
2. Between two places in a State through another State or a place outside of the United States; or
3. Between two places in a State as part of trade, traffic, or transportation originating or terminating outside the State or the United States.

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T

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T/F: 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

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True

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T/F: As a medical examiner, the fundamental obligation is to establish whether a driver has a disease, disorder, or injury resulting in a higher than acceptable likelihood for gradual or sudden
incapacitation or sudden death, thus endangering public safety.

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True

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When is Medical Certification Required?

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Medical certification in accordance with Federal Motor Carrier Safety Administration (FMCSA) physical qualification standards is required when the driver is operating a
commercial vehicle in interstate commerce that:
• Has a combined gross vehicle weight or weight rating of 10,0001 lbs. or more.
• Is designed or used to transport 9-15 passengers (including the driver) for compensation.
• Is designed or used to transport 16 or more passengers (including the driver) whether for compensation or not.
• Transports hazardous materials in quantities that require placarding under the hazardous materials regulations.

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Intrastate Commerce:
Intrastate commerce means any trade, traffic, or transportation in any State which is not described
in the term "interstate commerce."

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T

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T/F: Medical Certification of a driver is always 2 years

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F.
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 less than 2 years. The Federal Vision and Diabetes Exemption Programs require annual medical certification.

The medical examiner's certificate expires at midnight of the day, month, and year written on the certificate. There is no grace period on the expiration. The driver must be re-examined and recertified to continue to drive legally.

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Medical Review Officer (MRO):
A person who is a licensed physician and who is responsible for receiving and reviewing laboratory results generated by an employer drug testing program and evaluating medical explanations for certain drug teAs you conduct the physical examination to determine if the driver is medically fit to perform the
job of commercial driving, you must consider:
A. Physical Conditions
B. Mental Conditions
C. Medication effects
D. All of the above st results.

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D. All of the above
The medical examiner is examining for medical fitness for duty, not diagnosing and treating personal medical conditions. Nonetheless, the ME has a responsibility to educate and refer the driver for further evaluation if they suspect an undiagnosed or worsening medical problem.

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In examining Physical conditions, the CME must evalutate:
o Symptoms — Does a benign underlying condition with an excellent prognosis have symptoms that interfere with the ability to drive (e.g., a benign supraventricular arrhythmia that causes syncope)?

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o Incapacitation — Is the onset of incapacitating symptoms so rapid that symptoms interfere with safe driving, or can the driver stop the vehicle safely
before becoming incapacitated? Is the onset of incapacitating symptoms so gradual that the driver is unaware of diminished capabilities, thus adversely
impacting safe driving?

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In examining Medical treatment, the CME must evalutate:
o Effects — Does treatment allow the driver to perform tasks safer than
without treatment?
o Side effects — Do side effects interfere with safe driving (e.g., drowsiness,
dizziness, orthostatic hypotension, blurred vision, and changes in mental
status)?

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T

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T/F: The CME is to send a report of the medical exam to the employer

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F.
Although the Federal Motor Carrier Safety Regulations do not require the medical examiner togive a copy of the Medical Examination Report form to the employer, the Federal Motor Carrier Safety Administration does not prohibit employers from obtaining copies of the Medical Examination Report form. Medical examiners should have a release form signed by the driver if the employer wishes to obtain a copy of the Medical Examination Report form.

Employers must comply with applicable State and Federal laws regarding the privacy and maintenance of employee medical information.

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In examining Mental conditions, the CME must evalutate:
o Cognitive — Can the driver process environmental cues rapidly and make appropriate responses, independently solve problems, and function in a dynamic environment?
o Behavior — Are the driver interactions appropriate, responsible, and nonviolent?

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T

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FYI: Regulations Versus Medical Guidelines (Guidance) As a medical examiner, it is important for you to distinguish between medical standards (49 CFR 391.41) and medical guidelines. Regulations/standards are laws and must be followed. Whereas guidelines, such as advisory criteria and medical conference reports are recommendations. While not law, the guidelines are intended as best practices for medical examiners.

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T

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T/F: A driver may be qualified to to drive a commercial motor vehicle with a history of limb amputation

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T.
49 CFR 391.41(b)(1)
"A person is physically qualified to drive a commercial motor vehicle if that person — Has no loss of a foot, a leg, a hand, or an arm, or has been granted a skill performance evaluation
certificate pursuant to §391.49." The driver will need to obtain a Skill Performance Evaluation Certificate and will require more evaluation than just yours.

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Factoid: when performing a physical examination on the musculoskeletal system, Adapt the observation, inspection, palpation, and screening tests of the general musculoskeletal examination to ensure that the physical demands of commercial driving are assessed (e.g., rotation of the outstretched arms against resistance as if turning a large steering wheel, movement of the legs in braking and clutching, etc.)

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T

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If a referral to a neurologist or physiatrist is required for further assessment of a neurological disorder, who will make the final determination of certification status?
A. Neurologist/Physiatrist
B. You, the CME
C. The DOT
D. The Driver

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B. You, the CME
Examination by a neurologist or physiatrist who understands the functions and demands of commercial driving may be required to assess the status of the disease. However, as a medical examiner, it is your responsibility to determine certification status.

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According to FMCSA regulations, which of the following must the medical examiner evaluate when
examining a driver's eyes?
A. Pupil reactivity
B.Iris symmetry
C. Conjunctival injection
D. Corneal thickness

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A. Pupil reactivity. This is the correct response because it is the only option that is included on the Medical Examination
Report Form for physical examination of the eyes. This
is a cranial nerve test. A positive finding indicates a significant neurological problem that must be worked up or have an explanation that clarifies whether or not the driver has a condition that may interfere with the ability to safely operate a CMV.

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According to FMCSA regulations, medical qualification for two years can be given to a driver who has
A. An SPE certificate for a left below the knee amputation (BKA)
B. Hypertension
C. A recent diagnosis of Lewy body dementia.
D.Documented medical marijuana use for pain control.

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According to FMCSA regulations, medical qualification for two years can be given to a driver who has
A. An SPE certificate for a left below the knee amputation (BKA)
B. Hypertension
C. A recent diagnosis of Lewy body dementia.
D.Documented medical marijuana use for pain control. A. An SPE certificate for a left below the knee amputation.
This is the correct response because in order to obtain the SPE certificate, the driver had to demonstrate the ability to perform all tasks for the commercial driver job description.

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During his visit to the medical examiner, a driver complains of severe pain in his finger for the last two
weeks after it was punctured. The examination reveals an infected, swollen finger. After the medical
examiner inquires, the driver states that the pain is made worse when he grips the steering wheel.
Which of the following should the medical examiner do next?
A. Obtain a hand X-ray.
B.Assess capillary refill in the hand.
C. Obtain a culture and sensitivity.
D. Assess the driver's grip strength.

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D. Assess the driver's grip strength. This is the correct response because the condition does not present a safety risk unless it interferes with the ability of the driver to hold and control the steering wheel.

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A new driver who had a myocardial infarction six months ago is certified after completing an acceptable exercise tolerance test and is cleared by a cardiologist. According to FMCSA guidelines, which of the following is recommended regarding recertification and exercise tolerance test monitoring intervals?
Recertification Exercise tolerance
A.Every year Every year
B Every two years Every year
C.Every year Every two years
D.Every two years Every two years

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C. every year; every two years
This is the correct response because according to FMCSA medical guidelines, when a myocardial infarction is part of the medical history, there is a significant increased risk for another myocardial infarction to occur within six months to a year; therefore, a maximum of one year certification is the guideline. Myocardial infarction guidelines also recommend exercise tolerance testing at least every two years to demonstrate continued ability to safely operate a CMV.

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A 46 year old male driver presents for recertification. He has a history of chronic
gastro esophageal reflux disease (GERD). He takes esomeprazole (Nexium) and over the counter cimetidine (Tagamet). He states that he feels fine, but has trouble finding foods that do not trigger his GERD
when he is on the road. Which of the following should the medical examiner do first ?
A.Disqualify the driver until he has a nutritional consultation.
B.Certify the driver and advise him to carry non
triggering foods in a cooler.
C.Contact the driver's physician and request an upper GI study.
D.Correlate the GI history findings with the abdominal examination.

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D. Correlate the GI history findings with the abdominal examination. This is the correct response because given the information in the question; a medical examiner would need to examine the driver before having sufficient information about the health of the driver to consider any of the other options.

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A 25year old female driver denies a history of any medical problems. She is a nonsmoker who exercises regularly without symptoms. The medical examiner auscultates bilateral wheezes during the examination. The driver's SpO2 is 90 percent in the medical examiner's office. The rest of the examination is normal. The driver should be
A.Temporarily disqualified pending results of a cardiac workup.
B.Qualified since she has no cardiac symptoms.
C.Temporarily disqualified until further evaluation.
D.Qualified because her O2 saturation exceeds the minimum.

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C. Temporarily disqualified until further evaluation. This is the correct response because the driver has a non-diagnosed respiratory or thoracic illness that might interfere with the ability to safely operate a CMV. The driver should not be certified until the etiology is confirmed and treatment has been shown to be
effective, safe, and stable. Also, according to FMCSA medical guidelines, a SpO2 of less than 92 percent warrants obtaining an arterial blood gas analysis.

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TEST

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TEST