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115 Cards in this Set
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- Back
- 3rd side (hint)
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An unrestricted Commercial motor vehicle driver medical certificate must be renewed:
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Every 2 Years
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What testing procedure is not appropriate to ascertain hearing acuity in a CMV driver exam?
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Audio gram in booth with hearing aids in place
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hearing aids
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Continued certification of NRCE Medical Examiners requires what 3 things?
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1- Periodic training at least every 5 years
2-Completion of certification test every 10 years 3 - Electronic transmission to FN CA CM Medical Examinat I need Results at least monthly |
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What is the primary mission of FMCSA?
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to promote the safety of the roadways
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During the drivers history, she describes her role & responsibilities as limited to the driving component and excluding strenuous activities. What should you do?
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Conduct the full and standard physical examination
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During the examination a driver reveals "I had a touch of sugar" 2 years ago, but stopped taking the prescribed medication when it ran out, the name of which was forgotten. Driver did not indicate a yes on the medical history for diabetes. The examination and urinalysis are unremarkable. What action should the examiner take?
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Correct the medical history and discuss the signs, symptoms and health impact of diabetes and the need for regular follow up
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A 60 year old reveals a 6 month history of progressive worsening of dizziness and ringing in the ears. It is worse when he bends over. He denies hearing loss, no trauma or recent infections, and takes no chronic medications, but was told by another driver to try meclazine, which he did and it seemed to help. What routine screening tests may help you best decide on the severity of the symptoms during this CFL medical exam?
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Romberg Test
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Current Federal Motor Carrier Safety Regulations identify a person who can be a medical examiner by what 2 criteria?
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1- Professional Licensure
2- Scope of practice that includes performing physical exams |
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A 32 year old new driver applicant - military Veteran with a history of Mild Traumatic Brain Injury in war zone 5 years ago while on active duty. No LOC, only dazed by close blast- not hospitalized. CT negative at combat ED- awarded a 10% VA disability later for this injury. Never had a seizure, never prescribed anti-seizure medications. He is otherwise healthy. The ME's physical examination is negative for neurological impairment or deficit. According to medical guidelines, what is the appropriate ME decision?
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Document everything and clear the driver issuing a 2 year unrestricted certificate
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The newly hired driver's employer requests a copy of the "Long Form" for their personnel file. What is the accurate course for the ME to take?
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The CMV Medical Examiners Report is treated the same as any other confidential medical information and must have a signed release by the driver.
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What level of risk is acceptable when qualifying a CDL driver?
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1%
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What role does the examiner have concerning discretionary qualification standards
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It is the examiners discretion and clinical judgement regarding the drivers qualifications in these areas
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According to 49CRF391.41 (b)(8) regarding neurological conditions, what is considered unequivocal grounds for medical disqualification for the interstate CMV driver medical certification?
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Acute Seizure Disorder
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TRUE OR FALSE The purpose of the commercial driver physical exam is to determine "medical fitness for duty"
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True
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TRUE OR FALSE
The purpose of the commercial driver physical exam 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 CMV safely |
true
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Drivers of what type/weight load DO NOT require a CDL certificate?
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vehicle weight less than 26,000 pounds and designed to transport up to 12 passengers including the driver
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Does a driver require a CDL certificate to drive a vehicle weighing less than 26,000 pounds that transports hazardous materials?
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YES
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A 28 year old otherwise healthy driver repose had a sudden brief seizure 2 months ago, thought to be due to high fever during a recent serious lung infection. He is adamant that he does not have epilepsy, takes no medications. The seizure was unwitnessed. According to medical guidance from FMSA, what should the examiner do?
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Request medical records to obtain a neurological diagnosis to verify information, temporarily disqualify until cleared by specialist
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54 y o female delivery driver, divorced but in a long term relationship (X 10 years) that recently ended, no reported past health problems in all past CMV examinations. Always issued a 2 year license and is 6 years accident free. Well liked by employer and coworkers. Also has a part time job bar tending to make ends meet.
She became despondent and depressed while driving delivery route, stopped the vehicle on the side of the road and "fell apart". She called dispatch for help and was involuntarily committed for psych eval. Following discharge she was off work for 3 months and under the care of her PCP. She continued taking medications prescribed by the crisis center, but decided to stop them. It is now 3 months past the event and she presents for a return to driving physical exam. She brings a return to work note from her PCP clearing her to return to work. Since her PCP has cleared the driver to return to work and completed the employers fitness for duty form, what additional information would the CDL medical examiner require to determine her fitness to resume driving in order to provide her a driving certificate. |
Psychiatric Medical records from the crisis center including diagnosis and treatment plan
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A patient presents with a history of recently diagnosed bipolar disorder, with her medical records to demonstrate her stable condition and the medication prescribed. What medication would automatically disqualify a driver?
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Lamictal
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A driver who wears corrective contact lenses has the following uncorrected visual acuity:
R- 20/40. L - 20/20 both 20/40. What advice should the examiner provide? |
driver should carry a spare pair of eye glasses at all times
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Who may perform and certify vision testing?
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Licensed ophthalmologist
Licensed optometrist Certified Medical Examiner |
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What type of eye condition is the medical examiner NOT required to ask about?
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Allergic Conjunctivitis
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What eye conditions should the medical examiner inquire about?
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Retinopathy
cataracts macula degeneration |
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A drivers hearing and ear exam reveal the following:
forced whisper test R- 5ft, L 3ft. The Left to panic membrane is scarred and misshapen. what is the correct action for the medical examiner to take? |
Certify for 2 years if otherwise qualified
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To convert International Organization for Standardization (ISO) test results to the ANSI standard, subtract from the ISO test results:
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14 dB for 500Hz
10 dB for 1000 Hz 8.5 dB for 2000 Hz |
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The drivers corrected visual acuity is: R-20/40 L-20/80 both-20/40. The examiner should
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disqualify driver and inform of the visual exemption program
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A driver was issued a 3 month medical certificate due to elevated blood pressure and now returns for recheck. He is prescribed only HCTZ 12.5 MG and blood pressure is now 120/80. What length of time should you now provide certification for this driver?
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1 year from the initial exam date
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A driver is found to have a BP measured twice during the exam of 166/106. According to FMCSA guidelines on blood pressure, you should issue what?
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A 3 month card
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When the driver has a medical history of MI, According to FMCSA, what is the recommended recertification and ETT (exercise tolerence test) monitoring intervals?
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Recertification every year and ETT every 2 years
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According to FMCSA classification, a BP of 162/104 by repeat measure is consistent with BP category:
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Stage 2
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A skilled performance examination is only permitted when:
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the driver has a fixed deficit of the extremity
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Which one is not a required component of the urinalysis?
Specific Gravity, Protein, Creatinine, Blood |
Creatinine
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Which of the following are not allowed, resulting in disqualification of the driver?
Warfarin, Methadone, Antihistamines, Antidepressants |
Methadone
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The recommended wait period after a driver starts CPAP for obstructive sleep apnea (OSA) is
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1 month
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Which of the following are not specifically identified as an indicated assessment during the neurological examination?
equilibrium, deep tendon refexes, coordination, mini mental exam |
mini mental status examination
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Which of the following may warrant disqualification?
Excessively antagonistic behavior Severe personality disorder Severe depression |
ALL of the above
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A driver checks "yes" for"regular frequent alcohol use". What should the medical examiner do?
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Ask about the timing and quantity of alcohol intake
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Following ECT treatment for depression, the FMCSA recommended waiting period is:
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6 months symptom free
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What is the recommended symptom free wait period for a driv r who has experienced benign positional vertigo?
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2 months
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According to medical guidelance, which of the following neurological conditions is considered medically disqualifying?
A- progressive dementia B- febrile seizures C- TIA within 1 year |
Both A & C progressive dementia and TIA within 1 yr
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A 55 year old CDL driver presents for a renewal CDL exam. Since the
art exam 2 years ago, the driver was diagnosed with diabetes and started metformin 50 g tid. The physical exam is unremarkable. What test does the FMCSA require to complete this exam? |
urinalysis
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A 52 year old male driver reports he has regular eye exams, no medications prescribed and only wears glasses to see close objects. While performing the snellen test you note he is turning his head obliquely and owing his head side to side, and up and down while reading with the right eye occluded. He is slowly calling out the letters but with difficulty. What eye condition may be present?
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Macula degeneration with loss of central vision
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If a Driver fails the 5' whisper test, what audio gram threshold levels should the examiner test per the regulation?
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500Hz, 1000Hz, 2000Hz
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A CMV driver has indicated on the health history form that he had a coronary stint placement 9 months ago. Using cardiovascular medical guidance, what additional information does the examiner need to determine certification status?
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Results of his stress test obtained 6 months after his PCI AND clearance by his cardiologist.
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A 25 year old female driver denies history of any medical problems. She is a nonsmoker who exercises regularly without sx. You auscultate bilateral wheeze during your exam. Her Spo2 is 90%, the remainder of the exam is normal. You should:
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temporarily disqualify until further evaluation
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A 22 y/o male driver with a long h/o asthma is currently on Singulair and uses albuterol MDI as needed. BMI is 23, lungs CTA, normal respiration, and appears fit. What decision must the examiner make regarding his fitness to drive?
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certify for one (1) year as he has a stable chronic illness
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Jake, a 46 y/o driver with chronic health issues has a BMI measured at 38. He has hypertension controlled on 2 medications and returns for his yearly exam. Neck size is 18.25 in. and he responds "yes" to all sleep apnea screening questions. He was advised to get a sleep study but he has no insurance. Out of concern for the driver and public safety, the medical examiner must:
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temporarily disqualify and ref r him to seek medical follow up
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What FMCSA regulation is defined in federal standards and not discretionary by the medical examiner?
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Epilepsy & Hearing
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A trucking company sends 2 drivers for recertification. Driver A is the company supervisor. Both present their current CMV Medical card to you where you note the drivers were examined in another state and were issued a 2 yr card expiring on this day. Brier B does not have his drivers license with him. According to FMCSA regulations, what must the examiner do to confirm the identity of the driver?
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Do not perform the exam, the driver must present a current state issued drivers license to the examiner
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A driver wears binaural hearing aids and has a restriction to drive with them since his last medical card was issued. In the interest of roadway and driver safety, what must the examiner do to ensure the driver complies with the hiring standard?
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Examiner must remind driver to carry a spare battery for the hearing aid while driving
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According to the FMCSA, what information must be registered on all current Medical Examination Report: Part 7 Physical examination section?
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weight height and body system checklist
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A 46 year old female driver has been screened by the medical assistant and is awaiting the physical examination. The urine dipstick revealed 2+ blood. What is the next appropriate step for the medical examiner to take?
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Review the medical history and inquire about menses dates, menopausal symptoms
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A driver with a history of Traumatic Brain Injury, that is considered mild, with no dual penetration and with LOC less than 30 minutes, can be deemed medically qualified to drive if the following condition is met:
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Seizure free, no neurological deficits and no anticonvulsant medications are prescribed
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Headaches can interfere with driver alertness and concentration. What type of headache would be, in the interest of highway safety and potentially endangering the health and safety of the driver and public, be of grave concern to the medical examiner and be medically unqualified?
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History of atypical facial pain that is associated with intermittent unilateral vision loss
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According to FMCSA, the whisper test is sufficient to screen for hearing acuity at what MINIMUM distance?
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5 feet
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If the medical examiner questions the hearing acuity at the tested minimum distance, an audiogram is required. What form must the test be recorded in decibels following established by which group:
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The American National Standard Institute (ANSI)
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Any driver who presents with a chronic history of Mild shortness of breath and abnormal respiratory examination findings suspect for chronic lung disease should have, according to FMCSA, which initial respiratory test?
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Pulmonary Function Test (PFT)
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If a Driver with hearing aids fails the whisper test at the minimum distance, what should the examiner do?
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Refer to audiologist or Otolaryngologist to ascertain hearing acuity with hearing aids worn
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A driver sustainable severe crush injury in a MVA one year ago and required amputation of his right foot. The driver is released to duty with a foot prosthesis. FMCSA regulations require the medical examiner to:
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Complete the full medical exam and if no other deficits, refer this driver for a Skills Performance Evaluation
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The driver provides the medical examiner with a copy of records including a cardiologist report indicating a diagnosis of CHI and the drivers ejection fracture is 38%. Can this driver be certified?
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NO, the ejection fracture is less than 40%
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On examination, a driver is found to have a very irregular heart rate. He denies shortness of breath, palpitations, or other sx. He appears fit. What test should be recommended next to assess if this driver can safely operate a commercial vehicle?
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An electrocardiogram
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When examining the abdomen, the medical examiner notices a 4 cm bulge over the umbilical when the driver is supine. On palpation, there is no tenderness but the bulge is reducible. He admits to occasional constipation but otherwise no abdominal complaints. What course of action would the prudent medical examiner do next?
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Refer the driver for further evaluation
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A driver is prescribed Warfarin just after a pulmonary embolism 3 months ago. His INR are stable. A recent CT scan shows the condit I need is stable and he has a medical release from his pulmonologist. According to FMCSA guidelines for pulmonary emboli, the medical examiner would:
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Qualify for one year only with required monthly INR checks to meet regulations
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Essential job functions of the commercial driver should be considered:
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The same degree of work effort and intensity for ALL drivers, NO exceptions
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A motor coach driver with a chronic back complaint requests that the examiner write a requirement to his supervisor to provide a bus with air suspension adjustable seat for better posture and comfort, stating the older bus have worn out seats that aggravate his condition. Assuming all other parts of the examination is normal, what would the medical examiner do next?
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Educated the driver on back care, the need for a full evaluation of his back complaint if it worsens, and the need for regular exercise and stretching
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A 22 year old driver requests a new driver exam. He was diagnosed with diabetes 5 weeks ago and has done well on insulin. His younger sister has diabetes and he has helped her manage her condition from time to time so was familiar with injection and self monitoring. His CMV trainer informed him of the exemption program and he has downloaded the necessary paperwork, which he has brought to the visit. What action should you take?
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Inform the driver that he must be on insulin for 2 months prior to the examination
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A new company sends a new driver for a medical certification card. He admits to past drug use and is currently in a methadone treatment program. His random drug tests for the past year have been negative. He passed the drug test for new hire 2 Days ago. The medical examiner should:
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Disqualify the driver, Methadone is in itself disqualifying by FMCSA
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A 32 year old driver presents for renewal examination by his trucking company. Driver wears corrective lenses and has a vision restriction. It is unchanged on exam today and is qualified with corrective lenses. Driver states that he is scheduled for Lasik surgery next week and does not want a restriction on his certification card for the next 2 years. Driver asks you to issue a limited license so that he may return after surgery and retest. According to the vision regulation what action must you do now?
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Issue a 2 year certification with vision correction requirement
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A 42 y/o driver wears corrective mono vision contact lenses only. The vision results are: corrected R-20/100 L- 20/20. Based on this information, does the driver meet the vision standard?
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NO mono vision contacts cannot be worn to correct vision
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A driver is found to have a blood pressure measured twice during the exam at 166/106. According to FMCSA guidelines on blood pressure, the examiner should issue:
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A 3 month card
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A driver presents for certification and presents a letter from his cardiovascular surgeon indicating surgical repair of a 5 cm abdominal aneurysm 4 months ago. According to CVD, recommendations, which one is NOT true?
1- driver has met the 3 month waiting period 2- driver is disqualified due to history of aneurysm exceeding 5cm 3- driver may be certified up to one year 4- none of the above are true |
2- driver is disqualified due to history of aneurysm exceeding 5cm
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Can a driver with a class C CDL license transport hazardous materials?
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NO, class C is designed for transport of 16 passengers or more
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What determines if a driver is certified for interstate or intrastate?
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The commerce or goods of origination being transported
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Few commercial drivers now are enrolled in the FMCSA Diabetes Waiver program; what year did that waiver program end?
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1996
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FMCSA considers what level of HgbA1c to indicate poor blood glucose control?
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> 10%
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A driver with a history of hypoglycemic reaction should not be certified if the reaction resulted in:
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seizure
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A driver with a history of stable angina would require________________ for renewal
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exercise stress test every 2 years
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In regard to the physical examination portion of the medical examination report of the eyes, what exam is not listed as a required exam procedure or assessment?
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**Fundoscopic exam
Required are- extra ocular movement, confrontation, and pupil reactivity to light |
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A driver with diabetes who requires insulin can apply for an interstate diabetes exemption. What conditions are required by the driver if such an exemption is given?
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Must have a glucometer with memory for documentation
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The medical examiner interviews the driver prescribed digoxin 250 mcg for cardiac problems might ask if which common side effects are present that may impair driving ability
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Blurred or yellow halo vision
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You suspect weakness of grip in a driver who is being monitored closely for multiple sclerosis. What might the examiner do to best ascertain grip strength?
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Use a dynamometer with 3 repetitions on each side
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A skilled performance examination is only permitted:
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when the driver has A FIXED deficit of the extremity
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FMCSA has designated certain wait times for medical conditions. Which of the following is a CORRECT wait time?
1 - PCI requires 1 week 2- Stable angina requires 6 months 3- TBA - MILD has no waiting period 4- TBI- with dura penetration- severe with seizure is 10 years |
#1 is correct.....PCI requires 1 week
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At what age can a new driver apply for a CMV Medical certificate?
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At least 21 years of age
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A commercial driver new to the USA from a foreign country must meet what requirement to drive an interstate commercial vehicle in the USA?
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Read and speak the English language sufficient to converse with the public
Understand highway/traffic signals Respond to official questions Make legible entries on reports |
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Fatigue is a constant concern for driver and public safety. What is the RULE limit of driving service hours for driver after 10 consecutive hours off duty since July 2013?
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11 hours
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A company requires the medical examination report for the drivers file. What should the Medical examiner advise the company?
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The medical certificate card is all that FMCSA requires for the driver and a copy for the company file
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What is the minimum gross vehicle weight that will require a DOT medical examination for a driver?
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26,001 lbs
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Which of the following is non-discretionary for the medical examiner per FMCSA standards?
1 - hearing 2 - grade 2 hypertension 3 - symptomatic asthma 4 - history of MI |
1 - hearing
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In 1993 after researching the issue and soliciting public comment, the FMCSA began a case by case waiver program for what medical condition?
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Diabetes
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What is the first step for a driver who is prescribed insulin to do in obtaining a diabetes exemption?
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Undergo the standard examination and be otherwise fully medically qualified
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NRCME recognizes ADD/ADHD in the CMV driver as a treatable condition. How should an examiner handle a driver prescribed a stimulant medication ?
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Stimulant medications are contraindicated for the commercial driver and disqualifying
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A driver has an abdominal aortic aneurysm. The medical examiner obtains a copy of the abdominal sonogram indicating that the aneurysm is 5.3 cm in diameter. According to current CVD recommendations what should the examiner do?
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Disqualify the driver due to aneurysm exceeding 5 cm in diameter
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Using current FMCSA guidelines, what is the maximum certification period for a driver who was previously disqualified for stage 3 hypertension and now has a BP of 136/88?
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6 months
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A driver discloses history of exercise induced asthma controlled by use of albuterol inhaler prior to aerobic activity. Her pulmonary Function FEV1 must be greater than ______% of predicted to qualify.
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65%
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In which regulation are driver physical qualification standards related to respiratory conditions cited?
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49CFR 191.41 (b)(5)
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A driver with a history of diabetes that is well controlled, but has required insulin for the past 3 months, presents for his exam. He had previously required a vision exemption due to monocular vision. What should you do?
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Disqualify the driver because he is not "otherwise qualified" due to his monocular vision
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Medical certification in accordance with FMCSA physical qualification standards is required when the driver is operating a commercial vehicle in interstate commerce that:
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▪ Has a combined gross wight of 10,001 # 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 regulation |
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TRUE OR FALSE
When a driver returns from an illness or injury that interferes with driving ability, the driver is required to undergo a medical examination even if the medical examiner's certificate has not expired. |
TRUE
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TRUE OR FALSE
The medical examiner can issue an exemption. |
FALSE
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As a medical examiner, your fundamental obligation during the physical assessment is to:
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establish whether a driver has a disease or disorder that interferes with the ability to safely operate a CMV, increases the risk for sudden death, or increases the risk for the onset of gradual or sudden incapcitation, thus endangering public safety.
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An average hearing loss of less than ______dB in only one ear is passable.
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40
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Blood pressure readings between 140-159/90-99, are classified as stage _____.
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Stage 1 hypertension
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A blood pressure of 164/100 would be classified as stage _____ hypertension.
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2
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Stage 3 hypertension is a blood pressure greater than or equal to
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180/110
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For a driver with stage 3 hypertension during the exam, what certification should the examiner give?
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Driver should be disqualified
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For a driver with known stage 3 hypertension who has an acceptable blood pressure during exam and tolerates medication without side effects, when would his certification expire?
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6 MONTH certification and recertification applies
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Should abnormal findings be documented on the exam form if they do not affect whether the driver is qualified or disqualified?
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YES All abnormal findings must be documented
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What is the waiting period post MI?
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2 months
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What is the waiting period for stable angina, asymptomatic?
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3 months
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What is the waiting period for pacemaker insertion for syncope?
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3 months
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What is the waiting period for someone who has had bariatric surgery?
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6 months
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The driver reports having ECT 3 months ago. Can he be qualified?
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No he must wait 6 months
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The driver reports having Bipolar disorder. What medications would disqualify her?
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Any anti-seizure meds such as Depakote, Lamictal, Trileptal
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