Download Commercial Driver Medical Certification Requirements and more Exams Nursing in PDF only on Docsity!
2019 - 2024 DOT: Comprehensive Review for NRCME Exam
Corrective lenses that are prohibited by the FMCSA, including: - lenses that correct distance vision in one eye and near vision in the other.
telescopic lenses
Medical guidelines for the driver with diabetes mellitus include: - Annual medical examination.
Annual ophthalmologist or optometrist eye evaluation.
Disqualification for a diagnosis of unstable proliferative retinopathy.
Monocular Vision - Monocular vision is disqualifying.
However, the driver who has monocular vision that with the better eye meets all vision qualification requirements may be considered for a Federal Vision Exemption if the Medical Examiner finds the driver otherwise medically fit for duty.
Monocular vision is defined as vision that is at least 20/40 for distance in one eye with or without correction and vision that is less than 20/40 for distance in one eye with or without correction.
The driver must meet other vision requirements in each eye, including visual fields (horizontal field of vision).
Federal Vision Exemption: the driver with monocular vision who is applying for or has a federal exemption or is qualified by operation of 49 CFR 391.64 must have an annual physical examination.
Drivers with vision loss who meet standards may be certified for up to two years.
A driver who wears contact lenses which correct farsightedness in one eye and nearsightedness in the other, but has no other visual impairments can be certified under what additional conditions?
Only if the driver wears prescription glasses which provide the same correction as the contact lenses.
FMCSA guidance indicates that a driver should not be certified under these circumstances.
Only by federal exemption.
The driver is always certifiable under these conditions. - FMCSA guidance indicates that a driver should not be certified under these circumstances.
Explanation: FMCSA guidance indicates that contact lenses that correct one eye for distance and one eye for near vision are not acceptable.
Guidance recommends not to certify with ear problem diagnoses of: - a) Uncontrolled vertigo.
b) Ménière's disease.
c) Nonfunctioning labyrinth.
d) Nonfunctioning fistula.
The medical examiner's role in the exemption process includes _________.
Issuing the exemption.
Issuing the prescription for the driver's contact lenses and/or glasses.
Providing the driver with contact information for the Federal Vision Exemption Program.
Assuring that the driver has peripheral vision of at least 110 degrees in each eye. - Providing the driver with contact information for the Federal Vision Exemption Program.
Explanation: The medical examiner's role in the exemption process is limited to performing the driver examination and providing the driver with contact information for the FMCSA related to the exemption process.
Audiogram left 30/500 Hz, 40/1000 Hz, 60/2000 Hz; right 25/500 Hz, 35/1000 Hz, 80/2000 Hz.
Audiogram left 35/500 Hz, 50/1000 Hz, 40/3000 Hz; right 35/500 Hz, 35/1000 Hz, 60/3000 Hz. - Whisper test 5 feet right ear with hearing aid, 3 feet left ear without hearing aid.
Explanation: Whisper test results require 5 feet in at least one ear for passing, with or without a hearing aid. Audiometric testing results require an average of 40 dB loss in the better ear for results averaged across 500, 1000, and 2000 Hz. Although testing may be performed at 3000 Hz, results obtained are not used to determine whether the driver meets hearing requirements.
A driver has loss of hearing in the better ear of 25 dB loss at 500 Hz, 40 dB loss at 1000 Hz, and 60 dB loss at 2000 Hz. With respect to the hearing requirement for medical certification, the driver __________.
May be certified for one year.
May be certified for two years.
May not be certified.
May be certified if examined by an otolaryngologist who is familiar with the CMV driving duties who certifies the driver as medically qualified to drive a CMV. - May not be certified.
Explanation: An average hearing loss of 41.7 decibels averaged across 500, 1000, and 2000 Hz in the better ear is disqualifying. The driver should be referred to obtain a hearing aid and may be certified if the driver passes while wearing a hearing aid. A specialist cannot determine certification, and a specialist cannot override medical qualification standards such as the minimum hearing requirement.
Which of the following is acceptable for a driver who wears a hearing aid?
Testing of the driver's hearing is waived if the driver presents a letter from a qualified specialist.
Testing of the driver's hearing may be performed by the medical examiner using audiometric testing equipment.
Testing of the driver's hearing may be performed by an audiologist or otolaryngologist using specialized audiometric testing equipment.
Testing of the driver's hearing may be performed at 1,000 Hz only. - Testing of the driver's hearing is waived if the driver presents a letter from a qualified specialist.
Testing the hearing of a driver who wears a hearing aid may be accomplished in three ways: 1) whisper test, 2) audiometric testing by an otolaryngologist using specialized audiometric testing equipment, or 3) audiometric testing by an audiologist using specialized audiometric testing equipment. Audiometric testing is required to be conducted at 500 Hz, 1000 Hz, and 2000 Hz.
Passing Requirements for Vision Tests - Corrective lenses, eye glasses and/or contact lenses may be used.
Distance binocular acuity of at least 20/40 (Snellen) in each eye with or without corrective lenses. Field of vision of at least 70º in the horizontal meridian in each eye. Monocular vision - vision meeting requirements in only one eye - is disqualifying by regulation.
The ability to recognize the colors of traffic signals and devices showing standard red, green, and amber.
Contact lenses that correct vision in one eye for distance and the other eye for near are not acceptable.
Results must be converted to Snellen values if another test is used.
Measured in each eye individually and both eyes.
Drivers who wear corrective lenses should be advised to carry spare glasses.
In general, any vision condition, such as lazy eye, glaucoma, cataract, and others, is not disqualifying as long as the driver meets minimum vision testing parameters.
FMCSA is - Federal Motor Carrier Safety Administration. Is overseen by the DOT. The FMCSA creates standards for driver examinations. Regulates Interstate commercial operations, including the driver.
Many states use federal FMCSA standards to govern intrastate commercial operations, including the driver, but the FMCSA does not directly regulate any intrastate functions.
a division of the US Department of Transportation (DOT).
Three Months: recommend to certify for a three month certification if the driver has been given a one- year certificate for untreated Stage 1 hypertension in the past, whether or not the driver is taking medication to lower blood pressure.
If the driver is on blood pressure medication, the medication should be well-tolerated with no side effects that could affect safe driving.
Do not certify the driver with Stage 1 hypertension if the driver has been given a three-month certificate related to blood pressure within the past three months.
Do not certify a driver with Stage 1 hypertension who has a history of Stage 3 hypertension (> 180/110).
The driver with Stage 1 hypertension is at low risk for hypertension-related acute incapacitation.
Recertification:
Recertification examinations should be done annually thereafter, and driver BP should be at or below 140/90.
If at recertification examination the driver with a history of Stage 1 hypertension has a BP greater than 140/90 but less than 180/110, certification may be extended for three months.
The Medical Examiner should advise the driver:
That the driver should follow-up with her/his primary care physician for consideration of hypertension treatment,
About the nature of hypertension and the importance of hypertension as a risk factor for cardiovascular disease (CVD), and
That failure to lower BP to 140/90 or less will render the driver medically unqualified for continued certification.
That if blood pressure is uncontrolled at future examinations the driver may be temporarily disqualified.
Which of the following is a requirement for a driver with a history of alcoholism to be certified?
Complete driver certification examination.
Successful treatment with naltrexone.
Successfully completed counseling and/or treatment.
Passed a drug test. - Correct Answer: Successfully completed counseling and/or treatment.
Explanation: A driver certification examination is not a requirement for return to driving. Treatment with naltrexone is not required for driver certification for a driver with a history of alcoholism. Passing a drug test is not a requirement, although passing an alcohol test is a requirement.
Which of the following is true with respect to drivers with psychological disorders?
Drivers with chronic schizophrenia must be evaluated at least yearly by a qualified specialist such as a psychiatrist or psychologist who understands the function and demands of CMV driving.
The waiting period for a brief reactive psychosis or schizophreniform disorder is three months.
Alcohol and drug dependency and abuse are profound risk factors in the presence of personality disorders.
The waiting period following electroconvulsive therapy for treatment of depression is one year. - Correct Answer: Alcohol and drug dependency and abuse are profound risk factors in the presence of personality disorders.
Explanation: Drivers with chronic schizophrenia should be disqualified. The waiting period for a brief reactive psychosis or schizophreniform disorder is six months as is the waiting period for electroconvulsive therapy treatment.
Two years.
Five years.
Ten years. - Correct Answer: Five years.
Explanation: The waiting period for a history of bacterial meningitis with early seizures or single unprovoked seizure is five years seizure free and off anticonvulsant medications.
To apply for an exemption - the driver with monocular vision must demonstrate that he or she meets all other medical certification requirements, and must submit the Medical Examination Report and the Medical Examiner's certificate with the exemption application to the FMCSA.
NRCME - Created by the Federal Motor Carrier Safety Administration (FMCSA),
The NRCME establishes a registry of health care providers who may perform medical examinations on commercial motor vehicle (CMV) drivers (DOT examinations).
National Registry of Certified Medical Examiners (NRCME)
Which of the following is a disqualifying condition?
A past clinical diagnosis of alcoholism.
A breath alcohol result of 0.019%.
An alcohol-related stable physical condition.
Use of methadone. - Correct Answer: Use of methadone.
Explanation: A current diagnosis of alcoholism is disqualifying, a past history is not. A breath alcohol result of 0.02% or higher renders the driver unqualified to drive. Just because a condition is alcohol- related does not make it disqualifying.
Which of the following is true with respect to bipolar disorder?
Treatment with lithium has not been shown to increase risk for CMV accidents.
The maximum certification interval is six months.
The driver should be advised to report manic or severe depressive episodes within 10 days of onset to the driver's employer, medical examiner, or appropriate health professional and to seek medical intervention.
Onset of manic episodes is uniformly sudden. - Correct Answer: Treatment with lithium has not been shown to increase risk for CMV accidents.
Explanation: Treatment with lithium has not been shown to increase CMV driving risk. The maximum certification interval for a driver with bipolar disorder is one year. The driver should be advised to report manic or depressive episodes within 30 days. Manic episode onset may be gradual or sudden.
Stage 1 hypertension blood pressure - 140-159/90-
Drivers with initial Stage 1 hypertension should be advised that the condition will allow one-year certification and may or may not require medication treatment for control of the condition.
Code of Federal Regulations (CFR) - contains the rules of the federal government,
laws that must be followed. By regulation, disqualifying medical conditions are epilepsy, monocular vision, and hearing loss.
Which of the following is true?
The FMCSA does not consider feasibility or impact in the rule-making process.
Only the Medical Review Board can provide advice and opinions on FMCSA rulemaking.
FMCSA medical standards and guidelines are subject to public notice and comment rulemaking.
The Code of Federal Regulations provide guidance that the medical examiner may or may not follow. - FMCSA medical standards and guidelines are subject to public notice and comment rulemaking.
- Pulse oximetry O2 saturation = 90%. Arterial blood gas (ABG): PaO2 = 60 mm Hg, PaCO2 = 42 mm Hg. What is the certification determination?
Do not certify.
Certify three months pending additional testing.
Certify for one year.
Certification depends on whether testing is conducted at altitudes above or below 5,000 feet. - Correct Answer: Certification depends on whether testing is conducted at altitudes above or below 5,000 feet.
Explanation: The certification determination related to arterial blood gas (ABG) testing depends on the altitude at which testing is performed. A PaO2 of less than 65 mm Hg is disqualifying at altitudes of less than 5,000 feet; a PaO2 of less than 60 mm Hg is disqualifying at altitudes of greater than 5,000 feet.
A Skill Performance Evaluation (SPE) certificate pursuant to 49 CFR 391.49 is granted under which of the following conditions?
The driver has a fixed deficit of the torso.
The driver has progressive deficit of an extremity.
The driver has a medical evaluation summary completed by a board qualified or certified physiatrist or orthopedic surgeon.
The driver has completed a driving evaluation per FMCSA standards. - Correct Answer: The driver has a medical evaluation summary completed by a board qualified or certified physiatrist or orthopedic surgeon.
Explanation: A driver with a torso deficit should not be certified. To be considered for a Skill Performance Evaluation (SPE) certificate, the driver must have a fixed, not progressive, deficit of an extremity. A driving evaluation is not required for issuance of a SPE certificate.
Transient ischemic attacks (TIA's) are automatically disqualifying for __________. After the minimum waiting period the certification depends on the interval history, general health, neurological examination, and compliance with the treatment program.
Three months.
Six months.
Nine months.
One year. - Correct Answer: One year.
Explanation: The minimum waiting period for transient ischemic attacks (TIA's) is one year.
A driver with a history of major depression should be evaluated at least every __________ by an appropriate mental health specialist, such as a psychiatrist or psychologist, who understands the functions and demands of commercial motor vehicle driving.
Six months.
One year.
Two years.
Such evaluation is not required. - Correct Answer: Two years.
Explanation: The maximum certification interval for a driver with a history of major depression is one year. Regulatory guidance requires evaluation every two years by a specialist, such as psychiatrist or psychologist, who understands the functions and demands of commercial driving.
Passing parameters for hearing tests: - Driver first perceives a forced, whispered voice in the better ear at not less than five (5) feet with or without the use of a hearing aid.
Driver, if tested by use of an audiometric device, does not have an average hearing loss in the better ear greater than 40 decibels at 500 Hz, 1,000 Hz, and 2,000 Hz, with or without a hearing aid.
Recommendation to NOT surgically repair, does NOT mean driver is certified
Maximum certification period: one year.
Do not certify if:
5.0 cm
Aneurysm has increased more than 0.5 cm during six-month period regardless of size.
Surgical repair has been recommended by a cardiovascular specialist, regardless of size, but has not yet been performed.
Driver is symptomatic, regardless of size.
Which of the following is not associated with safety risks in drivers with psychological disorders?
The mental disorder, including symptoms and/or disturbances in performance that are an integral part of the disorder and may pose hazards for driving.
Residual symptoms occurring after time-limited reversible episodes or initial presentation of the full syndrome that can interfere with safe CMV driving.
Physical disorders which may be compromised by the mental disorder and may increase risk of CMV accidents.
Psychopharmacology, as many psychotropic medications can compromise performance to the degree that CMV driving would be hazardous. - Correct Answer: Physical disorders which may be compromised by the mental disorder and may increase risk of CMV accidents.
Explanation: Physical disorders are not noted by the FMCSA to increase risk related to psychological disorders.
Department of Transportation (DOT) - U.S. federal government body with primary responsibility for transportation safety regulation. Oversees the FMCSA.
Stage 2 Hypertension Maximum certification period - three months.
Recommend to certify if it is the first examination at which the driver has blood pressure equivalent to Stage 2 hypertension and the driver has no history of hypertension and does not use medication to control blood pressure.
Recommend to certify if the driver has a diagnosis of hypertension treated with medication and tolerates treatment with no side effects that interfere with driving.
Do not certify the driver who has been given a three-month certificate within the past three months.
Advise the driver issued a three-month certificate that:
To qualify at follow-up, blood pressure must be less than or equal to 140/90.
If the driver qualifies on follow up examination (has a blood pressure less than or equal to 140/90), a one-year certificate may be issued from the date of the follow up examination, not the expiration date of the three-month certificate.
If the driver fails to lower blood pressure by the expiration date of the one-time, three-month certificate, the driver will be disqualified until blood pressure is equal to or below 140/90 at exam.
Stage 2 hypertension is an absolute indication for anti-hypertensive drug therapy.
Two-point discrimination testing.
Audiometric testing. - Correct Answer: Using resistive force or a dynamometer to the have the driver demonstrate grip strength necessary to grasp a steering wheel.
Explanation: Nerve conduction study testing, testing of two point discrimination, and audiometric testing are not clinical evaluations of musculoskeletal function.
What is the recommended certification interval for a driver with diabetes mellitus who does not use insulin?
Three months.
Six months.
One year.
Two years. - Correct Answer: One year.
Explanation: Drivers with non-insulin dependent diabetes should be certified for a maximum of one year.
A driver with peripheral neuropathy __________.
May be certified for one year.
Should not be certified by regulation.
Should not be certified by guidance.
May be certified for three months pending specialist evaluation. - Correct Answer: Should not be certified by guidance.
Explanation: Peripheral neuropathy is a disqualifying condition. However, this is a guidance recommendation, not a regulatory requirement, so Medical Examiners may consider qualification for a driver with peripheral neuropathy.
The maximum certification interval for a driver diagnosed with asthma is __________.
Three months.
Six months.
One year.
Two years. - Correct Answer: Two years.
Explanation: The maximum certification interval for asthma is two years.
A driver underwent surgical repair of a 6 cm abdominal aortic aneurysm three months ago. The driver may be certified for __________.
Three months.
One year.
Two years.
The driver should be medically disqualified. - One year.
Explanation: The minimum waiting period for surgical repair of an abdominal aneurysm is three months. The maximum certification interval is one year.
disqualifying ear conditions and waiting periods - Drivers with conditions affecting the inner ear and balance should not be certified. The minimum symptom free waiting period for drivers with dizziness or vertigo is two months.
Guidance recommends a two-month, symptom-free waiting period for diagnoses of:
