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A CMV driver must perceive a forced whispered voice in the better eat at not less than with or w/o a hearing aid ✔✔ 5 Feet This test is performed only when the Forced Whisper Test is failed in both ears ✔✔Audiogram If tested by the use of an audiometric device, they must not have an AVERAGE hearing loss in the better ear greater than at 500Hz, 1000Hz, and 2000Hz ✔✔ 40 decibels ear and two eyes certifies! ✔✔One A driver with a hearing aid usually must go to an or a hearing aid center for audiometry testing ✔✔Audiologist How long can a driver who meets the hearing requirements in one ear be certified? ✔✔ 2 Years Inflammation of the inner ear that causes a sudden onset of vertigo. This requires a 2 month waiting period. ✔✔Acute and Peripheral Vesitbulopathy This occurs when a small piece of bone-like calcium breaks free and floats inside the Eustachian tube sending confusing messages to your brain about your body's position. This requires a 2- month waiting period. ✔✔Benign Positional Vertigo T/F It is OK to certify someone with Uncontrolled Vertigo, Meniere's Disease, Labrythine Fistula, or Non-Functioning Labryinthes ✔✔False
An inner ear disorder that affects balance and hearing. ✔✔Meniere's Disease An abnormal opening in the bony capsule of the inner ear resulting in the leakage of the peri lymph from the semicircular canals of the middle ear. ✔✔Labrythine Fistula Loss of vestibular function in both Labryinths leading to characteristic dysfunction in vision and balance. These symptoms reflect how crucial our Labryinth sense is for generating proper reflexes so that we can see clearly when we are moving and not lose our balance when we are standing or walking. ✔✔Non-Functioning Labryinths Another name for the Labryinth ✔✔Inner Ear 1 or 2 readings greater than or equal to 140/90 on the same day ✔✔Elevated Blood Pressure Two readings greater than or equal to 140/90 on consecutive exams on two different days ✔✔Hypertension Who should remeasure abnormal BP and or pulse rate or rhythm, especially if they are significant factors in determining certification? ✔✔The examiner When measuring a driver's BP they should sit in the chair for at least 5 min, back is supported, legs are uncrossed, and feet are touching the ground. Support the drivers arm at the elbow so the midpoint of the BP cuff is... ✔✔Even with the Sternum or right atrium of the driver Stage 1 HTN ✔✔ 140 - 159/90- 99 How long can you certify someone who comes in for certification for the first time and has Stage 1 HTN? ✔✔ 1 year
If a person comes in for an exam and their BP is 180/110 then they should be ...? ✔✔Disqualified Stage 3 HTN patient returns for a recheck. How long can they be certified and how often should they be recertified? ✔✔Certify for 6 months with recertification every six months What should happen if a Stage 3 HTN patient comes in for a recheck and their BP is greater than 140/90?? ✔✔The patient should be disqualified. This certificate is included in the annual certification interval and is not an extension of the certification period. It can not be used in consecutive increments. ✔✔One Time 3 month card Drivers who operate CMVs of 26,001 pounds or more, transport 16 or more passengers, or who carry placarded hazardous material on the public roadway -- All drivers operating CMVs in interstate commerce --- All drivers required to have a CDL ✔✔Drivers who must be tested for drugs and alcohol When is a driver exempt from Pre-Employment testing? ✔✔If they were in a testing program within the last 30 days and was tested within the last 6 months or a was a program for the previous 12 months What is the time frames for ETOH and drug testing after a crash? ✔✔8 hours for ETOH and 32 hours for drugs Testing that has to occur when the crash involves the loss of human life, the driver receives a citation within 8 hours of the accident, there is bodily injury to a person who immediately received medical treatment away from the scene, or if 1 or more MVs must be transported away by tow truck ✔✔Post-Accident Testing
take immediate action to remove employees from safety sensitive duties, and to make required When a driver returns to duty after violating drug and ETOH standards, how many f/u drug and ETOH tests would they need in the first year of returning to driving? ✔✔6 drug tests within the first year Employee must raise shirt and lower underpants to mid-thigh to show no device is being worn during what kind of urine testing? ✔✔Directly Observed Testing Heavy drinking average for men and women? ✔✔>2 drinks/day for men
1 drink/day for women A pattern of ETOH consumption that brings the Blood Alcohol Concentration (BAC) level to 0.08% or more in a 2 - hour period - Men 5 or more drinks and Women 4 or more drinks ✔✔Binge Drinking A pattern of drinking that results in harm to one's health, interpersonal relationships, or ability to work. Long term use can turn into dependence. ✔✔Alcohol Abuse A chronic disease that includes a strong craving for ETOH despite repeated physical, psychological, or intepersonal problems; An inability to limit drinking ✔✔Alcohol Dependence Evaluates employees who have violated DOT drug and ETOH regulations and makes recommendations concerning education, treatment, F/U testing, and aftercare ✔✔SAP (Substance Abuse Professional) Licensed MD responsible for receiving and reviewing labs generated by a drug testing program, contacts the user when there is a positive result for an interview to determine if there is an alternate explanation for drug findings in the urine specimen ✔✔MRO (Medical Review Officer) Individual who receives communications and test results from service agents, authorized to
Accelerated atherosclerosis of coronary, cerebral, and peripheral vessels, higher risk for cardiovascular disease, can cause TIA or stroke, leading cause of death among diabetics ✔✔Macrovascular Disease Neuropathy, Nephropathy, Retinopathy, Macular Degeneration ✔✔Microvascular Disease Disturbance in sensation and touch, loss of position sense, loss of vibratory sense, autonomic neuropathy ✔✔Neuropathy Fatigue, lethargy, sluggishness, transient cognitive disruption; Sudden onset unlikely; May begin around 280 - 300% but is more likely with a sustained plasma glucose of greater than 400% ✔✔Symptoms of Acute Hyperglycemia The FMCSA Medical Examiner Handbook states that a Hgb A1C of (275%) indicates poor glucose control ✔✔>10% Rapid heart rate, sweating, weakness, and hunger ✔✔Mild Hypoglycemia Seizure, loss of consciousness, need of assistance from another person, period of impaired cognitive function without warning ✔✔Severe Hypoglycemia When performing a UA... A MA detects glycosuria. What should be the test that she performs? ✔✔Blood Glucose Diabetics with excessive proteinuria may be indicative of what? ✔✔Glomerular Damage How often should diabetics be recertified because of the progressive nature of DM and the potential for complications? ✔✔Annualy
The act revised the authority of the Secretary of Transportation to grant waivers or exemptions and established procedures for pilot exemption programs ✔✔Transportation Equity Act of 1998 This 2005 act eliminated the 3-year driving requirement of driving a CMV while on insulin, adopted new waiting periods ✔✔SAFETEA-LU Minimum 1 - month if the driver was previously diagnosed and treated with oral mess but now requires insulin Minimum 2 - months of the driver is newly diagnosed with no prior treatment and is now starting insulin ✔✔New Diabetic Waiting Periods because of the 2005 SAFETEA-LU There are no specific FMCSA guidelines regarding meeting musculoskeletal tasks of lifting, pushing, pulling, and bending ✔✔True If a driver has limitations in extremity movement the medical examiner can send the driver for an on-road performance eval or a...? ✔✔Skill Performance Evaluation Motor Weakness: Extension of Quadriceps Screening Exam: Squat and Rise Reflexes: Knee Jerk Diminished ✔✔L3-L4 (Nerve Root L4) Motor Weakness: Dorsiflexion of the Great Toe and Foot Screening Exam: Heel Walking Reflexes: None Reliable ✔✔L4-L5 (Nerve Root 5) Motor Weakness: Plantar flexion of the great toe and foot
This usually affects older adults and causes a loss of vision in the center of the visual field due to damage of the retina. It can make it difficult or impossible to read or recognize faces, although enough peripheral vision remains to allow other ADL ✔✔Macular Degeneration Required vision tests ✔✔Distant Visual Acuity Peripheral Vision along the horizontal meridian in each eye Color vision If a driver has an inconclusive vision test, the next step should be to refer them to...? ✔✔An eye specialist Causes a progressive decrease in peripheral vision ✔✔Glaucoma Diminished visual acuity, contrast, and color resolution; also causes increased glare ✔✔Cataracts Leading cause of untreatable blindness in the US, Affects the central vision ✔✔Macular Degeneration DM is the most common cause; Can affect central vision, contrast sensitivity, and color discrimination. ✔✔Retinopathy 1 ear, certifies! Max certification is one year. ✔✔ 2 eyes Can someone be certified if they have contact lenses that correct distant acuity in one eye and near acuity in another eye? ✔✔No Vision in one eye; In low illumination or glare it can cause deficiencies in contrast, recognition, and depth perception compared to binocular vision ✔✔Monocular Vision
because of larger stroke area and an increased incidence of blood at the stroke site; Treatment: Allows drivers with monocular vision to operate a CMV - Should be recertified annually ✔✔Vision Exemption Focal neurological dysfunction, lasts > than a few seconds but less than 30 - 40 min ✔✔Transient Ischemic Attack Waiting period after TIA ✔✔1 year Max certification for someone with TIA ✔✔ 1 year Most common cause of stroke ages 45-65, caused by large artery atherosclerosis, often preceded by TIA; Treatment: Medical: Antiplatelet agents Surgical: Carotid Endardectomy ✔✔Thrombotic Stroke The heart is usually the source of the embolus, prognosis often worse than thrombotic stroke Medical- Coumadin, Requires INR monitoring, Increased Bleeding Risks ✔✔Embolism Stroke Waiting period after a stroke ✔✔ 1 year if the driver is not at risk for seizures Bleeding into the substance of the brain, Caused by ruptured arteriovenous malformation, there are also other causes as well ✔✔Intracerebral Hemorrhage Bleeding primarily in the space around the brain; often from a ruptured aneurysm ✔✔Subarachnoid Hemorrhage Waiting period for cerebellum or brain stem stroke ✔✔ 1 year; No additional time if no increased seizure risk and not on any anti-seizure meds
Waiting period for History of Epilepsy and Viral Encephalitis with an Early Seizure ✔✔ 10 years Waiting period for Single, unprovoked seizure, Bacterial meningitis with early seizures, Moderate TBI with early seizures, Stroke with risks of seizures, intracerebral or subarachnoid hemorrhage with risk for seizure ✔✔ 5 Years Waiting period for Seizure with acute structural insult to the brain, Moderate TBI without early seizure, Surgically removed supratentorial or spinal tumor ✔✔2 year waiting period Waiting period for TIA, stroke, intracerebral or subarachnoid hemorrhage with no risk for seizure, Surgically repaired arteriovenous malformation/aneurysm with no risk for seizure, Surgically removed infratentorial meningioma, acoustic neuromas, pituitary adenomas, benign spinal tumors, or other benign extra-ataxial tumor with no risk for seizures ✔✔1 year waiting period Sleepiness when an individual is supposed to be awake and alert, Daily or almost daily for 3 months or greater ✔✔Excessive daytime sleepiness A risk factor for OSA... Upper airway narrowing; This standardizes the assessment of the oropharynx ✔✔Mallampati Score of 3 or 4 Any driver with a neurological defecit that requires special evaluation and screening should have a medical certification how often? ✔✔Annually Focal Neurological Dysfunction in which there is inadequate blood supply to a portion of the brain; Usually last a few sections but usually less than 30-40 minutes ✔✔Transient Ischemic Attack (TIA) How long is the waiting period for someone who has had a TIA? ✔✔ 1 Year
How often should someone be recertified if they have a history of TIA? ✔✔Annual Certification Caused by large artery atherlosclerosis, often preceded by TIA; Treatment: Antiplatelet agents (Aspirin, Plavix) and Surgical: Carotid Endarterectomy ✔✔Thrombotic Stroke The heart is usually the source; This prognosis is usually worse than the thrombotic stroke because the emboli is larger, a larger stroke area, and there in increased incidence of blood at the stroke site; Treatment: Medical - Coumadin, Requires INR Monitoring, Increases bleeding risks ✔✔Embolic Stroke Bleeding into the substance of the brain, caused by ruptered arteriovenous malformation (AVM) ✔✔Intracerebral Hemorrhage Bleeding primarily into the space around the brain, often from a ruptured aneurysm ✔✔Subarachnoid Hemorrhage WHAT IS THE WAITING PERIOD FOR THROMBOTIC AND EMBOLIC STROKE ✔✔ 1 year for the stroke plus an additional 4 years if there is a seizure risk; Must be seizure-free and off anticonvulsant meds for 5 years; may shorten waiting periods after consultation with an expert in epilepsy ✔✔Cortical or Subcortical Stroke Two or more unprovoked seizures ✔✔Epilepsy A clinician can only certify drivers with an established hx of epilepsy if: ✔✔Off all seizure meds, Seizure free for 1o years, has a neuro clearance Minimum waiting period after a single, unprovoked seizure ✔✔5 years seizure free and off of anticonvulsants
Epworth Sleepiness Scale of 16 or higher ✔✔Disqualified A driver presents with suspected OSA. What can the provider give them while awaiting a sleep study? ✔✔Grant a limited-time certification (Typically around 30 days)
or = to 7 channels in a lab setting, gold standard, diagnoses all sleep disorders, this is required when the examiner suspects another sleep disorder in addition to sleep apnea ✔✔Full, Attended Polysomnography or = to 7 channels ✔✔Full, Unattended Polysomnography Home sleep tests use what type of tests? Limited channel devices and usually uses oximetry as a parameter ✔✔Type 3 or 4 A test based on staying awake as an indicator of a sleep disorder or of treatment effectiveness ✔✔Maintenance of Wakefullness Test A test based on going to sleep as an indicator of a sleep disorder or of treatment effectiveness ✔✔Multiple Sleep Latency Tests Airflow ceases for 10 or more seconds ✔✔Apnea Airflow decreases for 10 or more seconds ✔✔Hypopnea Mild: 5+ Episodes/Hour Moderate: 15+ Episodes/Hour Severe: 30+ Episodes/Hour ✔✔Apnea/Hypopnea Index
Polysomonogram shows what happens when ✔✔Airflow ceases while effort to breathe continues followed by arousal after airflow resumes An AHI > /hour needs treatment ✔✔ 20 A sleep study diagnostic for OSA that requires treatment is until treatment is documented ✔✔Disqualifying PAP compliance is ✔✔At least 4 hours/night for 70% of nights According to the FMCSA how long should you wait to certify after patient starts PAP? ✔✔ 1 month The use of cannot be considered an acceptable alternative in treating OSA ✔✔Dental Appliances If a driver is PAP compliant at one month, how long of a certification can they be issued? ✔✔ 3 month certification If a driver is PAP compliant at 3 months, how long of a certification can they be issued? ✔✔ 1 year certification A BMI of requires a sleep study according to the FMCSA ✔✔ 35 Usually requires 6 months or more to lose weight, may use CPAP until there is adequate weight loss to treat OSA, requires annual certification, reevaluate if there is a 5% weight gain or symptoms recur ✔✔Bariatric Surgery
Those on antipsychotic drugs like Rispersdal, Zyprexa, Seroquel, and Abilify can only be certified for how long? ✔✔ 1 year Loss of interest or motivation, poor sleep, appetite disturbance, fatigue, poor concentration, and indecisiveness ✔✔Major Depression Characterized by psychosis, significant percentage commit suicide, there is a risk of relapse, severe psychomotor retardation or agitation, cognitive impairment, and poor judgement ✔✔Severe Depression Lithium is used to treat acute mania and bipolar disorders. A driver should be disqualified if they have a disqualifying psychological condition or if their lithium levels are... ✔✔Not in therapeutic range 1st generation anti-depressants ✔✔Interfere with safe driving 2nd Generation Anti-Depressants have fewer side effects and are generally safe but can interfere with driving and require... (Examples include Prozac, Zoloft, Effexor, Wellbutrin) ✔✔Case by Case Evaluation Recommend certifying someone with a Personality disorder if they ✔✔Complies with the treatment program, tolerates treatment, and has a comprehensive eval from an appropriate medical professional How long max can you certify someone with Adult ADHD? Symptoms include age-inappropriate inattention, impulsiveness, hyperactivity, mood liability, low frustration, and explosiveness ✔✔1 year How long can you certify someone using CNS stimulants like Adderral, Ritalin, and Pemoline? ✔✔1 year
CNS stimulants improve performance on simple tasks but not on tasks requiring ✔✔Complex intellectual functions The FMCSA recommends that you someone on benzodiazepines ex. Ambien ✔✔Do not certify Electro convulsive therapy is used to treat major depression, schizophrenia, and related psychotic episodes. Causes confusion, disorientation, and a loss of short-term memory that usually resolve. The examiner should not certify a driver who has maintenance ECT but can certify a driver if... ✔✔Comprehensive eval from a medical professional and no disqualifying side effects The use of oxygen is disqualifying ✔✔Supplemental Inflammation of the nasal portion of the respiratory tract that causes sneezing, coughing, watery eyes, and rhinorrhea; Max certification is two years ✔✔Allergic Rhinitis Are avaliable without an RX and are sedating - You should abstain from antihistatimes for 12 hours prior to operating a CMV ✔✔1st generation antihistamines Chronic reduction of the maximal expiratory flow most often caused by a combination of chronic bronchitis and emphysema, need PFT to diagnose, smoking is the primary cause ✔✔COPD Obtain this test if there is any history of specific lung disease, any symptoms of SOB, chest tightness, or wheezing ✔✔Pulmonary Function Test FEV1 <65% of predicted; FEV1/FVC ratio <65% ✔✔Airway Obstruction FVC <60% of predicted, Obtain Oximetry ✔✔Restrictive Impairment
