Practice Test 1

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1) A driver has the following ANSI hearing results.  What is the driver’s status?

Hz Right:   500   1000   2000   4000            Hz Left:  500   1000   2000   4000

Db Right:   30       40       50       80               Db Left:  40       50       50       20

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2) Examination of which of the following is not part of the medical exam?

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3) Which standard or guideline allows for Medical Examiner discretion?

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4) Which of the following is not a required test?

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5) A driver presents with the following ISO hearing results.  What is the driver’s status?

Hz:   Right:  500    1000    2000    4000          Left:  500   1000   2000   4000

dB:                 35       45        55          55                       40      50       60       80

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6) During the hearing exam, the driver was able to hear a whisper at 6 feet on the right and 3 feet on the left. When examining the ears, you notice scarring on the left tympanic membrane. Visualization of the throat demonstrates post-nasal drainage. All other exam findings are normal. What is the next step?

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7) A driver with a history of hypertension, taking anti-hypertension medication, has the following blood pressure readings on re-certification.  What is the next step?

1st reading:  149/99

2nd reading:  139/85

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8) A driver without a history of hypertension has the following blood pressure readings on examination.  What is the next step?

1st reading: 141/85

2nd reading: 135/91

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9) A driver is taking a low dose of methadone for pain management. His treating physician has cleared the driver as being safe to drive and taking the medication as prescribed. What is the next step?

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10) A driver has the following visual measurements during re-certification:

Distant Visual Acuity:               Right (OD):  20/40   Left (OS):  20/60

Horizontal Lateral Vision:        Right:    50                 Left:   90

What is the next best step?

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11) The driver was recently prescribed Humulin.  What is the next step?

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12) The driver first perceives a whispered voice at 5 feet in his right ear and 3 feet in his left ear.  All other aspects of his physical examination are unremarkable.  The examiner would?

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13) A driver under the age of 35 has recently been prescribed Chantix. The medical exam is otherwise normal. What is the next step?

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14) The driver suffered a mild heart attack 5 weeks ago. Which of the following is not something the ME should consider when making a qualification determination?

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15) A driver admits to having recent dizzy spells that generally last about 20 minutes. They are not currently dizzy and have no significant medical history. The physical exam is all within normal limits. Should this driver be certified or disqualified? Why?

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16) The medical examiner notes that a driver is taking Metformin, Crestor, and Antabuse.  He reports no side effects from any of the medications. The driver had a recent HbA1c of 6.5%. The rest of the examination was unremarkable.  The examiner should:

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17) The following are symptoms of Congestive Heart Failure EXCEPT:

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18) During the examination, the examiner notices that the driver’s horizontal vision is 20 degrees to the left and 90 degrees to the right. Visual acuity is 20/20 in the right eye (OD), the left eye (OS) and both eyes together (OU).  What is the next step?

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19) During an examination, the examiner notices that the driver is distant, lacks eye contact and shows no emotional response during the exam.  The examiner’s best response should be:

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20) Which of these gastrointestinal conditions are most likely to cause incapacitating symptoms?

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21) The driver admits to the use of marijuana for the treatment of his glaucoma, which is legal in the State he lives in. He provides medical documentation for glaucoma indicating he can drive a truck.  His certification examination is WNL.  The medical examiner should?

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22) Which of the following is considered the normal amount of ROM for a shoulder?

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23) A driver for a truck driving school presents for a new medical certification.  He reports in his history that he was treated for epilepsy 14 years ago but stopped taking medication on his own since his move to your area 11 years ago.  He has not seen a neurologist or a health care provider in more than 10 years and reports no seizures since then.  The examiner should?

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24) A driver informs the examiner of having been diagnosed with sleep apnea 3 years earlier. They report seeing their “sleep doc” a few months ago and they have been using their CPAP. The exam is essentially normal other than they are overweight (BMI of 38).  The current medical certificate does not expire for 2 months. The best decision for the examiner is to:

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25) A driver should exhibit a minimum of what % compliance of CPAP usage?

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26) A driver is taking Celexa for the treatment of what he calls "mild depression”.  He reports he has not considered or attempted suicide. What should the examiner consider when making a qualification determination?

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27) A driver reports that he has been taking coumadin for the past two years to manage his atrial fibrillation. Which of the statements below is incorrect?

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28) A driver's history lists narcolepsy as a current medical condition.  During the exam, the driver seems nervous and has an episode of sudden loss of muscle tone while awake (cataplexy).  What is the next best step?

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29) For a spirometry test, which of the values below would be considered failing the test and is indicative of airway obstruction?

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30) A driver’s medical history is positive for hypertension and occasional headaches. His medications include Lisinopril, Topamax, Ibuprofen, and a multivitamin. Both his blood pressure and physical exam findings were normal. What is the best course of action for the medical examiner?

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31) A driver with monocular vision has been driving intrastate with the current condition for the last 5 years. What is the course this driver must take to drive across state lines?

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32) A driver presents for an exam. He has been driving for the last 18 years with a total leg prosthesis that he received over 20 years ago after stepping on a land mine. There are no other significant exam findings. How should the ME proceed?

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33) During the physical exam, the driver fails the whisper test in both ears. When examining the ears, you notice an impaction of ear wax blocking your view of the tympanic membrane in both ears. What is the next step?

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34) How long would the driver be certified if they are taking Micardis HCT for hypertension, with a confirmed blood pressure of 162/96 at the time of the examination?

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35) A driver with a history of diabetes and taking Trulicity provides a note from his PCP that lists his A1c level as 8.7%. His exam is essentially WNL, urinary glucose of 200mg/dl, notably overweight.  The medical examiner should?

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36) During the examination the driver has a positive “Babinski” reflex.  The examiner should?

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37) The driver marks “yes” for a history of lung disease and lists that he uses an albuterol inhaler multiple times per week to control his asthma, and that it is worse in the spring and fall.  Upon further questioning, he denies ever being hospitalized for his asthma and that he sees his PCP annually for a physical.  The examiner should?

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38) All the following are required components of a DOT medical examinations EXCEPT:

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39) The driver reports using the inhaled medication Afrezza for control of their diabetes.  The rest of the examination is normal.  The driver's current A1c = 7%.  The examiner should?

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40) A driver taking insulin has a letter indicating he is a driver in the FMCSA Waiver program from the mid-1990s. There has been no change in the driver's diabetes condition and the driver is otherwise medically qualified to drive. What is the best course of action?

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41) The driver is on dialysis, and the examiner is unable to obtain a UA during the certification examination.  The examiner should?

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42) The driver reports for a re-certification examination 8 weeks after having a CABG. He presents a note from his cardiologist stating that the driver can return to driving without restriction. The driver’s ETT results were normal, and his ECHO showed a left ventricular ejection fraction of 43%. Which of the following statements is correct?

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43) All the following eye conditions may require the medical examiner to seek specialist evaluation except:

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44) All of the following will need to be entered on the medical examiner report form except:

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45) A driver presents for recertification. He had Stage 3 hypertension on an exam 1 year ago and was certified 6 months later when his BP was below 140/90. The driver's 6-month certificate is about to expire. His confirmed blood pressure during the examination today is 166/92. What is the next step?

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46) The driver is taking Sinemet.  The medical examiner should?

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47) The driver uses hearing aides during the whisper test.  He can hear at 5 feet on the right and 4 feet on the left.  What is the next step?

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48) A driver had to use a hearing aid to pass the hearing standard.  What should the ME counsel the driver about?

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49) The minimum acceptable spirometry values required to certify a driver are:

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50) A female driver presents for re-certification who is in her fourth day of menses.  Her UA shows a Specific gravity of 1.020; Protein is +1; Blood is +4; Glucose is negative.  All other aspects of her medical examination are within normal.  The examiner should?

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51) A driver presenting to your office marks down that he is taking nitroglycerine for angina, and he has been doing so for a few years. Upon questioning he indicates that he has needed more recently because his episodes have become more frequent.  Your best course of action is to?

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52) You hear a bruit upon auscultation of the driver’s abdomen.  Palpation reveals a bounding pulse below the sternal angle of the rib cage.  What might you suspect?

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53) The longest the medical examiner would certify a driver with a history of Stage 3 hypertension is:

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54) The driver is taking a low dose of Wellbutrin to help him stop smoking.  He has provided a note from his PCP stating that he has no side effects and confirms that he is taking the medication for smoking cessation.  The examiner would?

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55) During the history, the driver admits to taking Gabapentin for peripheral neuropathy. They relate no adverse effects from the medication. The examiner should?

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56) A driver presents with swelling in their hands and synovitis. Who would be the best person to refer to?

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57) The driver reports that he suffered a seizure 5 months ago because of a medication reaction.  He only had one event and did not require any medication.  Medical records confirm the driver’s comments and indicate the underlying cause has been corrected and is unlikely to recur. The examiner should?

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58) The driver reports a suicide attempt 10 months earlier following the breakup of his marriage. He noted seeing a psychiatrist and he takes citalopram daily. He reports that he feels fine now and is moving on with his life. The medical examiner should?

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59) The driver reports that he has been taking Synthroid for about 6 months. This information is verified by his treating physician. His examination is essentially normal. The next step is?

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60) A 48-year-old male driver reports a back injury that occurred 4 years earlier that resulted in him being off work for over a year following back surgery. He has now returned to driving. His last certification was good for 2 years. He is taking Oxycodone, only as needed. He reports seeing his “pain doctor” every few months for evaluation. He also reports having a series of steroid injections about a year ago which “helped a lot”.  The examiner should?

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61) A driver presents for examination following a spontaneous pneumothorax one month earlier. The records provided by the driver indicate that the pneumothorax reduced the driver’s forced vital capacity (FVC) to 58% of predicted forced vital capacity. As the medical examiner, you should:

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62) A driver’s UA shows a specific gravity of 1.032, protein is negative, blood shows a trace amount, and glucose is 2000mg/dl. The driver reports that he does not have any known medical conditions. What is the suspected medical condition and the next step?

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63) The driver admits during the examination that he drinks frequently, usually only on the weekends, maybe a total of 12 to 14 beers a week to help him unwind.  The examiner provides a “CAGE” questionnaire, and the driver scores a 1 on the questionnaire.  The rest of the examination is unremarkable.  The examiner should?

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64) The driver admits that he has been treated for tuberculosis in the last year.  He reports that he feels okay and was cleared to drive. Which of the following is not required for certification?

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65) On recertification, a driver has medical records from his cardiologist providing clearance for the driver that had a successful catheter ablation 8 months earlier to treat his Wolf Parkinson White syndrome. His latest electrocardiogram is normal. Examination shows no significant abnormalities in rhythm and timing of the cardiac cycle. The rest of the examination is unremarkable. The examiner should:

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66) A driver lists in his history that he has diabetes and is taking insulin.  He presents the ME with an Insulin Treated Diabetes Evaluation form that was completed 40 days ago.  The ME should:

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67) A driver exhibits clubbing of the fingers. The examiners next step would be?


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68) The driver lists a history of hypertension and diabetes. Upon further questioning, he comments that his wife complains of his loud snoring. His current list of medications includes lisinopril, glucovance, and simvastatin.  His examination shows a BP of 136/82, a BMI of 42.26, and a 17.5” neck size.  The rest of his examination is unremarkable. The examiner should:

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  1. A 42-year-old female presents for a physical exam prior to starting CDL school. She reports that four years ago she had a wood beam fall and hit her head while at a construction site. The beam “knocked her out” for about 20 minutes. She was taken to the ER who performed some tests including a CT scan. The ER doc ordered a neurology consult but was comfortable sending her home. That night she had a seizure. She was evaluated by the neurologist two days later who prescribed a medication and told her she could go back to work. She has been seizure-free since the first seizure.

Medications:  Fluoxetine and Trileptal
Exam Findings:
Vitals: normal
Neuro: Normal mini mental status exam; Cranial nerves II-XII within normal limits; no other significant neurological findings.
MSK: Normal deep tendon reflexes; full musculoskeletal exam was within normal limits
The rest of the exam was within normal limits

What is the best course of action?

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70) The waiting period for a driver with a history of severe brain trauma is?

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71) A driver reports for examination 7 years post CABG.  He presents a release from his cardiologist two years ago that states that he has no restrictions from driving.  The driver brings a copy of a normal ETT that was performed 3 years ago.  Otherwise, his examination is unremarkable.  The next step is:

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72) The driver reports a history of COPD and smoking a pack and a half of cigarettes daily.  He has been treated by a pulmonologist for a few years now and insists he is able to drive safely.  He lists that he is taking Spiriva daily and his “water pill” which he cannot remember the name of for high blood pressure.  His examination reveals notable wheezing in all lung fields upon auscultation and a BMI of 34.23. The rest of his examination is unremarkable.  The examiner should:

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73) When asked to differentiate traffic signal green, red, and amber using colored cards, the driver can differentiate which color is which, but reports that the red card appears “greenish grey” and green card appears “gray-ish”. What is the next step?

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74) Of the following medical conditions, which one is most likely to cause a restriction of peripheral vision?

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75) A driver is taking Streptomycin for the treatment of chronic tuberculosis.  He has been asymptomatic over the past year. He reports no significant fatigue, and his examination findings are unremarkable.  He provides a note from his treating physician that indicates that he may drive a truck.  Office notes including his most recent X-ray and pulmonary function tests are also provided for the examiner’s review.  The X-ray shows a few discrete nodules, without any other abnormal findings.  Spirometry indicates an FEV1 of 75%, FVC of 70% and an FEV/FVC ratio of 75%.  The examiner should:

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  1. While completing the examination, the driver has noticeable pain in his lower back during lumbar flexion.  The driver reports a recent lower back injury and is under active treatment for a low back strain.  He has been released to return to light duty work. The driver relates that he never has to load or unload his truck. All other aspects of the examination are unremarkable.  The examiner should:

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77) The driver is unable to flex either hip more than 60 degrees due to right and left hip replacement performed 5 years ago and 7 years ago. He is adamant that he can drive a truck.  This is his first driver medical exam since the surgery. The rest of his examination is unremarkable. What is the next step?

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78) The driver is a thin, healthy-appearing female. She reports she is a triathlete and runs, swims and bikes daily.  Her examination reveals a BP of 98/62 and a pulse of 50. The best decision regarding her certification would be:

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79) A 48-year-old male driver presents for a physical exam. He has a history of hyperlipidemia for which he is taking Atorvastatin. Other medications include fish oil and occasional ibuprofen. He is otherwise healthy. Exam findings are unremarkable except for the urinalysis demonstrated 400mg/dl of protein in the urine. What should the ME be concerned about? Who would be the best specialist to consult?

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80) A driver reports a history of being treated for alcoholism many years prior.  He continues to attend AA meetings, and reports being in remission for over 5 years.  He does not take any medication to control his alcoholism.  His examination is free of any signs of alcoholism and is otherwise unremarkable.  The examiner provides a CAGE questionnaire, and the driver scores a 0 out of 4.  The best certification decision would be to:

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81) A 67-year-old male driver has a history of hypertension and diabetes listed on his examination form.  He lists lisinopril, pravastatin, metformin, and Aricept. The driver’s wife seems to answer many of the questions asked by the examiner during the exam. The rest of the exam is unremarkable. The examiners best decision would be to:

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82) The driver reports that he had surgery on his cervical spine 2 years ago. It involved a fusion of C4, C5 and C6. He has recovered fully and was released to return to work without restriction. He reports no pain and does not require medication of any kind. During the examination, the driver exhibits only 30 degrees of cervical rotation to both the right and the left. The examiners best decision would be to:

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83) The urine test that is performed during the DOT physical examination is primarily to assess?

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84) Which of the following is not part of the urine test during an examination?


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85) All the following meet the FMCSA definition of epilepsy except:

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86) A driver has a 15-year history of diagnosed epilepsy. The driver says he has been without medication and seizure-free for 12 years. His last visit with his neurologist was 13 years ago. What is the most appropriate action to take?

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87) The driver reports for examination 3 ½ months after being provided a 3-month certificate for having Stage 1 hypertension. His list of medications has not changed, and he is taking Lisinopril, and Crestor for high blood pressure.  He denies seeing his PCP or making any changes since his last exam.  A new exam is performed, and his blood pressure is 148/88, confirmed with a second reading.  The examiner should:

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88) A 43-year-old male reports for recertification.  His previous certification was good for 2 years.  His medical history is unremarkable.  Further questioning reveals an appendectomy 8 years ago. No current medications.  His examination results are as follows:

-Visual Acuity:  20/30 OS; 20/20 OD; 20/20 OU
-Able to distinguish signal red, amber, green
-Lateral Horizontal Vision:   80 left, 80 right.
-Whisper test:  5 ft. right; 4 ft. left
-BP 148/88; pulse:  86
-UA:  Specific Gravity: 1.010; Protein: trace; Blood: Negative; Sugar: Negative.
-The rest of the examination is unremarkable.

What is the best decision for the medical examiner?

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89) The previous driver reports back for recertification with the same findings except that his blood pressure is now 165/101.  The next step is:

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90) The previous driver returns 6 months after the exam date of his 3-month certificate.  His exam is unchanged except he is taking Lisinopril and HCTZ for hypertension and his blood pressure is 138/88.  What is the next step?

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91) A female driver reports for examination.  Her current list of medications includes Effexor (venlafaxine) which was prescribed following her divorce last year. She relates that she is fine now and really doesn’t need it anymore.  Her mannerism is normal and there is no apparent distress noted.  The rest of the exam was unremarkable. The examiners best decision is to:

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92) The driver has a history of stroke 7 months earlier and presents a letter from his neurologist stating that he is cleared to return to work without restriction.  The note indicates that the stroke was a cerebellar embolic stroke, and that the driver suffers no deficits in motor or cognitive abilities.  All other aspects of the examination are within normal limits.  The best next step is:

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93) A driver reports that he uses hearing aids.  During the whisper test it is noted that even when using hearing aids, he is unable to detect a whispered voice in either ear. The driver fails audiometric testing without his hearing aids. What would be the next step?

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94) If a medical examiner uses the number 6 in the comments section of examination form, they are referring to which of the following body systems listed on the exam form?

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95) What council should a ME provide to a driver who utilizes contact lenses to drive?

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96) A driver was not compliant with using their CPAP.  What is the next best step?

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97) A 60-year-old male driver admits to having low back pain for the last 15 years. He has always used the same daily treatment of OTC topical menthol-based patches and Naproxen (Aleve) 500mg BID. He also has a history of depression and has been prescribed Duloxetine. He denies history of any major or severe depressive episodes. The driver also admits to having a fainting spell. There is no other significant medical history and exam findings are normal. What should the ME be most concerned about?

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98) What is the recommended certification period for Obstructive Sleep Apnea (OSA)?

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99) Which of the conditions listed below would be most concerning when observed on the arms of a driver?

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100) When the examiner evaluates an audiometric test for hearing loss, what frequencies are used to determine average hearing loss?

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101) A 35-year-old right-handed female driver reports for a recertification. She reports in her history that she has recently been diagnosed with Carpal Tunnel Syndrome in her left wrist.  Additionally, she reports using a brace at night, taking NSAIDS OTC PRN, and seeing her PCP and a physical therapist for treatment.  She has no current restrictions from work.  Her grip strength in her right and left hand is 5/5. The rest of her examination is unremarkable.  The best next step is:

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102) A student at a local trucking school reports for a new certification.  During the examination he reports he takes Zyprexa.  He presents a note from his treating provider stating that the condition is managed, and he should be able to drive.  All other aspects of the examination are normal.  The examiners best decision would be to:

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103) A 56-year-old male driver reports a history of “intermittent claudication”.  He is being treated by his PCP and has a vascular surgeon consult scheduled.   He reports that his symptoms have worsened over the past year, now having pain at rest.  He takes aspirin for pain PRN.  During the exam, the driver reports pain when he is sitting on the examination table. The examiners best decision would be to:

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104) A driver's history indicates a diagnosis of hypertrophic cardiomyopathy.  Which of the statements below is correct?

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105) A 62-year-old male presents for a recertification examination with a history of COPD.  He reports that he smokes a pack and a half of cigarettes daily and that he feels totally fine.  Auscultation reveals positive findings. He is slightly hypertensive and overweight.  During the examination he has a frequent nonproductive cough. Upon receiving medical records from the driver’s pulmonologist, it confirms his diagnosis of COPD and it is revealed that he has suffered vasovagal syncope resultant from coughing a few times over the past year. His pulmonary function test shows a FEV1 of 69%, FVC of 66% and a FEV1/FVC ratio of 70%.  His ABG PaO2 was 65mmHg below 5000 feet and Pulse Ox was 91%.  

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106) A driver complains of painless gradual loss of night vision, peripheral vision, and decreased color discrimination.  Distance visual acuity has not changed. The most likely cause is:

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107) A driver presents for certification. He checks "yes" for "Anxiety, depression, nervousness, and other mental health problems". He explains that his depression is controlled with medications and electroconvulsive therapy (ECT). Following ECT, the driver should be symptom free for how long before being certified?

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108) A 52-year-old male driver presents with a resting tremor in both hands, worse on the right. He takes a daily multivitamin and ibuprofen when needed. There is no other relevant medical history.
Significant exam findings:
Good ROM and strength to both upper and lower extremities
Deep Tendon Reflexes were 2/4 to both upper and lower extremities
Resting tremor to both hands, worse on right. The tremor stopped when grasping.
Strong grasp strength and prehension to both hands
The rest of the exam is within normal limits

What is the best course of action for the medical examiner?

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109) A driver reports driving for a construction company Monday through Friday for 10 hours a day and then driving for a motor carrier on Saturday and Sunday for 12 hours a day. Although appearing tired, the driver is otherwise qualified for certification.  What is the next step?

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110) A driver was prescribed Provigil two weeks ago to treat excessive sleepiness. The driver reports feeling better and denies any medication side effects. The driver is otherwise medically qualified to drive. What is the next step?

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111) A motor carrier calls to request a copy of their driver’s medical exam form. What is the next step?

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112) Which of the following commercial drivers involved in interstate commerce are not required to have a current medical certificate?

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113) Which of the individuals listed cannot receive a DOT medical card?

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114) What is the minimum time the Medical Examiner must keep a copy of the medical exam report and medical examiner’s certificate?

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115) Which of the following health care providers not serving as the medical examiner can sign the medical exam form?

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116) While performing a physical exam, the driver remarks that at times they have some discomfort located a little below the right side of their stomach. While palpating the abdomen, you find a decent sized soft protrusion to the right of the groin that causes pain upon palpation. Who should this driver be referred to before making a certification decision?

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117) A driver complains of loss of central vision and difficulty recovering from bright lights such as headlights at night.  The most likely cause is:

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118) A driver reports sustained ventricular tachycardia (lasting> 15 seconds).  The exam is otherwise normal.  What is the re-certification status?

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119) The primary mission to reduce crashes, injuries, and fatalities involving large trucks and buses is associated with:

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120) During the history, the driver admits to taking Benadryl for seasonal allergies. The examiner should?

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