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1) Which of the following medical conditions is most likely to result in a driver being unsafe to drive?

20/100 vision in the left eye secondary to glaucoma

Monovision

Monocular vision

Driver failing the Ishihara color blindness test

Explanation: Monovision is when one eye is corrected for far vision and the other is for near vision. It is not disqualifying but it is unlikely that will meet the vision standard. The issue can be circumvented by having the driver acquire corrective lenses that allow for distance vision in both eyes. Monocular vision is when one eye meets the vision standard, but the other does not. Studies have shown that drivers with monocular vision are just as safe as those with normal vision. Technically, the first condition listed would be considered monocular vision. Provided the driver meets the vision standard in the other eye, they could be certified using the alternate vision standard. Finally, drivers are not required to pass the Ishihara test. They simply must be able to distinguish between traffic signal colors red, amber, and green.

Explanation: Monovision is when one eye is corrected for far vision and the other is for near vision. It is not disqualifying but it is unlikely that will meet the vision standard. The issue can be circumvented by having the driver acquire corrective lenses that allow for distance vision in both eyes. Monocular vision is when one eye meets the vision standard, but the other does not. Studies have shown that drivers with monocular vision are just as safe as those with normal vision. Technically, the first condition listed would be considered monocular vision. Provided the driver meets the vision standard in the other eye, they could be certified using the alternate vision standard. Finally, drivers are not required to pass the Ishihara test. They simply must be able to distinguish between traffic signal colors red, amber, and green.

2) During an examination of a male driver, the examiner identifies an inguinal hernia that is non-reducible.  Upon questioning, the driver reports that he has had this for quite some time (it was originally diagnosed a few years ago during a CDL exam). However, he has noticed that it recently has become mildly painful with exertion but getting worse in the past week.  The examiner’s best course of action would be to?

Temporarily disqualify the driver and refer him for further medical evaluation

Have the driver perform a Functional Capacity Evaluation to determine if he can lift greater than 50 lbs.

Certify the driver for 1 year

Certify the driver for 2 years

Explanation: Due to the fact that the hernia is non-reducible and symptomatic before certification an evaluation should be obtained.

Explanation: Due to the fact that the hernia is non-reducible and symptomatic before certification an evaluation should be obtained.

3) During a medical exam, the driver does not know English and fails to follow instructions from the medical examiner.  What is the next best step?

Disqualify the driver based on the driver's inability to drive a commercial motor vehicle safely

Disqualify the driver based on the driver's inability to understand or speak English

Disqualify the driver based on the driver's inability to read traffic signs or follow driving instructions

Disqualify the driver based on the inability to communicate effectively to perform the medical examination

Explanation: Although Medical Examiners are not required to determine whether a driver understands English well enough to drive (that is the Motor Carrier's responsibility), they are responsible to determine if the driver understands well enough for the medical exam to be performed.  In this case, the driver does not understand English well enough for a proper medical exam to be performed.  A remedy would be for an interpreter to be present during the medical exam.

Explanation: Although Medical Examiners are not required to determine whether a driver understands English well enough to drive (that is the Motor Carrier's responsibility), they are responsible to determine if the driver understands well enough for the medical exam to be performed.  In this case, the driver does not understand English well enough for a proper medical exam to be performed.  A remedy would be for an interpreter to be present during the medical exam.

4) A driver has a blood pressure of 168/112 confirmed during the examination. What is the correct qualification determination for this driver?

Disqualified

Certified for 6 months

Certified for 1 year

Certified for 2 years

Explanation: This is Stage 3 hypertension.  The driver is disqualified until their blood pressure is less than or equal to 140/90 at which time, they will have a maximum certification of 6 months from the date of this examination.

Explanation: This is Stage 3 hypertension.  The driver is disqualified until their blood pressure is less than or equal to 140/90 at which time, they will have a maximum certification of 6 months from the date of this examination.

5) A driver lives in a state where marijuana has been legalized. He admitted to recreational marijuana use two weeks ago.  He remarks that he does not regularly use marijuana.  What is the next best step?

Inform the driver they cannot use marijuana, and order a non-DOT drug test

Disqualify the driver for marijuana use

Certify the driver and counsel them that they cannot use marijuana with no exceptions

Put the driver into determination pending, inform the driver they cannot use marijuana, and order a DOT drug test

Explanation: For drivers that check the box for illegal drug use, the responsibility of the ME is to determine if they are still using marijuana.  Rarely is marijuana physically addicting, it is usually a choice.  If a driver is a regular marijuana user, they will test positive for marijuana for up to 8 weeks.  If they recently smoked a single joint, they would have a low concentration or will have a negative result after a week.

Explanation: For drivers that check the box for illegal drug use, the responsibility of the ME is to determine if they are still using marijuana.  Rarely is marijuana physically addicting, it is usually a choice.  If a driver is a regular marijuana user, they will test positive for marijuana for up to 8 weeks.  If they recently smoked a single joint, they would have a low concentration or will have a negative result after a week.

6) A driver’s medical history is significant for a gastric bypass 6 months ago which resulted in him losing 110lbs. There is no other significant medical history. All other exam findings are within normal limits. What is the best course of action for the ME?

Certify for 1 year

Certify for 2 years

Request an evaluation by their PCP

Obtain medical clearance from the treating provider

Explanation: With this type of question, FMCSA is looking for what the first step and the safest course of action is. It’s likely that the driver will be able to be certified for 1-2 years. However, it may be considered “best practice” to obtaining medical clearance to verify that the driver is not experiencing any possible side effects that may preclude them from driving.

Explanation: With this type of question, FMCSA is looking for what the first step and the safest course of action is. It’s likely that the driver will be able to be certified for 1-2 years. However, it may be considered “best practice” to obtaining medical clearance to verify that the driver is not experiencing any possible side effects that may preclude them from driving.

7) Which of the following information is not found on the medical examiner report form (MCSA-5875)?

National Registry number

Date the exam was completed

Certificate expiration date

National Provider Identification # (NPI)

8) While testing the driver for visual acuity using a Snellen chart, the driver continues to tilt their head obliquely and swaying from left to right. Which of the following statements is most likely to be correct?

The driver has a deficiency in their peripheral vision possibly due to glaucoma

The driver has aphakia

The driver has a deficiency in their central vision possibly due to macular degeneration

The driver has a deficiency in their central vision possibly due to glaucoma

Explanation: If a person needs to tilt their head to read a Snellen chart, it usually indicates a problem affecting their central vision. This could be due to macular degeneration or with an issue affecting their eye alignment or muscle control and potentially related to a cranial nerve issue. Aphakia means not having a lens inside the eye. Without a lens, the eye is out of focus and vision is blurry. Individuals with aphakia are very farsighted, but distance vision is also affected. The statement that glaucoma affects peripheral vision is correct. However, this driver is dealing with a deficit of their central vision.

Explanation: If a person needs to tilt their head to read a Snellen chart, it usually indicates a problem affecting their central vision. This could be due to macular degeneration or with an issue affecting their eye alignment or muscle control and potentially related to a cranial nerve issue. Aphakia means not having a lens inside the eye. Without a lens, the eye is out of focus and vision is blurry. Individuals with aphakia are very farsighted, but distance vision is also affected. The statement that glaucoma affects peripheral vision is correct. However, this driver is dealing with a deficit of their central vision.

9) 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?

Certify the driver for 2 years

Request consultation with an ENT

Require an audiometric test

Wait to certify until the post-nasal drainage is clear

Explanation: Even though the driver meets the hearing standard by passing the whisper test in the right ear, there is scarring of the tympanic membrane (tympanosclerosis). This may very well be the cause of the hearing loss to the left ear. If this scarring and hearing loss has not previously been evaluated, the examiner should refer the driver to an ENT prior to making a certification determination. There are many causes of post-nasal drainage, and it is not a risk for safe driving unless there is the possibility of cough syncope or a severe infection.

Explanation: Even though the driver meets the hearing standard by passing the whisper test in the right ear, there is scarring of the tympanic membrane (tympanosclerosis). This may very well be the cause of the hearing loss to the left ear. If this scarring and hearing loss has not previously been evaluated, the examiner should refer the driver to an ENT prior to making a certification determination. There are many causes of post-nasal drainage, and it is not a risk for safe driving unless there is the possibility of cough syncope or a severe infection.

10) Which of the following professionals is responsible for evaluation and/or treatment of drivers for drug or alcohol abuse?

MRO

SAP

PCP

ME

Explanation: The Substance Abuse Professional (SAP) is responsible for evaluation and treatment of drivers suspected of drug or alcohol abuse.  If a driver has had a DOT drug or alcohol test violation such as positive DOT drug test, they must be evaluated by a DOT Accredited SAP and successfully complete a treatment program if directed by the SAP.  If the driver did not have a DOT drug or alcohol test violation, the SAP is not required to be DOT Accredited.

Explanation: The Substance Abuse Professional (SAP) is responsible for evaluation and treatment of drivers suspected of drug or alcohol abuse.  If a driver has had a DOT drug or alcohol test violation such as positive DOT drug test, they must be evaluated by a DOT Accredited SAP and successfully complete a treatment program if directed by the SAP.  If the driver did not have a DOT drug or alcohol test violation, the SAP is not required to be DOT Accredited.

11) A driver admits to having an anaphylactic reaction to peanuts. They are otherwise healthy with no significant medical history and an unremarkable physical exam. What is the best way to proceed?

Suggest that the driver always carry an epinephrine injection device with them while driving

Refer the driver to an allergist

Disqualify the driver

Suggest that the driver carry Benadryl with them while driving

Explanation: Drivers with an allergy-related life-threatening condition should always be counseled to carry an epinephrine injection while driving. Benadryl (diphenhydramine) helps with the treatment of allergies but is not sufficient to treat anaphylaxis. In addition, Benadryl usually causes sedation, and an individual should not drive for at least 12 hours after taking this medication. If the driver is not already under the care of an allergist, a referral is not a wrong answer, but it is not the best answer.

Explanation: Drivers with an allergy-related life-threatening condition should always be counseled to carry an epinephrine injection while driving. Benadryl (diphenhydramine) helps with the treatment of allergies but is not sufficient to treat anaphylaxis. In addition, Benadryl usually causes sedation, and an individual should not drive for at least 12 hours after taking this medication. If the driver is not already under the care of an allergist, a referral is not a wrong answer, but it is not the best answer.

12) Which of the following is disqualifying?

Monovision

Telescopic lenses

Extended wear contacts

Retinopathy

Explanation: Telescopic lenses are disqualifying. Monovision is not disqualifying if they can meet the vision standard, with or without the use of corrective lenses. The use of extended-wear contacts is not disqualifying but the driver should be counseled to carry a pair of glasses while driving. An individual with retinopathy can be certified if they meet the vision standard.

Explanation: Telescopic lenses are disqualifying. Monovision is not disqualifying if they can meet the vision standard, with or without the use of corrective lenses. The use of extended-wear contacts is not disqualifying but the driver should be counseled to carry a pair of glasses while driving. An individual with retinopathy can be certified if they meet the vision standard.

13) A driver reports a slowly progressive, diminished distance visual acuity, glare from oncoming headlights at night, and decreased contrast.  The most likely cause is:

Macular degeneration

Cataracts

Glaucoma

Retinopathy

Explanation: Cataract formation causes diminished visual acuity in all fields, and night glare from headlights is one of the first changes to appear. Near vision may be improved. If this driver can meet the vision standard, they can be certified for up to 2 years.

Explanation: Cataract formation causes diminished visual acuity in all fields, and night glare from headlights is one of the first changes to appear. Near vision may be improved. If this driver can meet the vision standard, they can be certified for up to 2 years.

14) A driver is taking an amphetamine for treatment of ADHD.  Which of the following is true?

The ME should verify the diagnosis with the treating provider and that treatment is effective, safe, and stable

The driver can be certified if the ME verifies that the treatment/medication does not cause any disqualifying side effects such as sedation or impaired coordination

The use of an amphetamine is disqualifying

Both A and B

All of the above

Explanation: In addition, drivers cannot take a stimulant except for the treatment of ADHD.

Explanation: In addition, drivers cannot take a stimulant except for the treatment of ADHD.

15) On examination a driver’s blood pressure is measured at least twice. The lowest value recorded was 156/101.  This is:

Normal blood pressure

Stage 1 Hypertension

Stage 2 Hypertension

Stage 3 Hypertension

Explanation: This is Stage 2 Hypertension, which is defined as 160 – 179 / 100-109.

Explanation: This is Stage 2 Hypertension, which is defined as 160 – 179 / 100-109.

16) Indicators to have pulmonary function testing performed on a driver include:

A history of COPD

Symptoms of wheezing

Cigarette smoking in drivers 35 years of age or older

All of the above

17) A driver reports having a pacemaker implanted 2 years ago.  The cardiologist implanted a pacemaker/cardioverter defibrillator model although there was no current risk for defibrillation.  The defibrillation portion of the device is deactivated.  What is the driving status for this driver?

Certified for one year

Certified for 2 years

Disqualified until confirmation of defibrillation deactivation

Disqualified

Explanation: Implanted defibrillation devices with or without pacemakers are always disqualifying. There is a federal appeal program for drivers with an implanted defibrillator. However, in order to be considered, the driver would need to show a long history where the defibrillator did not activate, and/or the defibrillator was not needed to treat a cardiovascular condition.

Explanation: Implanted defibrillation devices with or without pacemakers are always disqualifying. There is a federal appeal program for drivers with an implanted defibrillator. However, in order to be considered, the driver would need to show a long history where the defibrillator did not activate, and/or the defibrillator was not needed to treat a cardiovascular condition.

18) A driver who does not use hearing aids has the following results during their whisper test.

Left ear: 4 feet
Right ear: 2 feet

What is the next step?

Disqualify the driver

Qualify the driver for 2 years

Perform audiometric testing

Repeat the whisper test wearing hearing aids

Explanation: If a driver fails the whisper test, audiometric testing must be performed prior to certification.  If the driver is unable to meet the audiometric standard, the driver should be counseled regarding obtaining hearing aids to meet the hearing standard.

Explanation: If a driver fails the whisper test, audiometric testing must be performed prior to certification.  If the driver is unable to meet the audiometric standard, the driver should be counseled regarding obtaining hearing aids to meet the hearing standard.

19) A driver admits to taking his wife’s hydrocodone regularly. The next step would be?

Refer the driver for a SAP evaluation

Council driver on risks of taking hydrocodone and having a random drug test

Advise the driver not to take his wife’s prescription for hydrocodone

Refer the driver to his PCP for a prescription

Explanation: Driver’s must have a prescription for narcotic use.  Use of medication not prescribed is illegal and is not allowed by the federal drug and alcohol program policy. Drug use is a violation of drug policy and an SAP evaluation is required.

Explanation: Driver’s must have a prescription for narcotic use.  Use of medication not prescribed is illegal and is not allowed by the federal drug and alcohol program policy. Drug use is a violation of drug policy and an SAP evaluation is required.

20) A driver returns for re-certification after CABG.  Which of the following is not acceptable for certification?

Achieving 6 METs on an ETT

Sustained ventricular tachycardia

Clearance by a cardiologist

Asymptomatic

Explanation: To return to work after CABG the driver should be asymptomatic, their sternum should be fully healed, and they should have clearance from their treating provider. A driver with sustained ventricular tachycardia should never be certified. One of the criteria for a “passing” ETT is achieving 6 METs on an ETT.

Explanation: To return to work after CABG the driver should be asymptomatic, their sternum should be fully healed, and they should have clearance from their treating provider. A driver with sustained ventricular tachycardia should never be certified. One of the criteria for a “passing” ETT is achieving 6 METs on an ETT.

21) A driver had an acute seizure 1 week ago due to an allergic reaction to a chemical he was transporting.  The risk for recurrence is low, the driver has recovered and has been counseled to avoid this chemical in the future, and no treatment or medication has been recommended. What is the next best step?

Qualify the driver for 1 year

Qualify the driver for 2 years

Disqualify the driver for 1 year

Disqualify the driver for 2 years

Explanation: An acute seizure from a systemic metabolic illness does not have a recommended time frame and can be qualified for up to 2 years.

Explanation: An acute seizure from a systemic metabolic illness does not have a recommended time frame and can be qualified for up to 2 years.

22) A driver has non-insulin treated diabetes mellitus and hypertension that are both well-controlled. What is the correct certification interval for this driver?

3 months

6 months

1 year

2 years

Explanation: A driver with well-controlled, non-insulin treated diabetes can be certified for 2 years. However, a driver with hypertension will always receive a maximum of a 1-year certification.

Explanation: A driver with well-controlled, non-insulin treated diabetes can be certified for 2 years. However, a driver with hypertension will always receive a maximum of a 1-year certification.

23) Hemoglobin A1c (HbA1c) greater than _______ is an indicator of poor blood glucose control and triggers additional evaluation or more frequent monitoring of the driver and a possible decrease in the certification interval.

7%

8%

9%

12%

Explanation: A HbA1C of 7% or greater causes end organ damage.  The American Diabetes Association (ADA) considers a HbA1C greater than 9% as uncontrolled. For those with a HbA1C greater than 9%, an ME may consider the ADA guidelines as "best practices" and provide a temporary certification status (up to 90 days) to allow the driver to gain better control of their blood sugar. Provided the driver is making improvements in the management of their diabetes, a ME can give consecutive temporary certifications until they have achieved proper control.  FMCSA suggests that HBA1c is not the only determining factor when considering driver qualification.

Explanation: A HbA1C of 7% or greater causes end organ damage.  The American Diabetes Association (ADA) considers a HbA1C greater than 9% as uncontrolled. For those with a HbA1C greater than 9%, an ME may consider the ADA guidelines as "best practices" and provide a temporary certification status (up to 90 days) to allow the driver to gain better control of their blood sugar. Provided the driver is making improvements in the management of their diabetes, a ME can give consecutive temporary certifications until they have achieved proper control.  FMCSA suggests that HBA1c is not the only determining factor when considering driver qualification.

24) Which of the follow drugs is not tested as part of the federal drug testing program?

Marijuana

PCP

Cocaine

Barbiturates

Explanation: The required 5-panel drug testing includes opiates, amphetamines, PCP, Cocaine, and Marijuana (THC).

Explanation: The required 5-panel drug testing includes opiates, amphetamines, PCP, Cocaine, and Marijuana (THC).

25) The UA result for a driver shows 30mg/dl of protein in the urine.  Otherwise, the exam is normal.  What is the next step?

Disqualify the driver pending follow-up for kidney disfunction testing

Temporarily disqualify the driver and refer to a urologist

Temporarily disqualify the driver and order a GFR

Qualify the driver and recommend follow-up with PCP

Explanation: Proteinuria, hematuria or glycosuria may be an indication for further testing.  When an abnormal urinalysis is indicative of a medical condition that endangers the safety and health of the driver and the public, you should not certify the driver until the etiology is confirmed and treatment safe, effective, and stable.  A UA result of 30 mg/dl for protein is a low result (just above trace) and may be normal or a result of exercise, recent illness, or other factors.  Qualify the driver, inform the driver of the abnormal finding, and recommend a follow-up UA or evaluation from PCP.

Explanation: Proteinuria, hematuria or glycosuria may be an indication for further testing.  When an abnormal urinalysis is indicative of a medical condition that endangers the safety and health of the driver and the public, you should not certify the driver until the etiology is confirmed and treatment safe, effective, and stable.  A UA result of 30 mg/dl for protein is a low result (just above trace) and may be normal or a result of exercise, recent illness, or other factors.  Qualify the driver, inform the driver of the abnormal finding, and recommend a follow-up UA or evaluation from PCP.

26) A driver checked the box for having a positive drug test 3 months ago as part of his employer’s random drug testing program. The driver is no longer working for that employer and his medical certificate is about to expire. The driver says that when he lost his job, he discontinued his drug use. What is the next step?

Disqualify the driver

The CME should order a Non-DOT drug test

The CME should order a DOT drug test

The CME should obtain the positive drug test records

Explanation: A positive DOT drug test is considered a violation of FMCSA policy.  When a violation occurs, a driver cannot be returned to driving until they have had an evaluation by a DOT accredited substance abuse professional (SAP) and have successfully completed a treatment program when recommended by the SAP.

Explanation: A positive DOT drug test is considered a violation of FMCSA policy.  When a violation occurs, a driver cannot be returned to driving until they have had an evaluation by a DOT accredited substance abuse professional (SAP) and have successfully completed a treatment program when recommended by the SAP.

27) What is the minimal clothing requirement for the driver to wear while a medical examination is being performed?

Gown

Gown and underwear

Gown, underwear, and hospital style drapes

There is no minimal clothing requirement

Explanation: Although it is best to have clothing suitable for access to the systems being examined, the FMCSA minimal clothing allowable is a gown and clothing considered as underwear according to male and female standards. Females generally consider underwear to be underpants and a bra. Therefore, for a female the minimum clothing requirement would be a gown, bra, and underwear.

Explanation: Although it is best to have clothing suitable for access to the systems being examined, the FMCSA minimal clothing allowable is a gown and clothing considered as underwear according to male and female standards. Females generally consider underwear to be underpants and a bra. Therefore, for a female the minimum clothing requirement would be a gown, bra, and underwear.

28) When is a determination pending exam reported to FMCSA?

By midnight of the day following the exam, and if the exam is completed before 45 days, it is resubmitted in the National Registry and the certification date is date the exam was completed and certificate signed

By midnight of the day following the exam, and if the exam is completed before 45 days, it is resubmitted in the National Registry using the original date of the exam as the certification date

By midnight of the day following the exam, and if the exam is not completed within 45 days, it is again reported to the National Registry using the expiration date as the exam date

By midnight of the day following the exam, and if the exam is not completed within 45 days, it is again reported to the National Registry using the original exam date as the exam date

Explanation: When an exam is placed into determination pending and the driver returns with what was required for certification within 45 days, the ME should sign and date the exam form and certificate on that day. The driver would then be certified from the time the certificate is signed. The exam must be resubmitted in the National Registry. In addition, they should initial and date any changes made on the Medical Examination Report Form.

For exams that expire past 45 days, the ME does not need to submit another CMV Driver Medical Examination Results Form, MCSA-5850, through their National Registry account.

Explanation: When an exam is placed into determination pending and the driver returns with what was required for certification within 45 days, the ME should sign and date the exam form and certificate on that day. The driver would then be certified from the time the certificate is signed. The exam must be resubmitted in the National Registry. In addition, they should initial and date any changes made on the Medical Examination Report Form.

For exams that expire past 45 days, the ME does not need to submit another CMV Driver Medical Examination Results Form, MCSA-5850, through their National Registry account.

29) During the medical examination, the medical examiner notices the driver has a prosthetic eye.  What is the next best step?

The ME should qualify the driver for one year and require a vision examination with a vision specialist before returning for their next medical certificate

The ME should complete the examination and disqualify the driver

If the driver meets the vision standard in one eye and is otherwise qualified to drive, the ME should issue a medical certificate for one year once a Vision Evaluation Report is completed by an eye specialist

If neither of the driver's eyes meet the vision standard and if otherwise qualified to drive, the medical examiner can issue a one-year medical certificate, mark the box requiring a Federal or State vision exemption

Explanation: To meet the alternate vision standard, at least one eye must meet the vision standard with or without corrective lenses and the driver must have a completed Vision Evaluation Report. Until then, the exam should be completed, and the driver should be disqualified.

Explanation: To meet the alternate vision standard, at least one eye must meet the vision standard with or without corrective lenses and the driver must have a completed Vision Evaluation Report. Until then, the exam should be completed, and the driver should be disqualified.

30) 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?

The driver should demonstrate monthly INR results between 2-3

The ME should verify that treatment is adequate and effective

The ME should ensure that the driver does not have sustained ventricular tachycardia

The driver should demonstrate no ischemic changes on ECG

Explanation: Ischemic changes on ECG is not part of the guidance for atrial fibrillation. A driver taking Coumadin should have monthly monitoring of their INR with results between 2-3 to be in therapeutic range. Also, the ME should obtain clearance from the cardiologist or treating provider to verify that treatment is adequate and effective, and the driver does not have sustained ventricular tachycardia.

Explanation: Ischemic changes on ECG is not part of the guidance for atrial fibrillation. A driver taking Coumadin should have monthly monitoring of their INR with results between 2-3 to be in therapeutic range. Also, the ME should obtain clearance from the cardiologist or treating provider to verify that treatment is adequate and effective, and the driver does not have sustained ventricular tachycardia.

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