Practice Test 2

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1) A driver with a history of Stage 3 hypertension has lowered his blood pressure to less than 140/90, lost weight, and was removed from medications by his treating physician.  The rest of the exam is unremarkable.  What is the certification interval?

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2) Which of the following FMCSA programs does not require a one-year recertification interval?

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

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4) A driver admits to using Diphenhydramine while driving.  What is the next best step?

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5) A motor carrier has asked the ME to perform the medical certification exams for their drivers, but they require that the driver be able to lift 100 lbs.  What is the next step?

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6) Which of the following must the ME follow?

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7) Which is not a component of a satisfactory ETT?

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8) Which is not an appropriate Hours of Service regulation for CMV drivers?

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9) A driver presents the following list of medications: Zofran, Zoloft, Zolpidem, and Zithromax. Which of these medications is most concerning to the medical examiner?

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10) Which of the following is not a duty of the Medical Examiner?


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11) Which of the following driver status is used if further information is needed before the ME can make a decision on driver status?

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12) Which of the following is disqualifying?

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13) When does the ME use the "Incomplete Exam" driving determination?

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14) During the examination, a driver is found to have a positive “Babinski” reflex. The examiner should:

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

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16) A driver is found to have red/green color deficiency using the Ishihara color blindness test.  What is the next step?

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17) A driver must have a prescription for which of the following?

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18) A driver with diabetes reports partial loss of central vision, color discrimination, and obscured vision in other vision fields.  The most likely cause is:

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19) A driver with a current medical certificate that does not expire for another year had an injury that interfered with his ability to drive.  What is the next step?

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

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21) What is the lowest accepted PaO2 level on an ABG performed for a chronic respiratory disorder that is necessary to certify a commercial driver?

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22) For cardiovascular guidelines, what is the definition of pulmonary hypertension?

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

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24) An alcoholic driver has stopped going to AA.  What is the next step?

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25) Which of the following is a sign of stable angina?

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26) Checking for pupillary equality is a required part of the examination. On a driver’s exam, you notice that the pupils are of different diameters, but react equally to light. This is consistent with:

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27) Which of the following does not have a mandatory waiting period?

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28) What is the driver signing for on the long form?

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

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30) 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?

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31) In the medical history the driver reports having chronic low back pain. They are not overweight and they have proper range of motion and muscle strength. The driver is not taking any medications. What is the best course of action?

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32) If a driver has been disqualified by another medical examiner but you believe the driver should be qualified to drive, what can be done?

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33) For an interstate driver on insulin, what is not needed to be recertified?

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34) When a driver is on Furosemide, what is the primary concern?

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35) A driver’s medical history includes the following medications: Lisinopril, Advil, Metformin, and Naltrexone. Which of these medications is of most concern to the medical examiner?

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36) 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?

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37) A driver weighs 500lbs, eats only fast food and gets no exercise. His total cholesterol is 400. Blood pressure is 138/88.  Pulse is 99.  The driver admits to not being faithful with his treatment plan, using his statins and other medications as prescribed.  What is the next step?

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38) While performing an abdominal exam you detect a bruit and a pulsing mass. What is the next step?

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39) Which of the following is not part of the responsibility and required knowledge of a Substance Abuse Professional?

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40) A driver does not pass the hearing standard with or without hearing aids or other devices. What is the next best step?

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41) A driver reports going into the ER with chest pain 2 months ago. He was advised to follow-up with a specialist, but he hasn’t done this yet. What is the next step?

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42) An elderly driver is late by 1 hour to his appointment and says he gets lost easily. He struggled during his exam to remember his doctor’s name and joked that it was due to his old age.  His exam is otherwise normal. What is the next step?

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43) Which of the following is an assessment of L4 nerve root pathology?

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44) If medication and dosages are listed in the driver’s history section in response to a “Yes” answer, which of the following does not need to be noted in the driver history?

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

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

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47) A driver reports a traumatic pneumothorax, this time on the left side. A previous spontaneous pneumothorax was on the right side. The doctor has released the driver to return to driving. What is the next step?

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48) A driver is missing his right index finger but has a thumb and all other digits. The next step is:

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49) A driver relates they had a mini-stroke 5 months ago. They don't have any decreased functional capacity or other stroke-related symptoms. The driver has no other significant medical history. What is the next step?

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50) Which of the following questions is not relevant for the examiner to ask the driver?

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51) Which of the following is not an indicator for pulmonary testing?

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52) During the medical examination, the ME suspects undiagnosed OSA. There are no other exam findings that indicate disqualification. What is the next step?

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53) Which of the following eye conditions is of most concern?

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54) Which of the following is not a yearly requirement for drivers with OSA?

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55) Should a driver who is taking an anticonvulsant medication for chronic pain be qualified or disqualified and why?

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56) 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?

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57) A driver reports that he sustained a childhood febrile seizure when he was 4 years old.  There has been no recurrence.  The next step is?

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58) A driver is missing all his digits on the right hand except for his thumb.  The driver has sufficient prehension and grip strength but is limited in range of motion.  The thumb appears to be highly muscularized. What is the next best step?

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59) A driver reports a single unprovoked seizure from an unknown cause that occurred 1 year ago. Since that time, the driver has been seizure free, is under medical management, and was not prescribed anti-seizure (anti-convulsant) medication.  What is the certification status of this driver?

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

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61) A driver comments that his PCP has recommended that he donate blood on a regular basis due to high iron levels. What should you focus on?

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62) During the ear and hearing portion of the examination, the medical examiner must always:

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63) Which of the following is the ME not required to ask every driver regarding their eye history:

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64) When the ME is uncertain of the severity or prognosis of a driver’s medical condition that could affect safe driving, the decision for certification should:

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65) A driver reports he had a neurological condition consisting of a focal neurological dysfunction from inadequate blood supply to one portion of the brain.  This lasted about 3 minutes.  All symptoms had resolved completely in 30 minutes.  The neurologist states that the risk of a recurrent event is highest during the next few weeks and months declining to less than 5% a year, within a year.  The most likely diagnosis for this condition is:

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66) Which of the following must be present to determine functional capacity of a hand?

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67) A driver cannot be considered for a SPE if:

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68) A driver with a history of diabetes presents for recertification.  He visits his treating provider every 6 months and his last HbA1C was 8%, measured 2 months ago. He is taking metformin and Trulicity. The driver also has peripheral neuropathy involving loss of temperature sensation in both feet.  The rest of the exam was normal. What is the driving status?

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69) The FMCSA definition of a severe hypoglycemic reaction does not include:

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70) 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.

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71) You obtained a report from the driver’s endocrinologist that demonstrated the lab results listed below. Which lab value is most concerning?

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72) MEs are required to ask all but one of the following questions to a driver with a history of diabetes:

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73) A person seeking a Medical Examiner's Certificate informs the ME that they are on a disability.  What is the next best step?

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74) Which of the following medical conditions is most important to have an evaluation from the appropriate specialist prior to making a certification decision?

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75) Dexedrine (Dextroamphetamine), Ritalin (methylphenidate), and Vyvanse can be used for drivers with:

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76) A driver has a history of kidney disease. Which lab result might be important to review?

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77) Which of the tests below is not required to satisfy federal drug and alcohol testing requirements for an interstate commercial driver of a vehicle weighing or rated over 26,000lbs?

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

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79) A driver is missing all digits of his right foot.  He demonstrates good plantar and dorsiflexion. The next step is:

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80) A driver taking insulin presents the ME a letter that they are in the program for drivers in an exempt intracity zone (49CFR 391.62) There has been no substantive change in his diabetes. What is the next best step?

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81) What is the most critical safety issue regarding diabetes?

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82) You certified a driver for 3 months and referred for a sleep study due to possible obstructed sleep apnea. They were subsequently given a CPAP. Which of the following is not a condition for initial recertification?

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83) A driver had a work injury 6 months ago that resulted in a disc herniation at L5-S1 on the left side.  He had lumbar surgery and was off work for 3 months. His orthopedic surgeon cleared him to return to regular work.  What specific component should be part of your examination to determine fitness for duty?

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84) Which of the following medications does not require blood test monitoring?

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85) The following distant vision acuity results were obtained during the medical exam for a commercial driver.  The driver is otherwise medically qualified to drive for two years.  What is the next step?

Right:  20/40
Left:   20/40-1

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86) Which of the following issues associated with commercial drivers has the most impact in the long term for control of non-insulin diabetes mellitus?

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87) Which of the following issues would be of the most concern for the blood sugar level in a driver with non-insulin diabetes mellitus?

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88) Which of the following is the most important component of the driver's health history?

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89) Who gets the original copy of the exam report form that is used during the medical exam?

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  1. Who gets the original copy of the Medical Examiner's Certificate?

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

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92) A driver's UA indicates elevated leukocyte esterase.  The exam is otherwise normal. Which of the following would not be the best way to proceed?

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93) A driver currently does not pass the visual acuity requirement but states that they are going to have Lasik surgery in the next month.  What is the next best step?

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94) You performed an exam on a driver one month ago. At that time, a complete physical was performed and they met all of the medical requirements except for visual acuity.  The driver stated they were going to have Lasik surgery within a month. You disqualified them from driving at that time.  Last week the driver had Lasik eye surgery and now the driver has returned and demonstrated that they meet the visual acuity requirement.  What is the next best step?

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95) The medical examiner notes a scar and a lump in the left upper anterior chest area. No abnormality was noted in the history portion of the exam. What is the next best step?

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96) A young driver's UA shows +3 protein in the urine. The rest of the exam is otherwise normal.  What is the next best step?

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97) A 40-year-old male driver presents for a physical exam. He denies having any medical condition or taking any medication and remarks that he has always been certified for 2 years. During the physical exam, the urinalysis produces a glucose value of 500mg/dl. Other than having a BMI of 45, the exam is otherwise unremarkable. What is the best course of action?

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98) Which of the following side effects is most common and a safety concern for drivers prescribed Tegretol?

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99) For which of the following conditions might the ME desire further testing when making the qualification determination?

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100) A driver checks the box admitting to smoking marijuana in the past 2 years but denies ever having a positive drug test or any recent use.  What is the next best step?

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101) 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?

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102) In an air conduction standard audiogram (graph), which color and symbol represents the right ear and which for the left ear?

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103) Which of the following are required for a driver to receive a SPE?

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

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105) A driver without a history of hypertension has an initial blood pressure reading of 145/80 during the exam.  What is the next best step?

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106) The driver in the previous question has a second blood pressure reading is 165/95.  What is the next best step?

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107) A 21-year-old male presents for a medical exam prior to obtaining his CDL learner’s permit. He reports being on psychostimulant medication for ADHD since the age of 12. No other medical history and physical exam is unremarkable. What is the most likely?

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108) What must be performed during examination of the eye?

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109) A thin, 56-year-old male driver presents for medical recertification. He relates that 2 years ago he was diagnosed with Parkinson’s disease for which he has routine visits with his treating provider and is taking Sinemet. His medical history is otherwise unremarkable. Physical exam findings demonstrate a slight resting tremor of the left hand but good grasp and prehension strength. He has good range of motion and strength to the upper extremities. Exam of the lower extremities demonstrate good range of motion and strength. The gait exam shows some rigidity and slight shuffling of the feet. What level of risk is this driver when operating a CMV?

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110) A 53-year-old female driver relates that she was diagnosed with cancer 5 months ago. She has been receiving chemotherapy but states that she feels fine enough to drive a truck. Her physical exam was unremarkable. What is the best course of action?

111 / 120

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

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112) A 32-year-old male driver presents for a DOT physical. They take no medications and have no significant medical history except that 2 weeks prior he was playing baseball and while at bat he was hit in the left thigh with the ball. Since then, he has had significant muscle cramps in more areas than just the leg and he has felt weak in general. Urinalysis demonstrates dark urine but with otherwise normal findings. You suspect rhabdomyolysis. What is the next best step?

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113) During an exam, the ME notices that one eye makes repetitive, rapid, uncontrolled movements suggesting nystagmus.  What is the next best step?

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114) A 52-year-old male driver is preparing to start trucking school. He reports that he had a single unprovoked seizure 16 years ago. He was initially placed on an anticonvulsant medication for 2 years and then taken off the medication. He has remained seizure-free. The rest of the exam is unremarkable. What else do you need to make a certification decision?

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115) When a driver is placed on either Pradaxa, Eliquis, or Xarelto, what monitoring is recommended?

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116) The medical examiner determines the driver is noticeably irritated during the medical examination.  What is the next best step?

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

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118) A 46-year-old female driver presents for a physical exam. She has a history of hypertension, well controlled with medication. No other significant medical history. Exam findings are unremarkable except for the urinalysis was positive for nitrite and demonstrated a leukocyte esterase level of 30 leukocytes/uL. What should the ME be concerned about?

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119) A driver is prescribed Bentyl for his irritable bowel syndrome.  He reports that the condition is well managed, and he has had no difficulty driving over the past few years.  The examiner should:

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120) A 56-year-old driver’s medical history includes the following medications: Eliquis, Lisinopril, and Allopurinol. Which of these medications is most concerning to the medical examiner?

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