Question 1

A 46-year-old male driver presents for examination. He has a history of pneumothorax as a result of a car accident 4 years ago. He is a smoker. Since the last 2 weeks, he decided on his own to use Ventolin inhalers to ease his symptoms. He experiences frequent chest pain and shortness of breath.His only medical record provided is a pulmonary function evaluation showing a FVC of 60%. Can this driver be certified and why?
A)Yes, he is controlling his pneumothorax symptoms by using Ventolin inhalers.
B)No, he must be asymptomatic, provide x-ray examination report, and have a FVC >?65%.
C)Yes, his symptoms are not related to pneumothorax and his FVC level is acceptable.
D)No, he is a smoker.

Accepted Answer

No, he must be asymptomatic, provide x-ray examination report, and have a FVC >?65%.
This is the correct answer because according to the recommendations of the 1990 Conference on Pulmonary/Respiratory Disorders and Commercial Drivers by the US Department of Transport (DOT), persons with traumatic pneumothorax must demonstrate full recovery through chest x-ray and no symptoms of chest pain or shortness of breath if they have no other underlying lung diseases. It is recommended as well that they have a FVC of 65% or more if they are smokers and over 35 years of age.

Question 2

A 29-year-old female army veteran presents for examination to qualify as a CMV driver. She admits that she has had a head surgery after a bullet penetrated her head 3 years ago. She lost consciousness for 36 hours after the incident occurred. No history of seizures post injury. No current medication or any other health issues. She is a smoker. Is this person qualified to drive a CMV and why?
A)Yes, the brain injury occurred more than 2 years ago.
B)Yes, she is taking no medication and has had no post-trauma seizures.
C)No, she is a smoker.
D)No, she is at high risk of post-traumatic brain seizures.

Accepted Answer

No, she is at high risk of post-traumatic brain seizures.
This is the correct answer because according to the recommendations of the 2009 Medical Expert Panel (MEP) presented to FMCSA, persons who have sustained penetrating injuries to the brain, or severe Traumatic Brain Injury (TBI) with loss of consciousness ? 24 hours, should be permanently precluded from being certified as physically fit to drive an interstate CMV, due to the high risk of neurological deficits and occurrence of seizures; even many years after the incident.

Question 3

A 34-year-old male presents for examination. He has a cast on his left forearm as a result of falling down the stairs 2 weeks ago. On questioning of his past and current health condition, he states that he is currently feeling dizziness, fatigue, irritability and nausea. Also 1 month before he broke his hand he had a bacterial infection in his right inner ear, he was prescribed amoxicillin pills and 1 week later he had an allergic reaction. Which one of the below mentioned is most likely to be the cause of the symptoms and must be investigated further?
A)The allergy to amoxicillin
B)A psychological disorder
C)A vestibular disorder
D)The forearm fracture

Accepted Answer

A vestibular disorder
This is the correct answer because vestibular (inner ear) disorders are associated with symptoms such as dizziness, imbalance, hearing changes, nausea, fatigue and anxiety. The allergic reaction in this case is not related to amoxicillin, but rather associated with changes in the inner ear fluids because of swelling of the Eustachian tube and production of fluid in the middle ear. Falling downthe stairs is a clear indication that it resulted from the person's loss of balance due to a vestibular disorder. The fatigue and irritability are not a strong indication of a psychological disorder in this case and thus can be ruled out.

Question 4

When performing a health history interview with the driver, what eye conditions require further investigation and a request for a specialist medical report?
A)Glaucoma, aphasia, and cataracts
B)Glaucoma, retinopathy, aphasia, macular degeneration, and cataracts
C)Glaucoma, retinopathy, aphasia, and cataracts
D)None of the above

Accepted Answer

Glaucoma, retinopathy, aphasia, macular degeneration, and cataracts
This is the correct answer because all of the above mentioned eye conditions affect the vision acuity and visual perception of a person. Vision acuity and visual perception are essential for safe driving. Drivers with such disorders must provide a specialist's medical evaluation to determine the extent of their disorders and their fitness to qualify as CMV drivers as per CFR 391 requirements.

Question 5

According to FMCSA guidelines, what is the hypertension stage of a chronic hypertension person with blood pressure 190/115?
A)Stage 2 hypertension
B)Stage 3 hypertension
C)Stage 1 hypertension
D)Stage 4 hypertension

Accepted Answer

Stage 3 hypertension
This is the correct answer because according to FMCSA's guidelines, persons with chronic hypertension of ? 180/110 are considered stage 3 hypertension and are disqualified. According to FMCSA,stage 1 hypertension is 140-159/90-99 and stage 2 hypertension is 160-179/100-109. There's no stage 4 hypertension.

Question 6

A 37-year-male CMV driver presents for examination. He has the fourth finger missing from his right hand. He provides a medical report confirming a strongright-hand grasp. Does this person require a Skill Performance Evaluation (SPE) Certificate by FMCSA to complete the qualifying procedure under CFR 391.41, and why?
A)No, as long as there is a medical report confirming no interference with hand grasp power a SPE certificate is not required for impairment / loss of a finger.
B)Yes, a medical report confirming strong right-hand grasp does not exempt from a SPE certificate.
C)Yes, an impaired or missing finger requires a SPE certificate regardless of whether it affects hand grasp power or not.
D)No, this person is medically not qualified to be a CMV driver.

Accepted Answer

No, as long as a there is a medical report confirming no interference with hand grasp power a SPE certificate is not required for impairment / loss of a finger.
This is the correct answer because according to CFR 391.41, persons with an impairment of a hand or finger that does not interfere with prehension and grasping power may be qualified. In this case, the presence of a medical report confirming the prehension power is valid evidence for the medical examiner and does not prompt for a SPE certificate.

Question 7

A 39-year-old female presents for examination. She's been suffering from carpal tunnel syndrome in her right hand for the last 6 months as a result of her previous job as office assistant. She has weak hand grasp and is not taking any treatment for the syndrome. What would you require from this person in order to complete the qualifying procedure under CFR 391.41?
A)To provide a Skill Performance Evaluation (SPE) Certificate
B)To provide a medical report confirming strong right-hand grasp
C)Nothing, she is not qualified under CFR 391.41
D)To treat her condition before proceeding with any further qualifying procedures

Accepted Answer

To treat her condition before proceeding with any further qualifying procedures
This is the correct answer because if carpal tunnel syndrome is left untreated, it will exacerbate the right-hand impairment and grasping power. Carpal tunnel syndrome is a treatable musculoskeletal disorder and thus, after treatment the person can proceed with the qualification procedure and will be able to pass any SPE.

Question 8

A 41-year-old male presents for examination. He has a history of thoracic aortic aneurysm which is reported by his treating cardio-vascular specialistas being 2.9 cm. How would you handle this case and what is the medical certification period for this medical history?
A)Request a cardiologist report; biennial certification.
B)Query and evaluate digestive system disorders; annual certification.
C)Disqualify the person.
D)Query and evaluate other associated cardiovascular diseases; annual certification.

Accepted Answer

Query and evaluate other associated cardiovascular diseases; annual certification.
This is the correct answer because as per FMCSA's guidelines, persons with a thoracic aortic aneurysm of less than 3.5 cm may be certified annually after thorough evaluation and ruling out of any associated cardiovascular diseases.

Question 9

A 44-year-old male presents for examination. He has undergone a surgery for repair of a 5.0 cm abdominal aortic aneurysm 1 year ago. He provides a clearance report by a cardiovascular specialist indicating he is asymptomatic. Is this person qualified? If yes, for how long?
A)Yes, for 6 months
B)No
C)Yes, for one year
D)Yes, for two years

Accepted Answer

Yes, for one year
This is the correct answer because as per FMCSA's guidelines, persons with an abdominal aortic aneurysm of ??5.0 cm may be certified annually if more than three (3) months have passed since surgery, they're asymptomatic, and are cleared by a cardiovascular specialist.

Question 10

According to FMCSA guidelines, what is the medical certification period for a person with a history of epilepsy?
A)Six months
B)One year
C)Two years
D)None; the person is not qualified

Accepted Answer

None; the person is not qualified
This is the correct answer because as per FMCSA's guidelines, persons with a known history of epilepsy are immediately disqualified from being CMV drivers. Epilepsy or brain seizures put drivers and the public at high risk of motor vehicle accidents.

Question 11

While reviewing a Skill Performance Evaluation (SPE) Certificate of a CMV driver the medical examiner must, as a minimum, evaluate the driver's ability to:
A)Bend, stoop, crouch, and climb.
B)Maneuver an oversized steering wheel.
C)Adequately use arms, feet and legs during driving and perform prehension and power grasping.
D)All of the above.

Accepted Answer

All of the above.
This is the correct answer because CMV drivers are expected to use various body parts while climbing ladders, exiting and entering the cab, loading and offloading, changing flat tires, and maneuvering large steering wheels and manual gears, which all involve bending, stooping and crouching and prehension grasping.

Question 12

According to FMCSA's guidelines, which of the following neurological health history conditions is immediately disqualifying?
A)Transient global amnesia
B)Transient sleep disorders causing excessive daytime somnolence (EDS)
C)A number of unprovoked seizures within a period of 6 years
D)All of the above

Accepted Answer

A number of unprovoked seizures within a period of 6 years
This is the correct answer because a repeated occurrence of unprovoked seizures constitutes a medical history of epilepsy. According to FMCSA's guidelines, a person with epilepsy must be disqualified.

Question 13

According to FMCSA's guidelines, which of the following physical health history conditions is immediately disqualifying?
A)Stage2 hypertension controlled with medication
B)Coronary artery bypass grafting (CABG) surgery 1 year before with LVEF >?40%
C)Stage5 chronic kidney failure, on dialysis 3 days a week
D)All of the above

Accepted Answer

Stage5 chronic kidney failure
This is the correct answer because according to FMCSA, and to the opinion of the Medical Expert Panel (MEP) in 2007, drivers with stage5 chronic kidney disease, requiring dialysis, must be disqualified.

Question 14

Which of the following are considered the most prominent as risk factors for obstructive sleep apnea?
A)BMI ? 21 Kg/m2, small jaw, and large neck size of ? 17 inches in males & ?15.5 in females
B)BMI ? 28 Kg/m2, small jaw, and large neck size of ? 17 inches in males & ?15.5 in females
C)BMI ? 21 Kg/m2, small jaw, and large neck size of ? 15.5 inches in males & ?17 in females
D)BMI ? 28 Kg/m2, small jaw, and large neck size of ? 15.5 inches in males & ?17 in females

Accepted Answer

BMI ? 28 Kg/m2, small jaw, and large neck size of ? 17 inches in males & ?15.5in females
This is the correct answer because according to FMCSA guidelines and the recommendations of the Medical Expert Panel (MEP) Members in 2008, these are considered risk factors for obstructive sleep apnea. Adding to them are factors such as aging, family history of sleep apnea, and small airway.

Question 15

A 43-year-old male presents for examination for the purpose of re-certification. He has a history of sleep apnea; however, he is cleared by his treating physician based on successful PAP (positive airway pressure) treatment. He indicated he had undergone a mitral valve repair surgery 6 weeks before. He provides a cardiologist report indicating that he is asymptomatic, tolerant to medication, can perform light duty work, and must return for post-operative evaluation after 12 weeks. Is this person qualified to continue the examination, and why?
A)No, individuals with history of sleep apnea and who are pending the findings of a 3-month post-operative evaluation are disqualified until they are cleared.
B)No, a known history of sleep apnea is a disqualifying condition.
C)Yes, the person is asymptomatic, tolerant to medication and is cleared to work on light duty.
D)Yes, the person has successfully treated his sleep apnea.

Accepted Answer

No, individuals with history of sleep apnea and who are pending the findings of a 3-month post-operative evaluation are disqualified until they are cleared.
This is the correct answer because according to FMCSA guidelines and the recommendations of the Medical Expert Panel (MEP) Members in 2008 about sleep disorders, individuals who have history of obstructive sleep apnea and who have undergone surgery pending the findings of a 3-month post-operative evaluation should not be certified or re-certified to drive a commercial motor vehicle.

Question 16

A 52-year-old female CMV driver states that she is taking Coumadin since 5 months ago in relation to her acute deep vein thrombosis (DVT). She provides a medical report indicating that she is asymptomatic. What additional health history information is needed from this person?
A)Nothing, she is disqualified
B)INR test results of minimum 5.0
C)A copy of her vaccinations records
D)A monthly INR test result indicating regulation of the Prothrombin Time (PT) within range

Accepted Answer

A monthly INR test result indicating regulation of the Prothrombin Time (PT) within range
This is the correct answer because according to FMCSA guidelines, persons with acute DVT maybe certified if they meet all the following conditions: asymptomatic, on Coumadin treatment regulated for at least 1 month, and monthly INR monitoring within range. INR of more than 5.0 is not a valid answer because INR of >?5.0 is not recommended as it increases the risk of bleeding.

Question 17

For the purpose of the Federal Diabetes Exemption Program, FMCSA defines a severe hypoglycemic reaction as something that results in:
A)Seizure.
B)Loss of consciousness.
C)Impaired cognitive function that occurred without warning.
D)All of the above.

Accepted Answer

All of the above.
This is the correct answer because according to FMCSA guidelines for the Federal Diabetes Exemption Program, a severe hypoglycemic reaction is one that causes seizure, loss of consciousness, requiring someone else's help, and a period of impaired cognitive function without warning.

Question 18

Which of the following is a medical condition possibly associated with diabetes?
A)Vestibular disorder
B)Carpal tunnel syndrome
C)Proteinuria
D)None of the above

Accepted Answer

Proteinuria
Proteinuria is one of the most common associated medical conditions for type 1 and type 2 diabetic persons due to the increased probability of damaged nephrons in the kidney causing increased albumin protein in the urine.

Question 19

According to the Federal Diabetes Exemption Program requirements, a CMV driver with diabetes mellitus who is previously treated with oral medication and now requiring insulin must establish a stable control of hypoglycemia or hyperglycemia for a period of:
A)At least 6 weeks before being certified.
B)At least 1 month before being certified.
C)At least 9 weeks before being certified.
D)At least 2 months before being certified.

Accepted Answer

At least 1 month before being certified.
This is the correct answer because according to FMCSA's guidelines, the "30-day requirement" of stable control of hypoglycemia and hyperglycemia for the Diabetes Exemption Program applies to CMV drivers with diabetes mellitus who had beenpreviously treated with oral medication, and who now require insulin.

Question 20

According to FMCSA's guidelines for the Diabetes Exemption Program, what is the minimum period required to demonstrate insulin stability following the first episode of hypoglycemia before a CMV driver with diabetes mellitus can be certified?
A)One month
B)Two months
C)One year
D)Two years

Accepted Answer

One year
This is the correct answer because according to FMCSA's guidelines, one of the conditions for a CMV driver with diabetes mellitus to be certified is to have no recurrent hypoglycemic reactions requiring the assistance of another person within the past five years and a period of one year of demonstrated stability is required following the first episode of hypoglycemia.

Quiz 4: Driver Identification and History

When performing a health history interview with the driver, what eye conditions require further investigation and a request for a specialist medical report?

According to FMCSA guidelines, what is the hypertension stage of a chronic hypertension person with blood pressure 190/115?

A 41-year-old male presents for examination. He has a history of thoracic aortic aneurysm which is reported by his treating cardio-vascular specialistas being 2.9 cm. How would you handle this case and what is the medical certification period for this medical history?

A 44-year-old male presents for examination. He has undergone a surgery for repair of a 5.0 cm abdominal aortic aneurysm 1 year ago. He provides a clearance report by a cardiovascular specialist indicating he is asymptomatic. Is this person qualified? If yes, for how long?

According to FMCSA guidelines, what is the medical certification period for a person with a history of epilepsy?

While reviewing a Skill Performance Evaluation (SPE) Certificate of a CMV driver the medical examiner must, as a minimum, evaluate the driver's ability to:

According to FMCSA's guidelines, which of the following neurological health history conditions is immediately disqualifying?

According to FMCSA's guidelines, which of the following physical health history conditions is immediately disqualifying?

Which of the following are considered the most prominent as risk factors for obstructive sleep apnea?

A 52-year-old female CMV driver states that she is taking Coumadin since 5 months ago in relation to her acute deep vein thrombosis (DVT) . She provides a medical report indicating that she is asymptomatic. What additional health history information is needed from this person?

For the purpose of the Federal Diabetes Exemption Program, FMCSA defines a severe hypoglycemic reaction as something that results in:

Which of the following is a medical condition possibly associated with diabetes?

According to the Federal Diabetes Exemption Program requirements, a CMV driver with diabetes mellitus who is previously treated with oral medication and now requiring insulin must establish a stable control of hypoglycemia or hyperglycemia for a period of:

According to FMCSA's guidelines for the Diabetes Exemption Program, what is the minimum period required to demonstrate insulin stability following the first episode of hypoglycemia before a CMV driver with diabetes mellitus can be certified?