A 21-year-old driver presents with a history of ADHD for 10 years, taking stable dosing of Ad-
derall. He describes no side effects. Which of the following is true?
a. A significant percentage of individuals with adult ADHD show a moderate to marked de-
gree of improvement on central nervous system stimulant medication.
b. ADHD is a disqualifying condition.
c. Adderall is a Schedule 1 drug.
d. Medical Examiners should test for serum drug levels of Adderall. - ANSWER a. A signifi-
cant percentage of individuals with adult ADHD show a moderate to marked degree of im-
provement on central nervous system stimulant medication.
The 2014 Medical Expert Panel (MEP) recommendations related to driver use of opioids
and stimulants indicate that the licit use of stimulant medication for ADHD likely reduces
the increased crash risk associated with ADHD, though timing of stimulant dosing can be
complex and positive effects are limited to the time during which the medicine is present
at therapeutic levels. ADHD is not in and of itself disqualifying, though as with any
condition Medical Examiners must consider each driver's conditions on a case-by-case
basis. The MEP recommendations indicate that serum drug levels for opioids and
stimulants cannot distinguish between licit and illicit drug use so testing for serum drug
levels is not recommended.
Which of the following is the most important examination finding that requires additional
evaluation?
a. Acrochordon.
1
,b. Hyperopia.
c. Palpable calf cords.
d. Verruca vulgaris. - ANSWER c. Palpable calf cords
Acrochordon's are skin tags and verruca vulgaris are common warts, neither of which
pose a significant safety risk. Hyperopia affects near vision; vision requirements for drivers
relate only to distance vision, although near vision issues could potentially compromise
safe driving. Palpable calf cords are an important possible indication of deep vein
thrombosis (DVT) and must be further evaluated before a driver is certified.
The driver reports taking Digoxin. What findings would raise the most significant concerns
regarding certification?
a. Arrhythmias.
b. Anorexia.
c. Nausea and vomiting.
d. Diarrhea. - ANSWER a. Arrhythmias.
Digoxin toxicity causes anorexia, nausea, vomiting, diarrhea, and neurological
symptoms. However, most important to risk for gradual or sudden incapacitation, digoxin
use can also trigger fatal arrhythmias. The use of digoxin is limited because the drug has a
narrow therapeutic index and requires close monitoring. Digoxin can cause many adverse
events, is involved in multiple drug interactions, and can result in toxicity. Despite its
limitations, however, digoxin has a place in therapy.
The driver presents with a SPE Certificate. The Medical Examiner's next step should be:
2
,a. Notify the FMCSA.
b. Proceed with the examination.
c. Perform functional testing.
d. Refer the driver to orthopedics. - ANSWER b. Proceed with the examination.
The Medical Examiner's responsibility with respect to SPE Certificates is to examine the
driver, document the presence of abnormal findings, assess whether the driver has a condi-
tion that requires a SPE Certificate in order to be cleared to drive, and, if so,document on the
Medical Examiner's Certificate that the driver is qualified if"Accompanied by a Skill Perfor-
mance Evaluation (SPE) Certificate." The driver is responsible to make the application, or re-
application, to the FMCSA for the SPE Certificate, which is approved and issued by the
FMCSA, not the Medical Examiner. The process of applying for a SPE certificate requires that
the driver is examined by an orthopedist or physiatrist, but there is no requirement that the
Medical Examiner make that referral. A Medical Examiner may perform some type of func-
tional testing or refer a driver for some type of functional testing but that should only be
done after the Medical Examiner has examined the driver.
The driver is taking theophylline. Which of the following is not true?
a. Serum levels may be checked.
b. The primary indication for theophylline is in the treatment of neurological conditions.
c. Cardiac toxicity is a significant risk of theophylline use.
d. Theophylline can be administered orally or intravenously (IV). - ANSWER b. The pri-
mary indication for theophylline is in the treatment of neurological conditions.
Theophylline treatment can be oral or IV. It is used in therapy for respiratory diseases
such as chronic obstructive pulmonary disease and asthma. The most serious potential
complications of use are cardiac arrhythmias and neurological symptoms. Serum levels
should be considered with initiation of therapy, changes in dosage, or if significant side
effects are noted. NOTE: this question is an example of some questions on the national
certification examination that test general medical knowledge, rather than questions
specific to FMCSA standards.
3
, The driver is taking Celexa and melatonin. The Medical Examiner should:
a. Advise the driver to only take these medications more than 12 hours before driving.
b. Advise the driver to stop melatonin as it can cause drowsiness.
c. Recommend an alternative to Celexa.
d. Advise the driver to discuss benzodiazepines as an alternative treatment. with the driver's
prescribing provider. - ANSWER a. Advise the driver to only take these medications more
than 12 hours before driving.
The potentially sedating side effects of both Celexa, and especially melatonin, are most
likely to manifest within the first hours of daily use. The primary role of the Medical
Examiner is to assess risk of gradual or sudden incapacitation of the driver, even though
some Medical Examiners may also be a treatment provider for a driver. Medical Examiners
should rarely make specific treatment recommendations. Benzodiazepines are associated
high risks of dependence, abuse, and are more likely than most other psychotherapeutic
medications to cause unacceptable risks of impairment.
The driver tells the Medical Examiner he has recently been prescribed contact lenses. He
notes that after 3-4 hours of use the contacts cause irritation and he has to take them out.
The driver passes the vision test only with contacts and does not have eyeglasses. The Medi-
cal Examiner should:
a. Advise the driver to carry a spare pair of contact lenses.
b. Certify the driver wearing corrective lenses.
c. Refer the driver for evaluation under the Alternative Vision Qualification standard.
d. Certify the driver without qualifications. - ANSWER b. Certify the driver wearing cor-
rective lenses.
4
derall. He describes no side effects. Which of the following is true?
a. A significant percentage of individuals with adult ADHD show a moderate to marked de-
gree of improvement on central nervous system stimulant medication.
b. ADHD is a disqualifying condition.
c. Adderall is a Schedule 1 drug.
d. Medical Examiners should test for serum drug levels of Adderall. - ANSWER a. A signifi-
cant percentage of individuals with adult ADHD show a moderate to marked degree of im-
provement on central nervous system stimulant medication.
The 2014 Medical Expert Panel (MEP) recommendations related to driver use of opioids
and stimulants indicate that the licit use of stimulant medication for ADHD likely reduces
the increased crash risk associated with ADHD, though timing of stimulant dosing can be
complex and positive effects are limited to the time during which the medicine is present
at therapeutic levels. ADHD is not in and of itself disqualifying, though as with any
condition Medical Examiners must consider each driver's conditions on a case-by-case
basis. The MEP recommendations indicate that serum drug levels for opioids and
stimulants cannot distinguish between licit and illicit drug use so testing for serum drug
levels is not recommended.
Which of the following is the most important examination finding that requires additional
evaluation?
a. Acrochordon.
1
,b. Hyperopia.
c. Palpable calf cords.
d. Verruca vulgaris. - ANSWER c. Palpable calf cords
Acrochordon's are skin tags and verruca vulgaris are common warts, neither of which
pose a significant safety risk. Hyperopia affects near vision; vision requirements for drivers
relate only to distance vision, although near vision issues could potentially compromise
safe driving. Palpable calf cords are an important possible indication of deep vein
thrombosis (DVT) and must be further evaluated before a driver is certified.
The driver reports taking Digoxin. What findings would raise the most significant concerns
regarding certification?
a. Arrhythmias.
b. Anorexia.
c. Nausea and vomiting.
d. Diarrhea. - ANSWER a. Arrhythmias.
Digoxin toxicity causes anorexia, nausea, vomiting, diarrhea, and neurological
symptoms. However, most important to risk for gradual or sudden incapacitation, digoxin
use can also trigger fatal arrhythmias. The use of digoxin is limited because the drug has a
narrow therapeutic index and requires close monitoring. Digoxin can cause many adverse
events, is involved in multiple drug interactions, and can result in toxicity. Despite its
limitations, however, digoxin has a place in therapy.
The driver presents with a SPE Certificate. The Medical Examiner's next step should be:
2
,a. Notify the FMCSA.
b. Proceed with the examination.
c. Perform functional testing.
d. Refer the driver to orthopedics. - ANSWER b. Proceed with the examination.
The Medical Examiner's responsibility with respect to SPE Certificates is to examine the
driver, document the presence of abnormal findings, assess whether the driver has a condi-
tion that requires a SPE Certificate in order to be cleared to drive, and, if so,document on the
Medical Examiner's Certificate that the driver is qualified if"Accompanied by a Skill Perfor-
mance Evaluation (SPE) Certificate." The driver is responsible to make the application, or re-
application, to the FMCSA for the SPE Certificate, which is approved and issued by the
FMCSA, not the Medical Examiner. The process of applying for a SPE certificate requires that
the driver is examined by an orthopedist or physiatrist, but there is no requirement that the
Medical Examiner make that referral. A Medical Examiner may perform some type of func-
tional testing or refer a driver for some type of functional testing but that should only be
done after the Medical Examiner has examined the driver.
The driver is taking theophylline. Which of the following is not true?
a. Serum levels may be checked.
b. The primary indication for theophylline is in the treatment of neurological conditions.
c. Cardiac toxicity is a significant risk of theophylline use.
d. Theophylline can be administered orally or intravenously (IV). - ANSWER b. The pri-
mary indication for theophylline is in the treatment of neurological conditions.
Theophylline treatment can be oral or IV. It is used in therapy for respiratory diseases
such as chronic obstructive pulmonary disease and asthma. The most serious potential
complications of use are cardiac arrhythmias and neurological symptoms. Serum levels
should be considered with initiation of therapy, changes in dosage, or if significant side
effects are noted. NOTE: this question is an example of some questions on the national
certification examination that test general medical knowledge, rather than questions
specific to FMCSA standards.
3
, The driver is taking Celexa and melatonin. The Medical Examiner should:
a. Advise the driver to only take these medications more than 12 hours before driving.
b. Advise the driver to stop melatonin as it can cause drowsiness.
c. Recommend an alternative to Celexa.
d. Advise the driver to discuss benzodiazepines as an alternative treatment. with the driver's
prescribing provider. - ANSWER a. Advise the driver to only take these medications more
than 12 hours before driving.
The potentially sedating side effects of both Celexa, and especially melatonin, are most
likely to manifest within the first hours of daily use. The primary role of the Medical
Examiner is to assess risk of gradual or sudden incapacitation of the driver, even though
some Medical Examiners may also be a treatment provider for a driver. Medical Examiners
should rarely make specific treatment recommendations. Benzodiazepines are associated
high risks of dependence, abuse, and are more likely than most other psychotherapeutic
medications to cause unacceptable risks of impairment.
The driver tells the Medical Examiner he has recently been prescribed contact lenses. He
notes that after 3-4 hours of use the contacts cause irritation and he has to take them out.
The driver passes the vision test only with contacts and does not have eyeglasses. The Medi-
cal Examiner should:
a. Advise the driver to carry a spare pair of contact lenses.
b. Certify the driver wearing corrective lenses.
c. Refer the driver for evaluation under the Alternative Vision Qualification standard.
d. Certify the driver without qualifications. - ANSWER b. Certify the driver wearing cor-
rective lenses.
4
