NRCME DOT Examiner Test Practice Questions & Answers

According to FMCSA regulations, which of the following must the medical examiner evaluate when examining a driver's eyes? A. Pupil reactivity B. Iris symmetry C. Conjunctival injection D. Corneal thickness - ANSWER Correct Response: A. Pupil reactivity Incorrect Responses: B. Iris symmetry This is incorrect because determining iris symmetry is not required by FMCSA. C. Conjunctival injection This is incorrect because most causes of conjunctival injection would not be disqualifying. Causes that are suspicious for a disqualifying condition need additional evaluation. While this abnormal finding should be explained, with determination of possible effects on safe driving before making a certification decision, it is not a condition that is specified in FMCSA regulations. D. Corneal thickness This is incorrect because it is not measured in an office examination except by an eye specialist. According to FMCSA regulations, medical qualification for two years can be given to a driver who has... ? A. An SPE certificate for a left below the knee amputation (BKA). B. Hypertension. C. A recent diagnosis of Lewy body dementia. D. Documented medical marijuana use for pain control. - ANSWER Correct Response: A. An SPE certificate for a left below the knee amputation.This is the correct response because in order to obtain the SPE certificate, the driver had to demonstrate the ability to perform all tasks for the commercial driver job description. Incorrect Responses: B. Hypertension. This is not the correct response because drivers with hypertension are only given a medical certificate that is good for one year. C. A recent diagnosis of Lewy body dementia. This is not the correct response because this is a progressive, degenerative condition with no known treatment. The effects of Lewy body dementia impact the ability to operate a CMV safely. D. Documented medical marijuana use for pain control. This is not the correct response because marijuana remains a drug listed in Schedule I of the Controlled Substances Act. It remains unacceptable for any safety-sensitive employee subject to drug testing under the drug testing regulations of DOT to use marijuana. Also, FMCSA medical guidelines state that "driving impairment due to marijuana use is well substantiated." During his visit to the medical examiner, a driver complains of severe pain in his finger for the last two weeks after it was punctured. The examination reveals an infected, swollen finger. After the medical examiner inquiries, the driver states that the pain is made worse when he grips the steering wheel. Which of the following should the medical examiner do next? A. Obtain a hand X-ray. B. Assess capillary refill in the hand. C. Obtain a culture and sensitivity. D. Assess the driver's grip strength. - ANSWER Correct Response: D. Assess the driver's grip strength.This is the correct response because the condition does not present a safety risk unless it interferes with the ability of the driver to hold and control the steering wheel. Incorrect Responses: A. Obtain a hand X-ray. This is not the correct response because this is a diagnostic test that a healthcare provider or specialist would perform or order. Your role as a medical examiner is to determine if the condition interferes with the ability of the driver to safely operate a CMV. B. Assess capillary refill in the hand. This is not the correct response because given the information in the question it is not the primary consideration for determining if the driver can safely operate a CMV. C. Obtain a culture and sensitivity. This is not the correct response because this is an action that a treating healthcare provider or specialist would do in the course workup and treatment- Your role as a medical examiner is to determine if the condition interferes with the ability of the driver to safely operate a CMV. A new driver who had a myocardial infarction six months ago is certified after completing an acceptable exercise tolerance test and is cleared by a cardiologist. According to FMCSA guidelines, which of the following is recommended regarding recertification and exercise tolerance test monitoring intervals? Recertification / Exercise tolerance A. Every year / Every year B. Every two years / Every year C. Every year / Every two years D. Every two years / Every two years - ANSWER Correct Response: C. Every year / Every two years This is the correct response because according to FMCSA medical guidelines, when a myocardial infarction is part of the medical history, there is a significant increased risk for another myocardial infarction to occur within six months to a year; therefore, a maximum of one-year certification is the guideline. Myocardial infarction guidelines also recommend exercise tolerance testing at least every two years to demonstrate continued ability to safely operate a CMV. Incorrect Responses: A. Every year / Every year This is not the correct response because the FMCSA medical guidance is to obtain an exercise tolerance test every two years. In this question, there is nothing to indicate that more frequent testing is necessary. B. Every two years / Every year This is not the correct response because it reverses the guidelines. Even if you do not recall the recommendation, logically, one would eliminate this option because having the driver obtain a test every year and then waiting for up to a year to review the test results is not reasonable when unacceptable test results indicate the driver may not be able to safely operate a CMV. D. Every two years / Every two years This is not the correct response because the guideline is to recertify every year. Even if you do not recall the actual guideline, one would logically eliminate this option because this is the maximum recertification period for a driver who meets all qualification requirements. It is appropriate that a driver at increased risk for an incapacitating cardiac event should be monitored more frequently. A 46-year-old male driver presents for recertification. He has a history of chronic gastro esophageal reflux disease (GERD). He takes esomeprazole (Nexium) and over-the-counter cimetidine (Tagamet). He states that he feels fine, but has trouble finding foods that do not trigger his GERD when he is on the road. Which of the following should the medical examiner do first? A. Disqualify the driver until he has a nutritional consultation. B. Certify the driver and advise him to carry non-triggering foods in a cooler. C. Contact the driver's physician and request an upper GI study. D. Correlate the GI history findings with the abdominal examination. - ANSWER Correct Response: D. Correlate the GI history findings with the abdominal examination. This is the correct response because given the information in the question; a medical examiner would need to examine the driver before having sufficient information about the health of the driver to consider any of the other options. Incorrect Responses: A. Disqualify the driver until he has a nutritional consultation.This is not the correct response because until completion of the examination, there is insufficient information to make a certification decision. In addition, there is no regulation or medical guideline that requires a nutritional consultation in order to be certified. B. Certify the driver and advise him to carry non-triggering foods in a cooler. This is not the correct response because until completion of the examination, there is insufficient information to make a certification decision. C. Contact the driver's primary care provider and request an upper-GI study. This is not the correct response because until completion of the examination, one does not have sufficient information to make a referral decision. A 25-year-old female driver denies a history of any medical problems. She is a non-smoker who exercises regularly without symptoms. The medical examiner auscultates bilateral wheezes during the examination. The driver's SpO2 is 90 percent in the medical examiner's office. The rest of the examination is normal. The driver should be... ? A. Temporarily disqualified pending results of a cardiac workup. B. Qualified since she has no cardiac symptoms. C. Temporarily disqualified until further evaluation. D. Qualified because her O2 saturation exceeds the minimum. - ANSWER Correct Response: C. Temporarily disqualified until further evaluation. This is the correct response because the driver has a non-diagnosed respiratory or thoracic illness that might interfere with the ability to safely operate a CMV. The driver should not be certified until the etiology is confirmed and treatment has been shown to be effective, safe, and stable. Also, according to FMCSA medical guidelines, a SpO2 of less than 92 percent warrants obtaining an arterial blood gas analysis. Which of the following stages of hypertension calls for a medical certificate that expires in a year? A. Stage 1 B. Stage 3 C. Stage 2 D. Stage 4 - ANSWER A. Stage 1 Medical certificates for drivers with Stage 1 hypertension expire after a year. Stage 2 hypertension results in a one-time, three-month medical certificate. Stage 3 corresponds to a medical certificate, good for 6 months from date of examination if the reading is less than or equal to 140/90. Lastly, Stage 4 hypertension doesn't exist. The FMCSA provides exemption programs for which of the following? A. Vision and diabetes B. Vision and hearing C. Hearing D. Pulmonary disease - ANSWER A. Vision and diabetes FMCSA has two medical driver exemption programs: Federal Vision Exemption Program (established in 1998) and Diabetes Exemption Program (established in September of 2003). The medical examiner determines whether the driver would be otherwise qualified if accompanied by the Federal vision or diabetes exemption. As a result of the exemptions, the driver must have an annual medical examination for maintenance and renewal of the exemption. Which of the following colors is not necessary to be able to distinguish and recognize in traffic signals and devices? A. Blue B. Amber C. Red D. Green - ANSWER A. Blue Due to specifically the colors of a stoplight and most road signs, it is necessary for a driver to be able to recognize the colors amber, red, and green. Blue is not a necessary color to recognize in traffic signals and devices. Which of the following is a medical examiner required to inquire about from a driver with diabetes mellitus? A. If the driver uses incretin mimetic B. If the driver has glycosuria C. If the driver carries rescue glucose while driving D. If the driver routinely monitors his or her blood glucose level - ANSWER B. If the driver has glycosuria While all of the questions are recommended to ask, the only question that is necessary is to see if the driver has glycosuria (dip stick urinalysis). It is recommended, though, to ask about carrying rescue glucose while driving, using incretin mimetic, and routinely monitoring his or her blood glucose level. Which of the following is not a concern that predisposes commercial drivers to an increased risk of cardiovascular disease? A. Exposed to environmental stressors that are detrimental to the cardiovascular system B. Driving stressors can lead to increased neurosympathetic and adrenocortical catecholamine and cortisol release C. Obesity and a sedentary lifestyle increase the risk of such a disease D. Long hours and rotating work schedules - ANSWER D. Long hours and rotating work schedules Obesity and a sedentary lifestyle increase the risk of cardiovascular diseases. Driving stressors can lead to increased neurosympathetic and adrenocortical catecholamine and cortisol release. Also, exposed environmental stressors that are detrimental to the cardiovascular system. However, the long hours and rotating work schedules do not predispose a driver for increased risks of cardiovascular disease. If a medical examiner uses the number 1 during the physical examination, the medical examiner is indicating which of the following parts of the body system? A. Ears B. Abdomen and viscera C. Heart D. General Appearance - ANSWER D. General Appearance 1 refers to General Appearance, 3 refers to Ears, 5 refers to Heart, and 7 refers to Abdomen and viscera. All but which of the following are respiratory conditions that interfere with oxygen exchange and could result in gradual or sudden incapacitation? A. Mitral regurgitation B. Asthma C. Carcinoma D. Chronic bronchitis - ANSWER A. Mitral regurgitation Asthma, carcinoma, and chronic bronchitis are all respiratory conditions that interfere with oxygen exchange and could result in gradual or sudden incapacitation. Mitral regurgitation is actually a heart condition, not a respiratory condition. Which of the following is true in regards to psychological disorders in drivers? A. Drivers with an active psychotic disorder will exhibit completely predictable behavior, accompanied with poor judgment B. Drivers with a mood disorder may, during a manic episode, exhibit grandiosity, impulsiveness, irritability, and aggressiveness C. Drivers with personality disorders may exhibit flexibility and adaptive behaviors along with a decreased crash rate D. Drivers with a mood disorder will exhibit quicker reaction times during a depressive episode - ANSWER B. Drivers with a mood disorder may, during a manic episode, exhibit grandiosity, impulsiveness, irritability, and aggressiveness Drivers with an active psychotic disorder will exhibit unpredictable behavior, accompanied with poor judgment. Drivers with a mood disorder will exhibit slower reaction times during a depressive episode and grandiosity, impulsiveness, irritability, and aggressiveness during a manic episode. Lastly, drivers with personality disorders may exhibit inflexibility and maladaptive behaviors, along with an increased crash rate. Types of vertigo and dizziness with incapacitating symptoms can interfere with all but which of the following? A. Staying awake B. Cognitive abilities C. Concentration D. Judgment - ANSWER A. Staying awake Types of vertigo and dizziness with incapacitating symptoms interfere with cognitive abilities, judgment, attention, concentration, and sensory or motor functions. However, it does not necessarily interfere with staying awake. A medical examiner is required to ask all but which of the following questions? A. Do you smoke? If so, how much and for how long? B. Do you have shortness of breath? C. Do you have lung disease? D. Do you have emphysema? - ANSWER A. Do you smoke? If so, how much and for how long? While it is recommended to ask, it is not required that the medical examiner ask about the driver's smoking habits. The other questions are necessary questions to ask during a medical examination. Which of the following is not true in regards to performing the physical examination? A. The individual parts of the body system are categorized numerically B. For each body system, mark "Yes" on the Report Form if abnormalities are detected, or "No" if the body system is normal C. There is a maximum height requirement D. The medical examiner must document all abnormal findings on the Report Form, even if they are not disqualifying - ANSWER C. There is a maximum height requirement There is not in fact a maximum (or minimum) height (or weight) requirement for drivers. For each body system, mark "Yes" on the Report Form if abnormalities are detected or "No" if the body system is normal. The medical examiner must document all abnormal findings on the Report Form, even if they are not disqualifying. Lastly, the individual parts of the body system are categorized numerically. Which of the following is not true in regards to antidepressant therapy? A. Second generation antidepressants, including fluoxetine and venlafaxine, have fewer side effects than first generation antidepressants and are generally safe B. Guidelines recommend a case-by-case assessment of drivers treated with antidepressant medication C. First generation antidepressants, which include tricyclics such as amitriptyline and imipramine, have consistently been shown to interfere with safe driving D. With long-term use of antidepressants, most drivers never develop a tolerance to the sedative effects - ANSWER D. With long-term use of antidepressants, most drivers never develop a tolerance to the sedative effects Guidelines recommend a case-by-case assessment of drivers treated with antidepressant medication. With long-term use of antidepressants, most drivers tend to develop a tolerance to the sedative effects. First generation antidepressants, which include tricyclics such as amitriptyline and imipramine, have consistently been shown to interfere with safe driving. Lastly, second generation antidepressants, including fluoxetine and venlafaxine, have fewer side effects and are generally safe. When deciding if a commercial driver should be medically certified, what is the fundamental question a medical examiner should examine in regards to cardiovascular health? A. What is the likelihood that he or she will contract a cardiovascular disease? B. Does his or her family have a history of cardiovascular disease? C. Has the driver ever had a cardiovascular disease? D. Does the driver have a cardiovascular disease that increases the risk of sudden death or incapacitation? - ANSWER D. Does the driver have a cardiovascular disease that increases the risk of sudden death or incapacitation? When looking at the cardiovascular health of a driver, the fundamental question is whether the driver has a cardiovascular disease that increases the risk of sudden death or incapacitation, creating a danger to the safety and health of the driver, as well as the public sharing the road. While history and family history of such diseases are important, they are not the fundamental questions necessary about which to ask. An implantable cardioverter-defibrillator is: A. A type of arrhythmia categorized as ventricular fibrillation and ventricular tachycardia and is responsible for the majority of instances of cardiac sudden death B. A type of arrhythmia that is usually not considered a risk for sudden death C. An implantable device designed to treat bradycardia D. An electronic device that treats cardiac arrest, ventricular fibrillation, and ventricular tachycardia through the delivery of rapid pacing stimuli or shock therapy - ANSWER D. An electronic device that treats cardiac arrest, ventricular fibrillation, and ventricular tachycardia through the delivery of rapid pacing stimuli or shock therapy An implantable cardioverter-defibrillator is An electronic device that treats cardiac arrest, ventricular fibrillation, and ventricular tachycardia through the delivery of rapid pacing stimuli or shock therapy. A pacemaker is an implantable device designed to treat bradycardia. Also, supraventricular tachycardia is a type of arrhythmia that is usually not considered a risk for sudden death. Lastly, ventricular arrhythmia is a type of arrhythmia categorized as ventricular fibrillation and ventricular tachycardia and is responsible for the majority of instances of cardiac sudden death. Which of the following is not true about the risk from headaches? A. Headache and chronic "nagging" pain may be present to such a degree that certification for driving is inadvisable B. Most headaches, vertigo, and dizziness are consequential, causing a danger for drivers that experience such conditions C. Disorders with incapacitating symptoms, even if periodic or in the early stages of disease, warrant the decision to not certify t