Question 1

On August 27, 2013 a 43-year-old male CMV driver requests that you perform a recertification examination. He provides you with a Medical Examiner's Certificate that has expired on July 23, 2013. You complete the medical examination, but before you issue a renewed medical certificate, you need additional medical reports concerning a previous knee surgery that was done back in March 2010. You ask him to return to you on September 10, 2013 with the required reports in order to complete the examination. The driver returns on September 10, 2013 and provides all needed documents. You complete the examination, confirm that he is qualified and you issue the renewed certificate. The expiry date to be recorded on his renewed medical certificate should be:
A)March 2010.
B)July 23, 2013.
C)August 27, 2015.
D)September 10, 2013.

Accepted Answer

August 27, 2015.
This is the correct response because according to FMCSA's requirements, the medical examiner's certificate expiration date is calculated as 2 years from the date of the new certification or recertification examination, and not from the date of any subsequent follow-up examination. Answer D is wrong because it is the date of the follow-up examination. Answer B is wrong because it is the old expiration date.

Question 2

The purpose of the health history questions is to obtain information for any pre-existing physical, mental, or organic health conditions. While you perform the health history assessment for a 37-year-old male CMV driver, he answered Yeswhen asked if he has high blood pressure. For this answer you need to discuss with or ask the driver for additional information, except for:
A)The treating physician's contact information.
B)The prescribed medications used in relation to his high blood pressure condition.
C)The over-the-counter medications he takes.
D)None of the above

Accepted Answer

None of the above
This is the correct response because as per FMCSA's guidelines all of the above are additional information required whenever the answer to health history questions is Yes. Answer A is wrong because this information is needed for any necessary consultationwith the treating physician. Answer C is wrong because as per FMCSA, additional information is needed for any over-the-counter medications the driver takes.

Question 3

A 20-year-old person approaches you and asks you to perform a medical examination for him as he is planning to apply for an interstate CMV driver job advertised by a local transportation company. According to the FMCSA standards, a person under 21 is not eligible to work as an interstate CMV driver; however, you can still perform the examination because:
A)The person is only applying for the job and not yet employed.
B)There's no indication that he intends to work as an interstate CMV driver.
C)It is not your responsibility to ensure that the person meets the age requirements.
D)From his physical appearance he seems quite healthy.

Accepted Answer

It is not your responsibility to ensure that the person meets the age requirements.
This is the correct answer because as per FMCSA's guidelines, it is the responsibility of the motor carrier to ensure that their interstate CMV drivers meet the age requirements. As a certified medical examiner you can perform the driver physical examination for any person who requests it.

Question 4

The driver must fill out section 1 of the Medical Examination Report. For the purpose of confirming the driver's identification, the medical examiner is responsible to check the following information in section 1:
A)Driver's name (in the following order Last, First, Middle), birthdate (in the following order Month, Day, Year), social security number, and driver's license number and license class.
B)Driver's name (in the following order Last, Middle, First), age, social security number, and driver's license number and license class.
C)Driver's name (in the following order First, Middle, Last), birthdate (in the following order Year, Month, Day), and driver's license number.
D)None of the above

Accepted Answer

Driver's name (in the following order Last, First, Middle), birthdate (in the following order Month, Day, Year), social security number, and driver's license number and license class.
This is the correct answer because as per FMCSA's official Medical Examination Report (a legal document),the order of the driver's name must be Last, First, Middle, the birthdate order must be M / D / Y, the social security number must be written, and the driver's license and its class must be indicated. Answer B. is wrong, because it's not enough to check age alone, the birthdate must concur with age.

Question 5

What are the main factors that contribute to a driver's stress and fatigue?
A)Road, traffic, shape of cargo, night driving, and passengers
B)Road, traffic, weather, vehicle size, night driving, noise, vibration, and type of cargo
C)Road condition, tires' condition, noise, and disturbing passengers
D)All of the above

Accepted Answer

Road, traffic, weather, vehicle size, night driving, noise, vibration, and type of cargo
Bad road conditions, traffic, weather and night driving require more attention and concentration. Vehicle size demands more physical effort. Noise and vibration result into a number of musculoskeletal disorders. Some cargo may be by nature hazardous to health if the driver is directly exposed to it. Answers A and C are both wrong because shape of cargo, tires' condition and attitude of passengers are insignificant to the driver's health and both answers missed other important factors.

Question 6

A 44-year-old female interstate CMV driver was recently prescribed medical marijuana as a pain and nausea relief medication following chemotherapy for breast cancer. Should this driver continue to be medically qualified to drive?
A)No, because breast cancer by itself is a disqualifying medical condition.
B)Yes, because as per FMCSA guidelines, prescribed medical marijuana is legal.
C)Yes, because medical marijuana used for pain relief from chemotherapy has no effect on the brain.
D)No, because as per FMCSA guidelines, drivers taking any form of marijuana cannot drive.

Accepted Answer

No, because as per FMCSA guidelines, drivers taking any form of marijuana cannot drive.
This is the correct answer because any form of marijuana at any prescription strength can result in mood changes, sleepiness, and may disrupt memory and decision-making ability. Large doses of medical marijuana can cause hallucination and paranoia. In addition, medical marijuana is legal in some states and illegal in others making it difficult for the driver to comply with various state regulations.

Question 7

When performing a risk assessment of a driver's current medical treatment, the medical examiner must determine if the treatment taken is:
A)Qualifying, because it controls the physical and/or mental conditions.
B)Qualifying, because it controls the physical and/or mental conditions and allows the driver to operate the vehicle more safely than without treatment.
C)Qualifying, because the side effects, even if medically optimal, interfere with safe driving.
D)None of the above

Accepted Answer

Qualifying, because it controls the physical and/or mental conditions and allows the driver to operate the vehicle more safely than without treatment.
During safety risk assessment of any medication, the medical examiner must evaluate the risks of driving while taking a medication and its side effects compared to the risks of driving while not taking the medication. B is wrong because it assumes that driving while taking medications is safe. C is a wrong answer because any side effects that interfere with safe driving are disqualifying conditions.

Question 8

Which one of the following best completes the below statement regarding affirmative questions in the driver's health history? The medical examiner must identify, query and note:
A)Any illness, surgery, or injury during the past five (5) years, recent changes inhealth, vehicle size, and prescription medications and supplements' side effects.
B)Any illness, surgery, or injury during the past five (5) years and limitations noted from previous FMCSA examinations.
C)Any illness, surgery, or injury during the past three (3) years and prescription medications and supplements' side effects.
D)Any illness, surgery, or injury during the past five (5) years, recent changes inhealth, current medical conditions or complaints, limitations noted from previous FMCSA examinations, prescription medications and supplements' side effects.

Accepted Answer

Any illness, surgery, or injury during the past five (5) years, recent changes inhealth, current medical conditions or complaints, limitations noted from previous FMCSA examinations, prescription medications and supplements' side effects.
This is the correct answeras per FMCSA guidelines. Answers A, B, & C are wrong because either they do not cover all requirements and/or have wrong requirements such as vehicle size or past 3 years' history.

Question 9

During the medical history questionnaire, the medical examiner must identify, query and note:
A)A medication interaction with other medications, food or supplements.
B)Any synergistic effects of combining medications (both prescribed and/or over-the-counter).
C)Possible side effects of a missed or late dose of a medication.
D)All of the above

Accepted Answer

All of the above
As per FMCSA's guidelines, any medications, both prescribed and over-the-counter, must be thoroughly assessed in terms of their reactions and side effects and their ability to alter or interfere with safe driving.

Question 10

A 50-year-old male CMV driver has chronic kidney failure and is on hemodialysis (Mon, Wed, & Fri) for the past 2 years. His treating physician provided him with a medical report indicating that he can work normally except on the days he is undergoing dialysis. He is also suffering from hypertension. This CMV driver would be:
A)Qualified normally for 2 years.
B)Disqualified.
C)Qualified for 1 year.
D)Qualified for 6 months.

Accepted Answer

Disqualified.
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. The hypertension condition of the driver in this case does not imply any exemption, because of the severity of the kidney disease. In general, persons who undergo dialysis are prone to fatigue and sleepiness, which jeopardize their ability to drive safely.

Question 11

During a health history questionnaire a 34-year-old male driver answers Yes when asked if he feels any lower back pain. Your subsequent discussion and queries concerning this affirmative answer must probe into:
A)The frequency of the lower back pain.
B)The duration and severity of the lower back pain.
C)The frequency and severity of the lower back pain.
D)The frequency, duration, and severity of the lower back pain.

Accepted Answer

The frequency, duration, and severity of the lower back pain.
This is the correct answer because according to FMCSA's guidelines any possible symptoms identified during the assessment of medical history must be evaluated in terms of their frequency of onset, severity or degree, and their duration.

Question 12

On September 25th, 2014, while you perform a health history questionnaire on a 25-year-old male driver, he informs you that he previously had two (2) incidents of unprovoked seizures, one in 2009 and a second one in 2012. He stopped taking anti-seizure medication since 2013. He has no other health issues. How would you define his medical history in relation to these seizure incidents and what would be your decision regarding his fitness to drive?
A)A medical history of epilepsy; thus disqualifying the driver
B)No medical history of epilepsy; thus qualifying the driver
C)No medical history of epilepsy, because he had only 2 seizures within 5 years; thus qualifying the driver
D)A medical history of epilepsy; thus conditionally qualifying the driver for 1 year

Accepted Answer

A medical history of epilepsy; thus disqualifying the driver
This is the correct answer because a second occurrence of unprovoked seizures, regardless of the time elapsed since the first incident, constitutes a medical history of epilepsy. According to FMCSA's guidelines, a person with epilepsy must be disqualified. Conditional certification (for 1 year) is possible if the person has been seizure free for a minimum of 10 years AND is off anti-seizure medication for at least 2 years. In this case the subject driver did not meet the required conditions.

Question 13

While you perform a health history questionnaire with a 50-year-old male driver, he informs you that he had a coronary artery bypass grafting (CABG) surgery 6 months ago. What additional information do you need to determine his medical condition and what would be your final certification decision accordingly?
A)A clearance by the treating cardiologist, LVEF <?40% post CABG, confirmed tolerance to medication, and asymptomatic status with no angina; thus certified unconditionally
B)A clearance by the treating cardiologist, a recent resting echocardiogram, LVEF >?40% post CABG, confirmed tolerance to medication, and asymptomatic status with no angina; thus certified annually for 5 years
C)A clearance by the treating cardiologist, LVEF >?60% post CABG, confirmed tolerance to medication, and asymptomatic status with no angina; thus certified unconditionally
D)A clearance by the treating cardiologist, a recent resting echocardiogram, LVEF >?40% post CABG, confirmed tolerance to medication; thus certified unconditionally

Accepted Answer

A clearance by the treating cardiologist, a recent resting echocardiogram, LVEF >?40% post CABG, confirmed tolerance to medication, and asymptomatic status with no angina; thus certified annually for 5 years
According to FMCSA's guidelines, a person who has undergone a CABG surgery may be certified annually for 5 years on condition that: 1) at least 3 months have passed since the surgery (to allow sternal incision healing), 2) the person demonstrates tolerance to medication, 3) the treating cardiologist provides approval, and 4) the person has LVEF of >?40%. The resting echocardiogram is recommended in this case to confirm no ischemic changes to ECG as it disqualifies the driver if found.

Question 14

A48-year-old male driver has lost his right-hand thumb in an accident during his work as a carpenter 6 years ago. The driver is left-handed. He has no other health issues disqualifying him from driving a CMV. Is there any additional information needed before you certify this person?
A)No, no additional information is needed. This person is not qualified as he has an impairment of a finger that interferes with prehension and grasping.
B)Yes, a Skill Performance Evaluation (SPE) Certificate by FMCSA certifying that this person can perform his normal duties despite the impairment.
C)Yes, a clearance by the treating orthopedist confirming that the impairment has no effect on the person's prehension and grasping ability.
D)No, no additional information needed. This person is qualified as he is left-handed.

Accepted Answer

Yes, a Skill Performance Evaluation (SPE) Certificate by FMCSA certifying that this person can perform his normal duties despite the impairment.
According to CFR 391.49(a) requirements, a person who is not physically qualified to drive under § 391.41(b)(1) or (b)(2) and who is otherwise qualified to drive a commercial motor vehicle may drive a commercial motor vehicle if the Division Administrator, FMCSA, has granted a Skill Performance Evaluation (SPE) Certificate to that person. C is a wrong answer, because the treating orthopedist clearance is needed as part of the application for a SPE certificate and not a stand-alone document.

Question 15

A 47-year-old male driver has had surgery 2 years ago and has an Implantable Cardiac Defibrillator (ICD). What is the certification period for such a medical condition history?
A)Six months, subject to clearance from the treating cardiologist
B)One year, subject to LEVF of >?40%
C)Two years, since more than three months have passed since his surgery
D)Driver cannot be certified

Accepted Answer

Driver cannot be certified
According to FMCSA's guidelines, persons with ICDs are at high risk of sudden death or incapacitation and cannot be medically certified as CMV drivers.

Question 16

A 50-year-old female driver informs you that 2 years ago she had a mastectomy as a result of breast cancer. She has healed completely andis now following an annual screening program. She is taking Enjuvia (Conjugated Estrogen) as a hormone replacement therapy (HRT) as she is suffering from severe menopause symptoms. Other than possible side effects from HRT medications, what important issues in relation to her medical history must you discuss and query?
A)The date when she started suffering from menopause
B)Recent changes inher health condition and the side effects of HRT medications
C)Recent changes inher health condition, the symptoms of menopause, and her overall psychological well-being
D)No other issues

Accepted Answer

Recent changes in her health condition, the symptoms of menopause, and her overall psychological well-being
You must query recent changes in the subject driver's health conditions, because HRT is known to increase breast density, making mammograms more difficult to read and thus, increasing the likelihood of missing early signs of recurring breast cancer. In addition, severe menopause symptoms may include insomnia and sleep disturbance, anxiety, panic attacks, depression, and mood changes.You must carefully evaluate the mental condition of this driver following her mastectomy and menopause treatment. This driver may be susceptible to emotional or adjustment problems that may contribute directly to her level of memory, reasoning, attention, and judgment and thus her driving ability.

Question 17

According to FMCSA's guidelines, the medical examiner's comments on a driver's health history must include as a minimum:
A)Concerns about the driver's vision acuity, blood pressure readings, and BMI.
B)Recent changes inthe driver's health conditions and their effect on the ability to drive.
C)The side effects of medications and their effect on the ability to drive.
D)The nature of an affirmative history, the medication/treatment effect on the ability to drive, and to note any supplementary medical reports substantiating the health history.

Accepted Answer

The nature of an affirmative history, the medication/treatmenteffect on the ability to drive, and to note any supplementary medical reports substantiating the health history.
This is the correct answer because according to FMCSA, the medical examiner must discuss and query all affirmative answers related to a driver's health history questions. Through the comments section the medical examiner attests that he has probed into the exact nature of the affirmative answers for medical conditions, the medication side effects, and has asked for additional supporting medical reports that would help draw a conclusion about the driver's medical history.

Question 18

A 56-year-old male driver applying for a new certificate admitted that he suffered a myocardial infarction (MI) 3 months before. He provides you with a clearance certificate by a cardiologist. He also informs you that he is not feeling any chest pain post MI. Is this information sufficient to determine his health history?
A)No, need information on post-MI LVEF, ETT, ECG, and tolerance to medication.
B)No, need information on ECG and on tolerance to medication.
C)Yes, no other information is needed.
D)No, need information on post-MI ETT and tolerance to medication.

Accepted Answer

No, need information on post-MI LVEF, ETT, ECG, and tolerance to medication.
This is the correct answer because according to FMCSA guidelines a person who has had a MI at least 2 months before and who is asymptomatic, must still demonstrate LVEF >?40%, normal ETT, no ischemic changes on ECG and good tolerance to medications before she/he can be certified.

Question 19

A 47-year-old male had a percutaneous coronary intervention (PCI) 8 months before. What additional information do you need concerning his health history before you determine his fitness as a CMV driver?
A)No further information, persons who had a PCI cannot be qualified as CMV drivers
B)Cardiologist approval, LVEF >?40%, and tolerance to medications
C)Cardiologist approval, normal ETT for 3 to 6 months post-PCI, non-ischemic ECG changes, and tolerance to medication
D)Cardiologist approval, normal ETT for 6 to 9 months post-PCI, non-ischemic ECG changes

Accepted Answer

Cardiologist approval, normal ETT for 3 to 6 months post-PCI, non-ischemic ECG changes, and tolerance to medication
This is the correct answer because according to FMCSA guidelines, a person who has had PCI may be qualified annually as a CMV driver if a PCI was done at least one week before examination date, a cardiologist clearance report is provided, there are no ischemic changes on ECG, normal ETT was performed 3 to 6 months post-PCI and demonstrates tolerance to medication.

Question 20

A 60-year-old male applying for re-certification declares that he previously suffered congestive heart failure (CHF). He was certified as a CMV driver annually for the past 2 years. He provides you with a cardiologist clearance report indicating normal ECG, normal Holter evaluation, no symptoms, no ventricular arrhythmias, tolerance to medication, and LVEF of 39%. What additional information do you need concerning his health history before you determine his fitness as a CMV driver?
A)Normal post-cardiomyopathy ETT
B)No further information, this person cannot be re-certified
C)Documented correct function by the pacemaker center
D)Results of a monthly prothrombin time (PT) test

Accepted Answer

No further information, this person cannot be re-certified
This is the correct answer because his LVEF is <?40%. According to FMCSA guidelines, a person who has a history of CHF can be certified annually if he is asymptomatic, has no arrhythmias, follows an annual cardiology evaluation including ECG and Holter and has LVEF of 40% to 50%. ETT is not required in this case according to FMCSA. INR tests and normal pacemaker function do not apply in this case.

Quiz 4: Driver Identification and History

The driver must fill out section 1 of the Medical Examination Report. For the purpose of confirming the driver's identification, the medical examiner is responsible to check the following information in section 1:

What are the main factors that contribute to a driver's stress and fatigue?

A 44-year-old female interstate CMV driver was recently prescribed medical marijuana as a pain and nausea relief medication following chemotherapy for breast cancer. Should this driver continue to be medically qualified to drive?

When performing a risk assessment of a driver's current medical treatment, the medical examiner must determine if the treatment taken is:

Which one of the following best completes the below statement regarding affirmative questions in the driver's health history? The medical examiner must identify, query and note:

During the medical history questionnaire, the medical examiner must identify, query and note:

During a health history questionnaire a 34-year-old male driver answers Yes when asked if he feels any lower back pain. Your subsequent discussion and queries concerning this affirmative answer must probe into:

A48-year-old male driver has lost his right-hand thumb in an accident during his work as a carpenter 6 years ago. The driver is left-handed. He has no other health issues disqualifying him from driving a CMV. Is there any additional information needed before you certify this person?

A 47-year-old male driver has had surgery 2 years ago and has an Implantable Cardiac Defibrillator (ICD) . What is the certification period for such a medical condition history?

According to FMCSA's guidelines, the medical examiner's comments on a driver's health history must include as a minimum:

A 47-year-old male had a percutaneous coronary intervention (PCI) 8 months before. What additional information do you need concerning his health history before you determine his fitness as a CMV driver?