DOT 2024 LATEST EXAM WITH
COMPLETE SOLUTIONS 100%
VERIFIED
Motor Neuron Disease - Answer- Examples include hereditary spinal muscular atrophy
and acquired ALS
-Debilitating and insidiously progressive
*No certification*
On appeal: Reconsideration possible based on neurologist or physiatrist
evaluation, based on knowledge of CMV role. May involve simulated
driving skills test, functional testing.
If certified, annual recertification required, with repeated specialist
evaluation, driving skills and/or functional testing.
No Certification - Answer- ALS
Muscular dystrophies*
Myasthenia gravis*
Myasthenic syndrome
Congenital myopathies*
Metabolic muscle diseases*
Parkinsonism*
Multiple sclerosis*
Peripheral neuropathies*
*Driver may appeal. Requires evaluation by neurologist/physiatrist with neuro‐
ophthalmologic
and neuro psychiatric testing, functional and simulated driving testing
PFT requested - Answer- -Clubbing of fingers
-Cyanosis
-Prolonged expiration
-Tachypnea at rest
-Pulmonary wheezes and rhonchi, pulmonary rales
-Absent or decreased breath sounds
-Pleural friction rub
-Unequal inflation‐deflation contours of the right and left thorax
-Significant kyphosis or scoliosis of the thoracic spine
-Use of accessory muscles of ventilation at rest
,Antihistamine Therapy - Answer- Must educate drivers about common prescription and
OTC drugs with
side‐effects and risks; teach to read labels
Driver should abstain from antihistamines for 12 hours prior to operating
vehicle
Should be relieved from duty until proper treatment for illness completed
Allergic Rhinitis - Answer- *Rarely disqualifying*
Symptoms should be treated with nonsedating antihistamines or local steroid sprays
Should not certify if complications or treatment impairs function, e.g.
Severe conjunctivitis affecting vison
Inability to keep eyes open
Photophobia
Uncontrollable sneezing
Sinusitis with severe HA
Sedating medications
Allergies Can be Life-Threatening - Answer- Stinging insect allergy: *Must carry
epinephrine injection device in truck
cab*; evaluate driver for immunotherapy
Hereditary or acquired angioedema: May require urgent medical
treatment; prevention and control should be accomplished with
appropriate prophylactic medication
Acute recurrent idiopathic anaphylaxis or angioedema can be
unpredictable.
Episodes often avoided by avoiding known allergens
Waiting period: Allergy‐related life‐threatening conditions must have
successful preventive measures and/or treatment before qualified
Asthma - Answer- Should not certify driver unless etiology confirmed and treatment
effective/safe
Certify for up to two years
*Not to certify if*:
Continual, uncontrolled, symptomatic asthma
Significant pulmonary function impairment (FEV1 <65% predicted and
PaO2 <65 mm
Hypersensitivity Pneumonitis - Answer- Immune‐mediated granulomatous interstitial
pneumonitis may be
recurrent, subacute, or chronic: cough, dyspnea, fever. Treatment must
alleviate these symptoms; causative agents to be avoided
*Certify if ME believes nature/severity does not endanger*
Monitoring: CXR, serum antibodies may identify antigen
At least biennial exam
COPD - Answer- *Chronic bronchitis and emphysema
,Chronic cough; sputum; dyspnea on exertion*
No specified waiting period, but treatment must be effective
Maximum certification 2 years
Not certified if hypoxemia at rest, chronic respiratory failure, history of
continuing cough with cough syncope
Monitoring: dyspnea at rest indicator for PFTs; If FEV1<65% predicted,
ABG should be measured
Follow‐up dependent on clinical course
Acute Infectious Diseases - Answer- With common cold, influenza, acute bronchitis,
drivers should be relieved
from duty until treatment completed; abstain from driving at least 12 hrs
after sedating medications; avoid operating vehicle while contagious
Medications such as antihistamines or antitussives can cause sedation and
should not drive for at least 12 hours after taking
Atypical Tuberculosis - Answer- Atypical TB: Certify if disease stable, normal lung
function, medication
regimen tolerated
No certification if extensive pulmonary dysfunction; weakness; fatigue:
adverse med tolerance
PFTs if suspect disease progressive and may cause extensive pulmonary sx
Follow‐up dependent on clinical course
Pulmonary TB - Answer- *No certification until determine driver not contagious and
treatment effective and safe*
Certify if not contagious; has completed streptomycin therapy without affecting
hearing or balance; is compliant with antitubercular tx; has no side effects that
interfere with safe driving
*No certification if*
• Advanced TB with respiratory insufficiency, not meeting PFT criteria
• Chronic TB
• Noncompliance with antitubercular tx
• Not completed streptomycin therapy
• Residual 8th cranial nerve damage with balance and/or hearing effects that interfere
with
driving
Positive PPD with normal CXR = no further actions; if CSR changes, pulmonary TB and
needs evaluation
Follow‐up dependent on clinical course*
Chest Wall Deformities - Answer- Many causes: kyphosis, pectus excavatum, scoliosis,
etc
Not to certify if hypoxemia at rest, chronic respiratory failure, cough with
cough syncope
ABG is FEV1 <65% predicted
, Cystic Fibrosis - Answer- Because requires frequent monitoring, 1 year certification
period
appropriate
*No certification if hypoxemia at rest; chronic resp failure; cough with
cough syncope; not meeting spirometry parameters, unstable condition
nor treatment*
ABG if FEV1 <65% predicted
Interstitial Lung Diseases-Pneumothorax - Answer- *Must ensure recovery by CXR*. If
air in pleural space or mediastinum, added
time away from work indicated
*Certify if asymptomatic, no disqualifying underlying lung disease, confirmed
resolution, meets pulmonary parameters*
No certification if criteria not met, history of 2+ spontaneous pneumothoraces if
no successful surgical procedure to prevent recurrence, rest hypothermia;
chronic resp failure; cough with cough syncope
Pulmonary Function Tests - Answer- Indications: History of specific lung disease,
symptoms of SOB, cough, chest
tightness, wheezing, smoking in drivers 35 years or older
FEV1, FVC, FEV1/FVC ratio
If normal and no other abnormality suspected, no further testing needed
Screening pulse oximetry and/or ABG indicated with FE1 <65% predicted,
FEV1/FVC ratio <65%
Screening pulse ox <92% must have ABG
Do not certify driver if PaO2 < 65 mm Hg (<5,000 ft) or 60 mm Hg (+5000 ft)
PaCO2 >45 mm HG
Pulmonary Hypertension - Answer- Increased risk incapacitation and sudden death
Primary pulmonary hypertension
Secondary pulmonary hypertension (Eisenmenger's syndrome)
Max cert = 1 year
*No cert if*
• Rest dyspnea
• Dizziness
• Hypotension
• PaO2 <65 mm Hg
Obstructive Sleep Apnea - Answer- FMCSA does not (currently) mandate screening,
diagnosis, or treatment
guidelines for MEs in determining issuance of medical certificate. FMCSA
expects MEs to exercise their clinical judgment in determining whether
additional information is needed for drivers at risk for OSA.
OSA - Answer- -Moderate‐to‐severe OSA defined by apnea‐hypopnea index (AHI) >15.
