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The driver presents with a SPE Certificate. The Medical Examiner’s next step should be:
b – 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 condition 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 Performance 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 functional 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.
Practice Question 2:
The driver does not indicate any medical conditions on health history. During the exam the Medical Examiner notes the presence of a hearing aid in one ear. The driver says that he doesn’t need the hearing aid to drive and doesn’t think it should be required. The next step for the Medical Examiner is:
a. Test the driver’s hearing without the hearing aid.
b. Examine the driver’s ears.
c. Refer the driver for hearing assessment by a specialist with specialized audiometric testing capabilities for testing drivers while wearing a hearing aid.
d. Certify the driver with the qualification “wearing hearing aid”.
a – The usual process for the driver examination is testing hearing, vision, and urinalysis, then performing the physical examination, so of the answers testing the driver’s hearing is the next step. If the driver passes a whisper or audiometric test without a hearing aid, no further testing of hearing is needed. If the driver fails the hearing test(s) without a hearing aid, then testing the driver’s hearing with a whisper test is the next step. If the driver fails a whisper test with a hearing aid, the driver will need to have audiometric testing by a specialist using specialized audiometric testing equipment.
Practice Question 3:
The driver describes alcohol use including 2 drinks a night during the week and a 6 pack on the weekends. The Medical Examiner’s next step should be to:
a. Refer the driver for evaluation by a substance abuse professional.
b. Further assess the driver’s history of and current use of alcohol.
c. Disqualify the driver.
d. Test the driver for drugs and alcohol.
b – The Medical Examiner should assess the driver’s history of alcohol (and other drug use) in detail, bearing in mind that denial is common in all types of substance abuse. Next steps after that assessment could include requesting medical records from the driver’s treating providers and/or referral for assessment by a substance abuse professional or other qualified provider. Disqualification should be considered if the Medical Examiner suspects that the driver may be impaired due to current substance abuse. Drug and alcohol testing is not required as part of a driver medical examination but may be performed by the Medical Examiner.
Practice Question 4:
Which conditions are disqualifying by regulation?
a – Current (as of 2024) disqualifying conditions by regulation are hearing loss and seizures/epilepsy. Insulin-dependent diabetes was disqualifying by regulation until 2018 and monocular vision was disqualifying by regulation until 2022, but both of those conditions are now subject to alternative qualification standards.
Practice Question 5:
Who is responsible to maintain a copy of the Medical Examination form MCSA-5875?
a. The driver.
b. The employer.
c. The Medical Examiner.
d. The medical office where the examination was performed.
c – The FMCSA requires that the Medical Examiner maintain a copy of MCSA-5875. This could be problematic if the Medical Examiner moves from 1 practice to another, retires, or otherwise may have difficulties meeting this requirement. The FMCSA will hold the Medical Examiner responsible, for example, if the FMCSA requires that a copy of the form be made available within 48 hours as part of an investigation or audit.
Practice Question 6:
Which of the following is not required by 49 CFR Part 391.46 which describes requirements for the evaluation of a driver with Insulin-Treated Diabetes Mellitus (ITDM)?
a. Evaluation by the treating clinician (TC), the provider responsible for managing the driver's diabetes and prescribing insulin.
b. A requirement for drivers to carry a rapidly absorbable form of glucose.
c. Completion by the treating clinician (TC) of form MCSA-5870, the Insulin-Treated Diabetes Mellitus Assessment Form.
d. Examination by the Medical Examiner no more than 45 days after completion of form MCSA-5870, the Insulin-Treated Diabetes Mellitus Assessment Form.
b – Although recommended, drivers are not required to carry a rapidly absorbable form of glucose.
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