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5th Flashcards

1
Q

What qualifications must a driver have, post- MI

A
  1. 2 month’s post MI
  2. cleared by a cardiologist
  3. no angina
  4. Post-MI EF >40%
  5. Tolerance of CV meds
  6. Biennial ETT with imaging stress test
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2
Q

Max cert post MI

A

1 year

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3
Q

How often do post MI patients get ETT?

A

Biennal but year certs

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4
Q

What DQ’s a driver post MI?

A
  1. Recurrent angina
  2. post- MI EF <40%
  3. abnormal ETT
  4. Ischmic changes on ECG
  5. Poor tolerance of CV meds
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5
Q

How long does a driver have to wait for cert after having angina pectoris?

A

3 months sx free

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6
Q

Can you certify a driver with angina pectoris ?

A

Yes is asx

Seen by cardio and cleared

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7
Q

Max cert for angina pectoris?

A

1 year

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8
Q

What DQ’s a patient with Angina pectoris?

A
  1. Rest anagina
  2. Change in angina pattern within 3 months of exam
  3. Abnormal ETT
  4. Ischemic changes on ECG
  5. CV med intolerance
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9
Q

Whats the waiting period after having a PCI ?

A

1 week post-PCI

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10
Q

How do certify after having a PCI?

A
  1. 1 week post op
  2. approval by cardiologist
  3. medication tolerant
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11
Q

Post PCI how often do they have to have an ETT?

A

q 3-6 months post PCI

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12
Q

How often to certify post PCI

A

Initially 6 months and must bring ETT results to 6 month follow up

  1. If results ar good may certify up to 1 year
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13
Q

What do you assess on the cardio exam

A 
Murmurs
extra heart sounds
arrhythmias
enlarged heart
Abnormal pulse
amplitude
carotid or arterial bruits
varicose veins
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14
Q

Can you certify a driver with Afbi?

A

Yes if they are lone with low risk of stroke

  • Check a CHAD2 VASC2 screening tool to determine risk.
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15
Q

Max cert for Afib with low stroke risk

A

Annual and bring in documentation from cardiologist

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16
Q

How do you certify a driver with Afib with risk of stroke decreased by anticoagulation?

A
  1. Adequately coagulated for at least one month with proof of documentation
  2. Rate/rhythm control deemed adequate by a cardiologist
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17
Q

Max cert for driver with Afib

A

1 year

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18
Q

Can you certify a patient with valve replacement or mechanical valve?

A

Yes, if

  1. 3 month post op
  2. asx
  3. cleared by cardiologist
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19
Q

What DQ’s a driver with valve replacement or mechanical valve?

A
  1. sx
  2. EF <40%
  3. thromboembolic complication post procedure
  4. pulmonary hypotension
  5. unable to maintain adequate anticoagulation
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20
Q

Max cert for valve replacement or mechanical valeve

21
Q

When do you need an annual echo for a driver certification

A

Moderate mitral regurgitation

22
Q

How do you certify a patient with severe MR

A
  1. Asx
  2. echo q6-12 months or at least 3 months post-repair
  3. cleared by cardiologist
23
Q

What disqualify a driver with Mitral regurg?

A
  1. symptomatic
  2. > 6 METS on bruce protocol
  3. ruptured chordae or flail leaflet
  4. AFIB + MR
  5. LV dysfx
  6. thromboembolism
  7. PAP>50% SAP
24
Q

How do you certify drivers with Ventricular Tach?

A

EF >40%
asx
1 month waiting period
Cardiology clearance

25
Max cert for ventricular tach
1 year
26
How do you certify a driver with cardiomyopathy or CHF
1. Asx 2. No ventricular arrhythmias 3. LVEF <40% Echo and hotter monitor every year with cardiology clearance
27
When a driver has DM assess target organ damage asking about what?
CHD, TIA, stroke, PVD, autonomic neuropathy, nephropathy
28
What must an ME document regarding the drivers DM
1. When diagnosed and onset date 2. current medications 3. Potential side effects of medications 4. Any additional tests or evaluations
29
All patients with DM must have a what?
consult and exam with PCP or specialist prior to clearance
30
Driver with DM , always assess
Hypoglyemic episodes and risk of hypoglycemia
31
Waiting period for DM dx?
No specific waiting periods, but has to be adequate and stable on therapy, use your clinical judgement
32
Max cert for DM
1 year- due to its progressive nature
33
When not to certify DM patient
1. Severe hypoglycemia ( 1 in 12 months or 2 in the past 5 years) defined as hypoglycemia with seizure, LOC, need fore assistance, impaired cognitive function 2. Loss of position senesation 3. loss of pedal sensation 4. resting tachycarida 5. Orthostatic hypotension 6. Dx of peripheral neuropathy, proliferative retinopathy
34
Driver with DM has glycosuria what do you do next?
FS for random BG or A1c
35
Driver with DM on incretin mimetics must get the following?
Written statement MCSA 5870 from provider that addresses the following 1. driver tolerance with medcaiton 2. how freq drivers is monitored for adequate BG control 3. Efficacy of treatment
36
Driver with DM on insulin must always carry what?
rapidly absorbable glucose
37
What is the 2 step process for certification for Insulin dependent mimetics
1. Treating clinician evaluation - provider fills out an ITDM assessment form masa-5870 - this ITDM is valid for 45 days - stabile insulin regimen and well controlled 2. CME exam - consider treating physicians assessment - 3 months BG records must be provided to the CME - request further info if needed - if all good certify for 1 year
38
What DQ's a driver with DM
Severe non-proliferative diabetes retinopathy proliferative diabetic retinopathy unstable insulin regimen DM not properly controlled.
39
How long would you certify a DM patient on new meds
Limited 3 month qual to allow for time to get 3 month BG record
40
Pt has hypoglycemia after certification what do they do?
Stop driving and be evaluated by clinicians as soon as reasonably possible - New ITDM form must be completed before recertification - All ITDM forms presented to the CME at next qualifying visit - ITDM still must be within 45 days.
41
How long to wait to certify a patient on insulin
at least 1 month and then 3 month cert to get enough BG cert to certify for 1 year. †
42
How long does a driver have to wait to be cleared after an MI
2 months
43
How long do you certify a driver with a vision exemption ?
1 year
44
What forms does the driver need to apply for vision exemption
Both the medical certification car and long form marked with certify for 1 year and also mark accompanied by a vision exemption
45
How often does a driver have to renew a vision exemption
2 year but only certified 1 year at a time
46
waiting period after a CABG?
3 month waiting period
47
What are the minimum acceptable spirometry readings for FEV1, FVC, FEV1/FVC
FEV1 65%, FVC 60%, and FEV1/FVC ratio of 65%
48
what is the minimum amount of time after a suicide attempt does a driver have to wait to be cleared
1 year - cert from original date of examination

FMCSA (6 decks)

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