Aeromedial Internal Medicine

Question 1

List the 6 parts of the aeromedical review process

Answer 1

1. Define aeromedical events of concern
2. Determine annual event rate
3. Determine threshold of acceptable risk (1% rule)
4. Define recertification/re-evaluation policy
5. Consider impact of medical therapy
6. Identify special considerations

Question 2

List 5 special considerations for military aviation

Answer 2

1. Single-pilot vs multi-place aircraft
2. Category of aircrew
3. High-G environment
4. Very high altitude flight
5. Mission completion

Question 3

What is the initial management of asymptomatic HTN?

Answer 3

May continue to fly for 6 months while undergoing 6 months of lifestyle changes

Question 4

List 3 classes of approved anti-HTN medications.

Answer 4

1. Diuretics (thiazide, potassium sparing)
2. ACE-I
3. ARBs

Question 5

Describe condition when HTN does not need a waiver

Answer 5

Uncomplicated HTN controlled on single approved med

Question 6

How is HCTZ/Triamterene considered?

Answer 6

As mono therapy for waiver purposes

Question 7

It is okay to start an ARB after an ACE-I. How long should you wait? Why?

Answer 7

3-4 weeks as angioedema from ACE-I can still occur that far out. Don’t want it to be attributed to the ARB.

Question 8

If a patient requires a beta-blocker or CCB (DHP only), what waiver restriction will they be given?

Answer 8

Non-high performance aircraft

Question 9

Why are non-DHP calcium channel blockers considered non-waiverable?

Answer 9

Non-DHP CCB are negative chronotropes and inotropes

Question 10

Are alpha-blockers waiverable?

Answer 10

No

Question 11

When does GERD not require a waiver?

Answer 11

Uncomplicated, tx with ppi

Question 12

When does HLP treatment not require waiver?

Answer 12

Single approved statin (+/- fish oil)

Question 13

When can DM2 be wavered? With what restrictions?

Answer 13

When treated with diet controlled (unrestricted) or metformin (with another qualified pilot)

Question 14

What is the status of glucose intolerance?

Answer 14

Not disqualifying

Question 15

List 5 items that must be evaluated in DM2.

Answer 15

1. BP
2. Lipids
3. DFE
4. Albumin-to-creatinine ratio
5. Monofilament foot exam

Question 16

What is the diagnostic criteria for hypogonadism? What is key item pertaining to lab draw?

Answer 16

Total testosterone < 300 on two occasions.

Lab must be drawn at 0800.

Question 17

If a patient’s testosterone level is low, what is the next step? What is the interpretation?

Answer 17

Draw FSH/LH.
If increased– primary failure
If decreased– secondary failure– check MRI sella, TSH, prolactin

Question 18

What is the treatment for hypogonadism?

Answer 18

Transdermal

Injection

Question 19

What 5 items must be surveilled for in patients with hypogonadism?

Answer 19

1. OSA
2. LFTs
3. Lipids
4. H/H
5. PSA + prostate exam

Question 20

What error is made with respect to rheumatoid arthritis in aviators?

Answer 20

Under-treat disease to avoid DQ

Question 21

List 4 aeromedical considerations with respect to cancer

Answer 21

1. Complications of tx (i.e. chemo)
2. Return to baseline fn
3. Risk of recurrence (? brain mets)
4. Required monitoring