Clinical Aerospace Medicine

Question 0

Cardiac arrhythmias which result in syncope can be catastrophic in the aviation setting. Which of the following can lead to atrial sinus arrest and syncope?

a) positive pressure breathing
b) The M-1 maneuver
c) an attempt to stop hyperventilation by deep breath holding.
d) all of the above.

Answer 0

d) All of the above. Positive pressure breathing of 100% oxygen is used as an emergency means of maintaining adequate arterial oxygen saturation in the event of loss of cabin pressurization at or above 40,000 feet. The M-1 maneuver, a continuous forced exhalation through a partially closed glottis, is used to overcome undesirable effects during exposure to G forces. Breath holding likewise can cause sinus arrest. Each of these can increase vagal stimulation, atrial sinus arrest, and syncope in sensitive individuals.

Question 1

In aircrew who suffer a spontaneous pneumothorax:

a) the treatment of choice is pleurectomy
b) the treatment of choice is chemical pleurodesis
c) the recurrence rate is 30% after a first pneumothorax
d) the condition may manifest only when airborne
e) A, C, and D are correct

Answer 1

e) The aeromedical importance of a spontaneous pneumothorax is related to the tendency to recur: at a rate of 30% after the first event, and rising to 80% after a third. Definitive treatment is therefore necessary before aircrew with the condition may be allowed to resume flying. Unlike pleurectomy, chemical pleurodesis is associated with significant failure rate and morbidity.

Question 2

Studies of miniature swine exposed acutely to G stress up to levels of +9 Gz for 45 seconds have consistently revealed subendocardial hemorrhage and cardiomyopathy. The cardiomyopathies include myofibrillar degeneration, translocation, and clumping of mitochondria and necrosis of cardiac myocytes. It is believed that these same cardiomyopathies occur in humans who are exposed to similar G forces.
A) True
B) False

Answer 2

B. False. Although the swine studies revealed these pathologies at operational G levels, a follow-on study in humans using all available clinical monitoring techniques did not reveal similar conditions.

Question 3

Syncope is an aeromedical problem that often confronts the flight surgeon. Which of the following signs and symptoms may be seen with a syncopal attack?

a) Generalized muscle weakness
b) Impairment of consciousness
c) Occurs while lying down on occasion
d) Brief duration
e) May have assoiciated clonic jerks

Answer 3

A, B, D, E

Question 4

Myocardial infarction and acute pericarditis are sometimes difficult to distinguish clinically. Which of the following laboratory findings often will be found in acute pericarditis?

1. Leukocytosis and increased sedimentation rate
2. Chest xray evidence of increased cardiac size
3. Pleural effusions and/or infiltrates on chest xray
4. Electrocardiographic changes in the ST segment
5. Subsequent T-wave inversion days to weeks later
6. Elevation of serum enzymes, SGOT, LDH

Answer 4

All the above

Question 5

How long is the usual clinical course of acute pericarditis, including common sequelae?

Answer 5

1-2 months

Question 6

Angina is a symptom complex attributed to transient and reversible myocardial ischemia, often caused by underlying coronary atherosclerosis. The ECG is normal in what percentage of patients with angina pectoris?

Answer 6

50-75%

Question 7

Myocarditis is frequently unrecognized either because of its subclinical nature or because of the severity of associated symptoms. Complications of myocarditis of aeromedical interest include congestive heart failure, hypoxia, arrhythmias, and sudden death. Causes of myocarditis include viral, bacterial, rickettsial, parasitic, fungal, spirochetal, and secondary reactions to systemic processes such as hypersensitivity reactions or connective tissues diseases. What is the incidence of myocarditis as determined by autopsy data?

Answer 7

3-9%

Question 8

What are the five major risk factors associated with the development of atherosclerosis?

Answer 8

Hypertension, smoking, diabetes, family history, and elevated cholesterol

Question 9

Which of the following foods has the highest cholesterol content (in mg)?

a) Sausage
b) Lard
c) Shrimp
d) Lobster

Answer 9

C) Shrimp

Question 10

Recent investigations have indicated that myocardial sarcoidosis may be much more common that heretofore believed. As a flight surgeon, which of the following statements is true and is of particular aeromedical significance?

a) myocardial sarcoidosis, although not a rare condition, is usually benign in that only normal variants such as first degree AV block and wandering pacemaker have been detected.
b) arrhythmias such as ventricular tachycardia and supraventricular tachycardia can occur causing incapacitation or sudden death.
c) myocardial sarcoidosis causes incapacitation arrhythmias but almost always in older patients (over age 60).
d) myocardial sarcoidosis in usually a serious condition but almost all patients have significant, detectable pulmonary disease well before cardiac involvement.

Answer 10

b) Arrhythmias such as ventricular tachycardia and supraventricular tachycardia can occur causing incapacitation or sudden death.

Question 11

In recent years, researchers in aerospace medicine have concluded that electrocardiograms, once thought to be abnormal, are actually normal variants. All of the following are usually considered normal variants EXCEPT:

a) first degree AV block
b) Mobitz type II block
c) premature atrial contractions
d) premature ventricular contractions
e) All of the above are normal variants

Answer 11

b) Mobitz type II is a heart block. It is NOT a normal variant.

Question 12

Many young men undergoing aircrew examinations have cardiac murmurs that do not indicate organic heart disease. Which one of the following findings suggests the presence of organic heart disease?

a) a grade II/VI systolic murmur detected only in the left lateral position.
b) a grade II/VI systolic murmur detected only in the left lateral position present only after exercise.
c) a grade I/VI diastolic murmur which becomes grade II/VI with exercise.
d) a grade I-II/VI systolic murmur heard intermittently by different physicians over the past 3 years.
e) a grade I/VI systolic murmur at the base of the heart, heard at the termination of treadmill exercise testing.

Answer 12

c) A grade I/VI diastolic murmur which becomes grade II/VI with exercise. As a general rule, the occurrence of any diastolic murmur should be considered secondary to organic heart disease until proven otherwise.

Question 13

Which cardiac disorder would be more directly related to the development of acute right heart failure in the presence of hypoxia?

a) Wenckeback phenomenon
b) Mitral insufficiency
c) Mitral stenosis
d) RBBB

Answer 13

c) Mitral stenosis due to an increase in right heart pressures.

Question 14

Undetectable patent foramen ovale probably exists in 25-30% of the population and poses no threat to the health of the flying population with the possible exception of which aerospace medical problem?

a) high -Gy force
b) hyperventilation
c) decompression sickness
d) severe active airsickness

Answer 14

c) Decompression sickness

Question 15

An A-V conduction defect characterized by a progressively increasing PR interval before a QRS complex is dropped could be termed as a(n):

a) Wenckebach phenomenon
b) 2nd degree heart block
c) Mobitz Type I
d) All of the above

Answer 15

d) All of the above

Question 16

Which of the following valvular disorders would likely result in a reduced tolerance to +Gz forces?

a) Aortic insufficiency
b) Mitral stenosis
c) Aortic stenosis
d) Mitral insufficiency

Answer 16

a) Aortic insufficiency

Question 17

Of the following electrical conductive abnormalities of the heart, which would most likely be associated with severe or extensive coronary artery disease and other cardiac disorders?

a) RBBB
b) LBBB
c) 1 degree AV block
d) Mobitz Type I

Answer 17

b) LBBB

Question 18

A the time of physical examination of a young adult male, you detect an apical systolic heart murmur. Further studies confirm your presumptive diagnosis of mild mitral insufficiency. Your advice should include which of the following?

a) Prevention of subacute bacterial endocarditis and recurrent rheumatic fever.
b) Restriction against aviation activities as a pilot due to the potential hemodynamic impairment caused by accelerative forces (G forces).
c) Explanation of the requirements for appropriate medical and administrative following of his condition, but little limitations of his activities.
d) a and c above.

Answer 18

d) A and C above.

Question 19

Functional cardiac murmurs are often heard at the time of physical examination for flying. As a general rule:

a) low intensity systolic murmurs, which can be heart only in the left lateral position over the base of the heart, may be considered physiologic.
b) the occurrence of a low grade diastolic murmur after exercise should be considered physiologic.
c) the occurrence of a low grade systolic murmur after exercise should be considered as secondary to organic heart disease.
d) All of the above.

Answer 19

a) low intensity systolic murmurs, which can be heard only in the left lateral position over the base of the heart, may be considered physiologic.

Question 20

One of the most common electrocardiographic interpretations that must be made in evaluating aircrew members involve nonspecific T-waves changes. These may be indicative of which of the following?

a) Previous myocardial infarctions
b) Failure of the subjects to have properly maintained the fasting basal rate.
c) Anxiety at the time of the electrocardiogram.
d) All of the above.

Answer 20

d) All of the above- Non-specific T wave changes can be caused by eating, smoking, drinking, apprehension, hyperventilation.

Question 21

Cardiac arrhythmias which result in syncope can be catastrophic in the aviation setting. Which of the following can lead to atrial sinus arrest and syncope?

a) positive pressure breathing
b) The M-1 maneuver
c) An attempt to stop hyperventilation by deep breath holding
d) All of the above

Answer 21

d) All of the above

Question 22

The appearance of frequent premature ventricular contractions in an asymptomatic pilot with no previous history of PVC’s:

a) should result in permanent grounding
b) should result in immediate grounding and a search for etiologic factors, including presence of cardiovascular disease.
c) are of no consequence if they occur at a frequency of less than five per minute.
d) are of no consequence as long as they are unifocal.
e) should result in permanent grounding if they are multifocal

Answer 22

b) should result in immediate grounding and a search for etiologic factors, including presence of cardiovascular disease.

Question 23

Meniere’s disease is characterized by:

a) vertigo which lasts a few seconds
b) vertigo which lasts a few days, decreasing in intensity from onset
c) an ill-defined feeling of imbalance
d) vertigo which lasts for hours

Answer 23

d) Vertigo which lasts for hours (1 to 24 hours) with most cases being 3-4 hours.

Question 24

The basic mechanism in the production of vertigo is:

a) stimulation of the semicircular canals
b) sudden imbalance in the vestibular system
c) stimulation of the otolith organs
d) increased inhibition of the vestibular system

Answer 24

b) sudden imbalance in the vestibular system. Can be central or peripheral.

Question 25

The pertinent aeromedical consideration in an airman with Meniere’s disease is the:

a) progressive sensorineural hearing loss
b) recurrent tinnitus which is usually roaring or buzzing and may be quite annoying.
c) recurring feeling of fullness or pressure, frequently with distortion of sounds.
d) possibility of recurring vertigo.

Answer 25

D) Possibility of recurring vertigo

Question 26

Which of the following is NOT correct?

a) It is generally agreed that the semicircular canals respond to angular acceleration but are relatively insensitive to linear acceleration.
b) The difference in specific gravity between the calcite crystals in the otolith membrane and the surrounding medium accounts for the sensitivity of the otolith structure to linear acceleration and to gravity.
c) In the absence of vestibular stimulation there is an absence of neural activity from the nerves leading from the crista of the semicircular canals and from the otolithic endorgans.
d) Electronystagmography is usually based upon amplification of corneoretinal potential.

Answer 26

c) In the absence of vestibular stimulation there is an absence of neural activity from the nerves leading from the crista of the semicircular canals and from the otolithic organs is NOT correct. In the absence of stimulation there is spontaneous activity in the nerves and discrimination occurring between the two ears.

Question 27

During or soon after rapid altitude change, pressure or alternobaric vertigo may occur. Indicate which of the following statements is INCORRECT:

a) Alternobaric vertigo sometimes results from a forceful valsalva maneuver.
b) Upper respiratory infections increase the probability of alternobaric vertigo in aviation.
c) Alternobaric vertigo is often brief in duration.
d) Alternobaric vertigo, though often severe, is rare occurring in very few pilots.

Answer 27

d) Alternobaric vertigo is NOT rare. It is usually severe and self limiting however. But it is not rare.

Question 28

A smooth, usually rounded, soft-tissue density demonstrated radiographically in a frontal sinus in which pain was experienced during descent in an aircraft is most likely:

a) mucocele
b) submucosal hematoma
c) polyp
d) pneumatocele
e) osteoma

Answer 28

b) submucosal hematoma

Question 29

An acoustic neuroma should always be suspected in a patient with:

a) recurring episodes of vertigo
b) history of noise intolerance
c) feeling of fullness in one ear
d) unilateral high-tone hearing loss

Answer 29

d) unilateral high-tone (sensorineural) hearing loss

Question 30

Which of the following suggests a central etiology for vertigo?

a) Spontaneous horizontal nystagmus that is suppressed by visual fixation (not seen when the patient’s eyes are open)
b) Nausea and vomiting with the attack of vertigo
c) Loss of consciousness associated with the attack of vertigo
d) Hearing loss and tinnitus with the attack of vertigo

Answer 30

c) Loss of consciousness associated with the attack of vertigo. Loss of consciousness with vertigo is ALWAYS associated with the central nervous system lesion.

Question 31

The most common predisposing factor in barotitis media and barosinusitis is:

a) allergic rhinitis
b) chronic sinusitis
c) enlarged adenoids
d) an acute upper respiratory infection

Answer 31

d) An acute upper respiratory infection

Question 32

The otolith organs respond to:

a) angular velocity
b) linear acceleration and gravity
c) angular acceleration
d) linear velocity

Answer 32

b) linear acceleration and gravity

Question 33

In an aircrewman develops a “sinus block”, the most effective management which can be initiated immediately is:

a) immediate descent and checking with the flight surgeon
b) performance of a valsalva maneuver
c) re-ascend until air pressure in the nose and sinus cavity is equilized
d) spray the nose with a vasoconstrictor

Answer 33

c) This occurs on descent. So re-ascend until air pressure in the nose and sinus cavity is equalized, then use nasal vasoconstrictor and attempt to descend slowly.

Question 34

The most reliable finding in an acute diffuse otitis externa is:

a) drainage from the external ear canal
b) a conductive hearing loss
c) fullness in the ear
d) pain on pinna traction and tragus pressure

Answer 34

d) pain on pinna traction and tragus pressure

Question 35

If an aircrewman has a stapedectomy for otosclerotic conductive hearing loss, the pertinent aeromedical consideration is:

a) possibility of the prosthesis becoming dislodged with sudden increase in hearing loss in that ear.
b) exacerbation of hearing loss in the ear secondary to the surgical procedure.
c) the probability of re-fixation and loss of the improvement in hearing.
d) increased vulnerability to barometric pressure changes with increased risk of formation of perilymph fistula.
e) possibility of contamination of the inner ear at time of surgery with development of bacterial labyrinthitis.

Answer 35

d) Increased vulnerability to barometric pressure changes with increased risk of formation of perilymph fistula.

Question 36

Acute frontal or maxillary sinusitis is most strongly suggested by:

a) purulent material in the nasal cavity
b) failure of a sinus to transilluminate
c) headache
d) pain in and tenderness over the involved sinus

Answer 36

d) pain in and tenderness over the involved sinus

Question 37

The most commonly involved sinus with barosinusitis is?

a) Ethmoid
b) Maxillary
c) Sphenoid
d) Frontal

Answer 37

d) Frontal. Maxillary is the next most common.

Question 38

You are called to see a patient who described a sudden onset of vertigo following a forceful Valsalva maneuver while ascending in an aircraft. He states that the vertigo only lasted between 30 and 60 seconds. It was also evident on examination that the patient had an acute upper respiratory infection. Your provisional diagnosis would be:

a) benign positional vertigo
b) toxic labyrinthitis
c) viral labyrinthitis
d) alternobaric vertigo

Answer 38

d) Alternobaric vertigo

Question 39

The appearance of the ear in barotitis media may be characterized by:

a) tympanum with ruptured vessels
b) fluid in the middle ear
c) retraction of the tympanum
d) all of the above

Answer 39

d) All of the above

Question 40

A student pilot presents with bilateral ear pain and injected and retracted tympanic membranes several hours following an uneventful hypobaric chamber flight to FL 350 which was preceded by thirty minutes of denitrogenation. Oxygen regulators were set to “100%” oxygen until passing through 10,000 feet on descent. The most likely problem is:

a) barotrauma induced during descent and delayed reporting by the student
b) inflammatory otitis media
c) oxygen absorption barotitis media
d) nitrogen deficiency barotitis media

Answer 40

c) oxygen absorption barotisis media. The onset is typically 2 hours or more after flight in which 100% oxygen was supplied. The oxygen is absorbed by the vascular space in the middle ear and a mild edema forms which can create a negative pressure if the ear is not ventilated during this time.

Question 41

The management of choice in most uncomplicated acute suppurative sinusitis is:

a) early surgical intervention followed by appropriate antibiotics
b) analgesics, antihistamines, and early surgical intervention
c) appropriate antibiotics for 24 hours followed by surgical intervention even though complications of infection are not present or pending.
d) antihistamines and humidification only.
e) appropriate antibiotics, topical and systemic decongestants when indicated, and appropriate analgesics.

Answer 41

e) appropriate antibiotics, topical and systemic decongestants when indicated, and appropriate analgesics.

Question 42

The ideal length of treatment with antibiotics for acute bacterial sinusitis is:

a) 3-5 days
b) 3 weeks
c) 7-10 days
d) 6 weeks
e) 2 weeks after the symptoms have disappeared.

Answer 42

c) 7-10 days

Question 43

Which preparation affords the greatest protection from the allergic event when used just prior to exposure to the allergen?

a) cromolyn
b) astemizole
c) phenylpropanolamine
d) beclomethasone
e) flunisolide

Answer 43

a) Cromolyn blocks the degranulation of sensitized mast cells in the nose.

Question 44

The medical treatment proven to be most effective for acute otitis media is:

a) mucolytics
b) antimicrobials
c) steroids
d) antihistamines
e) decongestants

Answer 44

b) antimicrobials

Question 45

Sinus and middle ear blocks are recognized sequelae of flight in some pilots and patients. Block occurs during which phase of flight?

a) ascent
b) descent
c) level flight
d) none of the above

Answer 45

b) descent

Question 46

Sinus and/or ear block occurring during flight are best treated by the following:

a) ascending, local decongestant, and systemic decongestant
b) ascending and local decongestant
c) descending, local decongestant and systemic decongestant
d) descending, local decongestant

Answer 46

b) ascent and local decongestant. Ascent alone may reverse the sinus block. Local decongestants such as oxymethazoline (Afrin) will act to open the sinus ostia and/or eustachian tube to help relieve the block.

Question 47

Nystagmus is frequently assessed in diagnosing vertigo and/or motion sickness. Where does nystagmus originate?

a) end organ (labyrinth)
b) central (brain)
c) both end organ and/or brain
d) neither

Answer 47

c) Nystagmus can originate either in the end organ and/or the brain

Question 48

Maximal protection from aircraft noise is achieved with the use of:

a) ear protection muffs
b) ear protection inserts (plugs)
c) both muffs and plugs
d) sedation

Answer 48

c) both muffs and plugs. Both together are more effective than singularly.

Question 49

With a unilateral conductive hearing loss, the Weber test lateralizes to:

a) neither ear (midline)
b) ear with the conductive loss
c) ear without the conductive loss
d) ear with the sensorineural loss
e) ear without the sensorineural loss

Answer 49

b) ear with the conductive hearing loss.

Question 50

Tympanometry provides diagnostic information about the function of the:

a) stapedius muscle
b) tympanic membrane and middle ear
c) cochlea
d) brainstem
e) tensor tympani muscle

Answer 50

b) tympanic membrane and middle ear

The stapedius muscle is tested with acoustic reflex.

Question 51

Noise induced hearing loss occurs most prominently at what frequency?

a) 1000 Hz
b) 2000 Hz
c) 3000 Hz
d) 4000 Hz
e) 5000 Hz

Answer 51

d) 4000 Hz - This is due to the resonance frequency of the external canal.

Question 52

During descent in flight, the eustachian tube is open by which mechanisms?

a) passive forced opening due to increasing middle ear positive pressure
b) passive forced opening due to increasing middle ear negative pressure
c) passive forced opening due to increasing ambient positive pressure
d) passive forced opening due to increasing ambient negative pressure
e) contraction of the tensor veli palatini muscle during swallowing

Answer 52

e) Valsalva or swallowing causes contraction of the veli palatini muscle which opens the eustachian tube.

Question 53

In the performance of the threshold tone decay test, the subject is presented with a sustained pure tone at his/her threshold level. He signals with a raised finger as long as the tone is heard. If the tone becomes inaudible (decays) before one minute, the intensity is increased. The procedure is continued until the tone is heard for one entire minute. A person with normal hearing continues to hear the tone for a full 60 seconds. Significant tone decay requiring increases of 20 to 50 or 60 db before the tone is heard for a full minute in the high frequencies is seen in what anomaly?

a) psychogenic hearing loss
b) hearing loss due to cochlear nerve involvement
c) Meniere’s disease
d) b and c
e) eighth nerve tumors

Answer 53

d) Both b (hearing loss due to cochlear nerve involvement) and c (meniere’s disease).

Question 54

The bone conduction (BC) audiogram, or pure tone bone conduction threshold test, is usually compared to the pure tone air conduction (AC) threshold test which is helpful in determining:

a) the amount of masking necessary
b) the amount of conductive deficit through the difference between the two tests
c) the presence or absence of a middle ear
d) that there is no conductive hearing loss if the AC and BC are equal
e) all of the above

Answer 54

E) all of the above.

Question 55

A rupture of the eardrum may actually occur at a decibel level above:

a) 160
b) 120
c) 90
d) 50
e) 30

Answer 55

a) 160 db

Question 56

In the normal young human, the range of audible frequencies extends from about 20 to about 20,000 Hz. The most sensitive region and the band most important for understanding speech is:

a) 125 to 1,000 Hz
b) 250 to 8,000 Hz
c) 300 to 6,000 Hz
d) 500 to 4,000 Hz

Answer 56

d) 500 to 4,000 Hz

Question 57

Overexposure to continuous noise results in a slowly progressing loss in acuity. This is the typically a high frequency loss and is actually observed first between 2000 and 6000 Hz with the greatest decrease at 4000 Hz. This noise induced hearing loss is described as:

a) Conductive
b) Sensorineural
c) mechanical
d) presbycusis

Answer 57

b) Sensorineural hearing loss results from overexposure to continuous noise. It is usually imperceptible by the individual early and is picked up on monitoring audiometry. The greatest decrease is usually at 4000 Hz.

Question 58

In performing speech audiometry, phonetically balanced (PB) words of one syllable are presented to the patient. All words are familiar –an, yard, carve, us, day, toe, stone, hunt and ran– and are presented through earphones at 30db above speech reception threshold. Failure to repeat the words, and thus failure of the test, indicates that he or she is most likely to have the hearing loss due to:

a) central nervous system disease
b) cochlear disease
c) middle ear disease
d) external ear disease

Answer 58

b) Cochlear disease (inner ear). A person with normal hearing will hear and correctly repeat 95 to 100% of the words. A person with inner ear (cochlear) hearing loss will fail to achieve a passing score, no matter how loud the words are presented. Such a patient is said to have poor discrimination ability and may not be able to use a hearing aid satisfactorily. In contrast a patient with conductive hearing loss merely needs amplification of the sound to due well on the test.

Question 59

For practical purposes, a person begins to be socially incapacitated when his hearing loss in both ears approaches or exceeds:

a) 40 db in speech frequencies (300-4000 cycles).
b) 20 db in speech frequencies (300-4000 cycles).
c) 100 db in speech frequencies (300-4000 cycles).
d) 60 db in speech frequencies (300-4000 cycles).

Answer 59

a) 40 db in speech frequencies (300-4000 cycles).

Question 60

It is recognized that prolonged exposure to noise above ______ decibels in intensity will impair hearing, the degree of injury depending upon the duration of exposure.

Answer 60

85-90 db. Exposure to noise levels above 85-90 db for prolonged periods causes cochlear damage. 4000 Hz is the area or frequency most often affected first, followed by extension to higher and lower frequencies later.

Question 61

If one is measuring sound from two different sources in a given area, and if one sound source produces 100 db when operating itself and the second source also produces 100 db when operating, it would be expected that the total noise level would be:

a) 200 db
b) 150 db
c) 125 db
d) 110 db
e) 103 db

Answer 61

e) 103 db. The 3 decibels are added to the loudest levels when both sources are operating simultaenously.

Question 62

Two small muscles in the middle ear, the tympani and the stapedius, that are attached to the ossicles of the middle ear which connect the eardrum with the cochlea, mediate the aural reflex and thereby play a role in audition, especially when noise is present. This aural reflex seems to be most readily activated and maintained by:

a) sounds which are intense and prolonged.
b) sounds which are intermittent and impulsive.
c) voluntary control by the average person.
d) pure tones of lower frequencies.

Answer 62

b) sounds which are intermittent and impulsive. The aural reflex seems to be most readily activated and maintained by intermittent intense impulses of noise. The reflex is involuntary and occurrence is not detected by the average person.

Question 63

The mechanism of the ear for converting the sound pressure waves from an air to a fluid medium without significant loss of energy is called impedance matching and this is done through:

a) rapid fatigue of the auditory nerves.
b) movement of the otoliths in the cochlear canals.
c) size differential between the eardrum and the footplate of the stapes and the lever action of the ossicles.
d) the property of binaural hearing and that sound waves do not strike the ears at the same intensity.

Answer 63

c) size of the differential between the eardrum and the footplate of the stapes and the lever action of the ossicles. Only 1% of airborne sound enters the liquid medium whereas 99% is reflected away. The middle ear has two arrangements to narrow this potential energy loss. The first is the size differential between the eardrum and the footplate of the stapes. The second is the lever action of the ossicles that act to intensify the sound as it traverses the middle ear.

Question 64

Loudness is a subjective awareness of sound as contrasted to sound intensity. Even if a sound is made 20 db more intense, it may be no louder if the patient still cannot hear it. An abnormally rapid increase in loudness is termed:

a) amplification
b) recruitment
c) shadow curve
d) diplacusis

Answer 64

b) Recruitment

Question 65

When a patient is presented with an intense sound to a unilateral dead ear through earphones and then the sound travels across his head to his normal ear and is reported as being heard is an example of what?

Answer 65

Shadow Curve

Question 66

An engine technician has been exposed for years to high noise levels. You will most likely find that he presents with:

a) low frequency hearing loss
b) otosclerosis
c) conductive hearing loss
d) high frequency hearing loss

Answer 66

d) high frequency hearing loss

Question 67

A 44 year old male pilot presents for his periodic aircrew medical assessment. He says he feels in good health, but he admits to a mild smoker’s cough. He gets little exercise and he is overweight (225 lbs) and has gained 10 lbs since his last medical. His nephew (sister’s son) developed insulin-dependent diabetes at age 14, but there is no other family history of diabetes. Apart from his obesity, the only finding of concern on your examination is a borderline elevation in blood pressure at 145/90. His fasting plasma glucose is 135mg/dl, his fasting cholesterol is 270, HDL of 31, and triglycerides of 225. You arrange an oral glucose tolerance test which shows a fasting plasma glucose of 120 mg/dl and two hour of 180 mg/dl. This pilot shows evidence of:

a) Type I diabetes mellitus
b) secondary diabetes
c) impaired glucose tolerance
d) Type II diabetes
e) gestational diabetes

Answer 67

c. Impaired glucose tolerance

The criteria for diagnosis are below:
Normal = Fasting less than 100, 2 hour less than 140
Impaired Glucose Tolerance = Fasting 100-125, 2 hour 140-199
Diabetes = Fasting > 126, 2 hour greater than 200

Question 68

A patient with impaired glucose tolerance is at increased risk for:

a) diabetic retinopathy
b) diabetic nephropathy
c) diabetic neuropathy
d) coronary heart disease
e) Type I diabetes

Answer 68

d) coronary heart disease

Impaired glucose tolerance is a potent risk factor for coronary heart disease, but is not associated with the microvascular, renal, or neurologic complications associated with Type I or Type II diabetes.

Question 69

The most serious aeromedical concern in this pilot with elevated cholesterol, triglycerides and glucose intolerance in the increased risk for:

a) an hypoglycemic episode
b) acute pancreatitis
c) a cerebrovascular accident
d) a coronary event
e) renal colic

Answer 69

d) Coronary Event

Question 70

The most important additional screening exam on a pilot with glucose intolerance and multiple cardiac risk factors is:

a) a glycosylated hemoglobin level
b) islet cell antibody levels
c) an exercise stress test
d) a coronary angiogram
e) carotid doppler examination

Answer 70

C) An exercise stress test

Question 71

A 25 year old male is applying for employment as a pilot with your organization. He has an identical twin brother who developed insulin dependent diabetes at age 18. You are concerned about the risk of diabetes in your candidate. What is the best screening test to rule out the likelihood of diabetes occurring in this young man?

a) a fasting plasma glucose
b) an oral glucose tolerance test
c) a serum C-peptide level
d) a serum insulin level
e) islet cell antibodies

Answer 71

e) Islet cell antibodies

Question 72

You see a 33 year old female Air Traffic Controller for a period medical. She complains of feeling tired. She has put on 5 pounds since her last medical a year ago, and complains that her periods have been irregular, and of constipation. What would be the most appropriate screening test to order to investigate her symptoms?

a) a serum thyroxine (T4)
b) a free thyroxine index (Ft4)
c) a thyroid stimulating hormone level (TSH)
d) anti-thyroid antibody levels
e) a thyroid screening battery

Answer 72

c) a thyroid stimulating hormone (TSH)

Question 73

Primary gout is a hereditable metabolic disease in which hyperuricemia is usually due to overproduction or under-excretion of uric acid (or sometimes both). Rarely, it is due to a specifically determined genetic aberration (eg- Lesch nyhan syndrome). Which of the following may cause secondary gout?

a) Myeloproliferative disorders
b) multiple myeloma
c) hemoglobinopathies
d) chronic renal disease
e) thiazide diuretics
f) lead poisoning

Answer 73

All the above

Question 74

Diabetes mellitus may produce a number of ocular changes. Identify the one condition listed below which is generally NOT associated with this disease.

a) Cataract
b) Adie’s Pupil (pupillotonia)
c) Retinal Hemorrhages
d) Refractive changes
e) Extraocular muscle paralysis

Answer 74

b) Adies Pupil. Adie’s pupil is a larger than normal pupil that responds minimally, if at all to light, but constricts slowly and tonically to a near stimulus accomodation. It is most likely from a toxin, injury, or infection that has damaged the ciliary ganglion.
In diabetes, early cataract, retinal hemorrhages, extraocular muscle paralysis, and exudates are all seen. Sudden shifts in blood sugar can cause marked changes in reflactive power.

Question 75

You are a flight surgeon. During a routine flight physical exam you observe the weight of a pilot to be 175 Ibs, and his height is 69 inches. What is a quick formula to determine if he is overweight?

Answer 75

106 pounds for the first 5 feet, then add six pounds for each additional inch. For females add five pounds for each additional inch over 5 feet.

Question 76

One important reason why functional hypoglycemia is of aeromedical significance is:

a) it can cause loss of consciousness
b) it can cause a decreased G tolerance
c) it can cause convulsions
d) it can result from skipped meals
e) it may indicate early diabetes mellitus

Answer 76

b) it can cause a decreased G tolerance. There is evidence that hypoglycemia and acceleration are additive and will cause a loss of consciousness.

Question 77

A 27 year old pilot presents at your office with a history of black tarry stools for the last two days. He is asymptomatic, has a normal physical exam, and a hematocrit of 42%. He gives a history of attending a party three days ago at which he drank excessively, resulting in one episode of vomiting clear fluid. The only other symptoms were associated with his hangover the next day which responded to aspirin. The most likely diagnosis is:

a) acute erosive gastritis
b) peptic ulcer disease
c) Mallory Weiss Tear
d) pancreatitis
e) Meckel’s diverticulum

Answer 77

a) Acute erosive gastritis. Between the alcohol and the aspirin, he has caused an erosive gastritis. Although mallory weiss could have occurred with the vomiting, it was not a protracted or forceful episode and had only clear fluid associated.

Question 78

The leading cause of GI inflight incapacitation in aircrew has been cited as:

a) GI bleed
b) erosive gastritis due to excessive alcohol intake
c) peptic ulcer disease
d) gastroenteritis
e) hiatal hernia with reflux

Answer 78

d) gastroenteritis.

Question 79

Male pilots of high performance aircraft (fighters) have been found to have an altered sex ratio of offspring (reproduced in 3 US and 1 European study), with 40% male and 60% female children. The mechanism for this finding is _______.

a) exposure to non ionizing radiation
b) exposure to high Gz
c) exposure to high oxygen concentrations
d) life style induced
e) unknown

Answer 79

e) unknown

Question 80

Prostate cancer is the number one cancer in American males; over 220,000 men were diagnosed with prostate cancer in 2003. Only patients who have undergone ______ therapy should be considered for waiver for returning to flight status.

a) radical prostatectomy
b) external beam radiation therapy
c) brachytherapy
d) watchful waiting
e) All of the above

Answer 80

e) all of the above.

Question 81

Kidney stones (nephrolithiasis) are a relatively common cause of incapacitating pain, and a cause for many trips to emergency departments in America. Because of the potential for sudden inflight incapacitation, pilots with kidney stones are disqualified from aviation service by both military and civilian regulations. The most appropriate disposition should be:

a) no waivers, they must never fly again
b) They must have no calcifications overlying the kidney on a KUB to be considered.
c) To obtain a waiver, they should have documentation (IVP, spiral CT, or ureteroscopy) demonstrating no stones in the collecting system.
d) If a metabolic working demonstrates no systemic conditions which caused the original stones to occur, the waiver is granted automatically.
e) To obtain a waiver, they must be free of recurrent stones for five years.

Answer 81

c) To obtain a waiver, there should be documentation showing no current stones in the collecting system, but a metabolic panel and workup of the stone type should also be pursued.

Question 82

Testicular cancer is of aeromedical significance because it is common and occurs primarily in the pilot age group; the peak age of occurrence is ____________. The decision to give a waiver should be based on the fact that progression occurs first in the central nervous system _________.

a) 20-50, very commonly
b) 20-35, very commonly
c) 20-35, very rarely
d) 20-50 very rarely
e) 35-50, about half the time

Answer 82

c) 20-35, very rarely.

Question 83

A 31 year old pilot complains of severe left abdominal pain for which an IVP was ordered to rule out a renal stone. Although no renal stone was found, it was observed that the patient had polycystic kidney disease. His symptoms rapidly remitted and were attributed to gastroenteritis. In a pilot with this diagnosis, what would be a reasonable aeromedical disposition and why?

a) Allow him to continue flying because polycystic kidney disease can remain quiescent for many years.
b) Allow him to continue flying because polycystic kidney disease is only an anatomic variation which causes no symptoms.
c) Remove from flying status since most patients with polycystic disease will develop progressive renal failure within 12-18 months of discovery.
d) Remove from flight status because 20-25% of these patients will development malignant hypertension with a rapid rate of onset.

Answer 83

a) Allow him to continue flying. However, this patient is under age 40 and was otherwise asymptomatic. This was an incidental finding. He will need a workup for proteinuria and BP checks. He will have strict following of his renal status and blood pressure. There is also a 20% incidence of SAH in polycystic kidney disease patients. So care an concern for aneurysm should be taken if the pilot has headaches.

Question 84

On reviewing the lab results after doing a routine physical exam on a young, healthy pilot, you notice that there are 5-7 hyaline casts per low power field in the urinary sediment. The history is completely negative except that your patient tells you that he jogged six miles one hour before he gave his urine sample. Your action is to:

a) hospitalize the patient immediately
b) request BUN, creatinine, and IVP stat
c) tell the patient to avoid excessive strenuous exercise
d) tell the patient to stop heavy physical exercise for a week and examine the urinary sediment at that time

Answer 84

d) the heavy hyaline casts can be from heavy exercise and bombardment of the kidney with proteins. Have the patient refrain from heavy exercise for a week, drink plenty of fluids, and repeat the test.

Question 85

A 26 year old male pilot has just completed his periodic long physical examination. In reviewing his laboratory data, you find that his urinalysis shows 7-10 rbc’s/hpf. He denies both any current genitourinary symptoms and any past urological conditions. What is your next diagnostic step?

a) Repeat the routine urinalysis (with microscopic) one more time for confirmation?
b) Repeat the routine urinalysis (with microscopic) two more times to show whether or not it is a persistent finding of “asymptomatic” microscopic hematuria.
c) Perform an intravenous pyelogram
d) Refer immediately to your local urologist?

Answer 85

b) Repeat the urinalysis with micro several times to see if there is consistent microscopic hematuria.

Question 86

After seeing a pilot of painless hematuria. You repeat the urinalysis with micro two more times to see if there is consistent hematuria. The next two urinalyses show 4-6 RBC and 5-8 RBC/hpf respectively. What is your next diagnostic step?

a) perform an intravenous pyelogram to screen for possible urolithiasis
b) perform three urine cytologies to screen for urothelial cancer
c) Request the urologist to perform a transrectal ultrasound as you are suspicious of an occult prostate lesion.
d) Refer to the urologist so that he can continue the diagnostic workup.

Answer 86

a) Perform an IVP looking for occult stones. Although I would also perform an urine cytology looking for abnormal cells simultaneously.

Question 87

A 35 year old navigator sees you Monday morning on Sick Call with complaints of temperatures up to 104 degrees, chills, dysuria, frequency, dark urine, and lower abdominal and low back discomfort. He has had three previous episodes over the past ten years, each requiring hospitalization and treatment. On reviewing his records, urine cultures were done on two of the occasions, each with E coli. The third occasion was when he was deployed on an exercise and was treated in a “field” situation. On gentle examination, his prostate is very tender. Your working diagnosis is:

a) acute febrile bacterial prostato-cystitis
b) acute gonorrhea
c) acute gastroenteritis
d) chronic bacterial prostatitis
e) A and D

Answer 87

e) A and D. He has acute on top of chronic prostatitis. A full sexual history is necessary. E. Coli in a young pilot on numerous occasions begs several questions about his sexual history.

Question 88

Your next step on a navigator seen with a 104 temp, chills, dark urine, back pain and tender prostate is:

a) just begin treatment with a urinary antiseptic
b) do a prostate massage to obtain secretions for analysis and culture
c) obtain an immediate UA with micro and urine culture and sensitivity with colony count. Start intravenous antibiotics.
d) urgent referral to a urologist
e) C and D

Answer 88

e) C and D

Question 89

A 24 year old female pilot comes to your office complaining of four similar episodes during the past four months characterized by dysuria q 2 hours, nocturia 2 times a night, urgency, mild dysuria, and feeling of incomplete emptying upon voiding. She denies any discoloration of the urine or any unusual odor. She denies any associated fever or chills. The past episodes have sponatenously resolved with a few days with an increase in water intake. She is having an episode currently. She has never had any prior evaluation. Your differential diagnosis assuming that this is urological in origin, is:

a) female urethral syndrome vs renal calculi
b) female urethral syndrome vs vesical diverticulum
c) recurrent bacterial cystitis vs renal calculi
d) female urethral syndrome vs recurrent bacterial cystitis

Answer 89

d) female urethral syndrome vs bacterial cystitis

Question 90

You are seeing a 41 year old black loadmaster for his periodic short physical examination. He tells you that his father (70) recently died of cancer of the prostate and his older brother is undergoing an evaluation for prostate disease. He denies any voiding difficulties. You should do:

a) a digital rectal exam alone
b) a PSA test alone
c) counsel the patient regarding options a and b and offer both of them.
d) defer any evaluation until his next long fly physical examination
e) send a consultation to your local urologist.

Answer 90

c) Counsel and offer both digital rectal exam and PSA.

Question 91

The load master with a family history of prostate cancer has a PSA which comes back at 3.8 mg/ml and a normal rectal exam. Your next step is:

a) repeat the same evaluation at his next examination
b) disregard the PSA since the digital rectal was normal
c) refer him to the local urologist as an urgent consultation for possible prostate cancer.
d) Repeat the PSA at 3 and 6 months. If the PSA is increasing, refer to a urologist.

Answer 91

d) Repeat at 3 and 6 months and look for a rate of rise.

Question 92

Pernicious anemia is a chronic anemia cause by a defect in the production of “intrinsic factor” in the gastric mucosa. This defect, of unknown etiology, results in the failure of the utilization of B12, producing a megaloblastic erythropoiesis. Which this disease can occur at virtually any age, its greatest incidence is seen in the middle age and above. While several clinical conditions may be associated with the disease such as fatigue, dyspnea, and syncope, which of the following groups of laboratory findings would most characterize pernicious anemia?

a) Macrocytosis, elevated serum iron, depressed total iron binding capacity, increased gastric pH, pancytopenia, and elevated MCH.
b) Microcytic hypochromic anemia, elevated serum iron, elevated serum iron binding capacity, increased gastric pH (greater than 6), hypersegmented neutrophils, and elevated MCH.
c) Macrocytic anemia, depressed serum iron, depressed serum iron binding capacity, achlorhydria, leukopenia, and decreased MCH.
d) Macrocytosis, elevated serum iron, depressed total iron binding capacity, lowered gastic pH (less than 5), neutropenia, and decreased MCH.

Answer 92

a) macrocytosis, pancytopenia, elevated serum iron (can’t be taken up and utilized) depressed total iron binding capacity, increased gastric pH and elevated MCH.

Question 93

Hereditary spherocytosis is a hemolytic anemia that is probably inherited as a Mendelian dominant factor. While several other factors, such as chronic anemia, may draw attention to the condition, which of the following is also considered one of the most common first signs or symptoms?

a) Basophilic stipling
b) Hypochromic anemia
c) Cholelithiasis
d) Achlorhydria

Answer 93

c) Cholelithiasis. Found in over 50% of those over 10 years of age with hereditary spherocytosis.

Basophilic stipling is seen in exposure to lead or other metals. Pernicious anemia is the anemia most closely associated with achlorhydria.

Question 94

Classifying anemias on the basis of morphology can, with other findings, be a valuable aid in determining the etiology. In which of the following disorders would one expect to find classification of microcytic hypochromatic anemia?

a) Pernicious anemia
b) Iron deficiency anemia
c) Liver disease and obstructive jaundice
d) Acute blood loss

Answer 94

b) Iron deficiency anemia. The Microcytosis and hypochromia that occurs in Iron Deficiency Anemia is due to increased cell division that is compensatory for the lowered iron stores and maturation defects. The insufficient iron for heme synthesis results in hypochromia.

Pernicious anemia and those associated with liver disease and obstructive jaundice are usually classified as megaloblastic anemia.

Acute blood loss, the cells have not had time to respond so the anemia is normochromic and normocytic.

Question 95

On routine periodic physical examination a 30 year old pilot was noted to have a hemoglobin of 13. He stated he has been on a self prescribed diet for six months in order to lose weight. Further studies revealed very small hypochromic red cells, negative stool guaiac, normal serum iron and total iron binding capacity, and increased reticulocytes. Hemoglobin electrophoresis revealed 92% HbA, 4% HbA2, and 4% HbF. What is the most likely diagnosis and appropriate aeromedical disposition?

a) Early nutritional iron deficiency anemia. Prescribe iron and allow continuation of flying duties.
b) A diagnosis cannot be made. Continue with the workup in search of a possible bleeding site. Order UGI series, barium enema, IVP, and bone marrow. In the meanwhile, restrict from flying duties.
c) Thalassemia minor. No medication is required and pilot can continue flying.
d) Thalassemia minor. Prescribe iron and follow patient quarterly. Although the pilot could continue to fly, he will eventually have to terminate his career because of progressive decrease in hemoglobin or other complication.

Answer 95

c) Thalassemia minor. This disorder causes a mild hypochromic microcytic anemia with slightly increased amounts of HbA and HbF. On the other hand, iron deficiency anemia causes a decreased serum iron and an increased total iron binding capacity. Patients with Thalassemia minor require no treatment and usually have normal lives. As long as the anemia is mild, there is no reason this pilot can’t continue to fly.

Question 96

An airman presents to you with a history of Stage 1B Hodgkin’s Disease. His diagnosis was made 15 years ago, and he finished therapy 12 years ago. All follow up visits with his oncologist have been positive; he has had no recurrence of the disease. He is apply for a third class medical certificate. You advise him that:

a) He does not qualify for a third class medical because of the high risk of secondary malignancy in Hodgkin’s patients. Denial is mandatory in all cases and you recommend that he not continue with his physical.
b) He does not qualify for a third class medical because of the diagnosis of Hodgkin’s disease. However, once he has reached the 20 year anniversary of the completion of his therapy, he would be eligible for a waiver.
c) He does not qualify for a third class medical because of the diagnosis of Hodgkin’s disease. However, since he has had no recurrences, the FAA might consider a waiver at this time.
d) He does qualify for a third class medical and you can issue this to him at this time of his visit if he can prove he has been disease free for 10 years.
e) He does qualify for a third class medical and no further evaluation or documentation is required.

Answer 96

c) Hodgkin’s disease is listed as a condition that warrants denial or deferral to the Aeromedical Certification Division. However, all defects are subject to further FAA considerations. There is a concern about secondary malignancies in these patients, but as long as his follow up visits have shown no recurrence, he is a good candidate for a waiver.

Question 97

Assuming that an ill or injured patient with a normal hemoglobin being transported by air should have supplementary oxygen when the cabin altitude exceeds 6000 feet, at what cabin altitude would supplementary oxygen be desirable if the patient has a chronic anemia of 10 grams hemoglobin and no other condition indicating increased oxygen need?

a) Sea level
b) 2000 feet
c) 4000 feet
d) 6000 feet

Answer 97

b) 2,000 feet. Having a 10 gram hemoglobin, chronically reached, is equivalent to 4,000 ft, so the patient would be at the equivalent of 6,000 feet when the cabin altitude was 2,000 feet. If the same level of anemia had been acutely reached (trauma, GI bleed) the altitude equivalent would be 6,000 feet and supplementary oxygen would be required at sea level.

Question 98

Infection with the Human Immunodeficiency Virus is:

a) disqualifying for any class of FAA airman medical certificate
b) disqualifying only for Class 1 medical certificates
c) disqualifying only for Class 2 and 3 medical certificates
d) only disqualifying if AIDS has been diagnosed, or the airman is taking antiviral medications for the condition.
e) not an issue in civil aviation because the FAA has not established a policy reference this infection and aeromedical certification.

Answer 98

d) HIV seropositivity alone is not disqualifying, but AIDS and use of antiviral medications, including protease inhibitors, is disqualifying for all classes of certification. The current policy of the FAA’s Office of Aviation Medicine permits pilots to obtain special issuance of any class of medical certificate provided the HIV + airman has not been diagnosed with AIDS or is asymptomatic, is treated by a physician with experience in HIV, and is on FDA approved antiviral medications, and has a viral load less than 1000 copies/ml and has no evidence of cognitive impairment.

Question 99

With respect to organ transplantation and civil aeromedical certification:

a) Any type of organ transplant is permanently disqualifying for all classes of Federal Aviation Administration airman medical certificate.
b) Select pilots may be medically certified by the FAA for all classes of medical certificates after undergoing organ transplantation.
c) the only transplant patients currently being medically certified by the FAA are kidney recipients, and only for Class 3 medical certificates.
d) The primary reason against medical certification of pilots is the significant side effects of the anti-rejection medications.
e) Cardiac transplant patients may be medically certified by the FAA after a six month waiting period, providing no complications arise.

Answer 99

b) Select pilots may be issues a special issuance for any class of certificate after an organ transplant provided they have no complications and proper care and documentation is obtained.

Question 100

In the course of their official capacity as an aircraft investigator, an individual has an exposure incident, as defined in the OSHA 1910.1030 (bloodborne pathogens) rule, at an aircraft accident site involving multiple fatalities. Subsequent actions by the employer:

a) Are not needed, because the accident site is under the jurisdiction of the NTSB, and hence exempt from Federal rules.
b) Should be in accordance with the provisions of OSHA 1910.1030
c) Mandates referral of the employee through the Department of Labor’s workman’s compensation process.
d) OSHA 1920.1030 would apply only to the non-Federal investigators at the aircraft site, therefore further actions depend on the individual’s employment status.
e) No further actions are needed because aircrew are HIV and Hep B tested as part of their physical exams; both these conditions would prevent them from flying.

Answer 100

b) Should be in accordance with OSHA 1920.1030

Question 101

A general aviation pilot, Class 3 medical certificate holder, has recently been diagnosed with diabetes. As an aviation medicine specialist, she comes to you for advice with regards to her return to flying as a pilot. You:

a) inform her she can no longer fly because diabetes is disqualifying for any class of pilot medical certificate, and FAA Authorization is not permissible.
b) Inform her she could continue to fly because the FAA is currently certifying diabetics provided diet and exercise are the only means needed to control the disease.
c) Inform her diabetes is disqualifying, she could eventually continue to fly because the FAA is certifying diabetic pilots for Class 3 medical provided they have an unremarkable examination, their diabetes is well controlled with either diet, exercise, and or oral hypoglycemic agents, control has been documented for at least three months, and no averse medical side effects exist.
d) Inform her that diabetes is disqualifying, but she could eventually continue to fly provided she has an unremarkable medical evaluation and no complications of the diabetes exists, her control has been stable at least three months, and no adverse medication side effects exists.
e) Inform her she can continue to fly, and that any type of hypoglycemic medication is acceptable to the FAA

Answer 101

d) She will get a waiver provided she has an unremarkable examination, and no complications exist. She is well controlled by either diet, exercise, or oral hypoglycemic agents and such control has been documented for three months, and no adverse medication side effects exist.

Question 102

In which of the following disease(s) is the pulse usually elevated out of proportion to the temperature?

a) Gas Gangrene
b) Typhoid
c) Strep
d) TB

Answer 102

a) Gas Gangrene

Question 103

Botulism in humans is characterized by which of the following descriptions?

a) An intoxication caused by ingestion of preformed botulism toxin in contaminated food.
b) An intoxication caused by absorption of botulinum toxin produced in vivo in the interestinal tract of an infant after colonization and multiplication of Clostridium botulinum organisms.
c) An intoxication caused by the elaboration of botulinum toxin in vivo after multiplication of C. botulinum in an infected, traumatized wound.
d) An intoxication caused by botulinum toxin in individuals older than 12 months in which no food or wound source has been implicated.
e) All the above.

Answer 103

e) The CDC now recognizes a clasification of botulism into the four categories, A, B, C, and D.

Question 104

A 24 year old airman was exiting a restaurant with his wife when he was observed to lose consciousness and stiffen his extremities. There was a minor urinary incontinence. He was transported to the hospital, where physical and neurological examinations were normal. What would be your best course of action?

a) Review ER notes and perform CBC, chemistry, ECG, CT brain, EEG.
b) Review ER notes and perform CBC, chemistry, ECG, MRI of brain, EEG.
c) Careful history from the airman and his wife followed by CBC, ECG, and basic chemistry panel. Additional studies as indicated.
d) Review ER history and perform CBC, chemistry, ECG, MRI brain, EEG, and 24 hour holter.
e) History from airman with CBC, chem panel, ECG, CT brain, and EEG.

Answer 104

c) in the history of syncope, patient history and witness history is paramount. History of fever, prodrome, family history of seizures etc, as well as the wife’s history of witnessing tonic-clonic episode, cyanosis, or other manifestions. the CBC, and chem panel is next. ECG looking for SVT or prolonged QT. MRI would be better than CT is suspecting a lesion leading to seizures.

Question 105

A 62 year old commercial pilot flying a short haul turboprop commuter aircraft with multiple stages per day has had three four minute episodes of vertigo in the past month. The spells were not related to position change. By history you are satisfied that he has true vertigo rather than non-specific dizziness. He denies ear pain or fullness, tinnitus, and hearing loss. He does not admit to any symptoms associated with the vertigo such as diploplia, numbness, weakness, or dysarthria. He is lightly overweight and has been treated with dyazide one daily for several years for hypertension. He quit smoking two years ago. Physical and neurological examinations are normal, blood pressure 142/89. Which is the best course to follow?

a) This is probably viral labyrinthitis and therefore a peripheral vestibulopathy. Tell him to stop flying, take meclizine, and return for follow up.
b) Perform a CT brain scan to rule out an acoustic neuroma, stroke, or other intracranial lesion, then have an ENT evaluation with audiometry if symptoms persist after treatment with medicine.
c) This is likely a peripheral vertigo related to the airman’s multiple ascents and descents. You are safe in observing him.
d) This is not likely a vertigo of central origin since has has no diploplia or other brain stem symptoms. You are safe in observing him on meclizine.
e) Obtain an ENT evaluation, audiogram, vestibular testing, MRI brain scan. If all are normal, perform imaging studies of the carotid and vertebral-basilar systems by conventional angiography or magnetic resonance angiography.

Answer 105

e) Vertigo is either of central or peripheral origin. He has no ear pain, drainage, fullness, tinnitus, or hearing loss to suggest peripheral. He also has no diploplia, facial or extremity weakness, or dysarthria to suggest central origin. He does however, have cerebrovascular disease risk factors (age, obesity, hypertension, history of smoking) such that he could be having vertebrobasilar TIA’s. He needs a more aggressive workup to include MRA angiography.

Question 106

A 28 year old airline first officer on a DC-9 has just transferred to your city. He calls you because he has just experienced a generalized tonic-clonic seizure. With careful history (pilot and a witness) you are satisfied that a seizure occurred, not syncope. The airman states he has not been sleeping well due to a recent divorce and blames sleep deprivation for the event. He has had no other symptoms. Physical and neurologic examinations are normal. You should:

a) Obtain an MRI scan and EEG. If they are normal tell him he has epilepsy, place him on medication, and tell him his flying days are over.
b) Obtain a CT scan of the brain, EEG, CBC, chemistry panel, blood alcohol, and drug screening. If all are normal, tell him he has idiopathic epilepsy, that he must take medication, and that his flying days are over.
c) Take a detailed history. If he tells you he had a febrile seizures as an infant, assume you are dealing with recurrence of an old problem. If a CT brain and EEG are normal, treat him and tell him he can no longer fly.
d) Take a detailed history, including information about febrile seizures, past history of seizures or history of remote neurologic insult, drug use, alcohol, sleep habits and psychiatric history with details of divorce. Obtain an MRI brain scan, EEG, CBC, chemistry panel, blood alcohol, and drug screen. If all tests provide no clue, tell him he cannot fly and must be observed with or without medication.
e) If he has had an impressive degree of sleep deprivation and all studies are normal (MRI, EEG, CBC, chem, drug screen, ETOH screen) accept sleep deprivation as the etiology and give him clearance.

Answer 106

d) In early adult onset seizures, trauma, neoplasm, alcohol withdrawal, and other drug withdrawals are the predominant concerns. If history and testing reveals no etiology, you are dealing with an idiopathic isolated seizure. He must be grounded and observed. Sleep deprivation will not cause a seizure in someone with a normal seizure threshold.

Question 107

The following is NOT true about migraine headaches:

a) Migraine is not always unilateral.
b) Migraine often begins in childhood or adolescence, but may begin in later adulthood
c) Ophthalmoplegic migraine may result in unilateral oculomotor (CN3) impairment and mimic an intracranial aneurysm.
d) If the headache is not severe with nausea and vomiting, is not migraine.
e) A migraine lasts hours to several days but status migrainosis may last weeks.

Answer 107

d) Acephalgic migraine has visual disturbances but no headache whatsoever.

Question 108

Which of the following is TRUE about stroke in the young?

a) Stroke is rare below 50 years of age.
b) Atherosclerotic stroke does not occur in young people.
c) Migraine does not result in stroke.
d) Most stroke in the young is ischemic rather than hemorrhagic.
e) Prognosis for stroke in the young is very poor because of young age of onset.

Answer 108

d) Most stroke in the young is ischemic rather than hemorrhagic. Migraine can cause stroke, and accounts for 25% of stroke in young people. Embolic stroke from valve or patent foramen ovale can cause stroke.

Question 109

Which of the following is TRUE about the neurologic implications of hypertension?

a) Hypertension is the most significant potentially reversible risk factor for stoke, exceeding that of the other risk factors including diabetes, hyperlipidemia, obesity, tobacco use, presence of cardiac disease, and family history.
b) Only diastolic hypertension correlates with increased stroke risk.
c) Hypertension raises the risk of cerebral hemorrhage but not that of ischemic stroke.
d) TIA’s are unusual in hypertensive stroke
e) Current attention to hypertension management has not impacted stroke incidence.

Answer 109

a) Hypertension may increase the risk of stroke six fold.

Question 110

The magnitude (slow phase velocity) of the electronystagmographic response to a given caloric stimulus is influenced by all EXCEPT one of the following:

a) the size and straightness of the external auditory canal
b) a visible but small light source
c) the direction of endolymph displacement in a normal ear.
d) position of the plane of the lateral semicircular canals relative to gravity
e) in corneoretinal potential during the first 15 minutes of dark adaptation

Answer 110

c) the direction of endolymph displacement in a normal ear

Question 111

If a pilot sustains head injury and loss of consciousness, the flight surgeon, when deciding aeromedical disposition of the patient, should rule out post-traumatic syndrome. This syndrome is best described as:

a) a symptom complex of headaches, poor mentation, personality changes, dizziness or anxiety.
b) recurring psychotic episodes
c) recurring seizures
d) periodic paralysis secondary to hypokalemia

Answer 111

a) symptom complex observed either immediately after or sometimes weeks after a head injury. Headaches, poor mentation, personality changes, dizziness, anxiety are manifestations.

Question 112

The recording of an abnormal electroencephalogram is an asymptomatic flyer or candidate for flying training poses a difficult problem of judgment in the individual case. Baseline EEG is currently required by the US Navy and certain commercial airlines. Those showing spike waves or focal spikes (Mayo Grade III EEG) are usually disqualified from flying duties. What is the approximate risk that such a case will develop an overt seizure disorder within 10 years?

a) 15%
b) 2%
c) 30%
d) 5%
e) 20%

Answer 112

d) 5%

Question 113

An inflight recorder has documented difficulties encountered by a pilot who attempted to land his aircraft while blinded by scintillating scotoma, clearly showing the risk of this symptom to flying safety. It is most closely associated with which type of headache disorder?

a) cluster headache
b) headache associated with frontal sinusitis
c) common migraine
d) Tension headache
e) Classic Migraine

Answer 113

e) Classic Migraine- Classic migraine occurs in about 10% of people and is characterized by sharply defined, contralateral neurologic manifestations, usually of a visual nature. By contrast in common migraine, where nausea and malaise are more common and not the visual or contralateral neurologic manifestations.

Question 114

What is the single most serious possible effect of a closed head injury from the standpoint of returning the person to flying status?

a) post-traumatic epilepsy
b) loss of consciousness greater than two hours but less than 24 hours
c) late onset obesity secondary to hypothalamic dysfunction
d) Post concussion syndrome
e) Elevated mean cerebral circulation time

Answer 114

a) Post traumatic epilepsy is the single most serious effect of a closed head injury from the standpoint of flying safety because it can render a pilot totally helpless immediately without any warning.

Question 115

An epileptic fit is usually adequate grounds for permanent removal from flying. Exception(s) to this rule may be:

a) following removal of a brain neoplasm
b) brief convulsion following Xylocaine injection for dental surgery
c) convulsion during a brief episode of significant cerebral hypoxia
d) a and c
e) b and c

Answer 115

e) b and c

Question 116

Flickering sunlight as seen through a helicopter rotor blade has been documented as a cause of:

a) hypertension
b) insomnia
c) Hypoxia
d) seizures
e) conversion reaction with paralysis

Answer 116

d) Seizures. Similar to a strobe light.

Question 117

Which of the following statements is true concerning nystagmus?

a) The quick phase is used for indicating the direction of the nystagmus, and the quick phase takes place in the same direction as the rotary acceleration.
b) the slow phase is used for indicating the direction of the nystagmus, the slow phase takes place in the same direction as the rotary acceleration.
c) The slow phase is used for indicating the direction of the nystagmus, and the slow phase takes place in the opposite direction as the rotary acceleration.
d) The quick phase is used for indicating the direction of the nystagmus, and the quick phase takes place in the opposite direction as the rotary acceleration.

Answer 117

a) The quick phase is used for indicating the direction of the nystagmus. In a Barany chair, the eyes turn slowly in the direction opposite to the rotary acceleration in order to maintain visual fixation.

Question 118

With regard to in-flight incapacitation which of the following are TRUE?

a) a generalized seizure is the most difficult sudden in-flight incapacitation event to control.
b) a routine aeromedical evaluation is insufficient to prevent all in-flight incapacitation.
c) Improved diagnostic tests may lower the risk of in-flight incapacitation.
d) Crew members are responsible for detecting abnormal symptoms in other crew and taking action.
e) All of the above.

Answer 118

e) All the above.

Question 119

With regard to the current use of EEG an an aeromedical screening tool, which of the following is INCORRECT:

a) the EEG may be useful for certain clinical indications (head injury, unexplained LOC, FHx of Seizure disorder, abnormal neurologic exam).
b) An asymptomatic pilot with an EEG showing spike and wave pattern (grade III dysrhythmia) may never develop a seizure during a flying career, and should not be grounded solely on the EEG.
c) EEG’s ae used to screen all military and airline transport pilots.
d) An EEG has a low positive predictive value as a screening tool for seizures in the medically screened
e) EEG results should be correlated with past history of a seizure, neurologic exam, neuroimaging studies, and neuropsych testing.

Answer 119

c) EEG’s are not required by the FAA or most military branches without an indication.

Question 120

Aeromedical disposition of the head injured aviator is based on:

a) absence of neurologic deficit- motor or sensory (vision, hearing) function.
b) absence of post traumatic syndrome
c) acceptable risk of post traumatic epilepsy
d) normal cognitive function
e) all of the above

Answer 120

e) All of the above

Question 121

Long term risk of post traumatic epilepsy is determined by:

a) prolonged period of loss of consciousness and or post traumatic amnesia
b) dural penetration
c) neurologic deficits
d) evidence of hematoma (epidural, subdural, intracerebral)
e) all of the above

Answer 121

e) all of the above. Post traumatic epilepsy has been seen is an early as less than one week post incident, to occurring months to years post injury. Risk for the development include seizure, penetrating injury, multiple lob injury, depressed skull fracture, dural penetration, intracranial hemorrhage, amnesia/unconsciousness greater than 24 hours, or focal neurologic signs. These risks are additive.

Question 122

The aeromedical consideration of migraine in aviators include all of the following EXCEPT:

a) incapacitating migraine symptoms, such as visual loss or altered consciousness, may be a hazard to flight safety.
b) family history of headaches and migraine phenomenon disqualify an aviator from flight duties.
c) the visual phenomenon associated with migraine headache could interfere with collision avoidance, instrument interpretation, and depth perception.
d) migraine related weakness or paresthesia may impair a pilot’s ability to control the aircraft.
e) migrainous vestibular phenomenon may contribute to spatial disorientation, particularly in altered visual conditions.

Answer 122

b) Family history alone is not disqualifying.

Question 123

During the exam a commercial pilot is noted to have had a change in his best corrected visual acuity from 20/10 to 20/20 in one eye. The opposite eye remains best corrected to 20/10. A review of his medical record reveals that he has always had vision at the 20/10 level in both eyes. The physician further elicits a history from the pilot of an episode of gradual blurring and distortion of objects that lasted several months (metamorphopsia). The pilot stated that the visual blurring has improved and is essentially back to normal. The physician suspects that the pilot may have had an episode of central serous retinopathy. Further work-up of the visual function of this pilot should include which of the following?

a) Amsler Grid testing
b) color vision testing
c) stereopsis testing
d) retinal exam
e) all of the above

Answer 123

e) all of the above- Idiopathic central serous retinopathy is an idiopathic detachment of the sensory retina that is generally asymptomatic unless if affects the macula area of the eye. It occurs in young individuals but more often in males 20-40 year of age. Serous fluid from the choroid passes through a break in the retinal pigment epithelium and accumulates beneath the neuroepithelium of the retina as a blister. Symptoms that develop represent local disruption of the cytoarchitecture and neurosensory relationships of the retina by the serous detachment in the macula. Macular involvement may cause disturbances visual acuity, color perception, depth perception, metamorphosia, etc. In almost all cases central serous retinopathy resolves with reabsorption of the subretinal fluid and visual recovery within 2 to 6 months. Photocoagulation of the site of fluorescein leakage by a laser may induce reabsorption of the subretinal fluid in those cases that don’t resolve spontaneously.

Question 124

A 57 year old male 747 pilot fails color vision testing during his flight physical. He is in excellent health with the exception of glaucoma, bilaterally treated with a topic beta blocker. During this exam his intraocular pressures are 18 bilaterally. He has a long standing waiver for defective color vision present since childhood. He also admits to increasing difficulty seeing yellow colors and increasing depression. Your tentative diagnosis and next step would be:

a) congenital color deficit and controlled glaucoma; no further workup needed.
b) congenital color deficit, controlled glaucoma and normal life doldrums; no further work up needed.
c) Clinically significant depression; refer for psychiatric evaluation
d) Congenital color deficit, controlled glaucoma, and clinically significant depression; refer for psychiatric evaluation.
e) Acquired color deficit, possibly controlled glaucoma, clinical depression of unknown etiology; refer to ophthalmology; possible psychiatry evaluation.

Answer 124

e) Color vision disturbances are typically of two types: red-green, and blue- yellow. Red cone defects are broadly referred to as protans, green defects are deutans, and blue cone defects which induce blue yellow disturbances are tritans. The complete loss of all three is called achromatopsia, or true color blindness, and is exceedingly rare. The depression could be a side effect of the beta blockers as well, so additional workup there is needed.

Question 125

A 27 year old female presents with a one week history of bilateral red burning eyes. She denies any other symptoms, such as itching or photophobia, and does not wear contact lenses. She does recall that a number of friends also have a similar problem and that many share make-up with each other. Your examination reveals a clear cornea, hyperemic conjunctiva bilaterally, a mild mucopurulent discharge, and bilateral preauricular adenopathy. Past medical history is noncontributory. You suspect she has:

a) allergic conjunctivitis
b) viral conjunctivitis; possible Epidemic Keratoconjunctivitis
c) bacteral conjunctivitis
d) a toxic reaction to eye make up
e) bilateral corneal abrasions

Answer 125

b) viral conjunctivitis. The hallmarks are bilateral in 90% of cases, a mild mucopurulent discharge, and preauricular adenopathy. Most viruses can survive in contact lens solution and eye makeup for weeks. EKC is a typical adenovirus but may invade the cornea.

Question 126

Snowblindness of sunblindness also known as photophthalmia is seen frequently in mountain climbers and those exposed to bright (especially reflected) sunlight for long periods of time without adequate eye protection. Which of the following is true regarding photophthalmia?

a) self-limited process which with patching and rest usually heals within 12 to 18 hours.
b) Caused by infrared burns of the cornea, symptoms may not appear until 4 to 6 hours after exposure.
c) Symptoms are similar to foreign body sensation
d) a and c
e) all of the above

Answer 126

d) a and c. Ultraviolet radiation is entirely absorbed by the cornea and a keratitis of the cornea occurs with overexposure. Infrared radiation, on the other hand, is transmitted by the lens and cornea to focus on the posterior ocular segment where it does its damage. Because of the rapid epithelialization of the cornea in 12-18 hours, the injury is self-limited. Lacrimation, foreign body sensation, photophobia.

Question 127

During an annual flight physical on a 37 year old Mexican American pilot, pterygiums are discovered 2mm onto the nasal aspect of both corneas. The patient states they have been present for about seven years and have not changed since the first year. You should:

a) refer the patient to an ophthalmologist for immediate removal
b) reassure the patient and forget it
c) consult a radiotherapist to consider Beta irradiation
d) document size/extension and have patient observe regularly for growth
e) ground the pilot and follow him at least every 3 months

Answer 127

d) Is quiescent leave it and observe. They have a tendency to recur once surgical removed and can be more aggressive the second time around.

Question 128

A 28 year old aircraft mechanic was using a hammer on a metal cotter pin when he experienced a mild pain in his right eye. He continued to feel as if there was something in his eye so he reported to your office. You found his vision to be 20/20, but in addition there was a small area of the cornea which stained with fluorescein. The most appropriate action for you to take is:

a) instill ophthalmic antibiotic drops
b) patch the eye for 24 hrs
c) refer the patient to an ophthalmologist
d) check his intraocular pressure
e) obtain xrays

Answer 128

c) refer to an ophthalmologist. Although all are correct, only the ophthalmologist has the equipment necessary for examination.

Question 129

A 52 year old 747 pilot remarks that he has noted “spots” in front of his eyes and occasional flashes of light in his side vision over the last three weeks. Your examination is totally normal. His vision is 20/20 in both eyes and visual fields are full bilaterally. You make the proper diagnosis and disposition.

a) Retinal traction- refer to ophthalmologist
b) Acephalgic migraine- refer to neurologist
c) Presbyopia- refer to optometrist
d) Stress- recommend vacation
e) Normal exam- return to flying

Answer 129

a) Retinal traction- refer to ophthalmologist
floaters and flashes are typically retinal tears or detachments. A fairly accurate rule of thumb is that approximately 50% of individuals over 50 years of age have posterior vitreous detachments. Traction is exerted on the retina by contraction of the vitreous pulling on the retina.

Question 130

A 22 year old female flight attendant seeks your advice concerning a 10 day history of hazy vision O.S. (left eye). History is negative except that she is in the process of a divorce. Her examination is negative except that her best corrected visual acuity O.S. is only 20/40 while on an annual exam on year previously it had been 20/20. You want to differentiate a functional complaint from an organic lesion such as retrobulbar (optic) neuritis. To do this you should:

a) obtain an erythrocyte sedimentation rate
b) order careful visual fields
c) order a computerized tomography of the skull and orbits
d) give a short tiral of high dose systemic steroids
e) do a careful pupillary examination

Answer 130

e) pupillary examination- Patients who have only functional visual symptoms will have pupils that react normally. In fact, patients with optic neuritis may have pupils that react properly to direct light and to accommodation, but the pupil in the involved eye acts paradoxically when a flashlight is swung from the uninvolved eye to the involved eye, in that it will dilate when the flashlight is swung to it after the other eye. This is the Marcus Gunn pupil phenomenon.

Question 131

Topical ophthalmic medications are not without potential serious side effects. One such preparation is all too frequently prescribed and may result in the exacerbation of herpes simplex infection of the cornea, may cause posterior sub-capsular cataracts, and may produce a type of open angle glaucoma. This medication is:

a) corticosteroid
b) pilocarpine
c) atropine
d) tetracaine
e) epinephrine

Answer 131

a) Corticosteroids.

Question 132

A 35 year old Squadron Operations Officer was found on annual flight physical to have only 20/40 vision in his right eye and failed the standard depth perception tests. History revealed that he had noted mild blurring of vision in this eye for about 10 days as well as some distortion and minification of objects viewed with the right eye, symptoms he attributed to fatigue due to an impending squadron deployment. Optometric examination revealed that the visual acuity in the right eye could be improved to 20/25 with a + .50 sphere. Ophthalmologic exam resulted in the recommendation to place the man on “duty not including flying” and to obtain additional studies. The most likely diagnosis:

a) ophthalmic migraine
b) eye strain
c) central serous retinopathy
d) optic neuritis
e) microstrabismus

Answer 132

c) Central serous retinopathy

Question 133

The differential diagnosis of the red eye is a frequent problem faced by every physician. Acute conjunctivits, iridocyclitis, and acute narrow angle glaucoma are the three major ocular conditions involved, with the acute narrow angle glaucoma being the one requiring the most immediate diagnosis and treatment. Which constellation of signs and symptoms most accurately describes this latter condition?

a) conjunctival injection, photophobia, moderate pain, blurred vision, small miotic pupil
b) conjunctival injection, blurred vision, normal pupil, normal intraocular pressure, tearing
c) Tearing, conjunctival injection, normal pupil, normal IOP
d) normal pupil, tearing, conjunctival injection, normal vision, elevated IOP
e) blurred vision, severe pain, mid-dilated poorly to non-reactive pupil, high intraocular pressure, conjunctival injection

Answer 133

e) The patient with conjuctival injection, severe pain, high intraocular pressure, blurring vision and a mid-dilated, poorly to nonreactive pupil is the one with red eye due to acute narrow angle glaucoma.

Question 134

Studies have revealed that monocular clues for depth perception as used by the one-eyed pilot are adequate for routine flying, but that during landing at minimums and formation flying binocular clues are very important. Name two binocular clues for depth perception.

a) customary size of objects and aerial perspective
b) convergence and motion parallax
c) shadows and customary size of objects
d) stereopsis and motion parallax
e) convergence and stereopsis

Answer 134

e) The principal binocular clue to depth perception is stereoacuity or stereopsis. Convergence is also a binocular clue due to the muscular action required to converge the two eyes on an object.

Question 135

Visual acuity is measured by determining the smallest object one can see at a distance. The value found is recorded as a fraction with 20/20 being considered standard. In this fraction:

a) The numerator represents the patient’s age and the denominator represents the distance separating the patient and the chart.
b) The numerator represents the distance separating the patient and the chart and the denominator represents the distance at which the letters being read could be seen by a person with standard acuity.
c) The numerator represents the distance separating the patient and the chart and the denominator represents the print size.
d) The numerator represents the distance separating the patient and the chart and the denominator represents what an average 20 year old would see.

Answer 135

b) 20- distance from chart/20- distance an average person could read that font size.

Question 136

Dilation of the pupil facilitates a thorough fundus examination, minimizing annoying reflexes and making it easier to study retinal and optin nerve head details. Occasionally, however, there may be a contraindication to pupillary dilation. Such complications include:

a) open angle glaucoma
b) acute iritis
c) patient under neurosurgical observation
d) all of the above
e) none of the above

Answer 136

c) actually narrow angle glaucoma is the portion that could be worsened by dilation. That isn’t one of the answers though. The head injury patient or someone with a subdural or epidural in which neurosurgery is checking pupils often is appropriate answer is this case.

Question 137

Myopia (near sightedness) is a significant cause of disqualification for flying training. Which of the treatment modalities listed below have been found to prevent and or reverse the development of myopia?

a) cycloplegia
b) bifocals
c) eye muscle exercises
d) orthokeratology
e) none of the above

Answer 137

e) none of the above.

Question 138

Keratoconus in a pilot applicant is a disease of particular interest to flight surgeons because:

a) its course is usually rapid and progressive leading to blindness.
b) its typical unilateral involvement leaves the pilot with one functioning eye. There is good evidence that monocular pilots have abnormal depty perception which is highly undesirable in aviation.
c) its slowly progressive course requires new prescriptions for spectacles approximately once a year. Therefore, the flight surgeon must ensure that the patient continues to be followed every 6-12 months.
d) patients may still demonstrate 20/20 vision, uncorrected, by corneal molding with contact lenses.

Answer 138

d) Keratoconus is characterized by a cone-like protrusion of the cornea causing an irregular myopic astigmatism, most often bilaterally. The clinical course is extremely variable in that it may progress rapidly, slowly, or remain stationary. The irregular astigmatism can be corrected only with contact lenses, not spectacles. However, it is especially important for flight surgeons to be aware that individuals with keratoconus who have recently worn contact lenses may be able to read accurately with 20/20 line uncorrected on the vision chart. This is due to molding of the cornea.

Question 139

Blunt trauma to or contusion of the eyeball is a very frequent ocular injury. Only of the problems listed below is NOT a feared sequelae of such an injury:

a) hyphema
b) central retinal artery occlusion
c) subluxed lens
d) iridocyclitis
e) retinal detachment

Answer 139

b) central retinal artery occlusion

Question 140

Normal color vision is important in order, for example, to identify navigation lights and airport beacons, to read maps, and, in military aviation, to discern targets. Which of the following describes normal color vision:

a) dichromatic
b) trichromatic
c) monochromatic
d) anomalous trichromatic

Answer 140

b) Trichromats have all three color pigments (red, green, blue).

Question 141

Which of the following includes diagnostic procedures which would be advantageous as a screening test for open angle glaucoma?

a) Schiotz, applanation, noncontact tonometry, electronic indentation tonometry
b) Schiotz tonometry, gonioscopy, visual fields by Goldmann perimeter
c) Ophthalmoscopy, visual fields by Goldmann perimeter, tomography
d) Noncontact tonometry, Schiotz tonometry, ophthalmoscopy

Answer 141

a) Although all are useful for the diagnosis of open angle glaucoma, the best screening tests are Schiotz, applanation, noncontact tonometry, or indentation tonometry since the first indication of open angle glaucoma is elevated intraocular pressure.

Question 142

While doing some cleaning, an airframe technician burned his right eye with a strong alkali. Your action should include the following EXCEPT:

a) copious lavage with normal saline or tap water.
b) use chemical antidotes
c) use topical anesthetic drops
d) administer homatropine

Answer 142

b) Remember this is an EXCEPT question. Copious lavage is the obvious choice. In order to allow the contact lens irrigation, topical anesthetics are used. You should also dilate the pupil to prevent iritis. But above all, irrigate. Never use chemical antidotes.

Question 143

Which of the following visual capabilities will be affected by a slight degree of altitude hypoxia?

a) visual fields, dark adaptation, fusional range and intraocular pressure.
b) visual fields, visual acuity, dark adaptation, and color vision.
c) dark adaptation, fusional range, eye movements and intraocular pressure
d) visual acuity, dark adaptation, fusional range, and color vision.

Answer 143

a) a slight degree of hypoxia can influence visual fields, dark adaptation, fusional range, and intraocular pressure.

Question 144

High powered corrective lenses may result in which of the following optical aberrations?

a) visual field limitation, visual field alteration, and meridianal aberration.
b) coma, visual field alteration, and chromatic aberration
c) image distortion, visual field limitation, and chromatic aberration
d) coma, image distortion, and visual field limitation

Answer 144

c) Spectacles with lenses stronger than +/- 5 diopters are not recommended due to the progressive increase in optical errors as the power of the lens increases.

Question 145

Which of the following disorders affect the retina?

a) Macular lesion
b) Retrobulbar neuritis
c) Papillitis
d) Uveitis

Answer 145

A) Macular lesion- Which is a degeneration or loss of function of the retina.

Question 146

Which of the following visual illusions will cause the pilot to fly a high landing approach?

a) narrow runway illusion
b) an upsloping runway illusion
c) featureless terrain illusion
d) a downsloping terrain illusion

Answer 146

d) A downsloping runway, downsloping approach terrain, or both, will create the illusion that the aircraft is at a lower altitude. The pilot who does not recognize this will fly a high approach.

Question 147

In dim illumination:

a) vision becomes less sensitive to light.
b) colors become more visible.
c) aircraft must be much closer to be seen.
d) white light facilitates dark adaptation.

Answer 147

c) Aircraft must be much closer to be seen.

Question 148

A general recommendation on sunglasses for pilots is:

a) gray with 15% light transmittance, and no distortions from refractive or prismatic errors
b) green with 30% light transmittance and no distortions from refractive or prismatic errors
c) gray with 30% light transmittance, and no distortions from refractive or prismatic errors.
d) green with 10% light transmittance and no distortions from refractive or prismatic errors.

Answer 148

A. Gray with 15% transmittance and no distortions or prismatic errors. Excessive reflection off the aircraft, clouds, water, snow, and desert terrain can produce glare with squinting. Gray lenses are recommended and 15% transmittance.

Question 149

Which of the following statement is NOT true regarding polarizing lights and filters:

a) Polarizing filters transmit light that is vibrating in a certain direction.
b) Polarizing filters are laminating and difficult to grind.
c) Stress patterns may appear in windscreens when viewing through a polarizing filter.
d) Polarizing filters are neutral, passing equal amounts of all wavelengths of light.

Answer 149

d) Polarizing lights transmit light that is vibrating in a certain direction, they pass more light from certain wavelengths than others, they are more costly because they are difficult to grind, they have developed stress patterns, and they reduce glare. They are NOT neutral, the pass certain wavelengths more than others.

Question 150

Which of the following is NOT true about colored filters?

a) A green filter absorbs proportionally less green light.
b) Yellow filters have been advocated for use in fog and haze
c) Yellow filters produce a sensation of increased brightness
d) A blue filter absorbs approximately equal amounts of all wavelengths of light.

Answer 150

All are true with exception of D. A blue filter absorbs more of other colors than it does of blue.

Question 151

If a pilot wears rigid contact lenses, which is NOT an effect from flying:

a) dislodged lens from G forces or acceleration
b) Bubbles under the lens from altitude
c) Dryness from low relative humidity
d) Warpage from low humidity and low oxygen pressure

Answer 151

d. Airmen with rigid lenses have less warpage, but increased dryness, bubbles in the central vision, and dislodgement.

Question 152

An applicant visiting his AME and a color perceptiopn abnormality was detected. What action should be taken by the AME or the applicant?

a) DQ the applicant
b) The AME may issue a medical certificate bearing the limitation “not valid for night flying or by signal control”.
c) An applicant who holds a medical certificate bearing color vision limitations may request a reevaluation and ask for the issuance or a SODA. If passed, the FAA will issue a medical certificate without limitation.
d) Both b and c

Answer 152

D) Both B and C

Question 153

The civil medical visual standards require that:

a) examiners check the distant vision, with or without correction.
b) examiners check intermediate vision for all three medical certificate classes.
c) examiners check aviation red, aviation green, and white for all three medical certificate classes.
d) examiners conduct ECG’s on first and second medical certificate classes, age 35 and 40 plus.
e) examiners conduct urine drug screening for amphetamines, opiates, THC, cocaine, and PCP.

Answer 153

a. Examiners check the distant vision with or without correction. Intermediate vision is not required for all three classes. Examiners do not check aviation red, green, and white on a routine basis. ECG’s are required only for first class certificates. No drug testing is required to issue a medical certificate.

Question 154

An Air Velocity Index of 1.2 (normal .8 -1.0) suggests which of the following?

a) Restrictive lung disease
b) Obstructive lung disease
c) Better than average physical conditioning
d) A defect in tissue oxygenation

Answer 154

a) Restrictive lung disease. The AVI is the ratio of the percentage of predicted maximum breathing capacity to the percentage of predicted vital capacity. An increase in the ratio is suggestive of a restrictive type disorder.

Question 155

The prevalence of chronic obstructive pulmonary disease seems to be increasing in the United States population. A general aviation pilot breathing only ambient air at cabin altitudes approaching 12,000 feet could be hypoxic as a result of the pulmonary impairment of COPD. What is the best disposition of such a pilot with COPD?

a) Symptomatic COPD should be considered an absolute disqualifying defect for further general aviation pilot function.
b) Pilots with COPD should be restricted to flying aircraft equipped with supplemental oxygen.
c) Minimally symptomatic pilots should be evaluated using their actual spirometric functional impairment to estimate their altitude tolerance.
d) Pilots with COPD should be simply counseled to alter their habit patterns, such as smoking, and be returned to flying when they become asymptomatic.

Answer 155

c) Spirometic function was found to be a reasonable option as an objective screening norm for acceptable tolerance to general aviation in its usual ambient air breathing altitudes.