FAA Guidelines Flashcards
The command pilot requires what type of FAA certificate?
1st class
Mandatory retirement for airline transport pilots is now_______.
65 years of age.
Pilots being paid to fly, and not flying more than 9 passengers and crew in turbine powered aircraft require a commercial pilot certificate and a Class ________ medical certificate.
Class II
What is the age limit for commercial prop plane pilots flying less than 9 passengers?
There is no limit.
Private pilots not flying for pay, require what class of medical certificate and what is their age limit?
Class III, there is no age limit.
Sport pilot certification is a relatively new designation by the FAA and is needed to operate low speed aircraft. The sport pilot certificate requires what class of medical certificate?
It does not require a medical certification and examination, rather a valid drivers license is a surrogate for medical and safety and eligibility to fly.
For US glider and balloon operation, only a self proclamation of health status is required. True or False?
True
What is the upper limit of age for flight attendants?
70
True or false, flight attendants may fly with diabetes mellitus or epilepsy if well controlled on medication.
True
Air Traffic Controllers are certified by whom?
FAA certification. They have a special medical requirement document for ATC’s.
What is the term the FAA uses for a waiver once a pilot with a disqualification is shown to be stable and able to return to flight?
Special Issuance
______________ is a special type of FAA waiver. It may be obtained for fixed deficit not expected to change (hearing loss, color blindness, loss of knee mobility). After application and demonstration of satisfactory performance to an FAA inspector.
Statement of Demonstrated Ability
Who may over-rule or rule on an appeal of the Federal Air Surgeon’s verdict regarding a pilot’s ability to fly?
A judge with the NTSB.
How many specific conditions are disqualifying for aviators under the FAA rules?
15
Name the 15 disqualifying conditions for the FAA.
1) Diabetes mellitus requiring hypoglycemic medication
2) Angina pectoris
3) Coronary Heart Disease that has been treated or is symptomatic
4) MI
5) Cardiac Valve replacement
6) permanent cardiac pacemaker
7) heart transplant or BiVad
8) Psychosis
9) bipolar disorder
10) Personality disorder that is severe enough to have overt acts
11) substance dependence
12) substance abuse
13) epilepsy
14) disturbance of consciousness without satisfactory explanation
15) Transient loss of control of the nervous system without satisfactory explanation
In fatal general aviation accidents, what percentage of pilots had alcohol in the bloodstream?
10 to 30%
What is the rule of thumb for “bottle to throttle” in the FAA?
8 hours
What agency is responsible for regulation and monitoring conditions at international airports?
World Health Organization
Which of the following groups require an FAA certificate to fly?
a) Pilots
b) First Officers
c) Flight Engineers
d) Flight Attendant
e) a and b
f) a, b, and c
g) all the above
A, B and C. Flight attendants do not require FAA medical certification.
Aeromedical disposition of the head injured aviation personnel 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 the above
e) All the above. Prior to return to status, aviation personnel should be asymptomatic, without disqualifying defect, acceptable risk of post traumatic epilepsy, and normal congnitive function.
Notes- FAA regulations are Code of Federal Regulations (CFR) Part 67. There are 15 Disqualifying conditions.
Cardiac: Six
MI, Angina, CAD, Cardiac Valve Replacement, Permanent Pacemaker, Heart Transplant
Neuro: Three
Epilepsy, Disturbance of Consciousness without explanation, Transient loss of control of nervous system function.
Psych: Five
Substance dependence, substance abuse, psychosis, personality disorder, bipolar disorder
Endocrine: One
DM requiring insulin or hypoglycemic med
Notes- FAA does not publish an “approved” list of medications. A special issuance (waiver) is based both on the UNDERLYING condition and the medication and its potential side effects. A few caveats:
A drug that is investigational and not approved by FDA is not approved for use. A drug must not be administered greater than its FDA approved max dose.
The drug must not have adverse events greater than 1%. Typically the FAA waits until a drug has been on the market and approved by the FDA for over 1 year before allowing it. The exception to this is antibiotics, antihypertensives, and anticholesterol in which the class is well known.
Medications which are disqualifying or not allowed include biologic agents as immune modulators and anti-cancer drugs due to their high variability and unexpected side effects. Drugs for Rheumatoid, MS, and cancer for example.
Other drugs that are typically disqualifying include anti-seizure medication, psychotropic medications (anxiolytics, mood stabilizers, ADHD meds, etc), narcotics, sedative hypnotics, Antihistamines (with exception of truly non-sedating ones) and Varenicline (smoking cessation med with side effect of psychotic breaks).
In a study by the FAA over a ten year period of fatal accidents, what percentage of airman were on sedating over the counter meds? What percentage of that was diphenhydramine?
12% overall, 6% of fatal accidents the airman were taking benadryl (diphenhydramine).
What is the FAA reg that covers operating an aircraft while on any drug that affects the person’s faculties in any way contrary to safety?
14 CFR part 91, section 91.17
Notes- Sleep aids. They are allowed, but the FAA requires you to wait 5 half lives before flying.
Melatonin is not controlled or addressed by the FAA
14 CFR part 61, section 61.53 states that a person given a waiver under part 61 of the FAA is the reg that tells a pilot that they must not fly if they knowingly have a medical issue or medication they know could make them unsafe.
Supplements/herbals/vitamins are generally not restricted by the FAA.
Notes- When waiting five half lives.
Example Ambien 1/2 life is 4.5 hours. So 4.5 hours x 5 equals 24 hours before flying.
This is based on max dose of the sleep aid.
Notes- AME’s may issue the medical certificate if the BP is
The AME must provide a letter from the treating physician addressing CAD risk factors. A physical that addresses cardiovascular exam parameters (bruits, retinal changes, pulses, etc), review the meds, a lipid panel and fasting glucose, and EKG (for an INITIAL evaluation). If BP exceeds 155/95, a three day series of AM and PM blood pressure readings should be taken and an average BP obtained.
Notes- Contact lens wear is ok, bifocal contacts are ok. Monovision contact lenses are not ok.
It causes a loss of stereopsis.
Notes- Skin cancer is of a concern when the Broslow depth exceeds .75mm or local lymph node spread occurs. Airman with melanoma less than .75mm can be issued by the AME. Greater than .75 require and MRI of the brain and a special issuance by the FAA. First and Second class pilots require a brain MRI every six months. Third class requires one annually.
20% will have mets to the brain. 60% of brain mets from melanoma have led to seizures and other neuro incapacitating events. If there is distant lymph node spread or mets, the airman will be disqualified for 3 years. When disease free will be required to provide a current status and brain MRI every 3 months. If the metastasis is the brain, then the airman is disqualified for 5 years and then when “cured” will provide status and MRI of brain every three months
Notes- an airman that develops monocularity, either due to the loss of an eye in trauma or due to central vein occlusion etc, will be given a certificate, but must first wait six months to adjust to monocular cues, as well as a flight capabilities test to obtain a SODA (statement of demonstrated ability)
An airman with monocularity has their visual field reduced by as much as 30%.
The FAA will NEVER certificate an airman with homonymous hemianopsia due to stroke. They would be particularly unsafe because the both eyes have a defective quadrant.
Notes- syncope. An AME may certificate is it sounds like a single episode of vasovagal syncope with no underlying cardiac factors. However, a second episode will require FAA special issuance. If a third event occurs, certification may not be likely.
If the workup and history are vague, the airman could be grounded for up to 2 years.
Notes- Diabetes on oral medications is disqualifying and the case must be deferred to the FAA for special issuance.
Historically, if the airman is on both a beta blocker for hypertension AND an oral hypoglycemic, he will need to change the antihypertensive medication prior to medical certification because beta blockers can maks the symptoms of hypoglycemia (stops the tachycardia etc). This was an issue for the first generation beta blockers. Recently, the FAA has allowed the second or third generation beta blockers.
Notes- insulin dependent diabetics can be given a special issuance by the FAA for a THIRD class certificate. The are typically told to run a little “sweet” in the cockpit. They must have a glucometer available and have enough 10 gram snacks to last the duration of the flight.
The US is one of the only countries that allow an insulin dependent diabetic to fly.
Notes- 1st class medical- required for airline transport pilots. 2nd class medical- Part 135 or commercial pilots. 3rd lass medical - Part 91 are general aviation pilots
FAA CFR Part 121- Air Transport Pilots
FAA CFR Part 135- Commercial pilots
FAA CFR Part 91- Private General Aviation Pilots
Notes- Class 3 on insulin initial application:
less than 2 episodes of hypoglycemia in last 2 years
No episodes in last year
2 HbA1C, current and 90 days prior
Physician exam
Eye specialist exam
If over 40, max stress test
statement of dexterity (able to do glucometry in flight)
diabetes education
Maintenance of SI-
Quarterly physician evaluations
Annual eye exam
Age 40, then every 5 years, max stress test
Notes- If an airman was placed on Gabapentin for peripheral neuropathy. Should you issue?
No. Gabapentin is also an anti-seizure medication.
Notes- Primary spontaneous pneumothorax peaks in the 16-24 age group and affects males 5 -10 times more frequently than females. Recurrence in 20-50%, after two pneumos, the risk is 62% and after three 83%. Thorascopic pleurodesis is the treatment.
You may issue a certification if there is only a single incident of pneumothorax and no xray or CT evidence of blebs.
Notes- an airman with an intrinsic heart rate less than 40 with the pacemake turned to its lowest rate or with the sensitivity turned down is pacemaker dependent.
3rd class airman may be certificated. 1st and 2nd class airman cannot have a pacemaker that has a rate less than 40.
Notes- myocarditis or endocarditis certification is deferred until the ejection fraction is normal. Would need holter, echo. Cardiomyopathies can cause sudden death.
Must rule out CAD, Chaga’s disease and other causes of myocarditis
Notes- The peak incidence is between ages 20-30 years of age. Risk of recurrence ranges from 20-50% over 10 years. A lifetime recurrence rate of 70% has been reported.
The FAA will certificate an airman with renal stones. They should have no current stones in the collecting system via CT or IVP. Normal renal labs, and the stone sent for analysis if at all possible.
Notes- Sudden cardiac death is the initial presentation in more than one third of MI’s (60% of patients dying in the first hour).
FAA allows all treatments currently for MI. Including CABG, angioplasty, stent insertion, and atherectomy. All airman must wait 6 months after a coronary event before consideration.
First and Second class airman require a cath at six months, a maximal Bruce protocol, Lipid panel, fasting blood glucose.
Third class airman require exam, maximal Bruce protocol, lipid panel, and fasting blood glucose.
Airman with ejection fractions less than 35% are not granted certification.
Notes- FAA now allows pilots (First and Second class) to be up to 65 years of age. ICAO allows this only is the other pilot is 60 or less.
In the US however, both pilots can be between 60 and 65.
Notes- In the FAA’s medical certification, the airman must only pass one of three acceptable hearing tests. The most common is the Conversational Voice Test. The examiner speaks to the airman in a conversational voice 6 feet away with the patient’s back turned to the examiner.
Most audiologists classify health loss the following way:
Normal hearing: (0-25 dB Hearing Loss)
Mild hearing loss: (26-40 dB HL)
Moderate hearing loss: (41 to 70 dB HL)
Severe hearing loss: (71 to 90 dB HL)
Profound hearing loss: (greater than 91 dB HL)
Notes- Airman with hearing deficits will have MUST WEAR HEARING AMPLIFICATION on their medical certificate.
Airmen who are completely deaf can attain medical certification but they are issued a medical certificate with the restriction: NOT VALID FOR FLYING WITHIN RADIO CONTROLLED AIRSPACE
Remember, the conversational voice test for FAA certification by the AME.
Notes- Aortic stenosis with valve repair. After six months and echo, 24 holter, lipid panel and fasting blood sugar as well as stress test.
Airmen with mechanical valves must be on Coumadin or one of the newer agents. Airmen on Coumadin are required to have an INR between 2.5 and 3.5. The FAA also permits airman with Aortic stenosis to be treated with the Ross procedure. This is a procedure where the aortic and pulmonic valves are reversed, and avoids the necessity for Warfarin anticoagulation.
Notes- What are the concerns for Aortic Insufficiency?
At risk for subacute bacterial endocarditis
Progression of AI to severe
Possible decreased + Gz tolerance
Airman with gradient over 40mm not issuable. Valve replacement is warranted, but requires special issuance as it is a disqualifying condition. Will need to be on Coumadin with INR between 2.5 and 3.5 after valve replacement. Typical cardiac workup required after six months (cardiac cath, echo, bruce treadmill, lipid panel, FBS, etc).
Notes- Regarding DUI, you should review the arrest record and take note of the BAC. If the BAC is suggestive of dependence (.15 or above) you must defer. Ask if he reported the incident to the FAA within 60 days of conviction (AMC-700). CFR 121 and CFR 135 (class 1 and 2 medicals) must have urinalysis programs for drug and alcohol. The biggest category with positives is the pre-employment. FAA is restricted to the "DOT 5" drugs.
CFR part 61.15 states the airman must report a conviction to AMC-700 within 60 days of the conviction. If he has a BAC less than .15, has reported the conviction to AMC-700 and has not had other DWI offenses or ETOH incidents, you may issue the medical certificate.
Notes- HIMS, Human Interventional Motivational Study. The FAA partnered with the air carriers and the unions to identify airman with an abuse or substance dependent problem.
This allowed airman a method to get back in the cockpit if they go through rehab and treatment once they have successfully completed the program. The FAA will special issue those pilots who successfully went through the HIMS program.
NOTES- AME cannot issue a certificate for HIV. FAA will do special issuance. In addition to the typical CD4, meds and viral load, CBC and liver function tests, the most important exam to the FAA is the CogScreen or Neurocognitive testing.
Follow up would be every 6 months with the neuropsych eval annually for 1st and 2nd class and every other year for third class.
Notes- What is the major concern with DVT in the airmen?
The major concern is recurrence. Look for underlying causes such as factor V lade, protein C and S deficiency. The classic acquired thrombophilia is antiphospholipid antibody. PE is obviously a concern as well.
Notes- First and Second class airman must correct to 20/20 distant, 20/40 near. Third class airman can be 20/40 distant and near. Contacts are allowed with the exception of monovision contacts.
LASIK is allowed.
The FAA otherwise has no requirements for refractive error.
Notes- RBBB in an otherwise health person 30 years of age or young should not require a cardiovascular exam. A LBBB in a person of any age should have a cardiovascular exam including a radionucliotide perfusion study. If areas of ischemia are noted, a coronary angiogram is indicated.
Changes in the EKG warrant a work up. LBBB warrants a full workup for CAD. Coronary angiogram is the gold standard.
Notes- There is no single effective cure for Meniere’s Disease.
95% have an associated hearing loss. 30% may develop bilateral. Tinnitis and vertigo lasting for hours.
After time, and decreased recurrence, a special issuance may be possible.
Benign Positional Vertigo and Transient Viral Labrynthitis is self limiting and full recovery is expected. A complete ENT exam is required to issue the medical certificate.
NOTES- Prostate cancer is the is the most common malignancy in men and third most common cause of deaths in men.
Sudden extremity weakness is an ominous sign (spinal mets).
All classes may be issued a Special Issuance when the patient is disease free post surgery. The FAA will follow prostate cancer annually for five years. It is one that is under the CACI (Conditions AME’s can Issue) program if the checklist is followed.
Notes- 16% of Americans will be affected by depression at some time in their life. 15% of depressed patients eventually commit suicide.
A history of a depressive disorder in a pilot is not a cause for disqualification if the individual is stable off medications for at least 90 days. On a case by case basis, as of 5 April 2010, the FAA has begun to consider special issuance for pilots with depression treated for at least 12 months and are stable on one of four antidepressant meds: Fluoxetine, Sertraline, Citalopram, Escitalopram.
Notes- The FAA allows treatment with steroids for Crohn’s disease up to 20mg of prednisone daily. Use of anticholinergic and opiate drugs for relief of diarrhea are not warranted ofr allowed.
For certification, the disease should be stable with no medications that would interfere with flight.
Notes- Non-Hodgkins lymphomas are a heterogenous group of malignancies of B or T cells. Usually originate in the lymph nodes, but may be in any organ in the body. Concern for extranodal involvement and CNS deterioration.
In general, while receiving treatment, no issuance is granted. Normally wait one year after treatment completed and no active disease, then a special issuance may be possible.
Notes- SVT with hemodynamic symptoms is disqualifying. A CAD workup should be undertaken.
Radiofrequency ablation of SVT from AV nodal re-entry pathways has a high success rate (90%) and low complication rate (5%).
NOTES- Pregnancy is a physiologic state not a disease.
For pregnant crewmembers the FAA recommends:
1) a limit of 1 millisevert to the fetus for the entire pregnancy
2) A monthly limit of 0.5 millisevert
The CARI (Civil Aeromedical Research Institute) computer program can be used to calculate the dose received on individual flights.
Notes- FAA has issued certificates on peritoneal dialysis, but NOT hemodialysis (electrolyte issues).
Will grant issuance after they receive a renal transplant and demonstrate 6 months of stability and no issues with anti-rejection medications.
NOTES- Duodenal ulcers are associated with H. Pylori in the majority of cases. Gastric ulcers not strongly associated with H. Pylori. NSAID abuse more common.
Return to flight when treated and asymptomatic. An airman with a Hemoglobin less than 10 gm is not granted certification. The proton pump and H2 antagonists, are fine for use.
NOTES- If someone reports they are a convicted felon, can you certificate?
You need to defer to the FAA.
If there is no evidence of psychiatric or medical illness, the FAA will certificate.
COPD will get a special issuance if your FEV1/FVC is 50% or better. Up to 20mg of prednisone allowed daily.
May require an exercise test, and also consideration of medications.
Notes- Any airman with ocular hypertension or glaucoma should be deferred to the FAA if uncontrolled. It is issued under the CACI process if controlled and the checklist followed.
The FAA has a specific form that the treating physician must complete on an annual basis along with the Humphrey visual fields.
NOTES- In general the FAA has allowed airmen to have up to three headaches per month for migraine sufferers. Persons with a history of aura, which gives the pilot sufficient warning and does not involve any neurological deficits will have a more favorable consideration than those with sudden onset without warning.
Obviously, when the migraine occurs the pilot is to refrain from flying. Migraines are also one of the CACI conditions that can be waived if the checklist is followed.
Sarcoidosis, usually found incidentally on CXR with bilateral hilar adenopathy. Typically not a lot of aeromedical concerns unless they have other organ complications.
Uveitis is one such concern and occurs in 15% of patients leading to severe vision loss. The primary concerns in aeromedical certification is when there is cardiac involvement (50% chance of sudden cardiac death with cardiac sarcoid involvement), eye involvement, or neurosarcoidosis (5% chance and may manifest as seizures, focal lesions or cranial nerve palsies).
When does sinus squeeze occur?
Descent
NOTES- With history of seizure, you cannot be certified.
The FAA will consider it after 8 years without a seizure, 4 years without meds. They will consider you. That is for a single seizure (happens after a head trauma sometimes). But two seizures are considered epilepsy and generally not considered for certification.
NOTES- Sickle cell disease is not one of the disqualifying conditions and it is not tested for.
Sickle cell trait is not tested for and is not disqualifying for any class of FAA certificate.
Airmen with sickle cell disease or trait are eligible for all classes of FAA certificate!!
NOTES- FAA accepts the following treatments: CPAP, BiPAP, oral fixation devices, Uvuloplasty, and nasal septal surgery.
FAA would require the evidence of continuing use for an average of at least six hours per night for 75% of nights.
Airmen with a history of spontaneous pneumothorax
Major concern is recurrence
Airmen with a history of recent renal colic
In most cases stones less than 8-10 mm in diameter will pass spontaneously within a few days to two weeks.
Regarding the medical certification of diabetic airman:
All classes may be granted a Special Issuance if well controlled on an oral hypoglycemic
FAA philosophy on medications:
It is the underlying medical condition and not the medication that is the major concern.
The highest level of BP at which an AME may issue the medical certificate is:
155/95
Airmen with melanomas may be issued by the AME if:
The melanoma is less than Breslow 0.75 mm.
Airman with a history of vasovagal syncope manifest by the following:
Pre-syncopal symptoms that may include nausea, repetitive yawning, deep breathing, tunnel vision, abnormal perception of color, sweating and dry mouth.
What are the decibels of normal conversation versus a jet engine?
Normal conversation is at 40-60 dB while a jet engine at 100 feet is 140 to 150 dB.
Regarding HIV positive airmen:
Require a Cogscreen or neurocognitive testing for consideration.
Airman with a finding of complete BBB on EKG.
If it is not possible to interpret a treadmill test in the presence of a complete BBB, a radionuclide stress test is needed.
Regarding airman who are pregnant:
The FAA recommends a limit of 1 millisevert to the fetus for the remainder of the pregnancy and a monthly limit of 0.5 millisevert.
Regarding the aeromedical concerns of an airman diagnosed with acoustic neuroma:
Vertigo is less frequently seen than tinnitus
Regarding aeromedical concerns of an airman diagnosed with glaucoma:
Left undiagnosed or inadequately treated, glaucoma can cause acquired changes in color vision, loss of central or peripheral fields, loss of visual acuity and blindness.
Regarding aeromedical concerns of an airman diagnosed with sinusitis.
In adults the most common etiologic agents of acute bacterial sinusitis are Strep pneumoniae and Hemophilus influenza.
According to the Code of Federal Regulations, which of the following specific conditions is disqualifying?
a) depression
b) Permanent cardiac pacemaker
c) Sickle cell disease
d) AIDS
b) Permanent cardiac pacemaker
Regarding the diagnosis of an airman with DVT
Massive pulmonary embolus is uncommon in a reasonably healthy outpatient so acute incapacitations are rare.
FAA eye standards for first class airman medical certificates:
Near vision acuity of 20/40 or better in each eye separately, with or without corrective lenses.
Distance vision is 20/20 or better in each eye separately, with or without corrective lenses.
Regarding an airman with anemia:
In general, if the cause for the anemia is determined to not be in itself disqualifying, an individual is allowed to pilot an aircraft as long as their hemoglobin is > or equal to 10 gm %.
