General Mediciine

Question 1

What are the types of thrombosis and there causes

Answer 1

Provoked
- hormones, surgery, cancer
Unprovoked
- 50% of idiopathic VTE is later to a thrombophlebitis
- Factor V Leiden
- SLE, antiphospholipid syndrome
- protein C, protein S, antithrombin III

Question 2

How can haematological conditions effect the aviation environment

Answer 2

Sudden incapacitation or subtle impairment

• acute bleed
• acute clot
• chronic organ disease

Question 3

Effects of the environment on haematological conditions

Answer 3

Operations - access to Mx
trauma
immobilisation increase risk of clot formation

Question 4

what clinical information is needed when reviewing a patient with haematological conditions

Answer 4

Previous personal VTE - age, provoking factor or idiopathic

• FHx VTE
• Clinical episodes of bleeding
• end-organ symptoms or signs

Question 5

military aeromedical disposition for haematological conditions

Answer 5

Consider MECR immediately as investigation and management process exceeds TMUFF period

Recruits - disqualifying
Trained aircrew - potential for continuing in category depending on medication, stability, surveillance requirements

Likely to require central MECR
INR record
specialist letters
pathology and imaging reports
details of clinical course since last review

Question 6

Medical disposition for haematological conditions for CASA

Answer 6

Reviewed Case by Case
information/reports required
INR needs to be stable, minimum monthly and 3 consecutive stable readings before certification

bloods tests and imaging for end-organ manifestations required
report from treating Drs

Question 7

effect of dermatological conditions on aviation environment

effect of aviation on the conditions

Answer 7

Think about area affect
ALSE - mask fit, oxygen use with ointments, gloves and clothing

Aviation on condition
- operational and deployment issues: hygiene, resupply, allergens/triggers

Question 8

Investigation and treatment for dermatological conditions

Answer 8

unless mild and self limiting will require dermatologist letter for diagnosis, mx and exacerbation, prognosis. Biopsy results and clinical images.

tx - topical, ointment/cream, oral
?frequency of dosage, implication of missing doses

Question 9

Military aeromedical disposition for dermatological conditions

Answer 9

Prognostic considerations

• stable and controlled
• relapsing and remitting
• chronic active
• deteriorating
• long term sequelae

TMUFF during initial evaluation - establish Dx, tx and response
Recruits vs trained aircrew
- severe, long term medications, frequent flares, poor control, oral medication are disqualifying.

depending on clinical features will determine UAMECR/IAMECR/CAMECR

Question 10

aeromedical disposition for dermatological conditions for CASA perspective

Answer 10

Limited impact on civilian medical certification
- roaccutane
Information/reports required: very similar to miliary

Question 11

military aeromedical disposition for endocrine condition

Answer 11

TMUFF during initial evaluation to establish Dx, Tx, and response
Immediate AMECR for clear cases as timeline to dx and manage will likely exceed TMUFF period

Recruits vs trained: chronic course likely to disqualify

Variable UAMECR/IAMECR/CAMECR outcome

Question 12

CASA aeromedical disposition for endocrine conditions

Answer 12

Thyroid: if euthyroid clinical and biochemically when likely to fly with annual surveillance and absence of symptoms

Diabetes and insulin: Class 2 with safety pilot, STRICT surveillance, QID BGL, 3/12 HbA1c and specialist. Annual stress test, cardiologist, eyes. requirements for pre and inflight monitoring and management
NIDDM - surveillance and reporting

Question 13

military aeromedical disposition for immunological conditions

Answer 13

TMUFF required during episodes. if frequency of TMUFF might need MECR
MECR required for medications

assessed case by case

Question 14

aeromedical disposition for immunological condition from CASA perspective

Answer 14

Allergies is based on severity and treatment
Anaphylaxis - epipen, multi crew/safety pilot
Immunodeficiency - case by case

Question 15

military Aeromedical disposition for infectious disease

Answer 15

TMUFF any acute symptoms and during evaluation.

Chronic carrier states, organ damage, long term medication, recurrence/reactivations = disqualifying

health directive - malaria, Health support plans, pre and post deployment

likely UAMECR/IAMECR/CAMECR

Question 16

Aeromedical disposition for infectious diseases from CASA perspective

Answer 16

HIV: class 1 with safety pilot, CD4 count/disease activity, AIDS - defining illness, medication effects

Hepatitis: acute is unfit, chronic based on symptoms

TB: being treated, no side effects, extent of lung damage.